HEALTH STRATEGIC PLAN (2011 – 2015)
GOVERNMENT OF SOUTHERN SUDAN
MINISTRY OF HEALTH
thSeptember 2010 (15 September 2010)
Table of Contents
1.1 Context and rationale for development of the Health Strategic Plan
1.2 Process for development of the Health Strategic Plan 1.3 Content of the Health Strategic Plan document
1.2 Political, demographic and socio-economic status 1.3 Health sector organization, function and management 1.4 Health service delivery system
3. Situational Analysis of the health sector
3.1 Burden of Disease
3.2 Health status of the population in Southern Sudan 3.3 Health Service Coverage
3.4 Integrated Support Systems
3.5 SWOT Analysis
4. Vision, Mission, Values, Goals, Objectives, Guiding Principles and Main
Desired results by 2015
5. Framework for the Health Strategic Plan (2011-2015) 5.1 Introduction
5.2 Conceptual Framework for the Health Strategic Plan 5.3 Service Delivery
5.3.1 Maternal, Neonatal, Child and Reproductive Health
5.3.2 Health Promotion and Disease prevention
5.3.3 Prevention and Control of Communicable and Non Communicable
Diseases and Essential Hospital Services 5.4 Programme Areas
5.4.1 Leadership and Governance
5.4.2 Human Resources for Health
5.4.3 Health Infrastructure Development and Maintenance
5.4.4 Pharmaceuticals and Medical Supplies
5.4.5 Health Sector Financing
5.4.6 Monitoring and Evaluation Systems
6. Implementation Arrangements for the Health Strategic Plan 6.1 Decentralization including organization and management of the health system
6.2 Roles of different stakeholders
6.3 Annual operational plans
6.4 Contracting out health service delivery 6.5 Aid Architecture
7. Monitoring and Evaluation of the Health Strategic Plan
7.1 Mechanisms for Monitoring and Evaluation 7.2 Joint sector review
7.4 Communication on progress
8. Costing and Financing of Health Strategic Plan 6.1 Costing of the Health Strategic Plan 6.2 Financing of the Health Strategic Plan
Chapter 1 Introduction
1.1 Context and rationale for formulation of Health Strategic Plan
The Ministry of Health Government of Southern Sudan prepared a Health Policy (2007-2011). The Health Policy was prepared through extensive consultations with key stakeholders in the health sector of Southern Sudan. The Vision of the Health Policy is a “Healthy and productive population, fully exercising its human potentials”. The Health
Policy spells out the priority areas in health that require to be strengthened in order to achieve its vision. In order to operationalize the Health Policy and contribute to the attainment of its vision and mission, health sector stakeholders must prepare a strategic plan. The Health Strategic Plan will provide an overall framework that will guide ALL strategies or interventions that will be implemented by ALL stakeholders at ALL levels of the health system in Southern Sudan over the next five years (2011 – 2015). The scope of the strategic
plan is therefore national.
This is the first five year Health Strategic Plan for Southern Sudan. The plan comes at an opportune time when Southern Sudan is emerging as a new and independent country. It therefore provides the foundation for the comprehensive and coordinated development of the health sector in the newly created Southern Sudan.
1.2 Process for development of the Health Strategic Plan
The Health Strategic Plan (HSP) was developed through a consultative and participatory process that involved all the key stakeholders in the health sector of Southern Sudan. A conceptual framework for the HSP was prepared, discussed and agreed with health sector stakeholders. The Ministry of Health-GoSS in consultation with key stakeholders formed Technical Working Groups (TWGs) in which health sector stakeholders participated in the preparation of the HSP. A Steering Committee for providing technical oversight and guidance and a Secretariat for providing overall coordination of the HSP preparation process were constituted. The TWGs
that were formed for the preparation of the HSP included: Service Delivery; Human Resources for Health; Health Infrastructure Development and Maintenance; Pharmaceuticals and Medical Supplies; Supervision, Monitoring and Evaluation; and Finance, Leadership and Governance. Terms of reference for guiding the TWGs were provided.
The TWGs conducted a review of available documents, some conducted specific assessments to obtain more update information and then prepared draft plans for the respective thematic areas. The different thematic draft plans were extensively discussed within the respective TWGs and were later integrated into the first draft Health Strategic Plan. The consolidated draft HSP then underwent a series of reviews and comment by health sector stakeholders to produce revised draft plan.
The revised draft HSP was presented and further discussed during a joint retreat of all the TWGs, representatives of health related sectors of Government, SMoHs including CHDs, Development Partners and UN Agencies, NGOs/CSOs and the private health sector. The inputs from the joint retreat were incorporated to produce an updated draft HSP which was again circulated to stakeholders for further review and comment. The final draft HSP was
presented and discussed in the Executive Board of MoH-GoSS. The final document was presented to the Council of Ministers for approval.
Chapter 2 Background
Sudan has witnessed perhaps the longest civil war in modern Africa which broke out immediately after independence in 1956. The Comprehensive Peace Agreement (CPA) which was signed between Government of Sudan and the Sudan People’s Liberation th January 2005, brought nearly 50 years of civil strife in Southern Movement (SPLM) on 9
Sudan to a halt. The civil war practically destroyed the whole infrastructure and social fabric of Southern Sudan along with deaths and displacement of over four million people.
The public health system along with every other sector virtually collapsed leaving Non Governmental Organizations/Faith Based Organizations (NGOs/FBOs) responsible for providing the majority of health services to the population. Due to limited capacity of NGOs to cover the vast expanse of the country and insecurity, only a limited proportion of population (estimated at less than 25%) could be reached. Since the signing of the CPA and the establishment of Ministry of Health (MoH), the Government of Southern Sudan with the support of Development Partners (DPs) is slowly rebuilding the health system.
The Government of Southern Sudan developed a Health Policy, which emphasizes Primary Health Care as the cornerstone of the health system development and provision of equitable and quality health services, free of charge, for all. The policy took into consideration findings from the Joint Assessment Mission (JAM 2003) and the JAM “Framework for Sustained Peace, Development and Poverty Eradication”. The Government of Southern Sudan is
emphasizing system wide and comprehensive development of all sectors in order to accelerate progress towards socio-economic development and poverty reduction in the country.
For development to be sustainable, health and economic growth must be mutually reinforcing. Health is an essential prerequisite as well as an outcome of sound development policies. Without good health, individuals, families, communities and nations cannot hope to achieve their social and economic goals. The health sector will therefore play a key role in poverty reduction and overall socio-economic development in Southern Sudan.
2.2 Political, demographic and socio-economic status
The Interim National Constitution of Sudan and the Interim Constitution of Southern Sudan, 2005 allows for a decentralized state with four levels of government mainly: National, Government of Southern Sudan, State and Local Government. The Interim Constitution of the Southern Sudan covers 10 states in Southern Sudan and about 90 Countries.
Figure 2.1: Map of Southern Sudan
The population of Southern Sudan was estimated to be 9,480,000 (2009) and is expected to increase to 12 million by 2010 owing to high rate of natural population growth of 3% per annum, high total fertility rate of 6.7 children per woman and the return of refugees from neighbouring countries and internally displaced populations in Northern Sudan. The majority of the population lives in rural settlements with the major economic activity being subsistence farming and cattle herding. Sedentary practices are however increasingly emerging with resettlement after the protracted war. Southern Sudan thus has wide variations in cultural beliefs and traditional practices but also a rapid transition through affluence.
Southern Sudan is one of the poorest countries in the world. It is estimated that more than 90% of the population lives on less than 1 US$ per day and the poverty rate is estimated to be between 40% and 50%. However, the prospects of oil revenue promise future economic improvements.
2.3 Health Sector Organization. Functions and Management
2.3.1 Introduction on the National Health System
The National Health System comprises all the resources, institutions, structures and actors whose actions have the primary purpose of achieving and sustaining good health. It is made up of the public and private sectors. The public sector includes all Government health institutions under the Ministries of Health (MoH-GoSS and SMoHs) and other ministries (especially Defence and Internal Affairs). The private health delivery system consists of Non Governmental Organizations (NGOs) (private not for profit), private health practitioners (PHP), the traditional healers and the communities.
The functions of a health system are: stewardship (leadership, governance or oversight); health financing (collecting, pooling and purchasing); generation and management of health resources (human and physical resources); and provision of health services. These functions are carried out by different aspects of the health system including government (public) and private; central and local government; and national, bilateral and multi-lateral partners.
2.3.2 Health sector organization and management in Southern Sudan
The Ministry of Health-GoSS provides leadership for the health sector. It takes a leading role and responsibility in the delivery of health services to the people of Southern Sudan. The management and provision of health services in Southern Sudan has been decentralized with the State Ministries of Health (SMoHs) and County Health Departments (CHDs) playing a key role in the delivery and management of health services. The Interim Constitution of Southern Sudan, 2005 defines the three levels of government and The Health Policy (2007-2011) details the roles of Ministries of Health at different levels of government and health system.
a) Ministry of Health – Government of Southern Sudan
The roles of the Ministry of Health-Government of Southern Sudan (MoH-GoSS), as outlined by the Health Policy (2007-2011) are: Stewardship and Governance; Policy formulation, setting standards, and quality assurance; Setting level priorities, standards and guidelines; Development of a strategic, regulated, accountable and transparent organization, and deliverable programmes; Selective decentralization and effective delegation; Human resources capacity building and leadership development; Research and Planning; Monitoring and Evaluation; Health Management Information System; Regulation and legislation; Strong partnership; Sector wide and inter-ministerial coordination; Health financing and management of financial resources; and Contracting out services when viewed necessary.
In addition to the above roles and responsibilities, the MoH-GoSS also manages the (3) Tertiary (Teaching) Hospitals.
b) State Ministries of Health
Within each of the 10 states, the State Ministry of Health provides leadership for health service delivery and management. There are County Health Departments for each County, Payam Health Departments for each Payam and Boma Health Committees. The Health Policy provides the roles of SMoHs, CHDs, Payam Health Departments and Boma Health Committee in the management and delivery of health services.
The roles of the State Ministries of Health (SMoH) are: Stewardship and Governance; Implementation of the Health Policy; Planning and Management of State health services; Joint assessments, research and planning; Monitoring and Evaluation; Health Management Information System; Sectoral and inter-sectoral coordination; Annual management work-plans; Implementation of government health care and services; Supervision and guidance including contracted out services; Referral system; Epidemiological surveillance; and Efficient and cost effective use of resources.
The roles of County Health Departments (CHDs) are: Health coordination; Assessment and analysis of local health and managerial needs; Joint strategic planning based on local needs and problems; Contribution towards management of information systems; Implementation of health care and services; Monitoring and Evaluation; Referral system and epidemiological surveillance; and Efficient and cost effective use of resources.
The roles of Payam Health Departments (PYDs) are: Implementation of Primary Health Care packages; Referral system and surveillance; Monitoring and Evaluation; Monthly work-plans by PHC centres and units; Outreach health programmes; Health education and promotion; Health campaigns and awareness programmes; and Efficient and cost effective use of resources.
The roles of Boma Health Committees (BHCc) are: Implementation of community health activities; Community participation and involvement; Community ownership and development of local leadership; Referral system and surveillance; Monitoring and Evaluation; Monthly work-plans by health committees; Outreach health programmes; Health education and promotion, Health campaigns and awareness programmes; and Efficient and cost effective use of resources.
c) Health service delivery in Southern Sudan
The health services are delivered through a three-tier system composed of hospitals, Primary Health Care Centres (PHCCs) and Primary Health Care Units (PHCUs). At the peripheral level, there is a Village Committee and other community-based networks. Health service delivery is carried out by both the public and private sectors particularly the Non Governmental Organizations (NGOs).
There are three levels of hospitals: Tertiary (Teaching), State and County Hospitals. Tertiary Hospitals: There are 3 Tertiary Hospitals (Juba, Malakal and Wau) also called Teaching Hospitals. Tertiary Hospitals are managed by MoH-GoSS and serve as referral hospitals for a group of states (or regions). Tertiary Hospitals provide specialist clinical services such as higher level surgical and medical services and clinical support services (laboratory, medical imaging and pathology). They are also involved in teaching and research. This is in addition to services provided by general hospitals.
State and County Hospitals: There are 7 State Hospitals and 30 County Hospitals. These are run and managed by the respective states. State and County hospitals are general hospitals and provide preventive, promotive, curative, in-patient health services and surgery. County Hospitals are expected to cover a catchment population of 300,000 people.
Primary Health Care Centres and Units
There are 270 PHCCs and 800 PHCUs in the 10 states of Southern Sudan. The PHCCs and PHCUs are run and managed by the respective CHDs in different states. They provide basic preventive, promotive and curative care. The service standards or norms that should be delivered at the PHCCs and PHCUs are defined in the Basic Package of Health Services. The PHCCs are the first referral centres for the payam. They also have provisions for laboratory services for diagnosis; maternity care and are expected to have a catchment
population of 50,000 people. PHCUs provide the first level of interaction between the formal health system and the communities. PHCUs provide outpatient care and community outreach services and are expected to have a catchment population of 15,000 people.
Village Level Health Care
At the village level, a team of Home Health Promoters (HHP) and Mother and Child Health Workers (MCHW) provide health care under the supervision of Community Midwives and Community Health Extension Workers (CHEWs). The HHPs are selected by the community and trained as community health workers. There is no physical structure but a team of people (trained community health workers) which works as a link between health facilities and the community. Village Level Health Care facilitates health education and promotion, service delivery, community participation and empowerment in access to and utilization of health services. There are also community-based networks which have been established in some regions to deliver disease specific programmes such as onchocerciasis and Guinea worm eradication.
Private sector in health care delivery
The private sector, particularly the private not-for-profit which mainly comprises of the NGOs are major providers of health services in Southern Sudan. After the collapse of the public health care system during the many years of conflict, NGOs played a major role in the health sector by providing a range of services in accessible areas. In the post-war Southern Sudan, NGOs continue to provide the bulk of health services. It is estimated that NGOs are providing about 80% of health services in Southern Sudan. The NGOs involved in health service delivery include international NGOs, faith-based organizations and local NGOs.
Due to weak capacity of the SMoHs and CHDs to manage and deliver health services and the fact that there are very few functional government health facilities, the MoH-GoSS and partners agreed to contract out the management and delivery of health services to NGOs. Some Lead Agencies were contracted to manage and deliver health services in a number of states. The Lead Agencies are expected to provide advice, capacity building and management support to SMoH and CHDs. The function of the Lead Agencies is to support the SMoH and CHD in the following aspects: Subcontracting and paying NGOs/agencies to provide health services or to support health facilities in providing services to the population focused on high impact interventions; Undertake performance measurement of subcontracted NGOs/agencies; Transportation of supplies and medication kits to states and counties; Procurement of communication equipment and transportation means; Monitoring of stocks of medication; Support to data collection and reporting; Training and capacity building of SMoH and CHD staff in management, procurement, finances, data collection and analysis, performance, human resources for health.
The private for profit sub-sector (private health practitioners) is still small, but fast developing. There is wide spread use of traditional medicine in all the communities of Southern Sudan.