Maternal and child health service delivery in conflict-affected settings: a case study example from Upper Nile and Unity states, South Sudan

Samira Sami,Paul Spiegel,James Wanyama,Augustino Mayai,Ties Boerma,Nicole Lightman,Hannah Tappis,Grace Sheehy,Hannah Wild,Wilfred Ochan

doi:10.1186/s13031-020-00272-2

Abstract

BackgroundDecades of war left the Republic of South Sudan with a fragile health system that has remained deprived of resources since the country’s independence. We 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.MethodsWe 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, we 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.ResultsCoverage 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 our 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.ConclusionsHealth 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.

Highlights

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 violence forced many people to flee their homes as refugees and internally displaced persons (IDPs), with some of the Internally displaced person (IDP) seeking shelter in the United Nations’ (UN) protection of civilians (POC) sites located in Juba (Central Equatoria state), Malakal (Upper Nile state), and Bentiu (Unity state) [3]
The number of violencerelated fatalities decreased from 2015 to 2016 in both states, the number of fatalities rose in 2017 following renewed insecurity in Upper Nile and Unity states [19]

Summary

Introduction

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. Decades of civil war with the Sudanese government left the Republic of South Sudan with a fragile health system that has remained deprived of resources since the country’s independence in 2011. The recent conflict initially resulted from a political struggle between the President, a member of the majority ethnic group, the Dinka, and Vice President, a member of the second largest ethnic group, the Nuer. In December 2013, fighting between Dinka and Nuer members of the presidential guard began in the capital city of Juba and rapidly spread throughout the country, ravaging the Greater Upper Nile and Unity regions [1, 2]. Indiscriminate killings of civilians, including attacks against health facilities, caused humanitarian agencies to abandon these areas and evacuate non-local staff

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Discussion

Conclusion