An Open Letter to President Kiir: Call for Re-appointment of Dr Makur Kariom to the National Ministry of Health
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Dr. Makur with Australia Amb. Geoff Tooth during the official launching of Health Pooled Fund on 30th Sept – 2nd October 2013
An Open Letter to the President of the Republic, H.E. Salva Kiir Mayardit: The Call for the Re-appointment of Dr. Makur M. Kariom to the Position of Undersecretary, National Ministry of Health – Juba, South Sudan
By Duluma SK’Maker, Juba, South Sudan
Thursday, November 11, 2021 (PW) — Healthcare is the 3rd important Sustainable Development Goal (SDGs) out of the 17th SDGs global call to action. The call to action emphasized that every country should ensure healthy lives and the well-being of all its citizens of all ages. Alarmingly, estimates made by the World Health Organization and United Nations Population Fund after the Independence proclamation on 9th July 2011 set the infant mortality rate in South Sudan as 102 deaths per 1,000 live births, the under-five mortality rate as 135 per 1,000 live births, and the maternal mortality ratio as 2,054 per 100,000 live births.
This is against the SDG 3 priority Targets in which all countries are mandated to reduce the maternal mortality ratio to less than 70 per 100,000 live births, reduce neonatal mortality to at least as low as 12 per 1,000 live births and reduce the under-5 mortality to at least as low as 25 per 1,000 live births by 2030 – just 8 years away from now. Being a new country, South Sudan inherited a dysfunctional healthcare system from Sudan.
The few existing healthcare facilities in the ten capitals of States were either delipidated to near total collapse, lacked adequate human resources for health or did not have a reliable commodity supply chain. There were no diagnostic facilities in the country and there was a severe shortage of skilled healthcare professionals. The statistics of healthcare professionals inherited was even insulting; imagine South Sudan after Independence, had only 8 Midwives, 9 Obstetricians and Gynaecologists, 2 Pediatricians and a handful of Surgeons and Physicians.
The healthcare professional population ratio was 0.02 per 10,000 people for doctors and 0.5 per 10,000 people for midwives as opposed to 43 per 10,000 people recommended by the World Health Organization. Healthcare professionals like Radiologists, Dermatologists, Ophthalmologists ENT Specialists et centra were hardly heard of and coupled with lack of Public Health Laboratory, the South Sudan government used to send samples to the neighbouring countries like Khartoum – Sudan, Nairobi – Kenya, Kampala – Uganda and Cairo – Egypt for testing when there were outbreaks of disease.
To change the narratives, President Kiir appointed Dr Makur M. Kariom – a British educated Medical Practitioner with MSc. in International Sexual and Reproductive Health from Liverpool School of Tropical Medicine – the University of Liverpool, the United Kingdom as the Undersecretary of the National Ministry of Health (MoH) on 11th November 2011. While in office as a Specialist in Obstetrics and Gynaecology, a tested administrator and a patriot, Dr Makur together with the leadership of the MoH adopted an aggressive strategy that encompassed all the blocks of healthcare with an aim to developing a responsive healthcare system in the shortest time possible.
Under his directives and supervision, the MoH embarked on Human resource development through training at the midlevel and specialty level. For example, at the midlevel, the MoH expanded horizontally and vertically. The number of Health Sciences Institutes rose from just 4 to 35 institutions by 2020 and intake jumped to an epic 1500 students from a mere 200 students annually. As a result, after 8 years, the number of midwives, for example, rose from only 8 to thousands across the country. At the specialty level, more than 200 doctors underwent specialty training in different countries such as Sudan, Ethiopia, Kenya, Uganda, Egypt, Tanzania, and South Africa.
Today, Juba Teaching Hospital alone is home to about 40 Specialists from different disciplines. The MoH also does capacity building training for healthcare professionals in the SSPDF and the University of Juba. As a result of human resource development in different medical fields, the maternal and child mortality rates dropped to 789 per 100,000 live births and 75 per 1,000 live births respectively by 2020. This is a significant achievement for the MoH and South Sudanese people at large.
On the Infrastructural Development, Dr. Makur and the leadership of the MoH together with partners initiated, launched and inaugurated several projects from Nov. 2011 up to May 2020. For example, more than 1500 new healthcare centres and units were built across the country, construction of 13 maternities in 6 states (EE, CE, NBG, Lakes, Warrap, and WBG); the establishment of Kiir Mayardit Women’s Hospital in Rumbek; the establishment of Al Cardinal Kidney Hospital in Juba; phase one of modernization and expansion of Juba Teaching Hospital (maternity and Accident & Emergency Departments); establishment and commissioning of National Blood Transfusion Service; the construction of two regional laboratories and two Regional Blood Transfusion Centers in Wau and Malakal; the construction of Gudele General Hospital in Juba, establishment and construction of the College of Physicians and Surgeons of South Sudan, Refurbishment of Dr. John Garang Infectious Disease Center in Juba, and formalizing community healthcare services through Boma Health Initiative that seeks to provide healthcare in the home setting.
To address the lack of a Public Health Laboratory, Dr. Makur initiated the completion of the Public Health Laboratory established in 1974 and was not completed by the Sudanese government. The Public Health Laboratory was then completed, equipped, and inaugurated in 2014 after 40 years of its establishment. As a result of having trained healthcare specialists and a public health laboratory, there were no samples taken outside the country for testing, an achievement the government and people of South Sudan should be proud of.
In the wake of the COVID-19 Pandemic and its sudden spread like a wildfire across the globe, the MoH further equipped the National Public Health laboratory with five Polymerase Chain (PCR) Machines and almost 20 Gene X-Pert Machines for testing the Corona Virus in the states and across the country as a preparedness strategy and remain on high alert. As expected, on the 5th of April 2020, a 29-year-old humanitarian aid worker was confirmed by the National Public Health Laboratory as COVID-19 POSITIVE.
With the confirmation of the COVID-19 first case in the country, Dr. Makur together with the team transitioned the strategy from preparedness to the response. As a military commander under attack from a fierce enemy, Dr. Makur was restive; he made sure the healthcare workers and medical professionals be deployed and equipped with response tools and make the public aware of how to prevent the spread of the pandemic. Among the response action points, the High-level Taskforce chaired by the first vice president of the Republic announced border closures, travel restrictions within the country, lockdown, and social distancing.
Despite all the efforts exerted by the MoH together with partners, and due to the level of South Sudanese people’s ignorance, the cases of COVID-19 rose to 1,604 confirmed cases with 15 patients recovered and 19 deaths recorded. On the 10th of June 2020, President Kiir decreed out Dr. Makur M. Kariom from the position of the Undersecretary of the MoH replacing him with Dr. Mayen Machut Aciek who was a Dean of School of Medicine from the University of Juba. The move was seen by many people as an attempt for the MoH to have fresh blood that would boost the performance of the healthcare system.
Still overwhelmed by the spread of the virus, Prof. Mayen Aciek was also fired shortly after a year in office and replaced with Dr. Anib Majur. But the biggest question is: what has changed regarding the COVID-19 level of spread in the country despite Dr. Makur replacements? It has risen from 1,604 confirmed cases during Dr. Makur’s time to 12,517 COVID-19 confirmed cases with about 133 deaths by October 2021. What else has improved in the MoH? The public has witnessed a series of power wranglings within the MoH and the latest was the suspension of the Undersecretary Dr. Anib by the Minister of Health Hon. Achuei Yol. This power wrangling has affected the normal operations of health institutions within the country at the time it is most needed.
What should be the remedy to this crisis in the MoH?
In the best interest of our country, President Salva Kiir Mayardit should reconsider his removal of Dr. Makur M. Kariom and reappoint him to the same position so that he can continue with his promising work in an effort of establishing a viable and sustainable healthcare system within the MoH and all health institutions in the country as attested by his major achievements in the past 9 years in office as discussed by the author in the preceding paragraphs. Someone may wonder why recommending the same man for the job.
The answer is simple, Dr. Makur is a down-to-earth administrator with vast skills and experiences in managing resources and personnel. His communication skills are exceptionally brilliant and that’s why a lot of health partners from the NGOs and UN agencies find it easy working and interacting with Dr. Makur. For the past 9 years, power wrangling, especially with his boss and subordinates have never been witnessed to the extent of public knowledge and this alone talks more about his good working relations with his boss and subordinates alike.
The key traits the writer admired from Dr. Makur includes his professionalism, his attitude towards people and work, his commitment to serving this country with patriotism and, his communication ability portrays his leadership qualities.
The author is a Humanitarian Aid Worker and an Activist on good Governance, Services delivery, and Accountability. The views expressed here are solely personal. He can be reach on the below contact details: Email: duluma88@gmail.com; Skype: +211917930449; Twitter: @dulumas; LinkedIn: https://www.linkedin.com/in/duluma-maker-1192b6132.
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