Health

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

Decades of conflict in South Sudan, pre and post-independence in 2011, poverty and poor access to services have increased the rate of disability and rendered people with disabilities more marginalised and excluded as a result of the numerous attitudinal, environmental, and institutional barriers they face, and the lack of concerted efforts to include them. This rapid review identifies the available evidence on the experiences of people with disabilities living in South Sudan. There are still numerous evidence gaps in relation to the experiences of people with disabilities living in South Sudan as very little research has looked at disability in South Sudan and the available evidence base is extremely limited. Much of the available information focuses on Juba rather than the rest of the country. Further research with people with different types of disabilities, and in different areas of South Sudan is needed to more fully understand the experiences of people with disabilities living on South Sudan, the barriers and challenges they face, and how they and their families have responded to them.

This rapid evidence review provides an assessment of negative and positive coping mechanisms of different groups (based on wealth (below the poverty line/elites), gender, age, (dis)abilities, geographies (rural/urban), and ethnicity of people in South Sudan in relation to different types of shock. It draws predominantly on a range of grey literature from multinational and bilateral institutionsas well as non-government organisations (NGOs) and think tanks. The report highlights that coping strategies are varied and multifaceted, they are a product of the vulnerability of particular individuals, households and communities and are the product of responses to shocks and stressors. These shocks(?) may be acute or chronic. It is also important to note that coping strategies in the South Sudanese context have often been developed in response to food insecurity, climatic change and conflict and that new shocks may undermine these existing strategies, necessitate evolution of these or the adoption of new strategies. It is also important to note that these may have both negative and positive impacts that may differ over short, medium and long term time horizons.