The post conflictSouth Sudan has huge challenges in delivering health care to the population. The challenges include: crippled health infrastructures, nearly collapsedpublic health system, and inadequate qualifiedhealth professionals. The country is far from achieving theMDGs by end of 2015. The health system needs a major resuscitation, in addition to supporting and developing health training institutions.
South Sudan is acknowledged to have some of the worsthealth indicators in the world.[1][2][3]
A new measure of expectedhuman capital calculated for 195 countries from 1990 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published byThe Lancet in September 2018. South Sudan had the second lowest level of expected human capital countries with 2 health, education, and learning-adjusted expected years lived between age 20 and 64 years. This was an improvement over 1990 when its score was 1.[4]
South Sudan's health system is structured into three main service tiers: Primary Health Care Units (PHCUs), Primary Health Care Centres (PHCCs), and hospitals operated at the state, county, police, or military level.[5]
Health service delivery operates across four levels: community, primary, secondary, and tertiary. Community-level services are provided in villages by trained local personnel. The primary level includes PHCUs and PHCCs, which deliver the Basic Package of Health Services (BPHS). The BPHS encompasses preventive, curative, health promotion, and basic administrative services.[6] The government finances it, the Multi-Donor Trust Fund (MDTF), and variousNGOs. These services are intended to be free and accessible to the majority of the population at both the primary and secondary levels.[6]
The Ministry of Health (MoH) administers a decentralized healthcare system in line with the Interim Constitution of South Sudan (2005)[7] and the Local Government Act (2009).[6] This system is organized across four administrative levels: national, state, county, and community.[8] The national Ministry is responsible for policy development, strategic leadership, funding, and monitoring and evaluation. State governments oversee the implementation and coordination of healthcare services at the county and community levels.
The health situation in South Sudan is far from ideal. More than 50% of the population lives below the poverty line, and the adult literacy rate is 27%. The under-five mortality rate (U5MR) is 99 per 1,000 live births, while the broader under-five infant mortality rate is estimated at 135.3 per 1,000.Maternal mortality is the highest in the world, with aMaternal Mortality Ratio (MMR) of 2,053.90 per 100,000 live births in 2006 (South Sudan National Bureau of Statistics, 2012).[3]
Access toantenatal care (ANC) is limited, with 47.6% of women attending the first visit and only 17% completing the recommended four visits.[9] Theinfant mortality rate (IMR) is 64 per 1,000 live births, and nationallife expectancy is estimated at 55 years.[10]
In 2004, there were only three surgeons serving Southern Sudan, and just three functioning hospitals. In some areas, there was only one doctor per 500,000 people.[1] A child born in South Sudan has a 25% chance of dying before reaching the age of five. Major causes of child mortality includepneumonia, diarrhea,malaria, andmalnutrition.[9]
The country also has one of the lowestimmunization coverage rates globally. Only 26% of children received all recommendedvaccinations in 2010, a slight decline from 27% in 2006.[11][12]
Most maternal deaths occur during labour, delivery, or the immediate postpartum period. These deaths are largely preventable with adequateinfrastructure and the presence of skilled personnel duringchildbirth.
South Sudan’s human resources for health are significantly below the minimum threshold recommended by theWHO.[13] Between 2009 and 2010, there were only 189 doctors across eight states—an average of one doctor for every 65,574 people. The number ofmidwives was 309, or one per 39,088 population.[14] However, estimates vary; other sources suggest a ratio of one midwife per 125,000 women.[15]
In October 2014Oxfam warned that 2.2 million people were facingstarvation.[16] The2017 South Sudan famine occurred after several years of food insecurity and affected an estimated five million people, just under half the national population.[17][18]
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