Egypt – South Sudan Establishing Two Family Medical Units in South Sudan:
Egypt – Ministry of Health
South Sudan – Ministry of Health
Egyptian Institutions involved:
Cabinet - funded the project
General Authority for Educational Buildings, Ministry of Education of Egypt - advisory body that supervises the construction
Central Department for Technical Support and Projects, Ministry of Health and Population of Egypt - Project Management
The central administration of the Secretariat, Ministry of Health and Population of Egypt - the contracting agency
Arab Contractors Company's business and investment - the Executing Agency
The Egyptian National Council for the Defence of the Egyptian General Intelligence - the mechanism of supply and installation of medical and non-medical equipment
Sudanese Institutions involved:
Ministry of Health of South Sudan through official correspondence and technical delegations
The General Consulate in Juba
The Egyptian Ministry of Health began an initiative with the objective of establishing two medical units for supporting the health services in the states of Warab (Akoun City) and Jonglei (Bor City). The project will help develop the health sector capacity in South Sudan. The overall outcome would be to improve the health standards in the two cities.
Background and set-up:
In 2006, the Sudanese government requested the assistance to sustain the health services in southern Sudan. The Egyptian government agreed to assist with the goal to support and develop the health services in southern Sudan. Egypt's government was further motivated to engage in the initiative due to political aspiration to strengthen relations and mutual understanding at all levels between both countries. In addition, Sudan's development and security is considered a national security priority, with a vital strategic importance and a key external relations priority for Egypt.
Accordingly, the coordination took place between the involved stakeholders through the official channels, followed by several meetings and delegations on both ends. The leading parties in the coordination process were through the Egyptian ministry of Foreign Affairs, the General Consulate in Juba, and both ministries of health.
Egypt's Ministry of Health developed the full concept of the project in terms of medical specialties and equipment necessary to provide medical service to patients in South Sudan. The required medical specialties were determined based on several coordination meetings between the Egyptian and Sudanese.
In June 1, 2009, the project Sites were handed over to the Egyptian contractors with a plan to finish construction and implementation in a period of 8 months. However, additional time was requested due to the high temperature in the summer season.
After the completion of the construction and equipping of the two units, the Egyptian ministry of health will provide the management and medical practitioners to insure a sustainable and successful outcome for the near future.
Ownership and mutual accountability:
1. Sudanese ownership and alignment of the project
The project concept is based on the government of South Sudan's healthcare improvement strategy. The project was requested by the Sudanese government. It is aligned with South Sudan's priority to provide better healthcare to its population. South Sudan was involved in the coordination of the project. The Consulate General in Juba and the Medical Advisor in Khartoum represented the Sudanese government in the coordination process. In addition, the Ministry of Health in South Sudan was responsible for the project's planning through official correspondence with the Egyptian technical delegations.
Further, the Sudanese government selected the medical clinics, and the locations of both units. Coordination meetings were held to determine the needed medical specialisations. The Director of the Medical Centre in Juba requested to amend the medical facilities to include ophthalmology clinic, surgery clinic, and internal medicine clinic. In addition, he recommended two gynaecology and paediatrics clinics to be established. The initial plan was to include dental clinics in both units, but both were cancelled based on the Sudanese government's request.
2. Responsibilities and divided workload
Egypt has the necessary experience in both health and construction sectors compared to the newly-born state of South Sudan. Therefore, responsibilities of the project were mainly on the Egyptian side. This includes the construction work, providing medical and non-medical equipments, financing the project, and providing management and medical practitioners. The Sudanese government selected the location and provided the land necessary for the project, as well as the necessary assessment for the local needs of healthcare.
The overall goal of this initiative is to assist in the development of the health sector in South Sudan, and to provide financial assistance.
Due to the political instability and environmental conditions in South Sudan, the Egyptian implementing agency was faced with several challenges:
Inadequate infrastructure (roads and transportation) where both sites are located, making working condition more difficult, other major factors are the lack of electricity and proper water source. Therefore, the Egyptian government had to provide electricity generators and water tanks to establish a working environment.
Inefficient security measures in South Sudan in both locations of the projects became a problem for the construction company responsible for the sites. This was mainly due to the violence resulting from tribal conflicts and rebellion in southern Sudan. The implementing agency had to provide the security necessary to protect the sites, and the construction equipments and materials through building a fence around the work areas, creating additional cost to the initial planned budget of the initiative.
Although the work plan included the suspension of work during summer due to the weather conditions, more delay took place because of unexpected harsh weather and heavy rain during the fall season. The timetable for the construction was extended to include additional period of time.
Due to the high temperature of the summer, air conditionings were added to both unites to create a better working environment.
The additional expenses required to overcome these challenges resulted in change of the initial budget. The cost is being studied by the implementing agency, and it will be presented to the Egyptian Cabinet of Ministers for evaluation and approval. This puts a constraint on the completion of the project, knowing the economic situation in Egypt after 25 January Revolution.
National capacity building
The project contributed to building the national capacities of both Egypt and South Sudan.
The project contributed to the development of the Egyptian capacity in construction sector through working in remote/rural areas with special needs and conditions to adapt to.
Training Egyptian cadres from physicians, engineers and labour on the work needed in remote areas with tough conditions in developing countries.
The experience gained through this cooperation would strengthen understanding, by both countries, of the potential gains of South-South Co-operation (SSC) with other African countries.
This co-operation would contribute to aid effectiveness through capacity development by granting the Sudanese government better resources to provide better health care in the projects' area, and to become more self-reliant in the future.
The success of this project is due also to clear political commitments at senior levels in both countries and the establishment of specific objectives, identifying the role of each side.
Being a demand-driven initiative, Sudan's officials had a clear idea of what was needed and Egypt had the necessary expertise and willingness to respond positively.
These objectives are aligned with Sudan's development priorities.
Periodic and final reports on achieved activities and budget are shared with the Sudanese authorities. This adds to South Sudan's experience for future co-operation in similar projects.
Practices that can inform global policies:
This experience resolved some problems of North-South Co-operation including culture and language differences, as well as high costs of transfer of resources and wages of staff.
While Egypt has a comparative advantage in the field of Healthcare, both parties benefited from this experience with regards to developing national capacities. The initiative focused on developing local capacity in South Sudan. It also strengthened the capacities of Egyptian cadres to adapt to hard working conditions and deal with several development challenges. In addition, knowledge gained from this experience added to Egypt and South Sudan's understanding of how to strengthen mutual co-operation, and South-South Co-operation (SSC) with other actors.
Lessons learned that can be shared with the international community:
Conducting a study on the environment of the targeted country prior to the implementation process leads to developing a better work plan and feasibility analysis, as well as reduces risks.
To avoid lags in the implementation process, certain mechanisms should be followed, such as: co-ordination among different stakeholders, resolving differences among stakeholders and implementing agencies (for example differences regarding quality standards and finishing), and careful assessment of estimates made by outside contractors.
It is important to provide security and insurance mechanisms that encourage the private sector to invest in Southern countries.
Engaging banks in SSC through providing long-term loans can resolve the problem of fund constraints.
Southern countries should develop systems and practices which would facilitate SSC.
Bridging South-South and North-South:
This initiative could have benefited from a Northern partner or an international organisation to overcome financial constraints, provided that co-operation is based on horizontal partnerships among the three parties.
A platform or framework for south-south and triangular knowledge, however, future support by mechanisms would be welcomed to replicate this experience with other states in South Sudan or similar countries.
Demand and Supply:
The Egyptian government is interested in sharing this experience with other south-south actors, which can enrich the initiative by receiving feedbacks, as well as strengthen south-south knowledge among south countries.
This initiative can be replicated in other countries that lack access to proper health care, especially in Somalia, Chad, Djibouti, and Ethiopia; however, some consideration should be given to the local needs depending on the nature of diseases that exist and available resources.
This case and others in the international network for knowledge exchange will facilitate matching supply and demand in the international community.
The project still in progress and expected to be up and running by August 2011.
Budget (Division of Responsibilities): The total cost of the units was initially 32 Million LE, 16 million LE for each unit, including the construction and equipments cost (Medical and Non-Medical). The cost was provided by the Egyptian government. Meanwhile, the government of South Sudan provided the needed land for the two units. The 32 Million do not represent the final cost since challenges required extra money to overcome, such as the necessary security of the two locations and power generators, which is provided by the Egyptian government.
Name of Primary Contact Persons
1. Mr. Bassam Hassan
2. Mr. Mohamed Abdel Maksoud
3. Joseph Michael
4. Esraa El Sheikh
Title of Primary Contact Persons
1. Advisor to the Minister of Health and Population for International Co-operation and Agreement Affairs
2. Economic Researcher, International Co-operation and Agreement Affairs, Ministry of Health
3. International Co-operation Officer, SSC Unit, Ministry of International Co-operation
4. International Co-operation Officer, SSC Unit, Ministry of International Co-operation
City Cairo, Egypt