By Dr. Garang M. Dut
![Oxygen plant at Juba Teaching Hospital. [Photo by Sudans Post]](https://i0.wp.com/www.sudanspost.com/wp-content/uploads/2021/09/Oxygen.jpg?quality=89&ssl=1)
Ineffective healthcare is a threat to South Sudan’s national security and sovereignty. The late Hon. Gatkouth died in Egypt after insufficient medical care in South Sudan’s capital, Juba. Similarly, Justice Majok Mading died in a Nairobi hospital in 2019, having been evacuated from Juba. He led legal affairs at the Presidency and had suddenly collapsed at work. In March 2021, the young musician, Trisha Cee, bled to death when hit by water tanker in Juba. South Sudan lacks trauma system and a reliable blood bank for rapid management of injuries. More avoidable deaths occurred during the coronavirus disease (Covid-19) pandemic, when the country subsisted on four ventilators. This trend reflects chronic underinvestment in South Sudan’s health sector: no capabilities for managing medical emergencies such as heart attack, stroke, blood clots in lungs, or major injuries requiring massive transfusion.
South Sudan’s dependence on evacuation to foreign hospitals is false security. It is also unsustainable. As in the foregoing examples, some medical conditions are time-critical and only capabilities within South Sudan would save lives. The advanced care sought in foreign hospitals is only useful as adjunct to life-saving interventions at the first point of care.
Take the instance of stroke or heart attack. In stroke, blood supply to the brain is impaired by either a blocked (ischaemic stroke) or torn (haemorrhagic stroke) blood vessel. In heart attack, the heart fails at nourishing itself, due to blockage in its own blood vessel(s). While the heart’s main purpose is to circulate blood around the body, it must also supply itself. So, this impairment causes a self-perpetuating incapacitation which is time-critical because, when denied oxygen and nutrients afforded by blood supply, the brain begins to die within minutes and the heart lasts only hours. This acuity explains the futility of relying on distant and foreign hospitals, however advanced.
Emergency medical service would avert avoidable deaths in South Sudan. Such service would comprise of an emergency retrieval component incorporating road, riverine and air ambulances. It will also need a call centre which coordinates retrievals and referrals, and a network of suitably-equipped hospitals. In addition to Intensivists on a 24-hour roster, these hospitals should be equipped with resuscitation bays, surgical operating theatres and catheterisation laboratories. This around-the-clock availability is important because medical emergencies don’t come on schedule. These facilities should also have wards which specialise in critical care. These urgent investments should begin now to save lives the soonest possible.
Peace agreements may assuage the current imbroglio in South Sudan, but greater legitimacy for the Government lies in services delivery. Shortly after independence, the Government enjoyed favourable ratings in areas with some health service. And, even when these services weren’t government-funded, communities trusted the Government will improve on such responsibilities in subsequent years.
However, a decade after independence, continued dominance of humanitarian health response dashes hopes among the citizenry. Similarly, measly budget for the health sector betrays the Government’s desire for sector-ownership. A hackneyed explanation is that South Sudan is only a poor country, and its failings ought not be critiqued against rich comparators. But, it’s not in the scale of development such comparison is sought; instead, it’s in the duties owed by governments. The Government of South Sudan should meet its responsibilities in equal measure to its claims on sovereignty. It is commendable that, in principle, it commits to Basic Package of Health Services (BPHS) for all citizens. It is also opportune that international bodies, such as the LSE-Oxford Commission on State Fragility, Growth, and Development, support the use of development finance in ‘de-risking’ fledgling private sector. This would be helpful for sustainability of essential capabilities, such as procurement of pharmaceuticals among other consumables. Notwithstanding efforts from elsewhere, the onus for effective healthcare is on South Sudan’s government.
In the same logic, South Sudan’s policymakers should desist from decisions which undermine sustainability in the health sector. This is evident in three examples. First, the recurrent violence from political impasse disrupts an already fragile health system, where various actors work semi-autonomously across disease-specific programmes. The destruction to facilities and health personnel diminishes capacity in the health system. These disruptions also promote unsustainability as laissez-faire organization of the health system compounds the short-term nature of operations which perform to donor preferences.
Second, the retaliatory decision to halt oil production in 2012 hindered sector-specific investments. It distanced external support for the health system, as development partners begun to doubt the Government’s sensitivity to fiduciary and governance risks. This also thwarted the Government’s desire for greater sector-ownership.
Third, monetary and fiscal policies appear insensitive to services sector needs. For instance, the Executive Order No. 36/2015, which established multiple ethnocentric states presented challenges beyond healthcare. But above all, segmentation into smaller jurisdictions undermines sustainability in volume-dependent sectors. Health service requires expensive equipment and skilled workforce. So, resources need to be pooled across large populations. Similarly, currency devaluations have been instituted without contingencies for essential imports, including pharmaceuticals. These make for a futile health sector strategy which fails at realising aspirations of National Health Policy 2016-2026.
Notwithstanding South Sudan’s shortcomings, an international imperative remains in the interest of global health security. South Sudan is a global security frontier. While food insecurity underlies malnourishment which afflicts its children, its wetlands support hydrological stability of the Nile Basin and therefore regional stability. Its location means fragility and epidemics in its borders are contagious for the Eastern, Northern, and Central Africa. Yet, despite natural endowments, it’s yet to see functional health system. Indeed, when Ebola harassed its borders in 2019, South Sudan needed effective response in Uganda and the Democratic Republic of Congo (DRC) to protect its weak health system. This weak health system, its porous borders which are traversed by nomadic communities, and disaster unpreparedness, are weakling in global health security. Therefore, investments in South Sudan’s health system are both for its own sake as well as global health security. If nothing else, global health security is a basis for a concerted international support in health systems strengthening.
While emergency medical service isn’t cheap, South Sudan could invest wisely. The Lancet Commission on Global Surgery estimates the average cost of a surgical theatre in a low-income country at US$ 320,000. This means, permitting for overheads, foregoing the purchase of five US M1A1 Abrams tanks could, for instance, afford the country at least 50-bed capacity of lifesaving medical capabilities. Such investments would offer exponential benefits as lives are saved among individuals afflicted with disruptions to blood supply and complications in childbirth. More than other intergenerational debts, this would be justified.
The economics of healthcare necessitate government interventions to tame distortions or ‘market failures’. Public-spirited leadership is therefore indispensable: a private insurance scheme and a free market approach would neither be effective nor equitable where poverty is rampant. But unlike advanced economies which suffer greater costs as they replace old and expensive technology, South Sudan could leapfrog in health systems capabilities. In this respect, South Sudan must seek visionary leadership which is cognizant of technological frontiers.
As well, the health profession should help uphold the right to life in South Sudan. While religious leaders have sought to midwife peace in the country, it is the province of health profession to promote physical and mental health of the citizenry. Médecins Sans Frontières (MSF), which is a key stakeholder in South Sudan’s health-sector, adopts neutrality on rights-based principles such as the ‘responsibility to protect’ (R2P). While the scope for advocacy is controversial among humanitarian agencies, South Sudanese health practitioners are naturally ‘physician-citizens’ within their country. They carry a dual responsibility as members of intelligentsia which aspires to better polity, and as professionals sworn to higher ideals. By championing health as a human right, making it centrepiece among criteria for which a government is qualified, the health profession could guide South Sudan towards servant-leadership. This requires it to lead on discourses spanning the whole gamut of human condition, including clinical care, town planning, environmental health and suchlike. This professional guidance would help ensure health in all policies and also promote strategic approaches to health system strengthening.
As South Sudan seeks a path out of fragility, its government should rethink its strategy on legitimacy. Violent confrontations have proven futile, yet effective healthcare promises human security, political stability and economic development. Therefore, the Special Fund for Reconstruction (SRF) which is stipulated in chapter III of the revitalised agreement on the resolution of the conflict in South Sudan (R-ARCSS), should consider investments in emergency medical service as key priority. South Sudan’s health profession should lead in domestic processes which carry health implications. In any case, it remains the Government’s responsibility to ensure health system effectiveness, and this embodies the ideals of justice, liberty, and prosperity to which South Sudan aspires.
Dr Garang M. Dut is Fellow in Health Systems at the Australian National University. He was educated at Monash University, Melbourne University, Harvard University and Oxford University, and has experience in healthcare, government and academia.
The views expressed in the ‘OPINIONS & ANALYSIS’ section of Sudans Post are solely the opinions of the writers. The veracity of any claims made are the responsibility of the author not this website. If you want to submit an opinion piece or an analysis please email us here.
“Opinion | The healthcare we can trust”
By Dr. Garang M. Dut,
‘Yaa Sudans Post propagandist pieces of creeps, be careful fellows. Trolling the websites or internet for South Sudanese sounding names and write your craps about South Sudan is not a good idea of low lives,
Sudans Post, you can post damn posts your piece of propaganda rubbish about South Sudan and the South Sudanese all you want, but you are wasting your damn times and South Sudanese people’s times. There is no way under the sun, we will ever again welcome anything that is connected to:
The devil worshipers, bloodsucking vampires, secret coteries, vermin/parasites/viruses/pests in our cloned so-called Arabs North Sudan, Abeshas (so-called ethiopian) prostitutes, Bantuses, white Americans, English people, their evil juus (so-called israelis) attack dogs, your gulf Arab states terrorist & financiers, gays, lesbians or LGBTQs, Italians, Irish, Indians, Pakistanis, Nepalese, Bangladeshis, Sri Lankans on the disguised or covert bullshits of Cabal AGENDA 21, now shifted to AGENDA 30, AGENDA 50, GOVERNMENT WITHOUT BORDERS, GOVERNMENT RUN BY THE UN, NGOs, HUMANITARIAN AID WORKERS, MERCENARIES (dressed up with UN attires) ALLEGEDLY TO PROMOTE DEMOCRACY, TO PROMOTE SO-CALLED RULE OF LAWS OR RULE BASED LAWS (what are they?), TO PROTECT SOUTH SUDAN CIVILIANS (from who?), TO PROTECT SOUTH SUDANESE HUMAN RIGHTS, WOMEN RIGHTS, GIRLS’ RIGHTS (from who?), GOVERNMENT RUN BY DONATIONS FROM FACELESS DONORS——–of multinationals, big corporations, big banking cartels, their subsidiaries and their massive mass media propaganda Machines (Sudans post included); who have stashed away their loots in tax havens or in shady countries of Kenya, Abesh (so-called ethiopia) prostitute, South Africa, Botswana, Rwanda, Nigeria, Senegal, Ghana and Morocco here in Africa; Tel Aviv (evil juus so-called israel) attack dog, the UAE and Turkey in Middle East.
Mumbai, India; Singapore, Kuala Lumpur, Malaysia; Bangkok, Thailand, Hong Kong, Taiwan, Macao, China, Bali, Indonesia, Sydney, Australia and Asia and pacific, pivot to pacific’ anyone—–says Mr. Barack Hussein Obama, a secret cabal and lowly educated criminal and his bunch of cabal’ in the US states’ department.
That rising costs of living pressure, interest rate rises, lack of sunflower (cooking oil), grains (maize/corn/wheat), Sorghum or cattle, sheep, goats and lack of petroleum fuel/energy/gas, because of war in Ukraine, is affecting the most vulnerable countries around the world; mostly mostly the Sub-Saharan Africa, countries and especially South Sudan—-the so-called World newest nation, the world youngest country, the world poorest country, says who?
We are the Ancient Egyptians, we don’t like these cheap phrases *first Africans, first African Americans, first black so-so; in Europe, Asia, fellows, South or Latin Americas & Caribbean first so-so. We are too well ahead of pieces of nonsense. If your so-called Western civilization is going to survive our bombings, then we will give all the keys and we will be their slaves, once and for all. But for all I care, white race, will be wiped you out of map, once and for all, reasons, pure HATRED and RACISM*
White people who can dare challenge us don’t exist. However, Russians, Germans, Chinese, Scandinavian countries, minus Norway, can try their luck to challenge us, but they are wasting time.
This is not NOT COLD WAR—-IT IS A HOT WAR. South Sudan and South Sudanese people have taken sides, on behave Russia federations and China. The NATO tribe is not going to exist again. Take it or leave it.
‘All of our African countries are pieces of shits, Bantuses, don’t have lives, they worship Europeans, Americans, Arabs, evil juus (so-called isrealis) attack dogs, Indians, the UN, and the NGOs’
Our lowly informed South Sudanese, no one like a bad neigbour (s). Abesh (so-called ethiopia), our cloned so-called arab North Sudan, Abesh (so-called ethiopia) prostitute, Kenya, Rwanda, Djibouti, evil juus (so-called israel) attack dog and their gulf Arab Saudi Arabia, UAE, Bahrain, Qatar, Kuwait are not our allies or our equals, They are enemies and they are walkover and pee.
There is damn oil left in Saudi Arabi and gulf Arab states—-only here in Upper Nile. The evil juus (so-called israelis) attack dogs are not going to reach or New York, there will second Auschwitz and Holocaust, we have informed the low lives, to look for Manhattan project 2.0, 3.0, 4.0, 5.0
The devil worshipers, bloodsucking vampires, secret cabals, vermins/parasites/viruses/pests always Aus used a region, countries against countries, people against people——the end justifies the means——war of attrition on a selected country and people.
The devil worshipers, bloodsucking vampires, secret cabals, vermins/parasites/viruses/pests pick as their cheap targets to expand, their devil woeshiping, bloodsucking vampirism, secret cabalism, verminism/parasitism/virusism/pestism and intriguism.
But the devil worshipers, bloodsucking vampires, secret cabals, vermins/parasites/viruses/pests and their cheap and dirty inrrigues is not going to fly over South Sudan and the South Sudanese people, reasons, pure HATRED and RACISM.
AFRICA UNITY & REGIONAL INTEGRATION, so-called East Africa community (EAC), will be destroyed. Who would want to live sides by sides with Bantuses, white Americans, English couple, our cloned so-called arabs of North Sudan, Abeshas (so-called ethiopian) prostitutes, gulf Arab terrorists, Dutches (so-called Afrikaans), Portuguese, Italians, Irish, gays, lesbians or LGBTQs, Indians, Pakistanis, Bangladeshis, Nepalese, Sri Lankans in South Sudan?
It is not a bad idea to be good neighbours, but honestly we are sick to being used by pieces of shits which are not damn equals and whom we can walkover in a matter of a week and pee, as their geopolitical chess games or football, every ten (10) years, their banking cartel are about to bust. And that is precisely why it is always a good idea, not to just sign things and join shifty club with questionable characters behind them.
Here is example, Mr. Paul Kagame and his Rwanda is not part of IGAD——-Intergovernmental Authority for Development (IGAD) countries, he (Mr. Paul Kagame and his Rwanda) is part of East Africa Community (EAC), Commonwealth of Nations, the African Union (the AU), NEW WORLD ORDER GOVERNMENT (or one world government), GOVERNMENT WITHOUT BORDERS, GOVERNMENT OF RUN BY DONATIONS FROM FACELESS DONORS OR MERCENARIES.
Mr. Uhuru Kenyatta of Kenya, who is mafia family has amassed a lot money from Kenyans, and he has stashed a lot money in London and the US, Dubai, South Africa—–he was exposed on deeply his family is deep in the next of corruption in Kenya last years. But (he, Mr. Uhuru Kenyatta and his family shrugged it off—-nothing to see there). His Arch rival Mr. Raila Odinga, now ally, is another secret cabal, Mr. Raila Odinga and his Luo community have some relationship with South Sudanese people, here in our Nilotic plains and valleys, corruption is frown upon.
We are 100% egalitarian people, our ancestors got rid of Pharaohs eons ago, and we know the reasons, why. Here in our Nilotic plains and Valleys, you can own over 3000 herd of cattle, but you still have to share a table with someone with nothing or someone with 20 herd of cattle—-it is the way. Former Abesh (so-called ethiopian) prostitute, Mr. Hailemariam Desalegn a lowly educated piece of trash, he thought, he can pull his former boss, Mr. Meles Zenawi piece prank, his successor. Mr. Abiy Ahmed lowly life—–let his secret cabal handlers, give him another so-called Nobel peace prize. Mr. Barack Hussein Obama, Young Africa leadership initiative (Yali).
https://paanluelwel.com/2015/08/14/troika-and-igad-the-unholy-alliance-working-to-invade-south-sudan-in-pretext-of-bringing-peace/
Africa countries can join China, Russia, India, Brazil, South Africa (with no Dutch and English people) so-called BRIC countries, Asian countries, South America, and Caribbean countries and will give ‘Mortar and be motley countries’ But here in Africa, No one trust African counties—–Bantus countries.
Here in East Africa, Mr. Kagame, a lowly educated piece of shit, a terrorist (he was behind the 1994 genocide in Rwanda), a European and American, secret cabal and an attention seeker, he took his Rwanda to so-called Commonwealth of nations, however his country has nothing to do with England, Belgium Congo, that bullied them should have been the one to take his country to if he really honest to himself and Rwandan people. But the secret cabal was just desperate for White King /queen to be his master. Good luck to Rwanda & Mr. Paul Kagame, with house Windsor. All the Rwanda mercenaries here in Upper Nile,
will be killed and thrown into the Nile, they are piece shits. Former South African president Mr. Thabo Mbeki, a piece of lowlife, he was brought here to South Sudan by his cabal and handlers to come and convince our people to live sides by sides with Bantus, our cloned so-called Arabs of North Sudan, Abeshas (so-called ethiopian) prostitutes, white Americans, English people, evil juus (so-called israelis) attack dogs, Dutch, Portuguese, Italians, Irish, gays, lesbians or LGBTQs, Indians, Pakistanis, Bangladeshis, Nepalese or Sri Lanka like they lives sides by sides in South Africa——Bantustan or Rhodestan/Rhodeesia?
Former Tanzania president, Mr. Jakay Kikwete (what damn name?), former president of Kenya, Mr. Mwai Kibaki, current president of Kenya, Mr. Uhuru Kenyatta, his former arch rival turn ally, Mr Raila Odinga, former Nigerian president, Mr. Olusegun Obasanjo (we want a report from him, and this India criminal, Mr, Mahmood Mamdani——that the Jaangs/Jenges/Dinkas killed the Nuers in Juba on the 15/12/2013, simply because they were Nuers),
Former Abesh (so-called ethiopia) prostitute, Mr. Hailemariam Desalegn, his successor, Mr. Abiy Ahmed, late Meles Zenawi, Mr Soyoum Mesfin, former evil juus (so-called israel) Zionist piece of low life, Mr. Benjamin Netanyahu, former US President, Mr Barack H. Obama—-his former secretary of sates, Ms. Hillary Clinton, his former foreign policy advisor, Ms. Susan Rice, his former Ambassadress to South Sudan, Ms. Susan Paige, she was deep in neck in 15/12/2013 foiled coup attempt in Juba, South Sudan. Former United general Assembly or the UNSC, Mr. Ban Ki Moon.
Those pieces of low lives above, members of secret cabal and the agents of the so-called ONE WORLD GOVERNMENT. Our low lives of Mr. Riek Machar, Aduok Nyabe, their new recruits of Mr. Pagan Amum, Mr. Majak Agoot, Mr. Madut Biar, Uyai Deng Ajak, Tomas Cirillo and others are members of secret cabals; they have sold themselves.
That South Africa, Zimbabwe, Kenya, Abesh (so-called ethiopia) prostitute, Nigeria, Senegal, Ghana and Morocco in West Africa, would be made manufacturing hubs/centres), and that the Resources in South Sudan, Zimbabwe, Democratic republic Congo (DRC), would be used as collateral to prop up or secure loans for those so-called would be made manufacturing hubs/centres and that is to stem or stop Bantuses from West Africa from crossing Mediterranean sea to Spain, Sicily, Lampedusa, Malta to Mainland Europe and go and caused problem there.
Fellows look for a place to hide. Regional Integration.
https://paanluelwel.com/2015/07/22/can-the-law-in-the-white-house-be-applied-on-south-sudan/
Sorry UN, US, and EU Countries: The Expulsion of Toby Lanzer is Irreversible
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjct_zd9_T4AhUZnpUCHe6qDbwQFnoECAMQAQ&url=https%3A%2F%2Fsudaneseonline.com%2Fboard%2F15%2Fmsg%2F1459876892.htm&usg=AOvVaw00yDwhRoa-OkLkGKAy9rDt
Fellows, there will be no damn US or so-called Western civilization, again. There will be NATO countries. We are going these sewers who is who on this planet earth. The Nile is control by owners. The Nile delta, is taken over by owners. Suez Canal will be closed by me>>>>