South Sudan has experienced significant levels of fragility, conflict and violence for nearly half a century. It is estimated that over 400,000 lives have been lost since 2013 due to conflict and millions more have been displaced. With limited access to basic health services, it has some of the worst health indicators in the world, with mainly women and children affected.

The Health Pooled Fund (HPF), of which KIT Institute is a consortium partner, is a partnership with South Sudan’s Ministry of Health. It focuses on strengthening the government’s capacity to meet basic needs, supporting around 80% of South Sudan’s health services to provide essential healthcare to approximately 10 million people. The HPF has already had notable successes such as immunising hundreds of thousands of children against childhood diseases and providing family planning to thousands of women.

Operational research & assistance

KIT is responsible for HPF’s operational research and provides technical assistance to the consortium and the NGOs serving as its implementing partners. In doing so, KIT provides better insight into priority areas for intervention, while drawing out contextually relevant, evidence-based lessons for programme enhancement, based on document review, qualitative and mixed methods research methods. Research themes range from analysis of the distrbitution of coverage and utilisation of care through health management information systems and geographic information systems mapping to the political economy of priority-setting of health interventions and local health governance, community health, supportive supervision, mental health and access barriers to care.

HPF has a full-time operations research manager and advisor based in the HPF office in Juba, South Sudan, and an overal HPF programme manager based at KIT in Amsterdam, the Netherlands. It is supported by short-term technical assistance and research advisory services from a pool of researchers, specialised in areas ranging from health systems strengthening and sexual and reproductive health and rights to epidemiology and disease control, that is drawn upon when needed.

The Boma Health Initiative

In March 2017, the Ministry of Health launched the Boma Health Initiative (BHI), a community health system strengthening initiative intended to bridge the gap between health facilities and communities, increasing equitable access to community health services, and the participation of communities in their ownership and sustainability.

As the BHI was new and lacking documented evidence of its practice, KIT’s operational research experts undertook a study to guide its implementation. The HPF programme is using the study’s findings to enhance community engagement and to improve health outcomes across the country. The study revealed that the majority of the barriers to effective implementation were the result of insufficient coordination between the different implementing organisations, health authorities and funders. Community members are happy to participate in the implementation of health initiatives that will benefit them, and community health programmes of any kind can thrive when community members are engaged in every step of the implementation process.

If the BHI strategy is going to be effectively implemented, robust coordination efforts are required to build connections and cooperation among stakeholders. But it is clear that community health programmes can be successfully implemented, even in conflict situations, if local human resources are leveraged, engaged, and nurtured.