Health care in South Sudan at a crossroads.

This was supposed to be a year of transition for South Sudan’s health system. After last July’s independence, the country—shored up by international donors—was set to move away from emergency response and toward post-confl ict health system development. But the government’s decision to turn off the country’s oil production—and with it 98% of the national revenue—over a pricing feud with Sudan, will slow that process. In building a health system after decades of war, South Sudan was basically “starting everything from zero”, according to Loi Thuou, the director general of medical services. The country had little health infrastructure, equipment, or trained medical providers—and little money for the health sector. In 2011, the government spent about US$9 per person on health care. International non-governmental organisations (NGOs) fi lled in some gaps, providing more than 80% of the country’s available basic health care, which still does not reach most of the population. Nevertheless, the government was prepared to begin directing the development of the country’s health system. Last year offi cials released a strategy—the Health Sector Development Plan (HSDP)—calling for a 5-year focus on providing a package of basic health services, with a specifi c emphasis on maternal and child health. Recognising that even with anticipated oil revenue, government funds were limited, the plan necessitated strategic national investments, along with a continued reliance on NGOs to fund most health services. However, there was an expectation that the government would slowly begin assuming more “running costs”, such as salaries and drug supplies. Then, in January, South Sudan switched off its oil. The oil-rich south had been running its crude through Sudan’s pipelines, but a row between the two countries over transit costs led to the shutdown. The decision has forced South Sudan to begin implementing an austerity budget.