This case study was published on 8 December 2022 as part of the WHO delivering results and making an impact: stories from the ground report, which presents a snapshot of how WHO has delivered on its mission in countries and contributed to health outcomes across a wide range of issues during 2020-2021.
South Sudan has experienced protracted conflict, both before and since the country gained independence in 2011. In 2021, more than 8 million people of South Sudan’s population of 13 million needed humanitarian assistance because of conflict and violence, major flooding and the coronavirus disease (COVID-19) pandemic. With poor access to health services due to an acute health workforce shortage, inadequate health infrastructure and poor health service utilization, the country has poor health indicators.1,2 Its maternal, infant and child mortality rates are some of the highest in the world and life expectancy is low, at 56.5 years.3
The Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP) brings together 13 multilateral health, development and humanitarian agencies, including WHO, to better support countries in accelerating progress towards the health-related Sustainable Development Goals (SDGs).4 Together, they work to advance the targets of SDG 3 (Good health and wellbeing) and collectively channel about one third of global development assistance for health annually. In South Sudan, development assistance is crucial as government funding for health is low, at less than 2% of the national budget, and out-of-pocket spending accounts for about 54% of total health expenditure, putting many South Sudanese people at risk of catastrophic health costs. Since 2020, SDG3 GAP agencies, including WHO, have been working with the Government of South Sudan to progress towards universal health coverage and the health-related SDGs. Despite some delays to progress due to COVID-19, key health sector coordination mechanisms have already been revitalized and SDG3 GAP agencies and other partners have begun to align more closely with the country’s primary health care (PHC) priorities.
Measuring height during administration of schistosomiasis treatment in South Sudan. ©WHO Country Office in South Sudan
How did South Sudan, with the support of the WHO Secretariat, achieve this?
- Identifying priority challenges
WHO, in collaboration with the United Nations Children’s Fund (UNICEF), supported South Sudan’s Ministry of Health in identifying priorities. These included strengthening leadership and governance, health commodity and supply-chain management, equitable service delivery and community systems strengthening. In December 2020, priorities were presented to agencies in the GAP PHC accelerator working group.
- Developing an evidence-based strategic plan
The Government of South Sudan aims to transition from humanitarian relief to longer-term health sector development, as is reflected in the country’s strategic plans5 and health initiatives.6 In 2021, to inform the next health sector strategic plan, WHO collaborated with the Ministry of Health to conduct a health sector performance review. The resulting policy dialogue on national priorities led to a commitment from the Government of South Sudan to anchoring the COVID-19 recovery strategy in PHC, plus consensus among development partners.
- Coordinating stakeholders
To foster PHC as the path to universal health coverage and ensure health partner interventions are harmonized and aligned with national health sector priorities, WHO advocated among partners to revitalize South Sudan’s health development partners forum secretariat. Now up and running, WHO co-chairs the committee and manages the secretariat. WHO also provides technical expertise to the secretariat of South Sudan’s Health Sector Steering Committee, a coordination platform that enables government and development partner leaders to discuss key policy and strategic sector issues. In 2021, WHO provided funding support to the secretariat of the Health Sector Steering Committee to cover staff incentives, transportation and basic operational costs such as for information and communications technology (ICT) equipment.
- Developing an action plan for implementation
In February 2021, the GAP PHC accelerator working group created a South Sudan working group. As a member of this working group, WHO collaborated at the global and country levels to develop an action plan. The plan is being used to map available financing, identify gaps and advocate for additional resources.
- Building capacity
WHO deployed facilitators to the Ministry of Health to conduct leadership and management training on key health sector leadership and governance structures, principles and skills. Delivered to 48 senior national and state-level leaders in Juba in August 2021, the training resulted in key recommendations being made to improve health sector leadership and governance. These were endorsed as key declarations during the inaugural Ministerial Advisory Board, facilitated by WHO and convened and chaired by the Minister for Health.
WHO continues to work alongside the Ministry of Health as part of the
SDG3 GAP partnership in South Sudan, advocating for resources and building
the leadership capacity necessary to strengthen the health system.
References
- Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division, executive summary. Geneva: World Health Organization; 2019 (accessed 14 August 2022).
- United Nations Children’s Fund, WHO, World Bank Group, United Nations. Estimates developed by the UN Inter-Agency Group for Child Mortality Estimation: levels and trends in child mortality 2019. New York: United Nations Children’s Fund; 2019 (accessed 14 August 2022).
- Global Health Estimates 2019: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2019. Geneva: World Health Organization; 2020. (accessed 14 August 2022)
- Do you know all 17 SDGs? [website]. New York: United Nations Department of
Economic and Social Affairs; n.d. (accessed 14 August 2022).
- South Sudan – strengthening primary health care in fragile settings. Geneva: World Health Organization; 20 May 2021 (accessed 14 August 2022).
- WHO supports new initiative to more easily allow people living in South Sudan’s rural communities to access health services. Juba: WHO Country Office in South Sudan; 3 April 2017 (accessed 14 August 2022).