An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan.

Abstract

Background: Community health workers (CHWs) are crucial for increasing access to health services to communities. Due to decades of conflict and under-funding, access to health care in South Sudan remains severely limited. To improve equitable access to healthcare, the government has introduced “the Boma Health Initiative (BHI)”, a strategy to harmonise community health programmes across the country. In order to scale up the BHI, it is necessary to assess the recent CHW programmes and draw lessons for future implementation. This study aimed to explore the characteristics, barriers, and facilitators to the implementation of CHW interventions in South Sudan between 2011 and 2019.Methods: The study used a qualitative approach drawing from 26 key informant interviews and a scoping review of 21 Health Pooled Fund (HPF) programme reports from October 2016 to June 2018 and policy documents from 2011 to 2019. The results were thematically analysed based on a conceptual framework on factors influencing the performance of CHWs.Results: Funding of CHW programmes has come from international donors, channelled through non-governmental organisations (NGOs) that have implemented a variety of CHW programmes. Communities have been participating in the selection of voluntary CHWs, intervention areas, and occasionally in the supervision of activities performed by CHWs. The coordination mechanisms among stakeholders have been weak, leading to wastage and duplication of resources. Although training of CHWs is done, training duration was short, and refresher-trainings were rare. There were and still are disparities in the type of incentives provided to CHWs. Monitoring and supportive supervision activities have been insufficient; drug misuse and stock-outs were common. Conclusion: Despite their challenges, CHW programmes can be implemented in conflict-affected South Sudan if the local human capital is leveraged and engaged by NGOs as implementing partners. Robust coordination efforts are required to build synergies among stakeholders for the effective implementation of the BHI strategy.

Determinants of health seeking behaviour in South Sudan: a cross-sectional household survey

“…The nding that respondents with a HoH aware of the BHWs are twice as likely to seek care, might suggest that BHWs have a positive effect on access to care. BHWs are intended to play an important role in health education, motivating appropriate HSB, and provide basic treatment for priority diseases and referral to specialized healthcare providers, based on good community health practices elsewhere (1,21). This is also corroborated by evidence from other low-and middle income countries (LMICs) that suggests that community health worker programmes can be (cost-)effective in reducing burden of disease and improving service utilization (51,52).…”

“…The HPF supports delivery of approximately 80% of health services in eight out of the country's ten states (20). This includes support for the Boma Health Initiative (BHI), a community health scheme designed to strengthen the linkages between communities and primary health facilities (1, 18,21). The initiative is based on previous community health programmes and it has not yet been implemented in all counties (21).…”