The theory of change: poor health care for mothers and children is both a cause and effect of South Sudan’s highly fragile state and society.
South Sudan in 2017 has been ranked by a Washington-based think tank, the Fund for Peace, as the most fragile state in the world, from an assessment of 178 countries. This ranking is based on 12 indicators reflecting proneness to conflict and instability. These indicators cover social cohesion, economic, political and social factors. Violent conflict and political instabili- ty undermine efforts to improve the prospects for development and the population’s well being. According to the OECD’s report States of Fragility 2016, South Sudan is in a similar situation to 34 other countries in sub-Saharan Africa, four in in Latin America and the Caribbean; and seven are in East Asia and the Pacific. South Sudan in common with many other fragile states is a low-income economy.
State fragility has a number of causes. A highly fragile state or society is one where its gov- ernment or communities cannot manage, absorb or mitigate the effects of an accumulation of risks involving the economy, the environment, politics, security and the operation of basic services such as health and education. This means that different actors in a particular context need to understand how their individual actions and programmes are interdependent. different actors will need to plan, design and implement programmes in a more collaborative way to address the range of factors contributing to fragility.
Putting people first is the best response to fragility by supporting local community efforts to develop resilience and the capacity to address the sources of upheaval. There is a need to help local communities and their young people in particular to break the cycle of violence and fear.
Investing in prevention of conflict saves lives, resources and money. It is not only logical: it is simply more effective. The OECD’s report on the State of Fragility 2016 notes that a pre- vention culture needs to permeate all levels of aid planning and decision making. This in- cludes investment in resolving the root causes of conflict.
One such root cause is the harm done to children aged below 18 years. This includes their
killing, maiming, abduction, sexual violence and recruitment into armed groups. According to UNICEF, in South Sudan between December 2013 and October 2017, some 19,000 children have been recruited into armed forces or armed groups.3
One factor undermining communities and the social control they can exercise is the high death rate of young mothers. Complications during pregnancy and childbirth are a leading cause of death among women in South Sudan which has the fifth highest maternal death rate in the world. Postpartum bleeding is one of the leading cause of maternal deaths in the world. But most maternal deaths can be prevented if birth deliveries are done by skilled health professionals with the right equipment and supplies. However, meeting these basic standards remains a huge challenge in South Sudan. Only about 1 in 5 births involves a skilled health care worker.
The Nzara Mission Hospital is managed by the Comboni Missionary Sisters, a religious order from Italy. Nzara Mission Hospital provides general, maternal, child and infant medical care. Major illnesses are malaria, gastrointestinal disorders and complications arising from TB and HIV/AIDS. All the hospital departments are involved in fighting the complications which often accompany malaria, affecting especially children under 5 years of age. Immune sup- pressed patients are also affected as well as expecting mothers. Nzara Blood Transfusion Ser- vice and the availability of effective antimalarial drugs have greatly contributed in reducing the life threatening consequences of this terrible disease.
A major ongoing challenge for Nzara Hospital is finding resources to meet the growing demand for services.