Health in South Sudan

The post conflict South Sudan has huge challenges in delivering health care to the population. The challenges include: crippled health infrastructures, nearly collapsed public health system, and inadequate qualified health professionals. The country is far from achieving the MDGs by end of 2015. The health system needs a major resuscitation, in addition to supporting and developing health training institutions.

South Sudan is acknowledged to have some of the worst health indicators in the world.^[1][2][3]

A new measure of expected human capital calculated for 195 countries from 1990 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by The Lancet in September 2018. South Sudan had the second lowest level of expected human capital countries with 2 health, education, and learning-adjusted expected years lived between age 20 and 64 years. This was an improvement over 1990 when its score was 1.^[4]

South Sudan's health system is structured into three main service tiers: Primary Health Care Units (PHCUs), Primary Health Care Centres (PHCCs), and hospitals operated at the state, county, police, or military level.^[5]

Health service delivery operates across four levels: community, primary, secondary, and tertiary. Community-level services are provided in villages by trained local personnel. The primary level includes PHCUs and PHCCs, which deliver the Basic Package of Health Services (BPHS). The BPHS encompasses preventive, curative, health promotion, and basic administrative services.^[6] The government finances it, the Multi-Donor Trust Fund (MDTF), and various NGOs. These services are intended to be free and accessible to the majority of the population at both the primary and secondary levels.^[6]

The Ministry of Health (MoH) administers a decentralized healthcare system in line with the Interim Constitution of South Sudan (2005)^[7] and the Local Government Act (2009).^[6] This system is organized across four administrative levels: national, state, county, and community.^[8] The national Ministry is responsible for policy development, strategic leadership, funding, and monitoring and evaluation. State governments oversee the implementation and coordination of healthcare services at the county and community levels.

In early 2025, health services in South Sudan suffered a major setback following cuts to United States Agency for International Development (USAID) funding initiated under President Donald Trump's "America First" policy. These cuts led to the closure of seven out of 27 Save the Children-supported clinics in Jonglei State and forced 20 others to reduce services, resulting in the layoff of roughly 200 health workers. In April 2025, Save the Children reported that five children were among eight people who died after walking for hours in extreme heat to reach medical care for cholera. A US-funded patient transport service had also been shut down. USAID had previously supported critical interventions for cholera, malnutrition, malaria, and HIV/AIDS, but over 90% of its contracts were reportedly canceled. While the US State Department maintained that some humanitarian projects were still active, it cited widespread corruption in South Sudan’s government as a barrier to continued support.^[9]

The health situation in South Sudan is far from ideal. More than 50% of the population lives below the poverty line, and the adult literacy rate is 27%. The under-five mortality rate (U5MR) is 99 per 1,000 live births, while the broader under-five infant mortality rate is estimated at 135.3 per 1,000. Maternal mortality is the highest in the world, with a Maternal Mortality Ratio (MMR) of 2,053.90 per 100,000 live births in 2006 (South Sudan National Bureau of Statistics, 2012).^[3]

Access to antenatal care (ANC) is limited, with 47.6% of women attending the first visit and only 17% completing the recommended four visits.^[10] The infant mortality rate (IMR) is 64 per 1,000 live births, and national life expectancy is estimated at 55 years.^[11]

In 2004, there were only three surgeons serving Southern Sudan, and just three functioning hospitals. In some areas, there was only one doctor per 500,000 people.^[1] A child born in South Sudan has a 25% chance of dying before reaching the age of five. Major causes of child mortality include pneumonia, diarrhea, malaria, and malnutrition.^[10]

The country also has one of the lowest immunization coverage rates globally. Only 26% of children received all recommended vaccinations in 2010, a slight decline from 27% in 2006.^[12][13]

Most maternal deaths occur during labour, delivery, or the immediate postpartum period. These deaths are largely preventable with adequate infrastructure and the presence of skilled personnel during childbirth.

South Sudan’s human resources for health are significantly below the minimum threshold recommended by the WHO.^[14] Between 2009 and 2010, there were only 189 doctors across eight states—an average of one doctor for every 65,574 people. The number of midwives was 309, or one per 39,088 population.^[15] However, estimates vary; other sources suggest a ratio of one midwife per 125,000 women.^[16]

In October 2014 Oxfam warned that 2.2 million people were facing starvation.^[17] The 2017 South Sudan famine occurred after several years of food insecurity and affected an estimated five million people, just under half the national population.^[18][19]

• List of hospitals in South Sudan