24/12/2025
The Prescription for a Nation: Why South Sudan’s Health System Must Harvest Lessons from the World
By Peter Garang Ngor Ayok
As we navigate the final days of 2025, a stark reality continues to confront the Republic of South Sudan: our healthcare system remains more of a blueprint for survival than a robust pillar of national development. While we boast the resilience of a people forged in struggle, the health indicators we present to the world tell a story of neglect that no amount of political rhetoric can mask.
The current state is, by all measures, critical. We are a nation where the maternal mortality ratio remains among the world's highest, recorded at approximately 1,150 deaths per 100,000 live births according to the World Health Organization (WHO). Malaria continues to be our silent executioner, accounting for nearly 47.3% of all illnesses [WHO South Sudan Report, 2024]. Our workforce is stretched beyond human limits; the World Bank notes a physician-to-patient ratio that sits among the lowest globally, with roughly 1 doctor for every 65,000 citizens.
To move beyond this "healthcare collapse," South Sudan must adapt the hard-won lessons from nations like Germany, Singapore, Rwanda, Colombia, etc who have transformed their systems through specific, disciplined pillars.
1. Financing and the Courage of Leadership
I must pause to applaud the Council of Ministers, who, in their meeting chaired by His Excellency President Salva Kiir Mayardit yesterday, December 23, 2025, expressed a firm interest in fulfilling our national co-financing commitments. This is a historic step. Like the Nordic models of Sweden and Norway, a health system’s success begins with domestic ownership. For too long, we have relied on ODA to fund over 80% of our services. By meeting these co-financing obligations, the government is finally transitioning from "project-based" health to a sustainable national system.
2. Universal Health Coverage (UHC): Sourcing Local Wealth for Health
If we are to achieve true Universal Health Coverage, we must look at the German and Rwandan examples of structured financing. We cannot achieve UHC through goodwill alone; we must be intentional about sourcing funding through progressive taxation and a mandatory National Health Insurance Scheme (NHIS). By diversifying our revenue, moving away from oil dependency to dedicated health taxes on luxury and harmful goods or telecommunications, we can create a pool of funds that protects our citizens from "catastrophic health expenditure," which currently forces many South Sudanese into poverty just to pay for basic surgery [World Bank, 2024]. A state-led insurance model ensures that the rich subsidize the poor, and the healthy subsidize the sick, creating a social contract of care.
3. Primary Healthcare and the HSTP Reality
The models of Australia and Japan prove that the most effective systems are built from the ground up. In South Sudan, the Health Sector Transformation Project (HSTP) is our primary vehicle for this. However, we must be honest about the hurdles. While the HSTP currently supports 816 facilities, the World Bank HSTP Project Appraisal indicates a challenging roadmap ahead. Due to funding constraints and the need for efficiency, the plan includes a strategic move to further reduce the number of supported facilities in 2026 to ensure the remaining ones are fully stocked and staffed. We must ensure this "reduction for quality" does not leave our most remote citizens in a vacuum of care and urgent take over by the government.
4. Technological Leapfrogging: The Israeli Lesson
Even with limited infrastructure, we must learn from Israel’s leadership in digital health. In a country where roads are often impassable due to seasonal flooding, telemedicine is a necessity. By integrating mobile data for disease surveillance and drug supply chain management, lessons highlighted by the World Economic Forum, we can prevent the perennial stockouts of life-saving medicines that plague our rural bomas.
5. Governance and Accountability: The Foundation of Trust
Perhaps the most critical lesson—from the likes of Germany and Singapore—is one of transparency. Over the years, I have seen how a lack of accountability erodes health outcomes. We must ensure that the Ministry of Health remains a credible institution where health worker incentives are paid on time and resources reach the frontline. The government’s move toward fulfilling co-financing is the first brick in this wall of trust.
The road to our health goals is steep. We have seen slight improvements, yet the pace is too slow for the mother currently in labor in a village without a midwife. By looking at global leaders, implementing a tax-based insurance model, and finally putting our own "skin in the game" through President Kiir’s recent commitments, South Sudan can find its prescription. We must move beyond survival; we must choose to thrive.
Merry Christmas and Happy New Year!
