Providing Quality of Care in Fragile and Vulnerable Settings: Lessons from South Sudan

Abstract

Background: In 2020, the World Health Organization (WHO) released a report concerning planning and actions to provide quality of care in fragile, conflict-affected, and vulnerable areas. South Sudan, the world’s newest country, has encountered both natural and man-made disasters in recent years that have posed marked challenges to delivery of care. The Southern Sudan Healthcare Organization (SSHCO) operates as a non-governmental organization (NGO) in this setting, delivering and improving healthcare through war, flooding, and infectious outbreaks. Objective: The goal of this paper is to highlight the challenges faced in providing care in South Sudan from an NGO perspective and apply the recent WHO guidelines on quality of care to optimize practical implementation. Method: Each of the WHO’s eight elements for quality of care in South Sudan were examined in relation to the experience of SSHCO from 2013–2021. Analysis included: 1. summary of the WHO element; 2. examples of successful implementation; 3. barriers to implementation; and 4. recommendations to improve implementation. Findings: The team found that communication and coordination were the most important aspects of improving quality of care in South Sudan. These should be prioritized and include intergovernmental partners, the local and national Ministry of Health (MOH), NGOs, and community stakeholders. Communication and coordination should foster community engagement, improved data collecting and reporting, and sharing of publicly accessible information. Better clinical staff training and governance are also required to ensure the most effective use of limited resources. Conclusion: South Sudan faces many barriers to quality of care with communication and coordination identified among the foremost issues. Practical application of the WHO elements of quality of care can assist NGOs in effectively identifying areas for improvement to deliver better quality essential health services.

Key Considerations: Improving Uptake of the COVID-19 Vaccine Amongst Women in South Sudan

“…50 In South Sudan, African-run NGOs such as Southern Sudan Healthcare Organisation (SSHCO) worked closely with community chiefs and other groups to discuss the risks and benefits of the vaccine, provide information, and listen to people's concerns before launching a COVID-19 vaccination campaign. 51 Other NGOs working on community engagement in relation to vaccination include the Catholic Medical Mission Board (CMMB) and Health Pooled Fund (HPF). African leaders have recently advocated for more funding for local and regional groups, who have strong ties to local communities and a good understanding of local priorities and concerns.…”

Health services supervision in a protracted crisis: a qualitative study into supportive supervision practices in South Sudan

“…South Sudan is ravaged by civil war, natural disasters, extreme health risks, food insecurity, the COVID-19 pandemic, and severe underfunding for basic services [ 1 , 2 ]. In turn, these challenges have a major impact on health care delivery.…”

“…In turn, these challenges have a major impact on health care delivery. Health service delivery has been directly affected by a shortage of health personnel, facilities and resources and a continuous disruption by conflicts [ 2 , 3 ]. The protracted violent conflict in the country has destroyed livelihoods, caused famine, deteriorated public health and led to the destruction and looting of health facilities, putting further pressure on the already fragile health system [ 4 – 6 ].…”

“…Supportive supervision is a process of guiding, helping, training, and encouraging workers to continuously improve their performance in a respectful and nonauthoritarian way [ 7 , 8 ]. Supportive supervision is vital in the management of health workers and is believed to improve the quality of care and health service delivery [ 9 – 11 ], yet it is challenging to implement due to the low levels of medical training in the country [ 2 , 12 ]. Supportive supervision is expected to improve the quality of care, which compensates for flaws in health workforce management and training [ 13 – 16 ].…”

“…These supervision frameworks were meant to align supportive supervision within the overall health sector reforms to strengthen quality improvement. Despite these efforts, the quality of care is still poor in most health facilities [ 2 , 3 , 26 – 28 ]. Little is documented about the link between the quality of care and supervision in South Sudan.…”