Working with the South Sudan National Malaria Control Programme (NMCP) and Population Services International (PSI), Malaria Consortium recently completed a successful long-lasting insecticidal net (LLIN) distribution campaign in Northern Bahr el Ghazal state of South Sudan. The campaign distributed 980,000 LLIN, reaching more than 1.8 million people in over 300,000 households.

In South Sudan, the COVID-19 pandemic brings additional complexity to an existing humanitarian crisis caused by prolonged conflict and instability, in particular a fragile health system. Malaria is the leading cause of mortality and morbidity in South Sudan and pregnant women and children under-five are the most vulnerable. The disease accounts for 47 percent of outpatient visits at health facilities, 30 percent of inpatient admissions and 20 percent of all deaths[1].

LLINs are one of the most effective ways of preventing malaria, reducing the number of uncomplicated cases in areas of high malaria transmission by half and childhood mortality by up to a quarter. LLINs offer twice the protection as that provided by untreated nets[2].

Adaptations to the LLIN distribution

Supported by the collaborative efforts of partners at every stage of the distribution, Malaria Consortium rapidly implemented a series of new measures to ensure LLIN distribution has continued during the pandemic. Adaptations included:

  • Malaria Consortium representation on a COVID-19 taskforce monitoring team to ensure the campaign adhered to new guidelines and working with local government teams to overcome logistical challenges
  • Modifying training for distribution volunteers, so that it was conducted in smaller groups, delivered in one day only and where possible, held outside in wide open spaces
  • Prioritising sanitation and hygiene, including working with UNICEF to install handwashing stations for everyone to use, at all fixed distribution points during the distribution
  • Reinforcing physical distancing at distribution points, with chalk markings drawn on the ground, in line with government and World Health Organization guidelines on physical distancing
  • Increased crowd control measures during distributions, helping to ensure people receiving nets left the area quickly and safely

The importance of Social Behaviour Change Communication (SBCC)

SBCC is a critical component of successful LLIN campaign delivery and especially important during a pandemic. Health messaging around both malaria and COVID-19 was broadcast to communities on radio talk shows and jingles, and communicated through Information, Education and Communication materials. As part of the training for campaign volunteers, an SBCC component was taught that emphasised key malaria prevention health messages and raised awareness of COVID-19. The recipients of the training were then able to disseminate this information through interactions with their communities during the distribution. These adaptations were implemented rapidly and as a result not everyone initially understood the risks of COVID-19 and the need to adapt the LLIN distribution, reinforcing the need for strong health messaging and protocols for sanitising and washing hands. Strong community leadership, effective training and the combined efforts of all partners helped to address the lack of understanding within communities of the risks posed and helped make the campaign a success.

The unique challenges presented during this LLIN campaign due to the impact of COVID-19 were overcome by partners working together to improve the health outcomes of individual recipients and to strengthen the national health system. The learning captured from the LLIN distribution in in Northern Bahr el Ghazal state will be vital to streamlining future LLIN distributions in South Sudan in the context of COVID-19. 

Read more about this work in our latest project briefScaling up for universal coverage and impact in South Sudan

[1] Ministry of Health, Republic of South Sudan Malaria Indicator Survey (MIS) 2017. Available from:

[2] Ministry of Health, Republic of South Sudan Malaria Indicator Survey (MIS) 2017. Available from: