Feasibility of health systems strengthening in South Sudan: a qualitative study of international practitioner perspectives

Abstract

ObjectiveTo explore the feasibility of health systems strengthening from the perspective of international healthcare implementers and donors in South Sudan.DesignA qualitative interview study, with thematic analysis using the WHO health system building blocks framework.SettingSouth Sudan.Participants17 health system practitioners, working for international agencies in South Sudan, were purposively sampled for their knowledge and experiences of health systems strengthening, services delivery, health policy and politics in South Sudan.ResultsParticipants universally reported the health workforce as insufficient and of low capacity and service delivery as poor, while access to medicines was restricted by governmental lack of commitment in undertaking procurement and supply. However, progress was clear in improved county health department governance, health management information system functionality, increased health worker salary harmonisation and strengthened financial management.ConclusionsResurgent conflict and political tensions have negatively impacted all health system components and maintaining or continuing health system strengthening has become extremely challenging. A coordinated approach to balancing humanitarian need particularly in conflict-affected areas, with longer term development is required so as not to lose improvements gained.

Factors Influencing Contraceptives Use among Women in the Juba City of South Sudan

“…Implementation of family planning interventions, however, is context dependent and the countries with stable sociopolitical infrastructure may be better suited to successfully implement the interventions and achieve the goals than their counterparts in conflict afflicted settings. The conflict afflicted settings often have fragile health systems that can hardly support provision of comprehensive SRH [4][5][6] Current reports on the global contraceptive prevalence rates and unmet needs for family planning indicate overall gains across countries [1]. Despite the overall gains, indicators of slow progress in contraceptive uptake and reduction in unmet needs or family planning are evident in some sub-Saharan African countries [1].…”

“…The low contraceptives uptake South Sudan has been a long-standing national issue with little concrete steps taken to address it 2 International Journal of Population Research [10][11][12]. The two decades of civil war disrupted South Sudan health care system and therefore very little efforts were placed on family planning, even after signing of the comprehensive peace agreement in 2005 [6,11]. Family planning services remained underutilized even where the services were made available [10][11][12].…”

Health policy mapping and system gaps impeding the implementation of reproductive, maternal, neonatal, child, and adolescent health programs in South Sudan: a scoping review

“…The structural factors identified in studies using qualitative data collection methods such as focus group discussions and individual interviews included distance, a lack of means of transport, service costs, sociocultural factors related to gender norms, and insecurity [35,43].…”

“…We are actually in the middle between Rumbek and Maper hospitals. If you want to go to hospital, you can spend one day to reach there" [43].…”

“…"What I dislike about the hospital is that after delivery, the mother is asked to pay money, but we don't have money; we just go there to get help" [43].…”