Immunization Activities in Post-Conflict Settings: Field Notes from Southern Sudan

In July 2011, The Republic of South Sudan will become the newest country in Africa. In January 2011, a referendum vote for Southern Sudanese independence passed, with 98.8% of the electorate preferring secession from the Islamist North Sudan (SSRC, 2011). The referendum vote was the final component of the Comprehensive Peace Agreement, which was signed in 2005 to end the Sudanese Civil War, the longest civil war in Africa. This civil war (1954-1983, and 1983-2002) claimed the lives of two million people and displaced four million Sudanese (Cometto, Fritsche, & Sondorp, 2010). The clashes between the northern-based Islamist government and the southern-based rebel group, the Sudan People’s Liberation Army, were prompted by various reasons, including conflicts over religion, resources, governance, and self-determination (ICG, 2002). When the Comprehensive Peace Agreement was signed in 2005, it brought an end to the conflict. Unfortunately, Southern Sudan was left with no health infrastructure and an inadequate healthcare system. In 2004, only 25% of the Southern Sudanese population had access to healthcare. The health situation in this country remains grave: the maternal mortality rate is 2,030 per 100,000 births, skilled healthcare personnel attend only 5% of pregnancy deliveries, and there is only one doctor per 100,000 people (Cormetto et al., 2010). Other socioeconomic indicators are grim; only 16% of females can read and write and schools have an average of 129 students per classroom (SSCCSE, 2010). About 80% of the population does not have access to any toilet facility (SSCCSE, 2010). The recovery of the health sector is impeded by lack of security, lack of electricity, secular conflicts, poor basic infrastructures, and weak leadership. The combination of these factors makes reconstruction more difficult than previously envisioned. Health sector recovery in Southern Sudan has been coordinated by World Health Organization and The World Bank. These organizations have been involved with technical assistance to the Government of Southern Sudan, providing resource mobilization and policy formulation (Cormetto et al., 2010). In this environment, the main implementers of healthcare activities are Civil Society Organizations (CSO), which include Non-Governmental Organizations (NGOs), Faith Based Organizations (FBOs), and Community Based Organizations (CBOs). Most NGOs run programs in two or three counties, each program having a budget of $1-2 million per year (Cormetto et al., 2010). The NGOs work under Southern Sudan governmental leadership to accomplish their goals while building the Ministry of Health’s capacity in the healthcare sector. There are at least 76 CSOs involved with healthcare delivery in Southern Sudan (Cormetto et al., 2010); they face a myriad of challenges. Inter-ethnic conflicts and rogue government soldiers continue to foster an insecure environment, which contributes to the slow pace of recovery. Poor infrastructures and lack of electricity escalate the operational costs of providing health care, while an inadequate supply of human resources for health makes it impossible to expand any health care activities.