VZCZCXRO6848
PP RUEHGI RUEHMA RUEHROV
DE RUEHKH #0592/01 1061401
ZNR UUUUU ZZH
P 161401Z APR 07
FM AMEMBASSY KHARTOUM
TO RUEHC/SECSTATE WASHDC PRIORITY 6865
INFO RUCNFUR/DARFUR COLLECTIVE PRIORITY
RUEHRN/USMISSION UN ROME

UNCLAS SECTION 01 OF 02 KHARTOUM 000592 
 
SIPDIS 
 
AIDAC 
SIPDIS 
 
STATE FOR AF/SPG, PRM, AND ALSO PASS USAID/W 
USAID FOR DCHA SUDAN TEAM, AFR/SP 
NAIROBI FOR USAID/DCHA, USAID/SFO, USAID/EA, AND FAS 
GENEVA FOR NKYLOH 
NSC FOR PMARCHAM, MMAGAN, AND TSHORTLEY 
ADDIS ABABA FOR USAU 
USUN FOR TMALY 
BRUSSELS FOR PLERNER 
 
E.O. 12958: N/A 
TAGS: EAID PREF PGOV PHUM SOCI SU
SUBJECT: Sudan - Juba Teaching Hospital 
 
KHARTOUM 00000592  001.2 OF 002 
 
 
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Summary 
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¶1. (U) Juba Teaching Hospital (JTH) faces numerous challenges as it 
adapts to rapidly increasing demand and the new management of the 
Government of Southern Sudan (GOSS). The imminent withdrawal of 
longtime supporter International Committee of the Red Cross (ICRC) 
will be a serious test for the hospital, as will the creation of new 
systems, the limited administrative capacity of the GOSS, and staff 
performance and training. The Multidonor Trust Fund (MDTF) will soon 
award a contract for hospital management, but it is unlikely to be a 
panacea for the myriad challenges confronting JTH. End Summary. 
 
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Juba Teaching Hospital 
------------- 
 
¶2. (U) With 479 beds, JTH is the largest hospital in Southern Sudan 
and the only functioning hospital in Juba county. On paper, Juba 
also has a military hospital, a police hospital, and a children's 
hospital, but neither uniformed service hospital is operational, and 
while the children's hospital--El Sabah--provides some patient care, 
it is not fully functional and reportedly stigmatized by the 
community. 
 
¶3. (U) The influx of residents since the signing of the CPA has 
substantially increased the demand for health services in Juba, and 
inadequate resources have made JTH the major service provider. The 
surgical caseload is high (434 operations were conducted in March 
2007). Wards are overcrowded. Epidemics of cholera, measles, and 
meningitis strain capacity. Trauma cases associated with road 
accidents have increased. The GOSS Ministry of Health (MOH) is 
responsible for drug procurement, but only one allotment has been 
received, in August 2006. 
 
¶4. (U) Built as colonial-era army barracks, JTH is undergoing an 
MDTF-funded renovation that began last year. The work, which is 
managed by the GOSS Ministry of Engineering and Public Works, is 
slower than planned and has forced some services to be displaced to 
inadequate temporary quarters. Hospital officials were not included 
in planning, and note that the renovation fails to address the need 
for increased space for patient care. 
 
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ICRC Withdrawal from JTH 
----------- 
 
¶6. (U) ICRC, which has backed JTH for 14 years, will cease support 
in December 2007 because its mandate is limited to emergency 
situations. ICRC has provided personnel, equipment, supplies, 
infrastructure support, and operating funds. It also supports two 
training programs: a nursing program that enrolls 90 students a 
year, who make up a key segment of JTH nursing staff; and an 
institute that trains lab and medical assistants. 
 
¶7. (U) The acting physician in charge estimates that ICRC provides 
more than 90% of JTH operating resources, though the ICRC says this 
is an overestimation. Both agree that the withdrawal will create 
major challenges. 
 
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Health Sector Changes 
------------- 
 
¶8. (U) After the signing of the CPA, uncertainty on whether JTH 
would be managed by the state or the GOSS hampered planning and 
affected staff morale. It was determined that the GOSS would enter 
into separate management contracts for tertiary facilities such as 
JTH. MDTF will initially provide $1.5 million a year for JTH 
management and operation, and fund drug procurement separately. GOSS 
ministries are responsible for staff salaries. Note: Many JTH staff 
appear to be unaware that this issue has been resolved. End note. 
MDTF will award contracts within the next six months, and 
anticipates that a contractor will be on ground by September. 
However, implementation is widely perceived to be slow, and ICRC 
officials are concerned that delays will impair the transition and 
adversely affect patient services. 
 
¶10. (U) Slow strategic planning has hindered progress. Attention was 
diverted by planning for a new health facility in Juba. However, 
funding has not materialized, and the John Garang Memorial Facility 
 
KHARTOUM 00000592  002.2 OF 002 
 
 
is likely some years from fruition. Uncertainty also spiked with the 
unexpected GOSS announcement of a contract with NORMECA to build, 
staff, and operate one prefabricated hospital in each southern 
state. Some stakeholders suggest this was negotiated by senior 
officials outside normal processes and may be under investigation. 
 
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Human Resource Issues 
---------- 
 
¶11. (U) Staff performance at JTH is a significant barrier to 
improving services. A culture of apathy pervades the hospital, 
exceeding that which is found at other facilities in the south. 
During the war, hospital employment was akin to a sinecure, and many 
MOH staff went on the hospital payroll after evacuating from 
hospitals in other towns. At JTH, human resource systems are absent 
or ineffective. The hospital matron observes that JTH has abundant 
nursing staff, but absenteeism is pervasive, dedication is uncommon, 
and employees resist new responsibilities. 
 
¶12. (U) Low wages contribute to morale problems and reduce 
management leverage. The new GOSS salary scale increased wages for 
higher-level workers, but decreased wages for nurses. Hospital staff 
has criticized the decision to set salary scales in US dollars 
because fluctuating exchange rates render monthly wages variable, 
and the declining value of the dollar has decreased salaries. One 
brief work stoppage occurred recently and rumors of more persist. 
 
¶13. (U) Juba's status as a former garrison town adds another layer 
of friction. JTH staff lived and worked under the GOS for years; 
some say that the GOSS now views them with suspicion for having 
"slept with the enemy." Rumors abound that staff will be replaced 
with GOSS personnel, while JTH doctors and nurses in turn voice 
skepticism about GOSS capacity to operate hospitals. MDTF reports 
that the GOSS Minister of Health has stipulated that any future JTH 
management contractor should not transfer or fire large numbers of 
staff. 
 
¶14. (U) JTH is also expected to adopt English as its official 
workplace and training language this year. Many hospital staff are 
not fluent in English, and second- and third-year nursing students, 
who began their education in Arabic, will now be taught in 
English--which reportedly a third of them do not understand. 
 
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USG Role 
------------ 
 
¶15. (U) The USG provides substantial support to JTH. The State 
Department Bureau for Population, Refugees, and Migration provides a 
fifth of ICRC's total funding for sub-Saharan Africa. USAID funded 
the recent construction of a new emergency wing at JTH, and programs 
to improve sanitation and access to water in Juba should contribute 
over time to reduced patient burdens at the hospital. USAID also 
funds a program that supports volunteer diaspora health 
professionals, including two physicians and one mental health 
counselor at JTH. With funding from the President's Emergency Plan 
for AIDS Relief, the Centers for Disease Control will support 
delivery of services, such as prevention of mother to child 
transmission (PMTCT). 
 
 
HUME