A White Flag for Health in Southern Sudan
With only 10 miles of paved road in all of Southern Sudan, a region the size of Texas, Steve Redding, Director of Health Service Delivery at Management Sciences for Health (MSH), explains that it is unusual to bump into any sign of government: “There are no roads, mostly cattle trails. Many of the people are seminomadic. . . . To have health facilities positioned along cattle routes reminds people that there is a government concerned with their welfare.”
Three years ago, life was different in Southern Sudan. The opposition government viewed infrastructure, such as health centers and schools, as signs of rebel support, and they were regularly bombed. Two decades and two million lives later, a landmark comprehensive peace agreement, signed in 2005, has ended Africa’s longest-running civil war. Today peace is beginning to pay dividends, especially in health. “It’s an opportunity to rebuild social and economic structures, including a health infrastructure that had been virtually destroyed by civil war,” said Anne Woodworth, a Director for International Project Development at MSH.
In peacetime, the Government of Southern Sudan has broken ground in developing health infrastructure, basic as it may be. District hospitals made of bricks and mortar have begun to replace tarp-covered clinics. The government has asked relief and missionary clinics, which have been operating semiautonomously in the area for decades, to adopt Ministry of Health policies and norms and follow standardized treatment protocols.
The government understands that creating a healthy population is not just a moral imperative, but it is also a means to achieving broader development goals. “One of the reasons for all those long years of fighting in the first place is all the inequities in the distribution of wealth in the country,” said Mary O’Neil, a Principal Program Associate who worked on the Capacity Project in Southern Sudan. Indeed, a guiding principle of the national health policy states, “Health is both a social and economic asset that shall be invested in and prioritized by the Government of Southern Sudan.” Health policy stresses decentralization, and the government intends to make its presence visible to people throughout the country. Access to health care, however, remains a formidable problem, with only an estimated 30 percent of the population using health services, the bulk of which are offered by international relief agencies.
Here only one in four infants survives to celebrate their fifth birthday, and 2 percent of mothers die in childbirth. Improvements in these statistics depend on continued peace. History has shown that war, and a long-standing crisis mode of operation, has decimated the workers and damaged the systems and facilities needed to extend health services to large segments of the population in Sudan.
The country’s continuing respite from war hinges on a referendum, to be voted on in 2011, that will allow southerners a vote on whether to separate from the North. The Government of Southern Sudan wishes to demonstrate that it can preserve unity and peace and be a legitimate government for the south. To do so, they must also show people that they are capable of providing health and other basic services. With the help of donors, the government has enlisted international agencies, including MSH and others, to help rebuild the health system, and the government is making progress in providing a basic package of services that includes immunizations, maternal and child health, family planning, water and sanitation, nutrition, and prevention of malaria and HIV.