By Agar Mayor Gai-Makoon

South Sudan is ranked among the fragile states in the world. According to American research firm Fund for Peace and the Foreign Policy magazine (in its annual 2024 report), placed South Sudan third among the most fragile states, with a social fragility index score of 109. Though many categories were assessed for the significance of this report, key metric that registered South Sudan in this list, in my view, could be poor public service delivery and the huge number of refugees and internally displaced persons.

And in that case, I am overly confident that poor health services in the country will always take center stage for anyone determining the state of affairs. South Sudanese have suffered enough from conflicts. This is the worst situation that could ever happen to a country. But we have numerous books of history to read from. Many nations across Africa including Nigeria and Uganda started in this similar pattern in their early post-independence era. Tribal or regional armed conflicts almost killed their hopes in freedom and independence. Nevertheless, as time went, the people began to realize the importance of diversity and the need to stop the reappearance of colonial ills that they fought against. Today, Nigeria is Africa’s top economy, while Uganda is Africa’s center for peace and stability.

South Sudan can move out of conflict, unregister from the fragile states list. The intriguing question is, how do we do it? Personally, I believe that we can drive South Sudan to the direction we want through a multi-sectional or institutional approach. In other words, each and every institution must do well in order to have the required ratings. For instance, if the health sector is strengthened, the poor growth indicators for this sector will be low or absent which is a positive sign. Perhaps, I appeal to every South Sudanese institution to revise their self and establish policies that support growth and stability.

Encouragingly, the health sector appears to be moving in the right direction. The recent adoption of National Nutrition Policy is a great signal that the sector is determined to deal with conflict inflicted health issues like malnutrition among children and the elderly. However, more policies and concerted efforts to curb pressing health issues are required. Perhaps, South Sudan health sector has to establish both health recovery processes, and build a resilient, strong health system through the following.

1. Ensure access to essential healthcare services

Accessibility to healthcare services is a major problem especially, in areas that have no roads, or those that are hotspots for conflict. The ministry of health should solve this issue by establishing well-equipped trauma centers and train local healthcare providers in emergency response. Expanding the already existing immunization programs, child and maternal programs is also very vital. Additionally, collaboration with state governments to establish roads that link to most vulnerable areas and ensure access to safe water and sanitation. Mobile medical units should also be considered in remote areas because it’s less expensive and more efficient. Basically, the county hospitals must be well equipped and prepared to always deliver the most needed rescue to the people because it is this neglected part of the country that faces the heaviest health burden.

• Strengthen local health systems

The hallmark of a strong local health system is its workforce. South Sudan must thus, build the capacity of local health workforce. It’s very unfortunate that oftentimes, most of our remote communities suffer a great deal because of lack of trained health personnel. The clear example is the incident that occurred in Adior payam of Yirol East County a year ago, where a teenager was injected at a pharmacy with wrong drug and later died few hours after injection. Till this day, no further reports about this particular case have been heard and it seems as if nothing has happened. This incident not only manifests the enormity of medical malpractices being committed by untrained medical personnel, but also, it generally suggests the vulnerability of South Sudan healthcare system. On the other hand, community participation in the design and implementation of health programs, cultivating a culture of health service quality and employing an open and idealistic health leadership should duly be encouraged.

• Safety and security

In light of ongoing conflict in some parts of South Sudan, murder of healthcare workers and destruction of health facilities have become rampant. The government must, ensure protection of health workers and facilities through advocacy and sensitization of local communities about rights of health care workers, establishing laws that punish those who breach health workers’ rights to life and peaceful work space, and instigators of war that targets healthcare facilities.

• Involvement in peace efforts

The health sector should identify and acknowledge their role in restoring peace. And the fact that the people who had led or leading this sector have political umbrella parties to the conflict can greatly help. Use such opportunity to influence decisions in the direction far away from armed conflict, for the greatest medical catchword,” To help, or at least do no harm”, must take the spotlight in South Sudan political, economic and social dimensions.

The writer has a background in sociopolitical philosophy. He currently studies medicine at Ain Shams university, Cairo, Egypt. He can be reached on +201129107334, or thieng.thiengwada@gmail.com.