VZCZCXRO2255
PP RUEHGI RUEHMA RUEHROV
DE RUEHKH #1821/01 3251115
ZNR UUUUU ZZH
P 211115Z NOV 07
FM AMEMBASSY KHARTOUM
TO RUEHC/SECSTATE WASHDC PRIORITY 9245
INFO RUCNFUR/DARFUR COLLECTIVE PRIORITY
RUEHRN/USMISSION UN ROME

UNCLAS SECTION 01 OF 02 KHARTOUM 001821 
 
SIPDIS 
 
AIDAC 
SIPDIS 
 
STATE FOR AF/SPG, PRM, AND ALSO PASS USAID/W 
USAID FOR DCHA SUDAN TEAM, DCHA/OFDA, AND AFR/SP 
NAIROBI FOR USAID/DCHA/OFDA, USAID/REDSO, USAID/SFO AND FAS 
GENEVA FOR NKYLOH 
NSC FOR PMARCHAM AND MMAGAN 
USUN FOR TMALY 
BRUSSELS FOR PBROWN 
 
E.O. 12958:  N/A 
TAGS: EAID PREF PGOV PHUM SOCI UN SU
 
SUBJECT: SOUTHERN SUDAN - LAINYA COUNTY UPDATE 
 
REF: KHARTOUM 0766 
 
KHARTOUM 00001821  001.2 OF 002 
 
 
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Summary 
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¶1. From November 4 to 6, program officers from USAID's Office of 
U.S. Foreign Disaster Assistance (USAID/OFDA) traveled to Lainya 
County in Central Equatoria State, Southern Sudan, to review the 
status of the planned transition of USAID/OFDA-funded programs to 
the Government of Southern Sudan (GOSS) Ministry of Health (MOH). 
Lainya County, with an estimated population of 200,000 people, 
experienced significant displacement during the civil war.  However, 
Lainya County is farther along than most other counties in Southern 
Sudan in transitioning away from emergency relief aid to more 
sustainable recovery and development assistance.  Even with the 
progress, the USAID/OFDA team found that significant obstacles to 
transition still exist.  End Summary. 
 
---------- 
Background 
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¶2. Since March 2005, the USAID/OFDA-funded ZOA Refugee Care primary 
health care project in Lainya County has provided life-saving 
services to more than 95,000 people at its three primary health care 
centers and 11 primary health care units.  The total population of 
the county is more than 200,000 people.  Approximately, 23 percent 
of patients treated at the facilities are recent returnees.  Many 
internally displaced persons (IDPs) and refugees cite the 
availability of quality health care as a factor in influencing their 
decision to return to the county.  Prior to the project, the county 
did not have a health department.  In addition to ZOA's health care 
program, the Lainya County Health Department employs 15 professional 
health staff and manages 30 community-based health workers and 30 
vaccinators. 
 
¶3. Further evidence of the functionality of the Lainya County Health 
Department is that the Lainya County Medical Officer and the Primary 
Health Care Supervisor have actively lobbied and negotiated with the 
Central Equatoria State health authorities to incorporate the county 
health department staff into the state public service payroll and 
health budget.  An agreement reached earlier in 2007 between ZOA and 
the Central Equatoria State MOH, laid out plans for all 11 primary 
health care units and three primary health care centers supported by 
ZOA in Lainya County to be handed over to the county health 
department by December 2007.  While significant progress has been 
made towards that goal, it is clear that several key obstacles will 
likely prevent this handover from taking place on target. 
 
--------------------------------------- 
Transition: Opportunities and Obstacles 
--------------------------------------- 
 
¶4. In Lainya County, like most other counties in Southern Sudan, the 
county health department staff are not yet paid by the government. 
The staff are still paid incentives by non-governmental 
organizations (NGOs), such as ZOA in Lainya.  After positive 
discussions between the County Health Department, ZOA and the 
Central Equatoria State MOH (SMOH) in May, the SMOH agreed to carry 
out the necessary steps to incorporate the ZOA-supported facilities 
into the County Health Department and state MOH health system.  The 
SMOH conducted a full assessment of the facilities and staffing in 
July 2007 and forwarded the details to the Ministry of Public 
Service, which is responsible for reviewing and approving the 
incorporation of staff and facilities in the GOSS budget. 
 
¶5. Unfortunately, the assessment report's list of staffing needs 
exceeded the state's staff ceiling imposed by the Ministry of Public 
Service.  The ministry's ceiling policy specifies that each state 
may only employ 5,000 civil servants across all departments.  At the 
same time, MOH's facility standards require certain staff levels for 
each facility type: 6 staff for health care units, 16 staff for 
health care centers, and 107 staff for hospitals.  Meeting the 
required health staff levels alone would likely exceed civil servant 
ceilings in most states.  In addition, the MOH has not budgeted 
funds for the support of county-level health staff salaries; it 
simply does not have enough revenue to cover salary support at this 
level.  Lack of funding at the county level is a critical problem 
because it directly impacts service delivery.  Without adequate 
support for salaries, it will be very difficult for any county to 
attract and retain qualified health personnel or train new staff, 
 
KHARTOUM 00001821  002.2 OF 002 
 
 
even in counties as relatively well positioned for handover as 
Lainya.  The dual obstacles of staff ceilings and lack of salary 
support are significant barriers to handing facilities over to the 
MOH in Lainya County in the near term. 
 
¶6. USAID/OFDA staff met with the Deputy Director at the Central 
Equatoria SMOH after returning from Lainya County.  While the SMOH 
and County Health Department are still optimistic that the planned 
handover will happen by the end of the year, they admit significant 
barriers exist.  The SMOH cites revenue flow as a major problem. 
The SMOH budget for 2007 was submitted in January and approved in 
August, yet no funds have been allocated from the central to the 
state level.  According to the SMOH, the central MOH claims that the 
funds are not there and that the GOSS' share of oil revenues has not 
met projected levels.  Instead, the central government has 
instructed states to raise their own revenues via taxation. 
However, relying on taxation seems unrealistic given the lack of 
systems to collect taxes and manage budgets, even in places where a 
realistic tax base exists such as Juba. 
 
¶7. Despite obstacles, it is clear that the presence of a truly 
dedicated and energetic County Health Department, County Medical 
Officer (CMO), and strong NGO partner (ZOA) has made a great 
difference in the progress of planning for an eventual handover of 
health facilities to the MOH.  The selection of the CMO has led to 
impressive progress towards handover in the past six months.  For 
example, the CMO traveled to Juba and spent one month negotiating 
with SMOH and GOSS MOH to get the promised three-month drug supply 
for his facilities.  Despite this effort, the CMO managed to obtain 
supplies for only half of the facilities and had to rely on ZOA for 
transportation back to the county.  The dedication of the CMO has 
increased the confidence of the county staff and opened vital 
communication links between the county health department and the 
Central Equatoria State health and public service authorities.  The 
Lainya County Health Department plans to further engage the Central 
Equatoria State authorities in other key health areas such as the 
provision of pharmaceuticals. 
 
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Conclusions 
----------- 
 
¶8. Lainya County benefits from its proximity to Juba and the 
presence of such a strong cadre of stakeholders actively engaged in 
supporting and improving the health care system.  Still, obstacles 
to sustainable handover exist and need to be overcome, such as the 
lack of support for county-level salaries and a dysfunctional system 
for developing the human resource base.  Many other counties in 
Southern Sudan more remote than Lainya County get less support from 
GOSS and state structures, and do not have a functioning county 
health department.  Donors must coordinate and engage the GOSS MOH 
to address these obstacles and provide ongoing support to fill 
critical gaps in health sector coverage over the coming year. 
 
FERNANDEZ