Access to health care in South Sudan
(Source: South Sudan Village Assessment Survey Report 2013, International Organization for Migration; IOM)
As South Sudan nears the second anniversary of its independence, the world’s newest state continues to face numerous challenges, with a fragile humanitarian situation and socioeconomic difficulties brought about by the suspension of the country’s oil production in early 2012. It is within this context that millions of South Sudanese have returned to their homeland, mainly from Sudan. Since the inception of the Comprehensive Peace Agreement in 2005, an estimated 2.5 million South Sudanese have returned, settling across all ten states that make up the Republic of South Sudan. This is the equivalent of approximately 23% of the country’s estimated population (based on estimates as of 2012). The influx continues to test the country’s absorption capacity and host communities’ ability to share limited basic services, livelihood opportunities and economic resources. Decades of civil war and the absence of structural investment have resulted in major gaps in infrastructure and service delivery across the country.
Increasing availability and access to the health care system in South Sudan has proved to be a challenging task for government organizations and the international community. According to the Ministry of Health (MoH), only 25% of the population of South Sudan has regular access to health facilities.1 Despite having a four-tier health services structure, South Sudan’s health facilities do not provide official referrals, placing the decision to seek specialized care to the discretion of the patient.
The limited accessibility to health care is directly affected by the lack of infrastructure and poor state of the existing health facilities. There is a critical shortage of qualified medical practitioners. According to WHO and the MoH, there are a total of 189 physicians in South Sudan—or one doctor for every 39,088 persons. Central Equatoria State accounts for the highest concentration of physicians in South Sudan (51%), while Western Equatoria and Jonglei do not possess any qualified South Sudanese physicians.2
County hospitals provide the most advanced medical treatments, well beyond the capacity of Primary Health Care Units (PHCUs) and Primary Health Care Centres (PHCCs). PHCUs are the most common health facilities and offer basic, preventative, promotive, and curative services.3 Hospitals are located at county administrative headquarters and PHCC cases are referred to this level where secondary health care is also available. Currently only 15 hospitals, 88 PHCCs and 348 PHCUs are available nationwide.
1 Ministry of Health: Health Sector Development Plan 2011 - 2015.
2 South Sudan Medical Journal (2012).
3 Republic of South Sudan, Ministry of Health: Health Sector Development Plan 2012-2016 (2012), pp. 8.