Since mid-December 2013, ethnic clashes in South Sudan have displaced about a half-million people and sent more than 100,000 fleeing across borders seeking refuge. That insecurity, and the attendant mobility of the population, has interrupted a number of development programs, including several that are receiving financial support from the Global Fund.
The Global Fund and its principal recipients, the UN Development Program and Population Services International, are among legions of international organizations working in South Sudan since the framework for its independence was established in the 2005 Comprehensive Peace Agreement, responding to the considerable unmet needs in a country with only a basic public infrastructure.
Recent clashes have ground to a halt the slow transition South Sudan was pursuing away from emergency humanitarian assistance towards a more stable development scenario.
PSI program manager Farhana Zuberi told Aidspan in late January that overall, the recent conflict has had only a limited impact on the arrival into South Sudan of commodities. Malaria commodities were in country prior to the outbreak of the crisis, and there were only “one or two weeks of delays when the Juba airport was closed [from 16-19 December]” in deliveries of HIV-related supplies.
Road deliveries, however, have been more severely compromised. Three states – Jonglei, Unity and Upper Nile – remain inaccessible due to security concerns, according to Francis Yatta, the coordinator of the country coordination mechanism (CCM) secretariat.
“The southern route between Juba and Yei is equally risky for trucks because of armed bandits,” he told Aidspan during a January visit to the capital, Juba.
A city that in November was bristling with international staff from NGOs and diplomatic missions, Juba is now almost deserted due to insecurity. This has caused many South Sudanese partner organizations to close their doors temporarily and evacuate the city of their employees, leaving a lot of the programs unstaffed and phones unanswered. According to the Global Fund, management of programs it supports has continued, with the UN Development Program maintaining a complement of staff to support HIV activities and the PSI management unit in close contact from Nairobi.
Yet in repeated comments to Aidspan, South Sudanese health ministry officials carrying out malaria and HIV response campaigns and activities spoke of their frustrations about what they termed a lack of response and reaction from the Global Fund’s in-country partners to the humanitarian emergency that was unfolding.
In particular they cited the impossibility of reallocating existing funds to emerging needs, such as assessments in the crowded camps for the internally displaced, where an estimated one-third of new arrivals are showing up with malaria.
Pleas for greater flexibility in programs that could receive Global Fund support were aired again at a 31 January meeting in Nairobi, at which representatives from the Global Fund met with the PRs, the CCM, health ministry officials and other technical partners to develop a strategic response to the crisis.
The meetings, to which technical partners were invited as well as other humanitarian actors in South Sudan, was an effort to collaboratively develop strategies on how to deal with the issues emerging from the crisis and how to be most effective in service delivery despite the prevailing insecurity. Marion Gleixner, the portfolio manager for South Sudan for the Fund also called the meetings important for deliberations on contingency measures to be implemented in case there was further deterioration of the security situation.
“If there is something needed in the field, we will figure out a way to get it there. But we also need to make sure that we maintain our commitments to our existing programs, to our routine work,” she said.
Those “routine commitments” present their own challenges even at the best of times. The rainy season renders the anemic network of mostly dirt roads in South Sudan virtually impassable, leaving only a four-month window of opportunity for commodity and equipment distribution outside the capital.
“It prevents us from developing an efficient surveillance system around the country,” noted Yatta. “At the health facility level, we have to continuously remind personnel to remain vigilant or risk stockouts of critical medicines.”
Such vigilance takes time and requires a more established and mature health infrastructure. And while South Sudan has made great strides in establishing a health management information system, there are still yawning gaps in data collection as well as in administration of the system as a whole. It is for that reason that PRs for the Global Fund remain international organizations.
The government has signaled its intention to take over PR responsibilities in coming grant proposals, an announcement that was anticipated by the current PRs and an eventuality that has driven the inclusion of capacity-building and skills transfers into all of the Fund’s grants that the CCM chair, Dr Riek Lul said were critical “to overcome the huge gaps and challenges we have, in order to achieve harmonization.”
“We are not wedded to being PRs for life,” noted PSI’s Zuberi.
The growing pains and lessons experienced by South Sudan are to be expected for a country that has yet to celebrate its third birthday. But they also present a unique opportunity for the Global Fund to review its engagement with fragile states and how best to navigate an evolving security environment while ensuring service delivery and support.
Such a review is currently under way. In his November address to the Global Fund Board, the Secretariat’s executive director, Mark Dybul, referenced an ongoing evaluation by the Technical Evaluation Reference Group of the Fund’s engagement in fragile states (see framing document here). Aidspan understands that South Sudan will be included as one of three case studies contained in the review, which is expected to be made public in 2014.