Pape Gaye: Health Care Challenges In Southern Sudan
The Disease Control Priorities Workshop held in Juba from June 9–11, 2008 gave us a golden opportunity to learn about the major dynamics and drivers of the health care delivery systems in Southern Sudan and to contribute ideas for the programming of health policies and interventions.
My general impression of health in Southern Sudan is that the challenges are huge and the situation is more grim than anyone would expect. Published indicators show the health system has all the typical signs and characteristics of a weak system that risks collapsing further if the urgent issues are not addressed in a timely fashion. The major hurdles are a dire health workforce shortage (including concentration of the country’s few available health professionals in three major areas—Juba, Wau and Malakal) and a severe lack of basic medical equipment and supplies. The data provided during the workshop on current domestic health financing and spending point to deep policy, structural and other management issues that result in a weak absorptive capacity of the Ministry of Health (MOH). I was also struck by the serious communication issues between the national and state levels of government.
The topic on which I focused, “Building and Motivating the Workforce,” generated rich discussion and sensible recommendations for action. Participants generally saw the workforce as the “essential cog” in the health system’s engine. With less than one health worker per 1,000 people and a very biased distribution of those health workers, the number of new health workers needs to dramatically increase and the work currently undertaken by the African Medical and Research Foundation—to train clinical officers, community midwives and community public health workers—significantly accelerated. The post-conflict situation and embryonic nature of the current health system require that attention be paid both to short-term and quick solutions while also continuing to build a strong foundation for long-lasting human resources development.
For sustainable human resources for health (HRH), the Government of Southern Sudan needs to make its HRH policy very explicit and pay serious attention to the workforce wage bill, which will be the largest in the sector and which currently has serious bottlenecks to be removed including resolving severance and retirement issues. With assistance from the IntraHealth-led Capacity Project and USAID, efforts are underway to complete and disseminate a human resources strategy that was developed following the first multi-sectoral HRH forum in the country held in August 2006. An implementation plan for 2006–7 was also produced.
A human resources information system (HRIS) developed by IntraHealth using Open Source software is currently managed by the Human Resources Department at the MOH and will be rolled out to other states. This work represents a strong foundation upon which a comprehensive HRH program can be built. It is essential, however, that these efforts be decentralized to the states according to a well-defined plan. There is also a need to harmonize the work being done with the HRIS with the current mapping of health delivery sites being sponsored by the Multi-Donor Trust Fund (MDTF).
Among the major gaps to be filled for sustained HRH is the serious lack of personnel and HRH champions. An HRH task force can be built around the attendees at the August 2006 forum, augmented by internal experts. IntraHealth can continue to facilitate this effort including enhancing the current collaboration with USAID, and we stand ready to participate in advocacy efforts among the international health community to attract desperately needed human resources to Southern Sudan as a way of contributing to highly needed health services while building and strengthening the health system.
—Pape Gaye, President and CEO of IntraHealth, International