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Conflict and Health
Published in: Conflict and Health 1/2021

Open Access 01-12-2021 | Research

An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan

Authors: George William Lutwama, Maryse Kok, Eelco Jacobs

Published in: Conflict and Health | Issue 1/2021

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Abstract

Background

Community health workers (CHWs) are crucial for increasing access to health services to communities. Due to decades of conflict and under-funding, access to health care in South Sudan remains severely limited. To improve equitable access to healthcare, the government has introduced “the Boma Health Initiative (BHI)”, a strategy to harmonise community health programmes across the country. In order to scale up the BHI, it is necessary to assess the recent CHW programmes and draw lessons for future implementation. This study aimed to explore the characteristics, barriers, and facilitators to the implementation of CHW interventions in South Sudan between 2011 and 2019.

Methods

The study used a qualitative approach drawing from 26 key informant interviews and a scoping review of 21 Health Pooled Fund (HPF) programme reports from October 2016 to June 2018 and policy documents from 2011 to 2019. The results were thematically analysed based on a conceptual framework on factors influencing the performance of CHWs.

Results

Funding of CHW programmes has come from international donors, channelled through non-governmental organisations (NGOs) that have implemented a variety of CHW programmes. Communities have been participating in the selection of voluntary CHWs, intervention areas, and occasionally in the supervision of activities performed by CHWs. The coordination mechanisms among stakeholders have been weak, leading to wastage and duplication of resources. Although training of CHWs is done, training duration was short, and refresher-trainings were rare. There were and still are disparities in the type of incentives provided to CHWs. Monitoring and supportive supervision activities have been insufficient; drug misuse and stock-outs were common.

Conclusion

Despite their challenges, CHW programmes can be implemented in conflict-affected South Sudan if the local human capital is leveraged and engaged by NGOs as implementing partners. Robust coordination efforts are required to build synergies among stakeholders for the effective implementation of the BHI strategy.
Footnotes
1
‘Boma’ is the lowest administrative unit of local government in South Sudan.
 
2
A payam is the second-lowest administrative division, below counties, in South Sudan.
 
3
iCCM was targeting treatment of malaria, pneumonia, diarrhoea, and screening for malnutrition for children the under five years of age.
 
4
Nine months trained CHW is a paid and health facility (PHCU) based worker responsible for provision of curative, preventive, and promotive services, including maternal health and health information management.
 
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Metadata
Title
An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan
Authors
George William Lutwama
Maryse Kok
Eelco Jacobs
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Conflict and Health / Issue 1/2021
Electronic ISSN: 1752-1505
DOI
https://doi.org/10.1186/s13031-021-00422-0

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