Factors affecting implementation of health systems strengthening: A case of the round 9 grant in South Sudan
The presence of poor health conditions in a country slows economic growth directly as societies lose potential workers and consumers to disease and disability. Without greater and more effective investment in health systems and services, the achievement of millennium development goals becomes impossible. Health outcomes are unacceptably low across Africa, owing to failing or inadequate health systems. The Republic of South Sudan boasts of being the newest nation in Africa. However, decades of war has left its health systems in disarray and in a state of collapse. The purpose of this study is to establish factors affecting implementation of health systems strengthening grants in South Sudan. The objectives of the study include: how the existing infrastructure, security of the country, procurement regulations and health personnel affect the Round 9 grant, which is funded by the Global Fund. This study employs a survey research design. The target population for this study is 49 staff involved in this project in UNDP, the MoH and CHAS. Purposive sampling was used to select program staff and technical experts in health systems strengthening from the target population. Both primary and secondary data was used. Primary data was collected using self-administered questionnaires while secondary data was collected by reading through grant reports, health system strengthening published journals from WHO and other international health organizations, the Global Fund published reports, brochures and health journals. Descriptive analysis was used to analyze the data. The study revealed that the current state of infrastructure negatively affects the implementation of the Round 9 grant in South Sudan. The poor state of roads, especially during the rainy season leads to delays in transporting construction materials to the sites. The study also concludes that the security situation prevailing in certain regions of South Sudan negatively affects the implementation of the grant. Insecurity has delayed the construction of health facilities. Health equipment in some completed facilities has been destroyed and looted as a result of conflict. In addition, construction of facilities in some regions has been cancelled as a result of conflict. Quality assurance procedures in procurement is one of the major aspects causing delays in grant implementation. Procurement of health products and equipment is normally delayed as a result of the quality assurance requirements at donor level and procurement regulations at the PR level. Finally, there is a critical shortage of health personnel in South Sudan. This has forced program management to recruit from neighboring countries. Some of the facilities constructed under the grant are not operational due to lack of skilled health personnel in the country.