The Case for Investing in Community Health in South Sudan

May 23, 2018

The Case for Investing in Community Health in South Sudan

South Sudan faces extraordinary challenges to build and strengthen its health system to meet the basic health needs of its people. After decades of civil war, the country faces a critical shortage of trained health personnel,[1] limited access[2] to essential health services,[3] and consequently experiences some of the worst health indicators globally. The majority of childhood deaths are due to preventable causes such as diarrhea, malaria, and pneumonia while an estimated one in seven women die due to pregnancy related complications.[4]

Amidst these challenges, the Government of South Sudan and its partners have prioritized the scale-up of community health services by training and establishing community health workers (CHWs) throughout the country. In March 2017 the Government officially launched the Boma Health Initiative (BHI), which aims to train more than 6,000 community health workers to provide an integrated package of promotional, preventive, and curative health services at the Boma—or local government—level. While the country’s BHI is critical to increasing access to health services and addressing the critical shortage of trained health workers, there has been limited evidence to guide its implementation.

With funding from UNICEF South Sudan, MSH and UNICEF helped to build the case to invest resources into the country’s BHI.

On April 13, 2018, the two organizations presented their investment case for scaling up community health services in Juba, South Sudan, to the Ministry of Health and partners. It provided much-needed data on BHI’s future costs, required financing, and expected health impact in terms of mortality averted over a 10-year period (2018–2028). MSH also presented an analysis of current health system bottlenecks that could impede the initiative’s success. Its results and corresponding recommendations should help to inform the future implementation of the BHI by providing a set of evidence to guide decision-making and support advocacy for resources from international donors.

More than 70 participants attended the presentation, including representatives from the Ministry of Health, UNICEF, DFID, the Health Pooled Fund, the Canadian Embassy, WHO, the European Union, and UNFPA.

The Minister of Health, Hon. Dr. Riek Gai Kok, praised the investment case, calling it “a great piece of work” that will help scale up community health services and contribute to South Sudan’s commitment of achieving universal health coverage.

More Information


Colin Gilmartin or David Collins
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Medford, MA 02155

Phone: 617-250-9500
Fax: 617-250-9090


  1. The country has a critical shortage of trained health personnel with an estimated 47.6 nurses and midwives per 39,088 persons and one physician per 65,574 persons. Source: Global Health Workforce Alliance.
  2. An estimated 83% of the population lives in a rural area and only 25.7 % of the population lives within one-hour (walking) of a facility. Sources: Republic of South Sudan National Bureau of Statistics ( and Macharia, Peter M., Paul O. Ouma, Ezekiel G. Gogo, Robert W. Snow, and Abdisalan M. Noor. “Spatial Accessibility to Basic Public Health Services in South Sudan.” Geospatial Health 12, no. 1 (May 11, 2017): 510.
  3. The estimated coverage of essential health services (Sustainable Development Goal indicator 3.8.1)4 is 30 %, far below the 42 % average of Sub-Saharan Africa (source: WHO and World Bank. Tracking Universal Health Coverage: 2017 Global Monitoring Report. 2017.
  4. UNICEF. South Sudan Facts and Figures. October 22, 2015. Available at: