Strengthening the Health System in South Sudan

Celebrating Independence Day in South Sudan. {Photo credit: Erin Polich/MSH.}Photo credit: Erin Polich/MSH.

South Sudan is strengthening their health system, despite the challenges of being the newest country in the world.

The World Health Organization (WHO) says that, “A health system consists of all the organizations, institutions, resources and people whose primary purpose is to improve health.” In South Sudan, MSH leads the USAID-funded Sudan Health Transformation Project, phase two (SHTP II), which works with the national Ministry of Health, county health departments, local organizations, and communities to transition the primary health care system from relief to development.

SHTP II set three main objectives to help rebuild South Sudan’s health system: (1) Expand access to and quality of health service delivery. (2) Expand knowledge and awareness of services. (3) Build the capacity of South Sudanese citizens to manage and deliver services.

Expanding access to, and awareness of, health services

It is easy to see the project’s success expanding access to health services through the 163 government health facilities supported by SHTP II. In 2011, 47,100 children under the age of one received the life-saving third dose of the vaccine for diphtheria, pertussis, and tetanus (DPT3), a 212 percent increase over the previous year’s accomplishment. Second doses of the intermittent preventive treatment to prevent malaria during pregnancy rose 65 percent from 13,400 to 22,100. Fourth antenatal care visits more than doubled from 8,100 to 19,200.

While these data show increased access to services, they also correspond to a significant rise in awareness about services provided in the South Sudan primary health care system. SHTP II supports behavior change communication activities through dance groups, drama clubs, community awareness events and school programs. All these efforts are aimed at increasing both awareness of and access to the facilities supported by the project.

Building capacity of human resources for health

But it is the third goal—building the capacity of South Sudanese citizens to manage and deliver services—that has perhaps the most significant and longest lasting impact on true system transformation. South Sudan’s human resource capacity was decimated during more than five decades of war when health workers often were displaced, fled the country, or were killed. Building human resources—from the facility to the national ministerial level—is crucial for a sustainable health system. 

One of the most important contributions towards this goal has been the Leadership Development Program. Health providers are rarely taught leadership and management skills, which are desperately needed in the sector. These trainings create micro-level teams at facilities that work to transform workplace culture. Working together, teams identify problems, pinpoint obstacles to overcome, address the root causes, and obtain measurable results. 

In Thiet Primary Health Care Center in Tonj South, the team increased the number of women delivering with a skilled attendant from 15 over the course of six months to 47. In Panyijar, a similar effort saw skilled births more than double from 30 births over the passage of six months to 72. In Gurei Primary Health Care Center, the team increased the number of children who received DPT3 from 323 over the course of five months to more than 4,000 in the same five month period one year later. Spurred on by these successes, the teams are now continuing to work on these challenges, but also identifying new areas to address.

“The Leadership Development Program is very important. In my office, we had a lot of organization problems. Those who had known Thiet before [the program] would say it is a different place. Now, Thiet is the best run facility,” said Marco Agor, who works in the county health department in Tonj South. The program has been so successful that the national Ministry of Health is now working with SHTP II to identify their own leadership challenges, and recently completed the second of four Leadership Development Program workshops. 

In the end, the importance of MSH’s work in South Sudan is precisely these legacies which it leaves behind. The project’s service delivery prevents and treats diseases. Community education emphasizes the importance of utilizing these services. The project empowers teams to work together to find solutions. And the capacity building assures that after SHTP II finishes in July, the progress achieved over the past three years through partnerships with national and local governments, as well as other partners, will continue under the leadership of the South Sudanese themselves.