An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan

Abstract Background Community health workers (CHWs) are crucial for increasing access to health services to communities. Due to decades of conflict and under-funding, access to health care in South Sudan remains severely limited. To improve equitable access to healthcare, the government has introduc...

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Autores principales:	George William Lutwama, Maryse Kok, Eelco Jacobs
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Boma health initiative Boma health worker Conflict-affected Community health worker Health pooled fund South Sudan Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/0a55805a807f456bbfcb3441a6c8398b
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spelling	oai:doaj.org-article:0a55805a807f456bbfcb3441a6c8398b2021-11-21T12:07:41ZAn exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan10.1186/s13031-021-00422-01752-1505https://doaj.org/article/0a55805a807f456bbfcb3441a6c8398b2021-11-01T00:00:00Zhttps://doi.org/10.1186/s13031-021-00422-0https://doaj.org/toc/1752-1505Abstract Background Community health workers (CHWs) are crucial for increasing access to health services to communities. Due to decades of conflict and under-funding, access to health care in South Sudan remains severely limited. To improve equitable access to healthcare, the government has introduced “the Boma Health Initiative (BHI)”, a strategy to harmonise community health programmes across the country. In order to scale up the BHI, it is necessary to assess the recent CHW programmes and draw lessons for future implementation. This study aimed to explore the characteristics, barriers, and facilitators to the implementation of CHW interventions in South Sudan between 2011 and 2019. Methods The study used a qualitative approach drawing from 26 key informant interviews and a scoping review of 21 Health Pooled Fund (HPF) programme reports from October 2016 to June 2018 and policy documents from 2011 to 2019. The results were thematically analysed based on a conceptual framework on factors influencing the performance of CHWs. Results Funding of CHW programmes has come from international donors, channelled through non-governmental organisations (NGOs) that have implemented a variety of CHW programmes. Communities have been participating in the selection of voluntary CHWs, intervention areas, and occasionally in the supervision of activities performed by CHWs. The coordination mechanisms among stakeholders have been weak, leading to wastage and duplication of resources. Although training of CHWs is done, training duration was short, and refresher-trainings were rare. There were and still are disparities in the type of incentives provided to CHWs. Monitoring and supportive supervision activities have been insufficient; drug misuse and stock-outs were common. Conclusion Despite their challenges, CHW programmes can be implemented in conflict-affected South Sudan if the local human capital is leveraged and engaged by NGOs as implementing partners. Robust coordination efforts are required to build synergies among stakeholders for the effective implementation of the BHI strategy.George William LutwamaMaryse KokEelco JacobsBMCarticleBoma health initiativeBoma health workerConflict-affectedCommunity health workerHealth pooled fundSouth SudanSpecial situations and conditionsRC952-1245Medical emergencies. Critical care. Intensive care. First aidRC86-88.9ENConflict and Health, Vol 15, Iss 1, Pp 1-14 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Boma health initiative Boma health worker Conflict-affected Community health worker Health pooled fund South Sudan Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Boma health initiative Boma health worker Conflict-affected Community health worker Health pooled fund South Sudan Special situations and conditions RC952-1245 Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 George William Lutwama Maryse Kok Eelco Jacobs An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan
description	Abstract Background Community health workers (CHWs) are crucial for increasing access to health services to communities. Due to decades of conflict and under-funding, access to health care in South Sudan remains severely limited. To improve equitable access to healthcare, the government has introduced “the Boma Health Initiative (BHI)”, a strategy to harmonise community health programmes across the country. In order to scale up the BHI, it is necessary to assess the recent CHW programmes and draw lessons for future implementation. This study aimed to explore the characteristics, barriers, and facilitators to the implementation of CHW interventions in South Sudan between 2011 and 2019. Methods The study used a qualitative approach drawing from 26 key informant interviews and a scoping review of 21 Health Pooled Fund (HPF) programme reports from October 2016 to June 2018 and policy documents from 2011 to 2019. The results were thematically analysed based on a conceptual framework on factors influencing the performance of CHWs. Results Funding of CHW programmes has come from international donors, channelled through non-governmental organisations (NGOs) that have implemented a variety of CHW programmes. Communities have been participating in the selection of voluntary CHWs, intervention areas, and occasionally in the supervision of activities performed by CHWs. The coordination mechanisms among stakeholders have been weak, leading to wastage and duplication of resources. Although training of CHWs is done, training duration was short, and refresher-trainings were rare. There were and still are disparities in the type of incentives provided to CHWs. Monitoring and supportive supervision activities have been insufficient; drug misuse and stock-outs were common. Conclusion Despite their challenges, CHW programmes can be implemented in conflict-affected South Sudan if the local human capital is leveraged and engaged by NGOs as implementing partners. Robust coordination efforts are required to build synergies among stakeholders for the effective implementation of the BHI strategy.
format	article
author	George William Lutwama Maryse Kok Eelco Jacobs
author_facet	George William Lutwama Maryse Kok Eelco Jacobs
author_sort	George William Lutwama
title	An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan
title_short	An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan
title_full	An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan
title_fullStr	An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan
title_full_unstemmed	An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan
title_sort	exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected south sudan
publisher	BMC
publishDate	2021
url	https://doaj.org/article/0a55805a807f456bbfcb3441a6c8398b
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An exploratory study of the barriers and facilitators to the implementation of community health worker programmes in conflict-affected South Sudan

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