Addressing the Drawbacks of the Contemporary Comprehensive Free Health Care Services in South Sudan
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What is an effective system that will address the drawbacksof the Contemporary Comprehensive Free Health Care Services in South Sudan?
By Francis M. Malwal, Houston, Texas, USA
Friday, June 19, 2020 (PW) — Since the signing of the peace agreement in 2005, the government of Southern Sudan has adopted a comprehensive free healthcare Services (CFHCS). The CFHS is defined as the provision of healthcare services to 90 % of citizens at no cost upfront. Although it is called free, it’s not free, as the name implies. Citizens contributed to the healthcare fund through a general tax that is collected from working civil servants. This system works well in a committed government that values the importance of healthcare institutions and injects funds regularly and continuously. However, with a super-defaulter government of South Sudan, the result is a broken healthcare system.
When the government regularly failed to finance the healthcare institutions, the healthcare institutions’ services continue to deteriorate and eventually run out of essential medical supplies such as life-saving medicines, consumables, equipment, among others. As a result of this shortage, the health institutions failed to maintain the standard quality of services; the health services shrike. For example, the teaching hospital no longer provides the kinds of services it is supposed to offer. Instead, its services become similar to those of primary health care centers. Consequently, the people who were getting higher-level standards of care no longer get such services.
Furthermore, the health institution failed to acquire modern medical equipment as well as maintaining or even repairing the current existing equipment. For instance, Juba Teaching Hospital has an X-ray machine that is not functioning because of the lack of X-ray films. A diagnostic laboratory unit that doesn’t run all necessary investigations. Besides, the healthcare institution failed to renovate or maintain its building. Even simple procedures such as cleaning of a hospital or supply continuous electricity become luxurious. Also, the health care institutions failed to pay healthcare workers incentives for extra hours or duties. Eventually, it leads to less motivated healthcare workers, who are not willing to exert extra effort in their jobs.
Healthcare workers are human beings, and their jobs should be appreciated for achieving particular objectives. For instance, they need motivation for performing the following; cutting the number of women who died during delivery in the health facilities or postoperative infections, just to mention a few. Besides, lack of motivation, low wages force healthcare workers to leave government jobs and search for better opportunities in non -governmental institutions or even foreign countries that paywall and recognize their essential role in society.
The consequence of the broken healthcare system is that citizenswhose government promised access to free healthcare in public hospitals cannot get it. Before the health institutions run out of essential services, rich and poor people get their services from public health institutions. However, after the health institutions, necessary supplies depleted, the wealthy citizens who afford private sector medical bills continue accessing services there. In contrast, those poor citizens who could not afford private sectorcosts have nowhere to turn to. As a result, some of them die in their homes with nobody’s notice.
Moreover, as healthcare services deteriorate in the public healthcare facilities, some particular groups of patients suffer most because of failing to get the services they needed. For instance, cancer, cardiac disease, Kidney failure, asthmatic, and infant patients failed to get their respective services. The result of this broken system is that people die from simple illnesses that would not kill a person if there were functional health institutions.
This CFHCS in South Sudan has significantly failed in the last 15 years and wrecked the healthcare system. It did not work, and it will never succeed with the current incompetent government. The current system for the previous 15 years has failed to build a single new hospital in South Sudan. Please note that KiirMayardit Hospital in Rumbek and Maternity Unit in Juba Teaching Hospital were all funded, constructed, equipped, and managed by the Chinese government. If Kiir’s government handled or managed the funding and construction of previously mentioned projects, they might have ended up like Juba International Project or Bahr Elgazal Road.
Even Kiir Mayardit Hospital that was built and equipped with all modern equipment, is no longer operating in its full capacity. It lacks simple things like electricity, although the generator is there, the government cannot afford fuel for running the hospital. Also, recall the fade of ALcardinal Kidney Dialysis Center.
The outcome of South Sudan CFHCS is the current broken healthcare. It failed to provide quality health services and maintained the capacity of its services. Also, it was unable to save lives. Again the system disadvantageous the poor citizens, who cannot afford private sector medical expenses or have noconnection within the government to access the medical referral fund similar to what entitled to government elites officials, members of parliaments, and organized forces generals.
So the question that comes on everybody’s mind is, what is the appropriate healthcare system that will effectively address the drawbacks of the current CFHC services? The answer is the Introduction of an independent National Health Insurance Corporation (NHIC) and Social security funds. The NHIC I’m proposing is meant to be public insurance that must be independent and run based on a private business mindset.
The NHIC will collect a specific percentage of the general taxfrom the government and private sector employees. The South Sudan Revenue authority will receive the fund and remitted the fund directly into the NHIC account. The NHIC will use the fund to develop and expand the health care sector and invest some of that fund on any developmental project that will generate more revenues.
The Parliament shall enact the National Health Insurance Corporation bill. When the president signed it, it becomes a law that enforces all government employees to sign up for public medical insurance. At the same time, private-sector employees are also required to sign up either for public medical coverage under the NHIC or private insurance companies. On the other hand, unemployed with either government or private sector, welfare social security will cover their medical bill. The unemployed groups include elderly, disable, wounded, orphans, and children. At this point, there would be nobody that will get services in health institutions without insurance that covers his/her medical bill.
The advantage of the NHIC is that every person who gets services from the hospital has an insurance company that covers his/her medical expenses. If the individual is a government or private sector employee, the NHIC or private insurance will always pay his/her costs. Hence, there will be no reasons that hospitals will run out of essential medical, laboratory supplies, or not expand their capacity or provide quality health services, acquiring new medical equipment and, above all, saving lives and achieving equal access to healthcare services between the elites and poor citizens.
In conclusion, don’t make a promise that you would not fulfill. Consequently, there is no meaning of government promising citizens of Comprehensive free healthcare Services that they cannot access in health institutions. Again no government has afforded the provision of free health services in developing countries without compromising the quality of its healthcare services. Hence, if the government is serious about reforming the healthcare sector, it should abolish the contemporary comprehensive free healthcare system and replace it with the National Health Insurances Corporation. Otherwise, no reform will take place under the CFHCS.
The Author, Francis M Malwal, B.Pharm, M.Pharm, FPGEC, is a South Sudanese based in Houston, Texas and Former head department of Pharmacology, University of Juba, College of Medicine, and can be reached via his email:francismalwal@gmail.com
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