Health in South Sudan

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Country profile

The republic of South Sudan is the world’s youngest nation. It is the 193rd member of the United Nations and 54th member state of the African union. The country was born July 9, 2011 through a self-determination referendum in which the citizens voted over warmly 98% for independence from the Sudan.^[2] The referendum was one of the provisions of the Comprehensive peace agreement in 2005 that ended one of Africa's longest civil wars lasting from 1983 to 2005. The site of the government is in Juba the capital city. The Government of South Sudan (GOSS) has administrative division of ten states. Each state is made of counties, each county is made of payms and each payam is made up of Bomas, which are the smallest administrative units. South Sudan is a land locked country bordered by the Sudan, Ethiopia, Kenya, Uganda, DRC and Central Africa Republic. It has a land mass of 644,000 km² and a population of around 12 Million people.

Health system

The national ministry of health (MoH) have a decentralized health services in line with the interim constitution of South Sudan^[3] (2005) and ^[4] local government act (2009). The decentralized organization structure has four levels: Central, state, county and the community.^[5] The national ministry of health provides policy guidance, leadership, funding, monitoring and evaluation. The state level oversees the implementation of health care services delivery at the rest of the levels. The structures in health services delivery is in the order of community, primary, secondary and tertiary levels. The community is located at the village level and manned by community health. The primary level includes Primary Health Care Units and Primary Health Care Centers which provide Basic Package of Health Services (BPHS). The BPHS covers preventive, curative, health promotion and managerial activities.^[6] .The BPHS is finance by government and contribution from MDTF and various NGO. The health services are meant to be free and accessible to the majority of the population at the primary and secondary levels.^[6]

Health indicators

The health situation South Sudan is far from ideal. This even made worst by high level of poverty where more than 50% of the population live below the poverty line. The adult literacy rate is also low at 27%,Maternal Mortality Ratio (MMR) 2045/100,000 live births in 2006 Antenatal care (ANC) attendance (1st Visit) 47.6%, 17% four visits.^[7] Infant Mortality Rate (IMR)64/1,000 live births,Under five Mortality Rate (U5MR) 99/1000 live births.life expectancy is 55 years^[8]

A child born in South Sudan has a 25% chance of dying before their 5th birthday. The major causes of the mortality include: Pneumonia, diarrhea, malaria, and malnutrition.^[7] The country has the lowest immunization coverage of only 2%.^[9] The proportion of children who received all recommended vaccinations dropped from 2.7 to 2.6% in 2006 and 2010 respectively.^[10] The ANC coverage is very low at 40.3% women attending first visit and 17% women who completed the four recommended visit. Most of the maternal deaths occur during labor, delivery and the immediate post partum period. Most of these deaths would have been prevented if the country had good infrastructures, skilled personnel during child birth. The human resource for health in South Sudan is far below the minimum threshold recommended by the WHO.^[11] Between 2009-2010 there were only 189 doctors across eight states and doctor population ratio was 1:65,574. There were 309 midwives in the country and the ratio was 1:39,088, MoH GOSS 2010). However, the is variation in the figures, other sources suggested the ratio of midwives as 1:125,000 women.^[12]

Maternal mortality ratio per 100,000 live births in 2006(South Sudan national bureau of statistics, 2012) A child born in South Sudan has a 25% chance of dying before 5th birth day (WHO 2009). The major causes of the mortality include: Pneumonia, diarrhea, malaria, and malnutrition (MoH and National Bureau of statistics 2012). The country has the lowest immunization coverage 2%.^[13] The proportion of children who received all vaccination recommended dropped from 2.7 to 2.6% in 2006 and 2010 respectively. The ANC coverage is very low at 40.3% women attending first visit and 17% women who completed the four recommended visit. Most of the maternal deaths occur during labor, delivery and the immediate post partum period. Most of these deaths would have been prevented if the country had good infrastructures, skilled personnel during child birth. The human resource for health in South Sudan is far below the minimum threshold recommended by the WHO (Gupta et el., 2011). Between 2009-2010 there were only 189 doctors across eight states and doctor population ratio was 1:65,574. There were 309 midwives in the country and the ratio was 1:39,088, MoH GOSS 2010). However, the is variation in the figures, other sources suggested the ratio of midwives as 1:125,000 women.

Conclusion

The post conflict South Sudan has huge challenges in delivering health care to the population. The challenges include: cripple health infrastructures, nearly collapsed public health system, inadequate qualified health professionals and so on. The country is way far from achieving the MDGs by end of 2015. The health system needs a major resuscitation, in addition to supporting and developing health training institutions. The others other components that need to be given urgent attention: peace and security, basic nutritional needs, water and sanitation, education, shelter, employment, and gender empowerment of women and girls. These require high level government commitment and leadership.

South Sudan is acknowledged to have some of the worst health indicators in the world.^[14][15][16]

Health situation

The under-five infant mortality rate is 135.3 per 1,000, whilst maternal mortality is the highest in the world at 2,053.90 per 100,000 live births.^[16] In 2004, there were only three surgeons serving southern Sudan, with three proper hospitals, and in some areas there was just one doctor for every 500,000 people.^[14]

Health care system

South Sudan has a health system structured with three tiers; Primary Health Care Units (PHCU), Primary Health Care Centers (PHCC) and Hospitals (which exist as either state, county, police or military).^[17] The best hospital in the country is Juba Teaching Hospital in Juba.

2014 Famine

In October 2014 Reuters reported Oxfam were warning '2.2 million people currently faced starvation' .^[18]

References