Unilateral decision making was the dominant approach used by Ministry of Health (MoH) officials when tackling scabies outbreaks in Sudan. However, the 5S Sudan team successfully utilised a participatory approach in both decision making and on-the ground awareness activities, by engaging policy makers (especially MoH officials) in an interdisciplinary group to exchange knowledge and promote integrated strategies. This inclusive approach had a positive impact in delivering ideas, knowledge, and messages on scabies.
Below we share some examples of how this was achieved.
Public engagement campaigns to dispel misconceptions around scabies
Scabies is a skin condition that is commonly found in Internally Displaced Peoples (IDP) camps in Khartoum, Wad-Madani and Port Sudan. The conflict in Sudan that erupted in 2023 has forced millions of Sudanese people to flee conflict affected areas and resettle in crowded IDPs camps, creating an environment conducive to the spread of scabies.
5S research in IDPs settings shows that scabies is a deeply stigmatised condition, often erroneously associated with other severe illnesses, poor hygiene and viewed as a sign of extreme poverty. Research in Sudanese camps highlighted the need to improve health providers’ awareness and understandings of the stigmatising nature of scabies and how this has adverse effects on the people affected by the condition, including social isolation and poor mental health.
With this understanding, the 5S Sudan team set out a public engagement campaign to highlight the causes and prevention of stigma, with a focus on scabies not being a condition exclusive to poor people or associated with other diseases.
The 5S Sudan team partnered with the MoH and other stakeholders to deliver six public engagement campaigns on scabies at IDPs camps and gathering places in Khartoum State, Gezira State, and Red Sea State at Port Sudan city. The campaigns targeted both individuals with scabies and those close to them for example family or close community.
The campaigns used leaflets, live talks, and artistic performances to share information on the nature, prevalence, causes, symptoms and treatment of scabies. The activities highlighted the role of individuals, families and communities in preventing the causes and spread of the disease. 8516 individuals were reached. Throughout the duration of the campaigns, the 5S Sudan team also provided medical personnel to enable diagnosis of and treatment for skin conditions. 494 people were diagnosed with scabies and received medication.
As a result of these campaigns, the 5S Sudan team reported changes amongst participants. There was greater understanding about the causes of scabies, with greater appreciation of environmental, structural, socio-economic, and cultural factors. This led to changes in practices such as people not sharing bed sheets, blankets, mattresses or soap. It also helped to reduce stigmatising behaviours and increase consideration for the experiences of affected people. Maysoun and Amna spoke from the IDP camps in Port Sudan and noted that “After the awareness campaigns, we stopped sharing bed sheets, clothes, soap, bath sponge and blankets because sharing helps spread scabies as we learned from the awareness campaigns. We also started using hygiene soaps in shared bathrooms and irons to iron clothes.”
Capacity building workshops for healthcare providers, decision makers and the media
In addition to the campaigns, the 5S team in Sudan also ran a series of workshops for local and state Ministry of Health and Social Development officials, health professionals, community and faith leaders, IDP camp coordinators and journalists to exchange knowledge and contribute to social-science informed perspective on scabies and the stigma associated with the condition. Each workshop included messaging from 5S research to convey the lived experience of those affected by scabies.
The aims of each workshop were to:
- To build and develop capacity of community leaders to help prevent the spread of scabies and mycetoma.
- To promote NTD awareness (particularly focussed on scabies) among community leaders to help patients and their community better understand the causes, symptoms, prevention and control, as well as the challenges faced by individuals due to stigma.
- To Create and maintain a durable and sustainable awareness by involving relevant individuals and institutions in a position to continue the messaging beyond the duration of the 5S project.
The unfolding crisis in Sudan forced many people to flee from major conflict areas to relatively safer places such as the city of Port Sudan on the Red Sea. This led the workshops to be hosted at both the University of Health Sciences and the University of Red Sea campuses in Port Sudan. A total of 190 people participated in the workshops. Participants included representatives from nine IDP camps around Port Sudan, senior administrators from local health facilities and officials from the Ministry.
Formation of a social science-informed scabies policy for Sudan
The 5S Sudan’s Public Engagement team held a final collaborative workshop in August 2024 to discuss and help shape health policies and plans for NTD control in Sudan. During the workshop, representatives from the State level Ministry of Health and Social Development requested 5S support for the formulation of policies to control and prevent the spread of scabies.
As a result, the 5S Sudan team has now established a committee of technical and scientific experts, incorporating social science expertise, to help formulate a strategy for scabies in Sudan. This demonstrates a crucial change in the approach of policy makers and decision makers towards favouring a multi-disciplinary approach and considering the social science perspective as a pillar in scabies policy and plans. And the committee is still carry on the work. Since the close of the project, the 5S Sudan team have continued their work through three dissemination workshops in Elkhabeer-Hassia Hall, Red Sea University, Port Sudan city.
The first of these aimed to educate the Federal Ministry of Health, the State Ministry of Health and Health Centre Administration staff. In addition, attendees from the State Ministry of Social Development and the University of Khartoum attended. The second targeted media professionals, National and Regional TV, Radio and Broadcasting Houses, the Higher Council for Environment and Natural Resources, the State Ministry of Health and the University of Khartoum and finally the third was aimed at specific groups from radio (national and community) and other broadcasting together with contributors and participants from different institutions who were purposively selected. The content from these workshops appeared for three consecutive days on Sudanese TV, and the 5S Team were able to discuss research findings live on air on Radio Community.
This piece was written in collaboration by Tom Barker, Dr Ahmed Elfaig, Dr Eltaib Ganawa, Esther Garibay and Jenni Wilburn
