Juba Teaching Hospital (JTH) was established in 1975 under the then Regional Government of Sudan and was intended to function alongside the University of Juba as the Southern autonomous regionโs principal teaching and referral hospital. It was designed to serve a dual purpose: providing advanced specialist healthcare while training future generations of health professionals.
Over time, however, the institutional environment that sustained the hospital weakened. Public financing declined, management increasingly shifted toward crisis response, and following South Sudan’s independence, JTH became a department within the National Ministry of Health. Like many public institutions, it came to rely on a central government budget that is often inadequate and supplemented by international Non-Governmental Organizations (NGOs), development partners, and humanitarian actors.
These realities have created a persistent dilemma. JTH is expected to function simultaneously as a national referral hospital, a teaching institution, and a center for specialized medical services, yet it operates within administrative and financial systems that were never designed to support such a complex mandate. As a result, public expectations frequently exceed the hospital’s capacity to deliver.
This challenge has fuelled a recurring debate about the future governance of JTH. Some argue that the hospital should remain under the National Ministry of Health, while others advocate transferring it to the University of Juba because of its teaching role. A third group calls for presidential intervention through executive action to address the hospital’s longstanding governance challenges.
Although these proposals differ in form, they are united by a common assumption: that changing who exercises authority over JTH will solve its problems. Yet this assumption overlooks the true nature of the challenge.
The debate is often framed as a choice between the Ministry of Health and the University of Juba, but such framing oversimplifies the issue. If the hospital remains under the Ministry without broader reform, it will continue to face the same bureaucratic constraints that have historically limited its effectiveness. If it is transferred to the University without reform, it merely exchanges one administrative hierarchy for another. In either scenario, the underlying governance problem remains intact.
The hospital would still operate within rigid public-sector systems governing recruitment, remuneration, procurement, budgeting, and institutional decision-making. Its leadership would continue to have limited flexibility to respond to operational emergencies, attract and retain specialized personnel, manage revenue effectively, or implement performance-based management systems. Changing the reporting line may alter who signs official correspondence, but it does not necessarily alter how the institution functions.
The call for presidential intervention similarly recognizes an important truth: meaningful reform often requires political will at the highest levels of government. However, political will and institutional reform are not the same thing. Presidential decrees and administrative directives can initiate change, appoint leadership, reassign responsibilities, and signal commitment, but they cannot by themselves resolve the structural challenges that have constrained JTH for decades.
Executive action is inherently temporary. What is created through a decree today can be amended or reversed tomorrow. More importantly, administrative directives cannot adequately address complex questions of financial management, procurement authority, employment structures, institutional accountability, and corporate governance. These matters require a durable legal framework rather than administrative discretion.
History repeatedly demonstrates that reforms dependent on individual leaders rarely outlast them. Strong national institutions derive their stability from law, not personalities. A presidential decree may therefore serve as an important catalyst for reform when a competent and good-willed individual is appointed, but it cannot substitute for the legislation required to make that reform enduring.
The crisis at JTH is therefore not fundamentally a crisis of ownership, reporting lines, or ministerial control. It is a crisis of institutional design. The hospital’s core challenge is not the absence of a new supervisor but the absence of a robust statutory foundation to support its complex mandate.
A modern national referral and teaching hospital is too important to be governed primarily through administrative arrangements that can shift with changes in leadership, ministerial priorities, or political circumstances. Such an institution requires a clear legal framework defining its powers, governance structures, accountability mechanisms, financial authority, and relationship with the state. Without such a foundation, any gains achieved through administrative action remain vulnerable, incomplete, and ultimately reversible.
For this reason, the most sustainable solution for Juba Teaching Hospital is not another administrative transfer but its establishment through a dedicated Act of Parliament. Such legislation would transform the hospital from a conventional government department into a legally constituted public institution with clearly defined powers, responsibilities, and accountability mechanisms. It would provide the foundation for long-term institutional stability while preserving public accountability.
A good statutory framework could grant JTH greater financial and operational flexibility, including the authority to retain and reinvest approved revenues, implement more responsive systems for recruiting and retaining specialized health professionals, and operate under an independent governing board. Such a board could bring together representatives from the Ministry of Health, the University of Juba, professional bodies, and other key stakeholders.
Most importantly, these arrangements would be protected by law rather than administrative discretion. The hospital’s governance and performance would no longer depend on the preferences or goodwill of any particular minister, vice chancellor, or president.
South Sudan’s development challenge is not merely the formulation of policies but the creation of institutions that endure beyond political cycles and individual leaders. Juba Teaching Hospital presents a critical test of that national aspiration.
The central question is not who should own the hospital, nor whether a ministerial directive or presidential decree can produce temporary improvements. The real question is whether South Sudan is prepared to establish a governance framework capable of sustaining a modern national referral and teaching hospital for generations.
If the answer is yes, then the path forward lies not merely through ministries or executive offices, but through Parliament. The future of Juba Teaching Hospital should be anchored in the certainty of law rather than the uncertainty of administrative discretion. Ownership matters, but in the long run, governance determines institutional performance, accountability, stability, and longevity.
Koiti Emmily 