Abstract
BackgroundPregnant women, neonates, children, and adolescents are at higher risk of dying in fragile and conflict-affected settings. Strengthening the healthcare system is a key strategy for the implementation of effective policies and ultimately the improvement of health outcomes. South Sudan is a fragile country that faces challenges in implementing its reproductive, maternal, neonatal, child, and adolescent health (RMNCAH) policies. In this paper, we map the key RMNCAH policies and describe the current status of the WHO health system building blocks that impede the implementation of RMNCAH policies in South Sudan.MethodsWe conducted a scoping review (39 documents) and individual interviews (n = 8) with staff from the national Ministry of Health (MoH) and implementing partners. We organized a workshop to discuss and validate the findings with the MoH and implementing partner staff. We synthesized and analyzed the data according to the WHO health system building blocks.ResultsThe significant number of policies and healthcare strategic plans focused on pregnant women, neonates, children, and adolescents evidence the political will of the MoH to improve the health of members of these categories of the population. The gap in the implementation of policies is mainly due to the weaknesses identified in different health system building blocks. A critical shortage of human resources across the blocks and levels of the health system, a lack of medicines and supplies, and low national funding are the main identified bottlenecks. The upstream factors explaining these bottlenecks are the 2012 suspension of oil production, ongoing conflict, weak governance, a lack of accountability, and a low human resource capacity. The combined effects of all these factors have led to poor-quality provision and thus a low use of RMNCAH services.ConclusionThe implementation of RMNCAH policies should be accomplished through innovative and challenging approaches to building the capacities of the MoH, establishing governance and accountability mechanisms, and increasing the health budget of the national government.
Highlights
Pregnant women, neonates, children, and adolescents are at higher risk of dying in fragile and conflict-affected settings
Step 1: identification of the research questions The research questions were as follows: (1) What are the policy documents used by the Ministry of Health (MoH) to guide policies and programs for improving RMNCAH in South Sudan? (2) What are the health system gaps impeding the implementation of RMNCAH policies and programs?
Step 2: identification of relevant documents We focused on documents that had been published by the government of South Sudan and peer-reviewed publications on South Sudan published between 2011 and January 08, 2019
Summary
Neonates, children, and adolescents are at higher risk of dying in fragile and conflict-affected settings. South Sudan is a fragile country that faces challenges in implementing its reproductive, maternal, neonatal, child, and adolescent health (RMNCAH) policies. According to the United Nation High Commissioner for Refugees, the number of forcibly displaced people has nearly doubled in the past two decades (from 33.9 million in 1997 to 65.6 million in 2016) [2]. This number is the highest it has been since World War II. Adolescents, newborns, and children are at higher risk of dying in fragile and conflict-affected settings [3]. Nine of these countries are fragile and conflictaffected settings (Nigeria, Angola, DR Congo, Benin, Central African Republic, Equatorial Guinea, Somalia, Chad, Mali, and Sierra Leone) [4]
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