southern sudan health system assessment - Health Systems 20/20

infrastructure, such as facilities, electricity, water, roads, and communications. Staffing, supplies,
equipment, and funding for recurrent costs are inadequate. NGOs provide most health care, and states
have limited capacity to manage, regulate, and coordinate services. Only 30 percent of the population of
Southern Sudan is covered by health services.
Recommendations:
The assessment team recommends that poor quality of care and coverage be addressed by giving
technical assistance, operational training, and tools to community health teams to develop a strong,
cost-effective, and scalable model. A scalable community outreach model would include a cadre of
community health promoters in select pilot counties to increase demand for health care by delivering
key health prevention messages to their communities. The team also recommends strengthening human
resources by increasing and improving the strategic planning workforce through recruiting and financing
strategic planners at the state level to increase salary support and bottom-up budgeting for health
services. Further, training and retaining primary health care workers through non-financial incentives and
clinical collaboratives, both established as highly successful methods for enhancing skills and improving
motivation, will greatly improve quality of care.
HEALTH INFORMATION SYSTEM AND PHARMACEUTICAL AND
HEALTH COMMODITY MANAGEMENT
The MoH/GoSS is committed to developing a M&E program and health information system (HIS) to
inform decision-making at each level of the health system; however, as a post-conflict country, the
existing HIS is not yet developed. The lack of good health management information and the poor
capacity to analyze and use data for decision-making are important factors limiting states’ ability to
develop strong strategic plans. Strategic planning is even more limited at the county level, due to limitedto-non-existent
budgets for salaried staff, as well as difficulty recruiting qualified staff and a low
education level among primary data collectors. NGOs provide most health care services, and as such
are a critical data source. However, they do not transmit their data to the central or state levels.
The regulatory system for pharmaceutical and health commodity management that the MoH has
developed in the past two years is a tremendous achievement. However, many challenges bar the
implementation of this system. There is a critical lack of staff, infrastructure, and training on existing
policies. Slow procurement leads to major stock shortages in the public system throughout country, and
although essential drugs are intended to be provided for free to patients by the central MoH, most
Southern Sudanese pay out-of-pocket and rely on NGOs and informal drug vendors. The limited
capacity of states and counties to forecast needs, the weak or absent distribution system, the lack of
qualified staff in pharmaceutical management, and the lack of management systems and of information
technology are obstacles preventing patient access to medicines and quality care.
Recommendations:
The health assessment team recommends addressing the problems of HIS and pharmaceutical and health
commodity management by recruiting, financing, and training strategic planners at both the state and
county levels. Increasing and improving the strategic planning workforce would allow states are to
engage counties in bottom-up budgeting, to adequately assess and forecast their resource needs, and to
engage in other critical planning exercises.
xiv