Where is South Sudan in achieving UN Millennium Development Goals?

By Nhial T. Tutlam

November 30, 2013 – As we commemorate World AIDS Day and with just a little over a year left until 2015, the year by which countries are expected to meet the United Nations Millennium Development Goals (MDGs), now is a good time to ask where South Sudan is in achieving these important goals. I am especially interested in goal 4 to reduce child mortality, goal 5 to improve maternal health and goal 6 to combat HIV/AIDS, malaria and other diseases. These goals come with specific targets to: reduce under-five mortality rate by two-thirds; reduce maternal mortality rate by three-quarters; halt and begin to reverse the spread of HIV; and halt and reverse the incidence of malaria and other diseases by 2015.

According to the most recent estimates from the 2006 Southern Sudan Household Health Survey, South Sudan’s maternal mortality rate is the highest in the world at 2,054 per 100,000 live births. And although the second household health survey showed a decline of mortality rate for children under-five years from a staggering 135 deaths per 1,000 live births in 2006 to 102 per 1,000 live births in 2010, the latest numbers from UNICEF indicates that the under-five mortality rate rose to 121 per 1,000 live births in 2011. To put these numbers in perspective, the maternal mortality rate means that there is at least 14% chance that a woman will die from pregnancy related complication in her life time and the under-five mortality rate means that 1 in 8 children will die before their 5th birthday. South Sudan stands out among its neighbors with these worst indicators. With exception of the Central African Republic and the Democratic Republic of Congo, two countries still mired in conflict, which have worse indicators than South Sudan, the gap between South Sudan and her immediate neighbours is so wide. According to a 2008 UNICEF report, the average maternal mortality rate and the under-five mortality rate for countries in the region were 210 per 100,000 live births and 43 per 1,000 live births, respectively. With respect to HIV prevalence, the ministry of health estimates the rates to be less than 3%. But the worry among experts is that given the limited available data, lack of widespread knowledge about the disease in the country, coupled with return of South Sudanese from countries with higher HIV prevalence rates, the rates are now almost certainly higher.

Based on all available data, it is very clear that South Sudan will definitely not achieve Goal 4 target of 72 per 1000 live births under-five mortality rate by 2015; UN agencies project the under-five mortality rate to remain alarmingly high at 108 deaths per 1,000 live births. Millennium Development Goal 5 will also not be met. In fact, in UNDP’s assessment, under the 2010 budget plans, goal 5 will never be achieved. It is also evident that goal 6 will not be met and it is feared that HIV rates may actually be on the rise.

So, where do we go from here? Pertaining to goals 4 and 5, a good starting point in the efforts to achieve these goals would be to understand the underlying factors for these unacceptably high rates in the first place. In the case of South Sudan, the reasons are clear. Some of the important factors that have been identified as major culprits include: shortage of properly trained healthcare workforce (according to the Ministry of Health there are very few trained midwives to attend to deliveries and the country has fewer than 200 medical doctors for a population that is now estimated to be over 10 million); substandard health care facilities; early forced marriages, which lead to extremely high adolescent birth rate, estimated to be 300 /1,000 births (UN agencies have declared that in South Sudan a 15 year old girl is more likely to die from childbirth than finish school); low vaccination coverage; poor sanitation that leads to all kinds of infections; extraneous duties during pregnancy and many other factors. Concerning goal 6, the HIV rates are known to be higher among females than males. Given the low literacy rates among women, lack of knowledge about the disease in this vulnerable group is an important factor. This has further negative impact on maternal and child mortality rates, especially through mother to child transmission.

We now know that these goals will not be met by the deadline and we have no idea when, if ever, these goals will be achieved. The question is then, what will be done to start moving these numbers in the right direction, not just to fulfil the Millennium Development Goals, but because it is the right thing to do. This will, of course, require focused and determined efforts on the part of the government of South Sudan and its international partners. In this regard, the 2011-2015 Health sector Development Plan and the 2011 National Reproductive Health Policy are steps in the right direction. Recent public pronouncements by the minister of health, the Honourable Dr. Riek Gai Kok, that healthcare has been designated as one of the top priorities is also encouraging. But the welfare of mothers and their young children cannot and should not be addressed by the health sector alone. This is a matter so vital for the survival of the country and it will require all stakeholders to play their part. More importantly, those of us who care about the future of South Sudan and are practitioners or researchers in the area of maternal and child health need to do more to improve the situation. I for one stand ready to do my part in this endeavour.

The author is a doctoral student at Saint Louis University College for Public Health and Social Justice. His research area of interest is maternal and child health, specifically in South Sudan and global health issues. He can be reached at: [email protected].