southern sudan health system assessment - Health Systems 20/20

figures into account and using a population base of 10 million, it is estimated that US$ 13 per capita was
budgeted (though not necessarily disbursed) for health in 2006 (see Figure 3). If these funds were all
disbursed, this level of funding would be significantly more than many countries with similar per capita
gross domestic product, especially among post-conflict countries. But a challenge faced by the MoH is to
effectively coordinate those funds to ensure efficient use of resources. While this needs the
commitment and cooperation of bilateral donors, NGOs, and UN agencies, the current needs are vast
and beyond what is currently available.
FIGURE 3: HEALTH SPENDING PER CAPITA IN 2006 (US$)
45
40
35
30
$US per capita
25
20
15
10
Southern Sudan
2006 estimate
5
0
0 100 200 300 400 500 600 700 800 900 1000
per capita GDPt 2000 ($US)
The GoSS has declared that basic health and emergency services should be provided free of charge to all
Southern Sudanese citizens. This declaration applies to all public facilities as well as NGO providers.
However, our interviews with state officials and NGO representatives indicate that out-of-pocket
expenses are commonplace.
The World Bank estimates that government expenditure on health as a percentage of total public
spending is approximately 8 percent, which is on par with other sub-Saharan countries.(World Bank
2007) As Southern Sudan is emerging from a long history of civil war, health indicators are still markedly
inferior than for the sub-Saharan region, despite the level of health spending.
Many officials interviewed attributed Southern Sudan’s poor performance relative to sub-Saharan Africa
as follows:
1. The GoSS did not fulfill its pledge for Phase 1 of the project. US$ 8 million was deposited in the
MDTF account of the US$ 40 million pledged.
2. The NGO sector is providing care inefficiently, in an ad hoc and often vertical manner.
3. Unit costs in Southern Sudan are much higher than in most neighboring countries.
4. MoH resources have not been strategically allocated to strengthen PHC: “specialized materials and
supplies” absorbed two-thirds of non-salary recurrent costs, and “scholarships” and “training”
account for half of the remainder (World Bank 2007).
23