Presented by: Dr. Richard Lino Loro Lako D/G Directorate of Policy Planning and Budgeting

1. 2nd South Sudan Health Summit, Juba Bridge Hotel, Juba, 4-6 Dec, 2013“Towards Better Healthcare Services that Meet People’s Expectations” National Priorities and Provisional Plans Presented by: Dr. Richard Lino Loro Lako D/G Directorate of Policy Planning and Budgeting

2. Directorate Mandate and structure • Mandate: • Enhance the leadership and governance functions of the MoH. • Ensures that sector Plans, instruments and frameworks guide the actions of the health sector and in place. • Monitoring & Evaluation; Health Policy & Planning

3. Overview of situation analysis • Health indicators Linked to MDGs • Maternal mortality rate 2054/100,000 Live Births • Under-five mortality rate109/1000 Live Births • Prevention of Mother to Child Transmission (HIV) in 23% of Health Facilities • 39% of facilities providing at least 3 modern methods of Family Planning • Under-five stunted 31% • Under-five wasted 23% • Children fully immunized before five years old 6% • DPT3 15% - Diphtheria, Pertussis (Whooping Cough) and Tetanus • Endemic and neglected tropical diseases are rampant and outbreaks common • Emerging new diseases (NS) are a problem in South Sudan and the region • Access to improved safe water 69% • Access to improved sanitation facilities (unshared) 7% • 43% of facilities without source of electricity

4. Overview of situation analysis • Dilapidated Infrastructures (1840/290) • Three Teaching hospital(Mostly secondary care) • 7 States 50 hospitals • 53 county Hospital • 356 PHCC (344 functional) 181 provide deliveries • 1360 PHCU (1065 functional) • Access to Health Facilities, 44% of Population has access and utilisation rate is 0.3 curative consultations person per year • Human Resource ( Inadequate Qualified HR) • Doctors population Ratio 0.02/10,000 Pop • Nurses/ Midwifes Ratio < 0.05/10,000 Pop • With the current rate, it will take us 66 years to meet 1/10,000 pop • Heath Finance, budget decline from 7% in 2006 to < 4% this year.

7. MOH Plans & Priorities • HSDP 2012 -2016 highlights three main objectives • To increase the utilisation and quality of health services, with emphasis on maternal and child health • To scale up health promotion and protection interventions so as to empower communities to take charge of their health • To strengthen institutional functioning including governance and health system effectiveness, efficiency and equity

8. MOH Plans & Priorities • Infrastructure • Equitable Construction of 100 PHCCs • Modernisation of 7 State Hospitals • Construction of 8 Maternity Hospitals • John Lee Memorial Hospital • Three new State Hospitals ( Wau, Juba, Malakal) • Improvement of existing Teaching Hospitals • Provision of ambulances to strengthen referral system • Advanced imaging and diagnostics centre (Referral facility) • A national reference laboratory • Intensive care unit • Renal dialysis units at 3 Teaching Hospitals • Mortuary • Blood transfusion centre • Oxygen plant

9. MOH Plans & Priorities • Human Resources • Six new Training institutions Wau, Malakal, Bentiu, Bor, Yambio and Torit to train mid-level cadres • Juba College of Midwifery and Nursing (JCONAM) • Establishment of post-graduate College of Physicians and Surgery (BMT) • Tutors (Botswana, Ethiopia) to support these training institutes • 30 postgraduate scholarships for medical doctors to strengthen health system • Strengthening of HR management and payroll with introduction of Human Resource Information System and South Sudan Electronic Payroll System II • Reforms to salary transfers to improve compensation for health workers and allow graduates to be employed

10. MOH Plans and Priorities • Health Financing and National Health Accounts • Lobby for more funding from Government and Donors ( States and County transfers, States support form Service delivery project e.g. HPF, IMA and MCHIP) • South Sudan Partnership Fund (new deal compact) • Developing NHA for the South Sudan • Further programme of decentralisation through increased funds for service delivery at State and County level • The Ministry of Health is pursuing a number of initiatives to increase the flow of resources through government systems to where they are needed most – at local level

11. MOH Plans & Priorities • Established Drug and Food Control Authority to ensure the safety and authenticity of medicines in South Sudan • Central Medical Supplies is currently being established to act as a semi-autonomous body procuring and distributing pharmaceuticals and medical supplies • Provision of medical supplies and equipment, including to special consignments to areas affected by flooding

12. Achievements • Supported Directorates in developments of policies, Guidelines and Strategies (Reproductive Health, Primary Health Care, Pharmaceutical etc) • Trained 88 Health Workers for Malaria Indicator Survey and data collection for HMIS so that it can be rolled out to all States • SMOH D/G and Directors of Planning Trained on GLM • Trained 79 County Medical officers on BPHNS • Trained 80 CHD on County Health Management Teams (Juba, Wau Malakal) • Conducted EmNOC needs assessment • Conduct currently Major surveys(MIS and HFA) • Developed South Sudan Commission on Accountability and Information for Women and Children framework and roadmap

13. Issues of Concern • Leadership and management at the County level • How well is the lead NGO per county model working? • Involvement of Counties in planning at State level • Dissemination of the national Policies and Tools to the County level • Judicious use of allocated resources(cash, vehicles, IT etc) • Improved equity between health worker salaries in the Government and NGO sectors • Planning

14. Take Home Messages • The Ministry of Health is committed to improving the distribution of resources to States and Counties for service delivery • This fiscal year sees new operating and capital transfers for Hospitals (10m SSP) and for County Health Departments (40m SSP) – continued disbursement of these funds will rely on proper reporting • The Ministry is committed to increasing training and ensuring that States have funds to employ graduates, and to increase the salaries of primary healthcare workers – any increases will be conditional on proper reporting • States & Counties must ensure their payrolls are accurate & contain all required information – currently payroll data are incomplete & inadequate. Job titles, qualifications and grading norms aren’t respected • The Health Management Information System reporting must be improved • State must ensure that from January all of their staff have full HR record entered into the Human Resource Information System

15. Key Directorate Related Challenges • Printing of Key MOH policies and Guidelines • Use of data for planning • Reporting through key systems needs to be strengthened to enable the Ministry to advocate for and target resources • Communications necessary for dialogue in policy development

16. Way forward • Pilot Health extension project for South Sudan • eHealth pilot in one Teaching hospital • Support development of HRIS and roll-out of SSEPS II • Conduct Surveys MMR, LQAS Early next year

17. Conclusion • The Directorate of Policy, Planning and Budgeting, and the Ministry as a whole is committed to addressing the multiple problems faced throughout the health sector • We look forward to hearing from various key players over the following days, and to discuss ways forward • We need your contributions to build robust systems which provide the data without which we are ‘flying blind’

18. Thank you