Persistence and Partnership against all odds in Southern Sudan

Persistence and Partnership against all odds in Southern Sudan

Health Workers in Southern Sudan

A few weeks ago, I had the opportunity to visit Southern Sudan. For over five decades, Southern Sudan endured civil war, unrest, and several waves of forced displacement and refugees. The infrastructure of nearly every sector was mostly destroyed throughout the region. It is a classic fragile state situation.

Since the Comprehensive Peace Agreement was signed five years ago, the Government of Southern Sudan, donors, international organizations, nongovernmental organizations, private organizations, and, most importantly, health workers are coming together to rebuild a shattered health system.

Now the global community focuses attention on Southern Sudan as they prepare for a Referendum vote to decide if they will officially break away from Northern Sudan to become an independent state. The vote is scheduled to begin January 9, 2011.

From years of experience in fragile states, MSH has found that there are two very important principles when working in these challenging, complex environments. First, you must focus on high health impact essentials. Second, you must build government leadership for health, from the national ministry of health to the local level.

In Afghanistan, with USAID support, MSH helped the Ministry of Health rollout the basic package of health services, while creating national, then provincial leadership capacity. By focusing on communities’ basic needs in Afghanistan, more than two-thirds of the population now has access to basic health services and deaths of children under the age of five have declined by one-third.

Similarly, the USAID-supported health sector transformation program in Southern Sudan is focused on seven high impact health services: child health, nutrition, malaria, hygiene and sanitation practices, maternal health, family planning, and HIV & AIDS prevention.

When working with fragile states, it is also essential to build the leadership capacity of health managers and the ministry of health. In post-conflict situations, the social fabric is often frayed, with less trust, guarded communications, and a high level of uncertainty. It can be quite challenging for people to work effectively to build their future together. The Leadership Development Program (LDP), a leadership training program developed by MSH, helps health managers and their teams to make a “leader shift” from leaders who command, to leaders who empower, from despair and cynicism to hope and possibility, from a mindset of blaming others for unsolvable problems to taking responsibility to overcome challenges.

The LDP made a difference in Afghanistan, and I can see it really making a difference in Southern Sudan. Visiting rural health facilities in Southern Sudan, I was truly inspired by the commitment, resilience, and persistence against all odds of the people and the Sudanese organizations that our team is working with. (MSH is leading a USAID-funded program, Sudan Health Transformation Project, Phase II, that provides transition funding and technical assistance to local, regional, and international organizations working in Southern Sudan to assist them in transitioning their health services from relief to development.)

Visiting Lui Hospital, in East Mundri County, I met Peter Knight Daniel, a Southern Sudanese nurse turned hospital administrator. In the midst of all the turmoil, the hospital was “almost collapsing” as a functioning health facility; Peter came, nearly gave up, and left. Instead, he chose to remain. After the peace agreement, with US Government and other donor support, the hospital now is a vibrant facility with over 120 staff and, among other services, a busy maternity unit and immunization program than serves the county. Mr. Daniel’s resilience and patience made all the difference.

Persistence and partnership against all odds: that’s what the health professionals I met in Southern Sudan have. It is people like Mr. Daniel, with qualities like these, that will serve Southern Sudan well following the January 9 Referendum. If it passes, which many are predicting, the real test will be how the new Government manages the transition.

Our role is to work with our Southern Sudanese colleagues and partners to turn the generosity of the American people into lasting local capacity to provide health services to families and communities.

USAID and other international organizations are looking at Southern Sudan very carefully. They are trying to apply the lessons from elsewhere on what leads a country to fall back into fragility after a sentinel event such as the Referendum. One lesson is the importance of meeting the rising expectations of the population for basic services. We believe that one vital element in meeting these expectations is working with local governments and communities to build responsive, sustainable local health services that deliver high impact interventions.

I am encouraged by the perseverance of the Southern Sudanese people. Although the health system has a long way to go, the government and its partners have made good progress in the health sector in the last five years. We remain committed to helping improve the health of Southern Sudanese people through and following the Referendum.

Jonathan D. Quick, MD, MPH is President and Chief Executive Officer of MSH. Dr. Quick has worked in international health since 1978, he is a family physician and public health management specialist.

Comments

J Mansour
Learning how to work in a fragile state is a key capability of strengthening governance. The story of this hospital administrator is a great example of what it takes to create sustainable health services. It starts with the commitment and motivation of health workers to persevere in the face of enormous obstacles. We have witnessed that managers who can lead others to face the challenges in these terrible situations can transform their health results.

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