SOUTHERN SUDAN - LAINYA COUNTY UPDATE

UNCLAS SECTION 01 OF 02 KHARTOUM 001821 SIPDIS AIDAC SIPDIS STATE FOR AF/SPG, PRM, AND ALSO PASS USAID/W USAID FOR DCHA SUDAN TEAM, DCHA/OFDA, AND AFR/SP NAIROBI FOR USAID/DCHA/OFDA, USAID/REDSO, USAID/SFO AND FAS GENEVA FOR NKYLOH NSC FOR PMARCHAM AND MMAGAN USUN FOR TMALY BRUSSELS FOR PBROWN E.O. 12958: N/A TAGS: EAID PREF PGOV PHUM SOCI UN SU SUBJECT: SOUTHERN SUDAN - LAINYA COUNTY UPDATE REF: KHARTOUM 0766 KHARTOUM 00001821 001.2 OF 002 -------------- Summary -------------- ¶1. From November 4 to 6, program officers from USAID's Office of U.S. Foreign Disaster Assistance (USAID/OFDA) traveled to Lainya County in Central Equatoria State, Southern Sudan, to review the status of the planned transition of USAID/OFDA-funded programs to the Government of Southern Sudan (GOSS) Ministry of Health (MOH). Lainya County, with an estimated population of 200,000 people, experienced significant displacement during the civil war. However, Lainya County is farther along than most other counties in Southern Sudan in transitioning away from emergency relief aid to more sustainable recovery and development assistance. Even with the progress, the USAID/OFDA team found that significant obstacles to transition still exist. End Summary. -------------- Background -------------- ¶2. Since March 2005, the USAID/OFDA-funded ZOA Refugee Care primary health care project in Lainya County has provided life-saving services to more than 95,000 people at its three primary health care centers and 11 primary health care units. The total population of the county is more than 200,000 people. Approximately, 23 percent of patients treated at the facilities are recent returnees. Many internally displaced persons (IDPs) and refugees cite the availability of quality health care as a factor in influencing their decision to return to the county. Prior to the project, the county did not have a health department. In addition to ZOA's health care program, the Lainya County Health Department employs 15 professional health staff and manages 30 community-based health workers and 30 vaccinators. ¶3. Further evidence of the functionality of the Lainya County Health Department is that the Lainya County Medical Officer and the Primary Health Care Supervisor have actively lobbied and negotiated with the Central Equatoria State health authorities to incorporate the county health department staff into the state public service payroll and health budget. An agreement reached earlier in 2007 between ZOA and the Central Equatoria State MOH, laid out plans for all 11 primary health care units and three primary health care centers supported by ZOA in Lainya County to be handed over to the county health department by December 2007. While significant progress has been made towards that goal, it is clear that several key obstacles will likely prevent this handover from taking place on target. -------------- Transition: Opportunities and Obstacles -------------- ¶4. In Lainya County, like most other counties in Southern Sudan, the county health department staff are not yet paid by the government. The staff are still paid incentives by non-governmental organizations (NGOs),such as ZOA in Lainya. After positive discussions between the County Health Department, ZOA and the Central Equatoria State MOH (SMOH) in May, the SMOH agreed to carry out the necessary steps to incorporate the ZOA-supported facilities into the County Health Department and state MOH health system. The SMOH conducted a full assessment of the facilities and staffing in July 2007 and forwarded the details to the Ministry of Public Service, which is responsible for reviewing and approving the incorporation of staff and facilities in the GOSS budget. ¶5. Unfortunately, the assessment report's list of staffing needs exceeded the state's staff ceiling imposed by the Ministry of Public Service. The ministry's ceiling policy specifies that each state may only employ 5,000 civil servants across all departments. At the same time, MOH's facility standards require certain staff levels for each facility type: 6 staff for health care units, 16 staff for health care centers, and 107 staff for hospitals. Meeting the required health staff levels alone would likely exceed civil servant ceilings in most states. In addition, the MOH has not budgeted funds for the support of county-level health staff salaries; it simply does not have enough revenue to cover salary support at this level. Lack of funding at the county level is a critical problem because it directly impacts service delivery. Without adequate support for salaries, it will be very difficult for any county to attract and retain qualified health personnel or train new staff, KHARTOUM 00001821 002.2 OF 002 even in counties as relatively well positioned for handover as Lainya. The dual obstacles of staff ceilings and lack of salary support are significant barriers to handing facilities over to the MOH in Lainya County in the near term. ¶6. USAID/OFDA staff met with the Deputy Director at the Central Equatoria SMOH after returning from Lainya County. While the SMOH and County Health Department are still optimistic that the planned handover will happen by the end of the year, they admit significant barriers exist. The SMOH cites revenue flow as a major problem. The SMOH budget for 2007 was submitted in January and approved in August, yet no funds have been allocated from the central to the state level. According to the SMOH, the central MOH claims that the funds are not there and that the GOSS' share of oil revenues has not met projected levels. Instead, the central government has instructed states to raise their own revenues via taxation. However, relying on taxation seems unrealistic given the lack of systems to collect taxes and manage budgets, even in places where a realistic tax base exists such as Juba. ¶7. Despite obstacles, it is clear that the presence of a truly dedicated and energetic County Health Department, County Medical Officer (CMO),and strong NGO partner (ZOA) has made a great difference in the progress of planning for an eventual handover of health facilities to the MOH. The selection of the CMO has led to impressive progress towards handover in the past six months. For example, the CMO traveled to Juba and spent one month negotiating with SMOH and GOSS MOH to get the promised three-month drug supply for his facilities. Despite this effort, the CMO managed to obtain supplies for only half of the facilities and had to rely on ZOA for transportation back to the county. The dedication of the CMO has increased the confidence of the county staff and opened vital communication links between the county health department and the Central Equatoria State health and public service authorities. The Lainya County Health Department plans to further engage the Central Equatoria State authorities in other key health areas such as the provision of pharmaceuticals. -------------- Conclusions -------------- ¶8. Lainya County benefits from its proximity to Juba and the presence of such a strong cadre of stakeholders actively engaged in supporting and improving the health care system. Still, obstacles to sustainable handover exist and need to be overcome, such as the lack of support for county-level salaries and a dysfunctional system for developing the human resource base. Many other counties in Southern Sudan more remote than Lainya County get less support from GOSS and state structures, and do not have a functioning county health department. Donors must coordinate and engage the GOSS MOH to address these obstacles and provide ongoing support to fill critical gaps in health sector coverage over the coming year. FERNANDEZ