Abstract:
At independence in 2011, South Sudan's health sector was almost non-existent. The first
national health strategic plan aimed to achieve an integrated health facility network that
would mean that 70% of the population were within 5 km of a health service provider.
Publically available data on functioning and closed health facilities, population
distribution, road networks, land use and elevation were used to compute the fraction of
the population within 1 hour walking distance of the nearest public health facility
offering curative services. This metric was summarised for each of the 78 counties in
South Sudan and compared with simpler metrics of the proportion of the population
within 5 km of a health facility. In 2016, it is estimated that there were 1747 public
health facilities, out of which 294 were non-functional in part due to the on-going civil
conflict. Access to a service provider was poor with only 25.7% of the population living
within one-hour walking time to a facility and 28.6% of the population within 5 km.
These metrics, when applied sub-nationally, identified the same high priority, most
vulnerable counties. Simple metrics based upon population distribution and location of
facilities might be as valuable as more complex models of health access, where attribute
data on travel routes are imperfect or incomplete and sparse. Disparities exist in South
Sudan among counties and those with the poorest health access should be targeted for
priority expansion of clinical services.