The appointment of Adut Salva Kiir Mayardit as Senior Presidential Envoy on special programs comes at a time when South Sudan is at a crossroads, both politically and socially. For decades, the conversation about national development has often revolved around roads, oil, and peace agreements. Roads connect towns, oil sustains the economy, and peace stabilises the state, but none of these can endure without a healthy people to walk the roads, work in the oilfields, and enjoy the peace so painstakingly negotiated. Her new role is more than symbolic; it represents a new opportunity for the government to turn its gaze inward, to prioritize the health of its citizens, and to create a future where development is not measured only in kilometers of tarmac but in the survival of mothers and newborn, in the strength of communities, and in the dignity of life expectancy that rises from despair toward hope.
In this context, Adut Salva Kiir’s public promise to support the construction of 450 hospitals is a powerful gesture of hope. It signals a long-overdue ambition to expand geographic access to care and to bring services closer to communities that have waited too long. Yet the reality of South Sudan’s current health crisis demands that infrastructure expansion be sequenced wisely. Bricks and mortar will not save lives without the people, systems, and recurrent financing required to run them. The most acute needs today are service delivery and the health workforce, including essential medicines and supplies, functional referral and emergency systems, reliable power, water, and cold chains, as well as a trained, motivated, and fairly distributed cadre of health workers at every level. Infrastructure should follow and reinforce these foundations rather than precede them. When built on a strong base of service readiness and human resources for health, new hospitals will become centres of healing instead of empty shells.
For years, the nation has poured much of its energy into infrastructure, particularly roads, under special programs. This was understandable. A nation emerging from decades of war and division needed physical connectivity. Roads symbolise unity, trade, and progress. They are the veins through which economic life flows. Yet the hard truth is that while roads are being opened, too many South Sudanese mothers still die during childbirth, too many newborns fail to survive the first days of life, and too many families bury their loved ones at ages far younger than they should. Maternal mortality remains among the highest in the world, with an estimated 789 women lost for every 100,000 live births. Neonatal mortality is equally devastating, with close to 39 newborn deaths per 1,000 live births. Life expectancy hovers around 55 years, one of the lowest globally. These figures are not statistics alone; they are stories of suffering that unfold daily in rural villages, urban settlements, and displaced communities. They remind us that development is incomplete when health is neglected.
The major killers in South Sudan are not diseases without cures or mysteries of modern medicine. They are malaria, respiratory infections, diarrheal diseases, and complications of pregnancy and childbirth. They are preventable and treatable conditions, yet they continue to claim lives because the health system remains fragile, fragmented, and under-resourced. Vaccination coverage remains well below global standards, with many children failing to receive basic immunisations such as measles, polio, and others. This leaves entire generations vulnerable to diseases that other countries have long brought under control. When seen through the lens of the Sustainable Development Goals and the global ambition for Universal Health Coverage, South Sudan is tragically behind. The targets to reduce maternal and child deaths, to expand access to essential services, and to raise life expectancy all remain distant unless urgent action is taken.
This is where Adut Salva Kiir Mayardit’s appointment holds profound significance. As the daughter of the First Family, she represents continuity of leadership, but more importantly, she symbolises a generational transition. The younger generation of South Sudanese expects leaders who understand that development must be human-centred. Her role as a Presidential Envoy offers her a platform to influence the priorities of government. She is in a unique position to call upon the very government she serves to put health at the centre of its national agenda. Unlike in the past, where health has been left largely to the mercy of international donors, her role must be grounded in the conviction that health sector funding is first and foremost a government responsibility. South Sudan cannot outsource its health to the goodwill of others. Donor support, while valuable, is unpredictable and often driven by external priorities. Donors prefer to fund diseases that resonate globally, for instance, HIV, tuberculosis, and malaria, because these fit within international frameworks. But maternal mortality, neonatal survival, training of midwives, or community health systems do not attract as much global attention. These are left underfunded, and yet they are the very issues that cost South Sudanese families the most. This is why relying on donor direction is dangerous. A sovereign state must finance the health of its people as a matter of national duty, not charity. Adut’s appointment is the right moment to insist on this. She can use her position to tell her government to place health at the centre of its own spending. The budget must reflect the values of the nation, and there is no greater value than protecting life.
The Boma Health Initiative, as designed by the government, is one of the best strategies available. It is a simple yet profound idea: deploy community health workers to the grassroots so that no family is left without access to basic services. The model is effective, cost-efficient, and adaptable. Countries that have invested in community health workers, like Ethiopia with its Health Extension Program, have seen dramatic improvements in maternal survival, vaccination coverage, and disease control. South Sudan has the blueprint already; what is missing is the political will and domestic funding. Adut can insist that this government-owned strategy must be government-financed, not left to wither under donor neglect. By pushing for consistent allocation of state resources to BHI, she will ensure that the system grows roots, survives donor cycles, and becomes truly national in character. Crucially, as hospitals are planned and built, BHI can serve as the feeder and first line of care triaging, referring, and following up so that new facilities are utilised effectively and not overwhelmed by conditions best managed at community or primary levels.
Adut can champion this cause by pressing for specific budget lines dedicated to human resource training, ensuring they are protected even during economic crises. Only then will a golden program to build 450 hospitals translate into real, high-quality services; without people and systems, buildings alone cannot deliver care. Service delivery readiness must be the yardstick for sequencing infrastructure. Essential medicines and commodities must flow reliably through an accountable supply chain.
Community-based organisations also play a crucial role. These organisations, born within the society, understand the culture, geography, and struggles of the people. They are trusted voices that can deliver health education, mobilise communities for vaccination, and monitor service delivery in ways that central institutions cannot. Working with them is not a luxury; it is a necessity. Adut, with her ASK Foundation, can facilitate this collaboration. Her Foundation can pilot projects that demonstrate how government funds, when aligned with community organisation efforts, produce tangible results. For example, a partnership between the ASK Foundation, local women’s groups, and the Ministry of Health could run maternal waiting homes near rural hospitals, reducing deaths from childbirth complications. Another partnership could equip rural clinics with solar-powered refrigeration to preserve vaccines, thereby increasing immunisation rates. Such efforts would ensure that when new hospitals open their doors, communities are prepared to use them appropriately and confidently.
The ASK Foundation must not be seen as replacing government responsibility, but as complementing it. It can be the innovative wing of national health efforts, testing models that the government can later scale up. By working hand in hand with the government and community-based organisations, the Foundation can demonstrate that partnerships anchored in national leadership produce lasting impact. In doing so, it will show that the First Family’s contribution to the nation is not only in politics but also in the very survival and well-being of its citizens.
South Sudan’s lagging position in achieving the Sustainable Development Goals is not inevitable. Countries that started from equally difficult positions have made remarkable progress when they decided to prioritise health. Rwanda, scarred by genocide, invested heavily in community health and maternal care, and today boasts one of the most improved health systems in Africa. Ethiopia, with a vast rural population, reduced maternal mortality significantly through health extension workers. Uganda improved vaccination coverage by making immunisation campaigns part of the government routine. South Sudan can learn from these examples, but it must commit itself financially and politically. Adut’s voice can ensure that this commitment is made not in speeches alone but in budget allocations and action plans. When a mother in Juba dies because the hospital had no blood, it is not an individual tragedy but a national failure. When a child in Torit succumbs to measles because vaccines did not reach his village, it is not fate but neglect. When young people across the country bury parents in their fifties, it is not destiny but poor planning. The government must recognise that these losses weaken the nation more than any external threat. By failing to fund health adequately, the state undermines its own survival. This is why Adut’s role matters. As Presidential Envoy, she can carry this message with clarity: that South Sudan must finance the health of South Sudanese as a matter of sovereignty, responsibility, and survival. Her leadership can help create a culture where the health budget is no longer the smallest, where hospitals are no longer places of despair, and where health workers are no longer symbols of sacrifice without support. It is time for the government to prove that it values the lives of its people. It is time for the health sector to be prioritised, financed, and protected. With Adut’s appointment, the moment to demand this has arrived.
South Sudan’s health challenges are often described through statistics, but behind every number lies a human tragedy and a missed opportunity for the nation. When we say that nearly eight hundred women die for every one hundred thousand live births, we are describing the mothers who collapse on dirt floors, bleeding without medical help, because there is no midwife nearby. We are speaking of young women whose families watch helplessly as childbirth, which should be a moment of joy, turns into a funeral. When we say thirty-nine newborns die for every one thousand live births, we are describing babies who take their first breaths only to gasp their last within days, because the health facility had no incubator, no antibiotics, or because their mothers were too weak to nurse them. Life expectancy of fifty-five years means fathers and mothers do not live long enough to see their children grow, and young people bury their parents while still struggling to find their own footing. These are not mere health sector problems; they are national security problems, economic problems, and human dignity problems. It is often said that a nation is only as strong as the health of its people. A country can build roads, drill oil, and print money, but if its people are sick, weak, and dying young, it has no foundation upon which to stand. South Sudan’s government must therefore treat health not as a side agenda but as a central pillar of state-building. Roads and bridges are important, but they are useless if the citizens who should use them are lying in hospital beds or graves. The appointment of Adut Salva Kiir Mayardit presents a golden opportunity for this truth to be spoken loudly from within the highest circles of power. As Presidential Envoy, she has the chance to make the case that government budget priorities must change, that the nation’s money must go first into the lives of its people, not last.
Her appointment is therefore not just an opportunity for personal achievement but a call to national responsibility. She can choose to be remembered as a ceremonial envoy, or she can choose to be remembered as the envoy who transformed the nation’s priorities. By placing health at the heart of her agenda, she will not only strengthen the credibility of her government but also create a legacy of compassion, foresight, and nation-building. Her leadership, supported by community organisations and her ASK Foundation, can redefine what development means in South Sudan. The task ahead is daunting, but it is achievable. The country has already shown that when political will exists, roads can be built, armies can be trained, and institutions can be sustained. The same determination can be applied to health. By channelling government resources into health worker training, essential medicines and supplies, primary care readiness, community health initiatives, and, at the right time, well-sited hospital infrastructure, South Sudan can begin to reverse its dismal health indicators. Maternal deaths can decline, newborn survival can increase, vaccination coverage can rise, and life expectancy can move upward.
The appointment of Adut Salva Kiir Mayardit as a Presidential Envoy is thus a historic chance to change course. It is an invitation to her and to the government she serves to recognise that development is not only about physical infrastructure but about the dignity and well-being of citizens. If she champions health sector funding from within government, if she mobilises the ASK Foundation to complement state investment, and if she collaborates with community-based organisations to implement strategies like the Boma Health Initiative, she will be remembered as the envoy who helped heal a nation. South Sudan has travelled far in pursuit of independence, unity, and peace. Now it must travel the road of health. That journey requires resources, leadership, and courage. Adut has the chance to provide that leadership, to insist that government budgets reflect the true needs of its people, and to demonstrate that the health of a nation is the Foundation of all other forms of progress. Roads may connect towns, but it is health that connects lives, dreams, and futures.
The writer, Dr. Ramzy Muorwel Matueny, is a Public Health Consultant, Specialist Physician, and researcher with extensive expertise in clinical medicine, public health, and health systems strengthening. He is affiliated with the School of Public Health, Mount Kenya University, and a Fellow at the Faculty of Medicine, Benha University, Egypt. His academic and professional work focuses on advancing healthcare delivery, medical education, and evidence-based research to address pressing health challenges in Africa and beyond. He can be reached at ramzymuorwel@gmail.com
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