The health industry in South Sudan encounters major obstacles, as delays in compensating health workers impede the delivery of
important services.
In July 2024, the Health Sector Transformation Project
replaced the Health Pooled Fund, which had been in South Sudan’s health system
for 12 years since 2012.
Despite its efforts to support the government in delivering
health services with limited resources, the Health Pooled Fund faced numerous
challenges, including financial constraints, shortages of medical supplies, and
staffing issues.
When the Health Sector Transformation Project took over in
July, many health workers hoped for major improvements. However, logistical and
administrative bottlenecks have left many without incentives for months, even
in the first four months of the project’s implementation.
The resulting frustration is evident in overwhelmed
facilities, absent medical staff, and frustrated patients.
Mbara Magret John Tana, a registered midwife volunteering at
Bazongua Primary Health Care Center in Yambio, shared the challenges of
balancing professional duties with personal survival.
“The challenges that we are going through as staff [include]
shortage of money, something that can motivate us. The fuel for coming here is
not there,” Magret explained.
In the absence of reliable salaries, Mbara and her
colleagues have adopted a rotation system to keep facilities operational from 8
in the morning to 5 in the evening.
“We planned; instead of leaving our people to die, let’s
make duty rosters. Like today someone comes; tomorrow you go off. You go and
help yourself; maybe you go to the garden, you harvest your peanuts, you go and
sell, you get soap for yourself, you buy a liter of fuel, then you come
tomorrow,” she said.
Despite these efforts, Mbara remains hopeful, saying, “The
new project has come, so we welcomed it very well, and still, they are telling
us it is still a new project; it is still in the process, so we are patient,
waiting for the good things that are coming ahead.”
James Ezikiel Ndukpo, Yambio County Health Director, voiced
concerns over the lack of clarity and support under the new Health Sector
Transformation Project.
“We are worried terribly because, four months after the
launch of the new health project, there has been silence until now. We do not
know what is happening. There are no drugs delivered to us, and there are no
salaries or incentives given until now,” Ezikiel stated.
“We have been waiting until now; things have come to what we
did not expect. I am hearing of incentive being brought already, but it has not
come to this end.”
However, the partner says the introduction of the Hope
Electronic Payroll System, a biometric system which was not used during the
previous funding yet required by donors, has compounded delays.
According to Peter Mbayo, UNICEF Health Officer for Greater
Equatoria, these delays stemmed from errors and inefficiencies in transitioning
to the new system.
“When the Health Automation Project started on July 1st, we
were waiting for the database to be handed to the Ministry of Health and then
UNICEF and. By mid-August, the database was still unavailable, raising concerns
and causing delays in incentive payments,” Mbayo explained.
The resulting errors, missing names, and incorrect entries
delayed the process further, with corrections requiring a lot of time and
effort.
“Transitioning to a new system always comes with challenges.
There were human errors and delays because this is a government-led project
that involves multiple stakeholders,” Mbayo added.
By the time officials were speaking to the media, the health
workers were receiving their two-month incentives for August and September.
Dr. Bonjo Samuel, Medical Director at Yambio State Hospital,
said the launch of the project has boosted the hospital in medical supplies,
and the hospital has seen an increase in people coming to seek medical services
but emphasized the broader implications of staffing and pay delays.
“The issue of staffing, the issue of human resources— it’s
not only here but all over the country. But we always advocate that, at least,
we increase the staffing of state hospitals so that patients can receive good
service,” said Dr. Samuel.
While Dr. Samuel speaks to journalists in Yambio, health
workers in Lakes State were on strike to address issues of unpaid incentives
and wages for four months.
In Northern Bahr el Ghazal, health centers face similar predicaments. Health workers had also gone on strike seeking payment. Reports
from the area indicate that many workers have sought alternative income
sources, further straining service delivery.
This is a similar situation in most of the states across
South Sudan. Without consistent incentives, many health workers remain
demotivated.
“The delay of incentives sometimes also demotivates the
staff. You will find that a lot don’t come. And this also makes the morale of
the staff reduce. You find their morale at work is not all there,” Dr. Samuel
noted.
Patricia Paulino, an expectant mother, travels two hours
from her village to Bazongua primary health care for antenatal care. Yet, her
journey often ends in disappointment.
“What is paining us so much is that doctors are not coming
to the hospital; they should be given their money so that they can work well.
They should be asked to come to work,” Mrs. Paulino said.
“There are times we come to the hospital and find that
doctors are not there, and we will go back home. Because they are not being
paid, sometimes they don’t come to work.”
Susan Simon, another mother seeking care at Bazongua PHCC,
shares similar frustrations.
“Sometimes, I come here and take more than two hours before
I can see the doctor because we are many and the doctors are few. The doctors
sometimes reveal to us that their salaries are not being paid, leading to many
of them not coming to the hospital,” she said.
The transition to the new Health Sector Transformation
Project (HSTP) has not only highlighted systemic weaknesses but also exposed
the fragility of South Sudan’s health infrastructure.
The World Bank and donor countries have supported this
project, aiming to improve healthcare delivery across the country. However, the
delays in payments have raised concerns.
The government’s financial constraints have exacerbated the
situation. Civil servants, including healthcare workers, have gone unpaid for
months. The Ministry of Finance recently announced the commencement of
one-month salary payments after nearly a year of arrears, following President
Salva Kiir’s directive to prioritize settling these debts.
The cumulative effect of these delays is a demoralized
healthcare workforce, leading to protests and strikes that further disrupt
service delivery. Without timely and adequate compensation, the motivation and
capacity of health workers to provide essential services are severely
compromised, hindering the progress of health sector reforms in South Sudan.
As the Health Sector Transformation Project continues
to unfold, addressing the systemic delays and improving communication among
stakeholders is critical.
Despite the urgency of the situation, health workers such as Mbara Magret and directors like James Ezekiel hold onto their hope for change. Ensuring that health workers are promptly paid and facilities adequately stocked is not just a logistical issue; it is a matter of life and death for millions across South Sudan.
