South Sudan's Leaders Left Over 80 Percent of Births Without Skilled Care

Picture giving birth in the dark, with no trained hands to catch your child and no one to call when the bleeding does not stop. In South Sudan, more than four out of five births happen without a skilled health professional present. That is not a rounding error in a spreadsheet. It is mothers and newborns left to chance in the world's newest nation, a country that celebrated its independence in 2011 with promises of dignity and a future for its children.

Here is the arithmetic that should keep every South Sudanese leader awake. The national health workforce density stands at 7.9 health workers per 10,000 people, according to the South Sudan Annual Health Sector Performance Report 2024/25 and the 2025 Health Statistical Abstract. In practical terms, that means one health worker for roughly every 1,266 people. Those figures fall well short of what is needed to deliver essential services, and the source material puts the country at fewer than one-fifth of the workforce density considered necessary. Fewer than one-fifth. Let that sink in before you move on to the next paragraph.

Look closer at who is actually doing the work. Nurses have the highest density at 1.14 per 10,000 people. Midwives follow at 0.80, clinical officers at 0.68, and laboratory technicians at 0.35. These cadres are the backbone of frontline care, and South Sudan is leaning on them heavily. But look at the cadres that diagnose complex illness and steer a hospital through an emergency. Medical officers stand at 0.14 per 10,000 people, which works out to roughly one for every 71,000 citizens. Pharmacists sit at 0.08, and public health officers at 0.07. Ask yourself how a mother with pre-eclampsia, a child with severe malaria, or a man with a bullet wound is supposed to survive when the people trained to treat them are this scarce. The answer, for too many families, is that they do not.

The access problem runs deeper than headcount. The system records just 0.78 outpatient visits per person per year. Read that again. On average, a South Sudanese citizen does not even make one visit to a health facility in twelve months. The workforce gaps are compounded by service readiness problems across health facilities, meaning that even where a clinic exists, it may lack the staff, supplies, or basic capacity to deliver care when people arrive. The clinic is a building. Without people, medicine, and functioning systems, it is a shelter with a sign on the door.

South Sudan did not arrive at this place by accident. Its path since independence has been a brutal one, marked by the 2013 civil war, the collapse of the power-sharing arrangement in 2016, and the fragile Revitalised Peace Agreement of 2018. Each cycle of violence has drained trained professionals out of the country and into exile, and each cycle has left the health system to rebuild from rubble. Meanwhile, oil revenue has long supplied the bulk of government income, and the UN Panel of Experts on South Sudan has repeatedly documented the diversion and looting of public funds by those who hold power. So we must ask the question our leaders would rather we did not ask. Where did the money go, if not into nurses, midwives, and medical training schools? Universal health coverage is a noble phrase. In South Sudan, it currently exists mainly on paper, in communiqués and donor presentations, while mothers bury their children.

The tragedy is that the path out is not mysterious. Africa has already shown us what works. Rwanda built one of the most extensive community health worker networks on the continent, deploying trained local volunteers to reach households that formal clinics could not. That model saved lives, and it is worth studying seriously. We must also be honest about the hypocrisy that accompanies it. Kigali celebrates its health achievements on the global stage while its army wages a war of aggression inside eastern Congo, and the cost of that war is measured in the same human lives that health systems exist to protect. Rwanda's clinics are not a moral license to invade a neighbour. Botswana, meanwhile, has long combined disciplined public spending, strong institutions, and sustained investment in primary care, proving that a relatively small African state can keep its promises to its people when accountability is real. Mauritius has demonstrated the power of stable governance and open institutions to turn limited resources into broad human development. These are not abstractions. They are blueprints.

So what must South Sudan do? First, it must treat its health workers as an investment rather than an afterthought. Health workers who go unpaid for months will leave, and no training programme can outpace a mass exodus. The government should guarantee regular salaries, publish payroll data, and clear arrears as a matter of urgent public priority. Second, it must ring-fence the health budget and subject every dollar of spending to independent audit, with the results published in plain language for citizens and parliament to scrutinise. Transparency is not a luxury for a country trying to rebuild. It is the foundation of trust, and trust is what draws skilled professionals back home. Third, it must expand training pipelines for midwives, clinical officers, and medical officers, with schools in Juba and in the states most desperately short of staff. Fourth, it should use certified community health workers to reach rural households, backed by supervision, supplies, and a clear career path. Private sector partners, including pharmacy distributors and medical supply firms, can help strengthen supply chains if contracts are competitive, transparent, and enforceable under rule of law. Regional bodies such as the East African Community, which South Sudan joined in 2016, and the African Union's health agencies should provide technical support and hold Juba to its commitments.

Above all, the solution requires institutions that outlast any single politician. An independent judiciary that can prosecute the theft of public health funds. A civil service that promotes people on merit rather than loyalty. A free press that can expose empty clinics and unpaid nurses without fear of retaliation. These are the building blocks of a functioning state, and South Sudan cannot build a health system without them.

To the citizens of South Sudan, we say this. You are entitled to a nurse who shows up for work, a midwife who arrives before the crisis, and a doctor who has the training to save your child. You are not asking for charity. You are demanding the basic return on the resources your nation already produces. Demand published health budgets. Demand the payment of health workers. Demand that your representatives tie every new oil contract and donor pledge to measurable improvements in staffing and birth attendance. Show up at the health ministry and at parliament with the names of the clinics that have no staff. Make the numbers in the Annual Health Sector Performance Report impossible to ignore.

To African leaders across the continent, the question is equally simple. Will you keep treating South Sudan's health crisis as someone else's problem, or will you insist that every African mother deserves a trained attendant at her side? The 19.5 percent figure is not a footnote. It is an indictment of a political class that has had the resources and the chance to act, and of every regional partner that has looked away. Fix the workforce, fix the money trail, and fix the institutions that let both rot. The mothers of South Sudan are not waiting for another summit. They are waiting for someone in power to finally answer for the births that happen alone.

Based on reporting by RELIEFWEB