Is development aid to strengthen health systems during protracted conflict a useful investment? The case of South Sudan, 2011–2015

Bibliographic Data

ID21879307
AuthorsJoseph J Valadez (0000-0002-6575-6592, Liverpool School of Tropical Medicine, corresponding author), Sima Berendes (0000-0001-7000-868X, Liverpool School of Tropical Medicine), Jackline A Odhiambo (0000-0003-0028-9900, Liverpool School of Tropical Medicine), Jackline Odhiambo (Liverpool School of Tropical Medicine), William E Vargas (0000-0001-8460-8491, Liverpool School of Tropical Medicine), William Vargas (Liverpool School of Tropical Medicine), Baburam Devkota (Liverpool School of Tropical Medicine), Richard Lako (Federal Ministry of Health), Caroline Jeffery (0000-0002-8023-0708, Liverpool School of Tropical Medicine)
Year2020
Volume5
Issue4
Pagese002093
Publication date2020-04-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2019-002093
PMID32377402
OpenAlexW3017354144
LanguageEN
Citations received6
References cited31

Introduction: Is achievement of Sustainable Development Goal (SDG) 16 (building peaceful societies) a precondition for achieving SDG 3 (health and well-being in all societies, including conflict-affected countries)? Do health system investments in conflict-affected countries waste resources or benefit the public's health? To answer these questions, we examine the maternal, newborn, child and reproductive health (MNCRH) service provision during protracted conflicts and economic shocks in the Republic of South Sudan between 2011 (at independence) and 2015. Methods: We conducted two national cross-sectional probability surveys in 10 states (2011) and nine states (2015). Trained state-level health workers collected data from households randomly selected using probability proportional to size sampling of villages in each county. County data were weighted by their population sizes to measure state and national MNCRH services coverage. A two-sample, two-sided Z-test of proportions tested for changes in national health service coverage between 2011 (n=11 800) and 2015 (n=10 792). Results: Twenty-two of 27 national indicator estimates (81.5%) of MNCRH service coverage improved significantly. Examples: malaria prophylaxis in pregnancy increased by 8.6% (p<0.001) to 33.1% (397/1199 mothers, 95% CI ±2.9%), institutional deliveries by 10.5% (p<0.001) to 20% (230/1199 mothers, ±2.6%) and measles vaccination coverage in children aged 12-23 months by 11.2% (p<0.001) to 49.7% (529/1064 children, ±2.3%). The largest increase (17.7%, p<0.001) occurred for mothers treating diarrhoea in children aged 0-59 months with oral rehydration salts to 51.4% (635/1235 children, ±2.9%). Antenatal and postnatal care, and contraceptive prevalence did not change significantly. Child vitamin A supplementation decreased. Despite significant increases, coverage remained low (median of all indicators = 31.3%, SD = 19.7). Coverage varied considerably by state (mean SD for all indicators and states=11.1%). Conclusion: Health system strengthening is not a uniform process and not necessarily deterred by conflict. Despite the conflict, health system investments were not wasted; health service coverage increased

Economic growth · Economics · Environmental health · Malaria · Measles · Population · Public health · Vaccination · Child Nutrition and Water Access · Demography · Global Maternal and Child Health · Health and Conflict Studies · Medicine · Nursing

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