South Sudan’s Ministry of Health on Tuesday announced a scale-down of services in more than 100 health facilities nationwide following major reductions in donor funding for the Health Sector Transformation Project (HSTP), a flagship reform initiative originally budgeted at $400 million.
Speaking at a press conference in Juba, Health Minister Sarah Cleto Rial said support under the HSTP will be withdrawn from 101 health facilities, while six hospitals will scale down selected non-core services to focus on life-saving care. She said the decision follows an extensive review aimed at keeping the project viable through its planned end in 2027.
“When the HSTP was launched in 2024, it was designed as a multi-donor investment of about $400 million,” Rial said. “However, the withdrawal of key donors and global funding constraints has reduced available resources by nearly half, forcing us to realign priorities.”
According to the minister, the United States and Sweden—both major contributors—pulled out of the project early in its implementation, leaving the program with roughly $200 million in pledged funding, not all of which has been disbursed.
She said the government has committed to co-financing the project and has raised the funding gap with the Council of Ministers.
The Health Sector Transformation Project is a three-year national roadmap running from 2024 to 2027, aimed at shifting South Sudan’s health system away from emergency, aid-dependent responses toward a sustainable, government-led model. The project is supported by development partners including the World Bank, Canada, the European Union, the United Kingdom’s Foreign, Commonwealth and Development Office (FCDO), and GAVI, with UNICEF and the World Health Organisation providing management support.
Despite the funding cuts, Rial said the Ministry of Health currently oversees 1,158 health facilities, including four national referral hospitals and 11 state hospitals, implemented through partnerships with more than 28 international and national non-governmental organisations across the country’s 10 states and three administrative areas.
Explaining how facilities were selected for the scale-down, Dr. Akello Harriet Pasquale, Director General for International Health, said the ministry and its partners used clear criteria to minimise disruption to health services.
She said that facilities severely underutilised due to poor access, flooding, insecurity, or weak infrastructure were among those dropped from HSTP support.
“In some cases, facilities were located very close to others serving larger populations,” Pasquale said, adding that consultations were held with state health ministers and state directors general before final decisions were made.
She said the final number of facilities affected stands at 102, a move intended to close a funding gap of about $38 million over the remaining two years of the project.
Pasquale emphasized that the affected facilities will remain operational and continue to provide services, even though HSTP support will no longer be extended to them.
She said the ministry is engaging with state authorities, donors, and other partners to identify alternative funding mechanisms.
Rial also stressed that the scale-down does not amount to the closure of health facilities, countering concerns raised by the public and civil society.
“No health facility has been shut down,” she said. “Health workers are still working, and services are continuing. What has changed is the level of funding under the HSTP.”
The minister said administrative and training costs under the project will be reduced so that limited resources are prioritised for essential medicines, frontline health workers, and direct patient care.
She called on state governments to take greater ownership of health service delivery, including mobilising local resources and ensuring the safety of health workers.
While acknowledging that the adjustments are difficult, Rial said the measures are temporary and necessary to protect the long-term sustainability of South Sudan’s health system.
“We are not merely spending resources,” she said. “We are investing in a health system that must endure beyond this project.”
Meanwhile, Dr Benjamin Malek Alier, Chairperson of the Specialised Health Committee in the Transitional National Legislative Assembly, stated that public concerns about hospital closures stem from a widespread misunderstanding of the funding situation surrounding the Health Sector Transformation Project.
He said the project was initially planned to run until 2027 with a proposed budget of $400 million, including a $10 million government contribution, but donors were ultimately able to mobilise only about $216 million, forcing the World Bank and partners to introduce reduction criteria to keep the project running.
Alier said the decision to scale down support for some health facilities was discussed during the national health summit and involved state health ministers, senior officials from the Ministry of Health, and development partners. He added that the matter was formally raised with the government and presented to the Council of Ministers, which pledged to address the funding gap.
He acknowledged receiving complaints from communities and health facilities, including Kiir Mayardit Women’s Hospital, but stressed that services have not been permanently shut down.
Alier urged the government to increase domestic health financing, noting that the health sector still receives only 1.3 percent of the national budget, and called on the public to remain patient as the government and partners work to stabilize the health system.