Taking the bull by the horn: South Sudan’s ministry of health takes charge of health development in the country.
Date of Publication: August 18, 2021
1Juliet Nabyonga-Orem; 1Gilbert Buckle; 2Moses Ongom
South Sudan has faced internal conflict and fragility for more than a decade, but who says it will be a conflict setting for many more years to come? The South Sudan Government is poised to transition the country from a fragile situation to a developing one. The Leadership of the Ministry of Health (MoH) is already sending a clear message that conflict is over, it’s time to think development. The MoH organised a Leadership and Governance Conference from 16th – 20th August under the theme, “Strengthening governance and leadership capacities at national and subnational levels towards a more effective and efficient health system”, which attests to the paradigm shift.
Launched by the His Excellency the Vice President for service cluster with the support of the Honourable national Minister of Health; in attendance were all the 11 State Ministers of Health, Director Generals at state and the national level MoH and an official from the ministry of finance. The conference was a landmark one, not only to symbolise the dawn of a new era, but to build consensus on critical issues to accelerate the efforts towards universal health coverage. This blog highlights the positive development taken by the leadership of the MoH to end the status quo and take charge of health development in the country.
Plagued by conflict due to a prolonged civil war, weak health infrastructure and a fragile health system, the public health systems was not able to adequately respond to the health needs of the population. Far from adequate was government funding for health at only 2% of general government expenditure, translating into a current percapita expenditure of $3 (2018) – as compared with $86 per capita considered necessary for attaining universal health coverage. As a result, non- governmental and civil society organisations have been the bedrock of health service delivery in the country, and donor sources as the major source of funding. Participants in the conference opportunities realised from partner investments but also highlighted the persistent challenges, admittedly from gaps in leadership and governance in the sector. The conference frankly discussed teething problems among which were gaps in communication between states and the national level, poor information flow between MoH and partners, weak negotiation capacity of government officials especially at state level, fragmentation in coordination structures and information systems and partnerships embroidered in imbalanced power plays. Statement such as “we need support, but mutual respect is important” were echoed. Reemphasizing the principles of the Paris declaration on Aid effectiveness, the Ministry of Finance official reiterated some of the challenges in realising them. For example, it was noted with concern that some partners come with decisions already made at their headquarters regarding which areas to support; and the need for timely sharing of information by partners to ensure comprehensive and coordinated planning.
The conference built a common understanding of the health sector vision among the leadership at both national and state level to serve as a basis for alignment of partner investments. The Aid strategy for the Republic of South Sudan which provides a framework to improve the effectiveness of development assistance and humanitarian aid delivery in South Sudan was also shared and discussed. A frank internal reflection on weaknesses within the MoH structures as well as between MoH and other related sectors and partners provided a window to forge clear action to end the status quo. Participants admitted that they knew what they wanted as leaders in health as well as the persistent challenges, they resolved to confront the issues that disempower them.
It was reassuring to hear bold statements from the leadership such as “We cannot put the health of the people of South Sudan solely in the hands of partners, it should be our responsibility as government" from the Deputy Chairperson, South Sudan AIDS commission. “It is us, the solution lies with us” a State Minister of health admitted. “Why do we blame partners, let’s take up our responsibilities and be accountable” another State minister of Health admonished. From the resolve of the participant, an enthused Director General of the MoH underscored that “The conference is coming late, we needed it yesterday”. All these attest to the point that indeed it is a turning point for health development in South Sudan.
The Declaration that ensued from the conference proceedings made bold pronouncements symbolising commitment to turn a new leaf. Among these: to ensure health leadership by government at all levels, building mutually respectful partnerships that are accountable, primarily relying on and progressively increasing government funding for health with partner contributions considered as complementary.
Dr. Kediende Ocom: Director General MoH
The newly formed Ministerial Advisory Board was a welcome initiative envisaged to consolidate and oversee implementation of agreed commitments. This forum will bring together National and state level ministers of health on a regular basis to dialogue on health leadership in the country and monitor implementation of the Declaration. Further, the forum will serve as a platform to ensure smooth flow of information, addressing leadership and governance challenges and ensuring aligned implementation of national level priorities.
With the Revitalized Agreement on the Resolution of the Conflict in the Republic of South Sudan (R-ARCSS) paving way for peace, and the proceedings from this conference, it is time for a justified hope and optimism that the paradigm shift and the dawn of a new era is here, to transition South Sudan from fragility and humanitarian context onto the path of health development. The health sector leadership is boldly taking charge, development partners and citizen are invited to play their roles and in all these, mutual accountability will be critical.
1World Health Organization; Regional office for Africa, Congo Brazzaville
2World Health Organization; WHO South Sudan Country Office
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Profile of Author(s)
About Juliet Nabyonga-Orem
Health systems Expert, WHO
About Moses Ongom
Health systems advisor WHO Country Office; South Sudan