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The Grim Reality of Health Care in Southern Sudan

By Sara A. Fajardo

Catholic Relief Services health program manager Katie Morris shares facts and statistics that underlie one of several key problems southern Sudanese face in building their soon-to-be independent nation.

The Numbers

Nurse Jonas James tends to a patient with malaria.

Nurse Jonas James tends to a malaria patient on a crumbling rectory porch that has become a makeshift clinic. Photo by Karen Kasmauski for CRS

  • Only 719 health facilities serve a population of 8.26 million people.
  • One doctor is available for every 10 facilities.
  • The prevalence of malnutrition in children under 5 is 48 percent.
  • The maternal mortality rate per 100,000 live births is 2,037.
  • Only 5 percent of births are attended by skilled health care practitioners.
  • Malaria is the leading cause of death, and yet only 36 percent of children under 5 are treated with anti-malaria medication.
  • Only about 6.4 percent of the population has access to improved sanitation, which is basically no more than a pit latrine, while the rest of the population relies on open defecation or open trenches.
  • The Government of South Sudan's Ministry of Health reported in 2005 that, for a population of 8.26 million, there were 225 doctors working in southern Sudan. A total of 86 were actually Sudanese, while the remaining 139 were foreign doctors. Many of these doctors are not available to work in health facilities, hence the 1-in-10 figure I mentioned earlier.

Training

  • Juba University is launching a new medical school and has accepted its first students.
  • Primary health care staff are trained. But volunteers brought on during the war maybe received 1 week or 1 month of training and have yet to update their skills.
  • Rampant levels of illiteracy are also a huge impediment because illiteracy really shrinks the pool of people qualified to pursue a career in medicine.

Improvements

  • International agencies are responsible for supporting more than 60 percent of the health facilities in southern Sudan. The Ministry of Health struggles to overcome physical, financial and human resources limits.
  • Another important advance is that the Ministry of Health has developed guidelines and policies based on real needs.

Logistical Challenges

  • A lack of roads and very limited public transportation. To travel from the capital city of Juba to Torit, a distance of only 86 miles, it can easily take 5 hours by car. Few people have any sort of vehicle. You'll see people carrying their loved ones in handmade stretchers, walking mile upon mile to reach an adequate treatment facility. Some people die in transit because they weren't able to get the care they needed at the first facility they reached.
  • Inadequate equipment and supplies. Health centers don't have tools like blood pressure cuffs or thermometers, making accurate diagnoses difficult to impossible.
  • No access to water or electricity. This hinders inpatient 24-hour care, sanitation, functional laboratories and refrigerated medicines such as vaccines.
  • Pharmaceutical shortages. In the worst case, you have rural facilities with no drugs and drugs expiring in Juba because there are insufficient means of distributing them. And, in the villages, if patients know that certain drugs are not available at the clinics, they simply stop coming. It is hard to foster a health care culture when there is very little reliability.

Women's Health

  • Maternal and infant mortality in southern Sudan is among the highest in the world. Fewer than 20 percent of expectant mothers get any type of prenatal care during their pregnancy.
  • Not enough midwives or skilled birth attendants are available to go around: about 9.4 midwives attend every 10,000 expectant mothers. That's well below the average of other developing nations. And more than 90 percent of these midwives are not properly trained.
  • Women don't go to health care facilities to deliver because those facilities are often one-room mud huts lacking privacy and equipment. It's hard to go into labor and then have to travel several miles on foot. Even if expectant mothers went and they had a complicated delivery that required surgery, it would be very difficult for them to make it to the hospitals that could give them the care they needed.

Sara A. Fajardo is CRS' regional information officer for eastern and southern Africa. She is based in Nairobi.

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