South Sudan healthcare system

Photo: health worker with mother and child

Years of conflict and underinvestment have resulted in a minimally functional public health system in South Sudan. The Government's commitments to the population’s health are clearly expressed in the Transitional Constitution, the Vision 2040, the National Health Policy 2016-2026 (HSP), the Basic Package of Health and Nutrition Services (BPHNS), and the Health Sector Strategic Plan (HSSP) 2017-2022. However, the technical and operational capacity of the health sector is currently unable to meet these commitments. The Government relies on the support of a wide range of regional and international partners to fund health services, including the HIV, TB and malaria programmes. 

Public health services are delivered through a three-tiered, decentralised system from the central to the State, County, Payam and Boma levels. The Basic Package of Health and Nutrition Services (BPHNS) defines the services to be offered at each level: 

  • Community-based Boma Health Teams (BHTs) that are part of the Borna Health Initiative  (BHI),  
  • Primary health care units (PHCUs) and primary health care centres (PHCC),  
  • County and State hospitals, 
  • Tertiary hospitals.  

The BHI is a unique feature of the design of the health system.44 BHTs, comprising three home health promoters (HHPs) are expected to serve approximately 5,000-6,000 people in communities and offer basic services such as health promotion, treatment of selected conditions and community surveillance. The BHI is beginning to be rolled-out across the country, largely where partners are operating.  

While malaria services are offered at the Boma level, HIV and TB services have yet to be included (although they are provided for in the BPHNS). An assessment in 2017 found significant challenges for the country to offer a minimal level of health services, with acute shortages of health workers and most health facilities unable to operate due to a lack of the necessary infrastructure or equipment. Another factor is accessibility: a previous assessment had found that only 44% of the country's largely rural population (83%) lived within a five-kilometre radius of a functioning facility. In 2017, the HSSP estimated that almost US$2 billion would be required to make the public health system functional. 

Within this context, however, the 2017 assessment found that malaria services were generally available, with 95% of all facilities surveyed able to provide malaria diagnosis in some form. Sixty percent of facilities surveyed had trained staff with some knowledge of treatment guidelines. However, 25% had at least one trained staff member in intermittent preventative treatment ( IPT). Medicines and commodities were available in less than half of the facilities. Of the medicines and commodities tracer items, facilities most often had in-stock first-line antimalarial medicines (53%), paracetamol cap/tabs (48%), and IPT drugs (37%). Only 6% of facilities had all malaria service tracer items. However, on average, facilities had 49% of malaria service tracer items.