Southern Sudan

Deborah Nyantiok is 56 years old and lives with her grandchildren in Kaya, near the border of Uganda. She lost her husband during Sudan’s 20-year civil war and now takes care of her grandchildren. In order to pay for food and school fees, Deborah operates a small business and keeps animals to generate income. Despite her hard work, in the past Deborah found life difficult as she and her grandchildren often fell ill.

Lacking a source of clean drinking water, residents of Kaya gather drinking water from the nearby Kaya River. While the river provides vital irrigation which makes the surrounding land lush and green, unfortunately it also carries dangerous viruses and bacteria. These pathogens cause many waterborne ailments like typhoid, diarrhea, and parasitic diseases. Deborah and her grandchildren often suffered from these diseases, and while they sought medical treatment, it always seemed only a matter of time until their suffering returned.

Children in Southern Sudan

Malaria is preventable and curable, yet every year it kills more than a million people throughout the world and tens of thousands in Southern Sudan alone.  Malaria infection remains the highest cause of morbidity and mortality in Southern Sudan. Every year, thousands in Southern Sudan die unnecessarily due to lack of access to appropriate prevention and treatment. In the wake of nearly 50 years of civil war, the country is hastening towards independence and a future with unlimited potential. Yet, every death brought about by malaria steals another life from contributing to the nation’s future.

The US Agency for International Aid (USAID)-funded, Management Sciences for Health (MSH)-led Sudan Health Transformation Project, Phase 2 (SHTP II) is working to combat this scourge. Through 165 health facilities in 14 counties and 10 states, SHTP II is providing vital services to prevent and treat malaria. 

Tukuls in the process of construction which will house midwives and PHCC staff, as viewed from Muni PHCC, (Muni Payam, Terekeka County, Southern Sudan)

Terekeka, a growing county and town just 60 miles north of Juba, translates as “The Forgotten” in the local dialect.  Just five years ago, this area was awash in violence, poised close to the frontlines of a civil war which resulted in the death and displacement of millions. Villagers and returnees began repopulating the area after the signing of the Comprehensive Peace Agreement in 2005, which heavily increased demand for health services. Today, Terekeka is heavily populated by southern returnees seeking refuge, land, and jobs, as well as internally displaced persons escaping nearby tribal violence.

Health Clinic in Southern Sudan

 

For the past week, we in Southern Sudan have crowded polling stations to vote on a referendum that, if passed, would declare Southern Sudan the world’s newest nation. Observers have declared the voting “broadly fair,” and the 60 percent voter turnout required for the vote to pass has been reached. We are optimistic that this referendum will bring us closer to a peaceful, prosperous future.

The mood in Juba (the capital city of Southern Sudan) is bright as we await the results of the polls, set to be announced February 1. But our government and people realize that secession will bring new challenges along with its opportunities. About 150,000 of our Southern Sudanese brothers and sisters have returned home in recent weeks and still more are expected. While we welcome them joyfully and are delighted to see extended families reunited, this great influx of people will put additional strain on a health system that already struggles to meet the needs of the people it serves.

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.

Fragile states such as Afghanistan, the Democratic Republic of Congo, Haiti, Liberia, and Southern Sudan have among the worst health statistics – especially for women and children.  For political, economic, security and other reasons they can be extremely challenging work environments. Despite this, I have been deeply inspired to see what local health leaders have achieved when they have created strong partnerships among government, donors,  non-governmental organizations and where possible the private sector.  The charismatic former minister of health from Afghanistan, the  medical director of an urban clinic in northern Haiti, and the director of Torit hospital in Southern Sudan stand out as examples of local leadership in action under circumstances that would immobilize many of us.

In fragile states, constraints on governments often prevent them from simultaneously building their stewardship role and immediately expanding service delivery. Supporting the Ministry of Health to establish a basic package of health services, train local organizations to implement those services, and provide incentives (such as through performance-based financing) is critical to success. Additionally, the goal should be to move from many plans and actors across districts to one health plan with committed partners. 

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