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

Abstract Background 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. We describe the coverage of interventions for women’s and children’s health in Upper Nile and Unity states, and explore factors t...

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Main Authors: Samira Sami, Augustino Mayai, Grace Sheehy, Nicole Lightman, Ties Boerma, Hannah Wild, Hannah Tappis, Wilfred Ochan, James Wanyama, Paul Spiegel
Format: Article
Language:English
Published: BMC 2020-05-01
Series:Conflict and Health
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13031-020-00272-2
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spelling doaj-44d764274f194b69a1e03d7350fe8d942020-11-25T03:18:09ZengBMCConflict and Health1752-15052020-05-0114111210.1186/s13031-020-00272-2Maternal and child health service delivery in conflict-affected settings: a case study example from Upper Nile and Unity states, South SudanSamira Sami0Augustino Mayai1Grace Sheehy2Nicole Lightman3Ties Boerma4Hannah Wild5Hannah Tappis6Wilfred Ochan7James Wanyama8Paul Spiegel9Center for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public HealthUniversity of Juba, and The Sudd InstituteDepartment of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public HealthDepartment of International Health, Johns Hopkins Bloomberg School of Public HealthCentre for Global Public Health, University of Manitoba, and Countdown to 2030 for Women’s, Children’s and Adolescents’ HealthStanford University School of MedicineCenter for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public HealthUnited Nations Population Fund South SudanUnited Nations Population Fund South SudanCenter for Humanitarian Health, Department of International Health, Johns Hopkins Bloomberg School of Public HealthAbstract Background 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. 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. Methods We 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. Results Coverage 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. Conclusions Health 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.http://link.springer.com/article/10.1186/s13031-020-00272-2South SudanConflictHealth systemDisplaced populationsMaternal healthChild health
collection DOAJ
language English
format Article
sources DOAJ
author Samira Sami
Augustino Mayai
Grace Sheehy
Nicole Lightman
Ties Boerma
Hannah Wild
Hannah Tappis
Wilfred Ochan
James Wanyama
Paul Spiegel
spellingShingle Samira Sami
Augustino Mayai
Grace Sheehy
Nicole Lightman
Ties Boerma
Hannah Wild
Hannah Tappis
Wilfred Ochan
James Wanyama
Paul Spiegel
Maternal and child health service delivery in conflict-affected settings: a case study example from Upper Nile and Unity states, South Sudan
Conflict and Health
South Sudan
Conflict
Health system
Displaced populations
Maternal health
Child health
author_facet Samira Sami
Augustino Mayai
Grace Sheehy
Nicole Lightman
Ties Boerma
Hannah Wild
Hannah Tappis
Wilfred Ochan
James Wanyama
Paul Spiegel
author_sort Samira Sami
title Maternal and child health service delivery in conflict-affected settings: a case study example from Upper Nile and Unity states, South Sudan
title_short Maternal and child health service delivery in conflict-affected settings: a case study example from Upper Nile and Unity states, South Sudan
title_full Maternal and child health service delivery in conflict-affected settings: a case study example from Upper Nile and Unity states, South Sudan
title_fullStr Maternal and child health service delivery in conflict-affected settings: a case study example from Upper Nile and Unity states, South Sudan
title_full_unstemmed Maternal and child health service delivery in conflict-affected settings: a case study example from Upper Nile and Unity states, South Sudan
title_sort maternal and child health service delivery in conflict-affected settings: a case study example from upper nile and unity states, south sudan
publisher BMC
series Conflict and Health
issn 1752-1505
publishDate 2020-05-01
description Abstract Background 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. 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. Methods We 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. Results Coverage 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. Conclusions Health 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.
topic South Sudan
Conflict
Health system
Displaced populations
Maternal health
Child health
url http://link.springer.com/article/10.1186/s13031-020-00272-2
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