As the parties celebrating independence across South Sudan die down, and the euphoria begins to wear off, the reality of governing the world's newest country begins to set in.
The 2005 Comprehensive Peace Agreement (CPA) ended 50 years of intermittent civil war and allocated political power in southern Sudan to the Government of Southern Sudan (GOSS). That government, which has been operating semi-autonomously since 2005, transitioned over on July 9 to act as the government of the Republic of South Sudan and is now running without training wheels.
These past six years have served as a foundation for the new government as it absorbed most aspects of public service delivery, including healthcare. After decades of civil war, the newly independent government, along with local and international organizations, is continuing the process of rebuilding the health system.
In 2006, Sudan performed a nationwide health survey. The results were stunning. The lack of functioning infrastructure decimated healthcare during the civil war, and the health indicators showed exactly how devastating that neglect has been.
In South Sudan the maternal mortality ratio was 2,054 deaths for every 100,000 live births - one of the highest in the world. One out of seven children didn't see their fifth birthday. Forty-two percent of children never received a single recommended vaccination, and only 17 percent were fully vaccinated. Fifty-two percent of people had no access to clean water. Ninety percent of women gave birth without a skilled attendant.
As devastating as those numbers are, the shock becomes even more acute when compared graphically with results for all of Sudan. When looking at the disparity in indicators between the whole country and the south, it appears the region simply dropped off a cliff. In essence, five decades of war blocked the area from any sustainable development. The war left the region with no functioning transportation system, millions of internally and externally displaced, and a dearth of qualified health providers.
After 2005, southern Sudan was flooded with international organizations and donors who came to support the newly formed GOSS. Massive health, education, economic and protection programs sprung up throughout the region. Slowly but surely, roads began being built, schools filled, shops opened, and health facilities spread to previously inaccessible areas.
Since 2009, the Sudan Health Transformation Project, Phase II (SHTP II), led by Management Sciences for Health and funded by the United States Agency for International Development (USAID), has worked diligently to improve the primary healthcare system in South Sudan. Working through a two-pronged approach, SHTP II aims to improve both the accessibility of and demand for services, while simultaneously building the capacity of both services and staff.
One of the most important parts of SHTP II is developing local leadership through the Leadership Development Program (LDP). In late 2010, the Terekeka County Health Department hired Dr. Joseph Tshomba Marcello as county medical director. Initially excited at the prospect of working to improve healthcare in the area, Marcello became disheartened when he discovered that many health workers in the county simply did not show up for work. Discouraged and unable to end the absenteeism, he nearly resigned his post.
But before he resigned he attended his first LDP session. There, he learned to see workplace problems not as obstacles, but as challenges with solutions. Reinvigorated, he returned to his post and engaged the health facilities in his county with the tools he learned during the LDP session.
Marcello started visiting staff in their homes to talk with them about absenteeism. Staff started to sign daily attendance registers without complaints.
Two months later, all staff were showing up to work regularly. "Without LDP I would not have achieved this success," he says.
Thanks to efforts such as this, on the dawn of independence South Sudan is not starting from scratch.
During the years operating as GOSS, the Ministry of Health set out a national Basic Package of Health Services, which outlines the first steps in moving the country from relief to development.
In addition to its own outline, South Sudan can look to other countries' health interventions to learn lessons from best practices. In other post-conflict countries such as Liberia, Afghanistan and Sierra Leone, marked improvement has been made in the past decade by implementing community-based care and emphasizing local leadership in primary healthcare.
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For those of us in South Sudan our hope is that within the next decade, by emphasizing community, facility, and government ownership and leadership, we will be able to improve on those devastating 2006 health indicator statistics so dramatically that the world will look to South Sudan for inspiration and leadership in the decades to come.
The task ahead will not be easy, nor will be be completed quickly, but South Sudan - invigorated with new national pride and direction - is facing it head and hopes held high.
John Rumunu is the chief of party for Management Sciences for Health SHTP II. Management Sciences for Health (MSH) is a nonprofit international health organization composed of more than 2,000 people from 73 nations. It aims to save lives and improve the health of the world's poorest and most vulnerable people by closing the gap between knowledge and action in public health.
This article does not necessarily reflect the position of USAID and represents the sole opinions of John Rumunu and MSH.
