South Sudan blog 2: The right advice

Whilst no-one is deliberately trying to kill you in South Sudan, the real hazard is the health hazard. The myriad natural resources and the idea of a blessed land I described in my first note, is thwarted by pretty much every conceivable tropical killer disease known to man. Lucky for me, I’ve been jabbed and protected from pretty much all of them. There is no inoculation for malaria, however, only prophylaxis and treatment.

Any of you that have had malaria will know that it is a bit like having ‘flu on steroids. I’ve had it a few times in my life and I’ve also been hospitalised by it (it was a leaving present from my last foray in South Sudan). It caught me two weeks after the end of my deployment. I was visiting my parents, entered the living room and collapsed. Trust me; it is no fun knowing that you have cerebral malaria and that you might die. So I’m going to personalise this communiqué, as I recently recovered from yet another bout of malaria.

So what’s the stabilisation angle? I think in terms of basic service delivery as contributing to political stability. I look at health and education as key stability (and poverty) indicators, amongst others. It’s the nexus of what I reflect on as social contract building – government accountability to deliver services and rule through law; balanced by citizen accountability to contribute to sustaining a viable economy, protected by law.

Unsurprisingly, given that South Sudan has just emerged from decades of civil war, poverty indicators are amongst the worst in the world. The population currently do not (yet) feel aggrieved that there is no viable health service – there is a general perception and understanding amongst the South Sudanese that the government needs more time to deliver comprehensive social protection. Those of us engaged with stabilisation out here – not only the Brits – consider that this concessionary window will close in the next three to five years. So it becomes imperative that the basics of social protection, particularly health and education, tangibly emerge in that period. They help stabilise the polity.

Let’s get to the rub of my bleating: when it cost me $90 to be treated for malaria in South Sudan; how on earth does one expect the 50% plus of South Sudanese living way below the poverty line (less than US$1 per day) let alone those on a $1.50 per day to afford it? In my previous experience I have managed large-scale health interventions in several countries of Asia and Africa. In all those countries, basic service delivery is pathetic and it causes grievance. No prizes for guessing they’re not stable.

In South Sudan the political economy is shattered. The government cannot as yet extend its reach to adequately protect its citizens, let alone rule through law. In a built state, there is a legal framework through which the government and citizens govern. That’s governance to you and me – governments need to be able to rule through laws that citizens have been a part of making. It’s social contract 101, the deal. So if there is limited law through which people can hold the private sector accountable, why imagine that privateers will be any more accountable to their punters? Publicly funded and privately delivered is an altogether different prospect of course, but don’t be fooled that is being posited.

Basic services need to be thought of in terms of contributing to political stability. Privateers are in it for profit, pure and simple. When it comes to a question of health service delivery, who would challenge the precept that a population that can access free healthcare is less temperamental than those that can’t? It’s not the cure-all (no pun intended) but it contributes unerringly to political stability – socio-economic development, of which health is a part, makes up a corner of a social protection triangle; governance and security being the other two. Get them in relative equilibrium and it’s more likely that a stable country will emerge.

There will always be privateers seeking a quick buck, but it is reprehensible to declare that people have ‘access to healthcare’ when privateers are noted in health assessments. Whilst the times are changing for us in the UK, let’s not forget that in the post-war period it was free access to healthcare, inter alia, that took an element of fear out of people’s existence. So why would somewhere like South Sudan be considered in any way different?!

Many of us get this simple equation. “Us” includes UK and early thinking is already pointing to influencing South Sudan health policy to ensure that, at the very least, women and children under five years of age – the most vulnerable – can access free healthcare. Multilaterals need to “get it” too.
Multilaterals have a responsibility to help South Sudan emerge as a viable state. It starts with the right advice and with the right advice; perhaps South Sudan’s time might indeed be theirs, as our Dinka man from my first instalment so emphatically hopes.