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

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Valadez, Joseph ORCID: https://orcid.org/0000-0002-6575-6592, Berendes, Sima, Odhiambo, Jackline, Vargas, William, Devkota, Baburam, Lako, Richard and Jeffery, Caroline ORCID: https://orcid.org/0000-0002-8023-0708 (2020) 'Is development aid to strengthen health systems during protracted conflict a useful investment? The case of South Sudan, 2011–2015'. BMJ Global Health, Vol 5, Issue e002093.

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Abstract

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.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 300 General. Refugees
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1136/bmjgh-2019-002093
Depositing User: Helen Fletcher
Date Deposited: 29 Apr 2020 15:59
Last Modified: 29 Apr 2020 15:59
URI: https://archive.lstmed.ac.uk/id/eprint/13804

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