Health

South Sudanese people have extensive knowledge of infectious diseases and experience of organizing responses to epidemics during wars and other crises. There are multiple, locally-specific methods used by communities for interrupting infection transmission and managing epidemics. This report documents these community infectious disease management strategies, based on sustained investigative research in the Yei, Juba, Wau, Malakal, Aweil West and Rubkona areas in 2020. The research encourages collaborative engagement with local knowledge and community healthcare leadership.

This is the final report from the Rift Valley Institute’s research project, Community Approaches to Epidemic Management in South Sudan (CAEMSS). The project, which began in response to the global coronavirus pandemic, was designed to document how communities across South Sudan have created systems and structures to control the spread of epidemics and infectious diseases in the country. A summary briefing can be found here.

This report was written by Nicki Kindersley, Peter Majiek, Stephen Othur, Deng Barjok, Emmanuel Luga, Elizabeth Nyibol, Alex Miskin, Chirrilo Madut and Joseph Diing Majok.

In recent times, there has been an increasing drive to demonstrate value for money (VfM) for investments made in public health globally. However, there is limited information on practical insights and best practices that have helped implementing organisations to successfully embed VfM in practice for programming and evaluation.

In this article, the authors discuss strengths and weaknesses of approaches that been used and insights on best practices to manage for, demonstrate, and compare VfM, using a health pooled fund programme implemented in conflict-affected South Sudan as case study supported by evidence reported in the literature while critiquing adequacy of the available approaches in this setting. An expanded and iterative process framework to guide VfM embedding for health programming and evaluation is then proposed. In doing so, this article provides a very relevant one-stop source for critical insight into how to embed VfM in practice. Uptake and scale-up of the proposed framework can be essential in improving VfM and aid effectiveness which will ultimately contribute to progress towards achieving the Sustainable Development Goals by 2030.

Background: Decades of war left the Republic of South Sudan with a fragile health system that has remained deprived of resources since the country’s independence. The authors describe the coverage of interventions for women’s and children’s health in Upper Nile and Unity states, and explore factors that affected service provision during a protracted conflict.

Methods: The authors conducted a case study using a desk review of publicly available literature since 2013 and a secondary analysis of intervention coverage and conflict-related events from 2010 to 2017. During June through September 2018, they conducted 26 qualitative interviews with technical leads and 9 focus groups among health workers working in women and children’s health in Juba, Malakal, and Bentiu.

Results: Coverage for antenatal care, institutional delivery, and childhood vaccines were low prior to the escalation of conflict in 2013, and the limited data indicate that coverage remained low through 2017. Key factors that determined the delivery of services for women and children in the study sites were government leadership, coordination of development and humanitarian efforts, and human resource capacity. Participants felt that national and local health officials had a limited role in the delivery of services, and financial tracking data showed that funding stagnated or declined for humanitarian health and development programming during 2013–2014. Although health services were concentrated in camp settings, the availability of healthcare providers was negatively impacted by the protracted nature of the conflict and insecurity in the region.

Conclusions: Health care for women and children should be prioritized during acute and protracted periods of conflict by strengthening surveillance systems, coordinating short and long term activities among humanitarian and development organizations, and building the capacity of national and local government officials to ensure sustainability