A Health Project in South Sudan is Helping Provide Critical Services for Women and Children in the Midst of Conflict

SOUTH SUDAN, March 6, 2014—Recent fighting in South Sudan is afflicting millions of people, many of them still recovering from the country’s five-decade civil war. The conflict is impacting the northern states of Jonglei and Upper Nile, where tribal clashes had left only a tenuous peace.

Even before the latest outbreak of violence, South Sudan had some of the lowest health indicators in the world: one in 10 children under five years of age did not survive; maternal deaths were among the highest in the world at 2050 per 100,000 births; and only 45% of the population lived within 5 km of a health clinic.

Despite these formidable challenges, the World Bank-supported Rapid Results Health Project (RRHP), which targets Jonglei and Upper Nile, is seeing strong results. The project, which began in August 2012 with a US$28 million grant from the Transitional Trust Fund for South Sudan, focuses on maternal and child care as well as treatment for preventable diseases like malaria, respiratory tract infections and diarrheal diseases.

Nearly 375,000 people have received critical health services – making a major impact in a region where lack of proper health care can mean the difference between life and death.

In the last nine months over 90,000 children have been vaccinated and 9,500 deliveries have taken place in the 283 centers supported by the project.

The ongoing conflict between government and opposing forces has made delivery of health care services a major challenge.

“The conflict in key areas, resulting in the death of thousands and displacement of hundreds of thousands, placed significant strain on health resources and made operations nearly impossible,” says Dr. Mounir Lado, head of Interchurch Medical Association (IMA), a non-profit organization contracted by the Ministry of Health to coordinate and deliver services.

IMA continues to operate despite the looting and vandalizing of its offices in Malakal, the scene of recent confrontations between government and rebel forces.

In an effort to continue supporting essential health services in South Sudan at this critical time, the World Bank is providing an additional $35 million in March 2014.

“We have learned how to adapt to challenges and deliver results even in situations of extreme isolation or conflict, using innovative methods,” says Anne Bakilana, Senior Economist and the RRHP’s Task Team Leader. “The World Bank responded positively to the government’s request to continue to support delivery of primary health care services in very challenging environments.”

Serving mothers and children displaced by the conflict

The Kodok Primary Health Care Center is a two-hour motor boat ride down the Nile from Malakal. During South Sudan’s six-month rainy season, the center is cut off from the capital Juba. Even during times of peace, it takes five days for life-saving drugs to arrive by boat from Juba. It’s even tougher to find trained medical staff willing to live and work there.

The Center normally caters to a population of about 7,000 people, according to staff. The conflict has increased those numbers. During a recent visit to the clinic by members of the World Bank project team and representatives from the Ministry of Health, a group of 1,300 men, women and children, displaced from their homes in South Kordofan, was waiting to receive treatment.

“We walked for days to reach Kodok because we were hungry and we had nothing left,” whispered Shama Syed, a refugee cradling her sick baby.

During the journey, Shama lost her first born son. “So many people died on that journey,” she said. “But now we are here and we are going to make a new life in this town.”

With food supplements provided by the United Nations High Commissioner for Refugees (UNHCR) and treatment for eye and ear infections at the clinic, Shama’s younger son already was returning to good health.

“Before the latest crisis, Kodok clinic was already overflowing with patients,” according to the World Bank’s Bakilana. “Today because it is in the more peaceful north-western part of Upper Nile, it is receiving a steady influx of internally displaced people.”

Conservative estimates show that the population here has more than doubled. Some estimates show a population increase of four times what is was.

In September 2013, young mothers, like Angelina Khaldun were concerned that their children should have all their immunizations in order to grow up and become doctors and scientists in the new South Sudan. Today, health workers at the clinic are focusing on cholera vaccinations to save children’s lives.

Angelina Aman, one of 3000 health workers trained by the Project, is attending to a woman in the early stages of labor, while another woman recovers from a miscarriage and a third begins contractions.

The current crisis has shown that investments made over the past few years in strengthening the role of County Health Departments (CHDs) are slowly bearing fruit. Even as South Sudan’s crisis continues, CHDs strengthened by years of support from the World Bank and other donors largely continue to function. They collect medical supplies from the state ministries, distribute them to health facilities under their supervision and ensure that information flows to the Central Ministry in Juba.

And, despite the conflict, work continues to ensure quality health care in the near and long-term.

“There is a major reconstruction job ahead of us,” says the IMA’s Dr. Lado, “and we hope that a political solution will come soon so that lives can be saved.”