southern sudan health system assessment - Health Systems 20/20

5.4.2 AVAILABILITY AND ACCESS
At present, of the 30 percent of the population covered by formal health services in Southern Sudan,
the NGO/FBO sector provides 68 percent of these services. Although many health staff technically are
government workers, they are not on the government payroll but rather are paid by NGOs. The
majority of the NGOs are funded by bilateral and multilateral emergency assistance (funded on a yearly
basis). The focus is on providing first-level health services, not building the capacity of the government
to provide services.
The GoSS must currently rely on NGOs to fulfill the acute need for service delivery; however, it should
concurrently develop policies and procedures to coordinate and standardize service delivery. Indeed,
the provision of health services by the many organizations (estimates range from 50 to 75 NGOs), each
with its own policies and procedures, creates a fragmented, inefficient health system. In addition, more
technical assistance, financed by donor resources, is coming into the country. So the MoH has now the
task of filling the health services gap (which can be helped by a more coordinated approach between
organizations), managing the coordination while, at the same time, developing the structures necessary
to establish a rational health care system for the country.
Currently underway is an MoH-contracted mapping of health facility infrastructure, including assessing
staffing, financing/management, and health services type. This will provide a much-needed picture of the
distribution of current health care services to determine where underserved populations are, who is
served in which areas, and which organizations are providing the services.
5.4.3 EQUITY
Equity of access to care − for geographically isolated, ethnic, and other underserved groups − is a
primary concern for the MoH. Because most of the country is without services, the MoH is focused on
expanding geographic access to formal health services. Although procurements have been slow, the
objective is to rapidly provide formal health care services to the estimated 70 percent of the Southern
Sudan population who now lack them by introducing high-impact interventions delivered through
community and household channels. High-impact services reduce child mortality and morbidity rapidly
and include: immunization; vitamin A supplementation; ITNs for malaria prevention; oral rehydration
therapy/zinc and point-of-use water treatment to avoid diarrheal and other water-borne diseases;
community-based treatment of malaria with pre-packed ACT (artemisinin combination therapy) drugs;
treatment of acute respiratory infection with antibiotics; and mass treatment of hyper-endemic
communities infected with bilharziasis. Delivery of these interventions will be done through existing
governmental, nongovernmental, and community networks and through social marketing.
5.4.4 QUALITY
Because a great number of organizations have implemented health services over the years in Southern
Sudan, there is no standard measure of service delivery quality. Quality (and standardization of services)
should improve once the recently developed BPHS is rolled out and the procurements to expand
services in each state are implemented. This BPHS is a PHC-oriented approach to service delivery −
moving from the community level to first-referral hospitals to county health departments is an integral
part of the system.
An assessment of the three major hospitals – Juba, Malakal, and Wau – was recently completed in
preparation for strengthening and reforming hospital service delivery. The MoH will contract on a pilot
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