The eMMT has implemented its intervention in 38 counties spread across nine states, with almost half (42%) of the counties located in Jonglei and Unity States (Figure 1). The interventions implemented ranged from disease outbreak investigations, and implementation of emergency pre-emptive and reactive vaccination campaigns to conducting mobile medical outreaches. Notably, eMMTs have investigated and confirmed rift valley fever outbreaks in 2018. The eMMT investigated measles outbreaks and implemented reactive vaccination campaigns in seven counties during the review period, including Maruwa and Labarab in Pibor, during the widespread measles outbreak in the country in 2019. Labarab and Maruwa are hard-to-reach locations in Pibor Administrative Area, where the eMMT implemented a reactive measles vaccination as the provider of last resort as no partner could access the area. Overall, 148,725 (72-125% coverage) under-5-year-old children were vaccinated in seven locations with confirmed measles outbreaks in 2019 and 2020. Some 355,790 (coverage 51-89% in round 1 and 50-78% in round 2) individuals were reached with oral cholera vaccines in four locations with active cholera outbreaks in 2018. Further, the eMMT implemented a pre-emptive oral cholera vaccination campaign in Bor South, a severe flood county in 2020, and vaccinated 63,280 (88.1%) people in round 1 and 64,137 (89.3%) people in round 2. In 2019 and 2020, the eMMT took the lead in training RRTs and other health workers as part of the country s preparedness activities for the Ebola Virus Disease (EVD) and COVID-19 pandemic and formed a critical component of the COVID-19 response team after the outbreak was confirmed in the country as members of contact tracers. A summary of some critical achievements is presented in Table 1.
The implementation of the mobile medical team strategy has revealed a few important lessons that can be used to strengthen the future approaches for the intervention. First, there is a need for collaboration and coordination with the local administration and partners on the ground for adequate information on insecurity and access challenges critical for planning. Second, the team composition must be reconstituted and adapted based on the nature of the emergency being responded to, assuring adequate capacity within the team to attend the event. A different set of skills and experiences is required to respond to different emergencies adequately. Thirdly, to ensure the needs of the vulnerable populations are addressed comprehensively, it would be prudent to broaden the scope of the services offered by the eMMTs to include psychosocial and mental care. Mental health and psychosocial disorders, including post-traumatic stress syndrome and depression, are prevalent among conflict-affected populations. There is a high need for mental health services during and after conflicts. The effectiveness of delivering community mental health services through mobile health clinic approach has been demonstrated in rural Haiti. Further, there must be a proper referral linkage with local health facilities where the mobile outreaches are being conducted to attend to severe clinical cases requiring an inpatient or specialized service. Transportation and costs of referring these cases from outreach sites to the receiving facilities should be anticipated and planned. Fifth, there is a need for collaboration between eMMTs and local health workers, including community health workers during outreaches and outbreak investigations for on-the-job training and skills transfer with the view of promoting ownership and sustainability of interventions.
Our operations and delivery of essential services have been affected by multiple factors ranging from insecurity to difficulties in delivering essential commodities and personnel on time to where they are required. Unpredictable security situations, inefficient and costly logistics, rugged terrain and poor road and transportation networks, frequent flooding, and lack of continuity of services the mobile teams offer are some of the key challenges faced. The frequent insecurity flare-ups, displacement of the targeted populations, flooding of airstrips, impassable roads, delays in delivery of essential medicines, vaccines, emergency responders, and funds required for planned activities and attacks on health facilities or health personnel have contributed to the mobile missions being postponed, terminated, or being unsuccessful. Many of the locations served by the mobile teams are hard-to-reach areas that caused the teams to trek for long hours through challenging terrains, mud, or flood water or be flown into the area to reach the vulnerable, isolated groups. Some locations lacked a partner or local authority to address the reported emergencies and required WHO to send in the mobile teams as the provider of the last resort.
The lack of continuity of the services offered by the eMMTs is related to the absence of strategies to ensure the continued provision of vaccination services and the management of the chronic conditions initiated during the mobile outreach. The lack of predictability of the visit by the mobile teams may negatively affect the community s uptake of the services and the ability of the teams to offer certain services. The other notable challenges encountered include weak public health surveillance and poor mobile network coverage in the conflict-affected counties contributing to delays in receiving and responding to reports of public health events and inconsistent capture and reporting of data from the mobile clinics.