Role of an international non-governmental organisation in strengthening health systems in fragile-state context: Evaluation results from South Sudan

Abstract

World Vision implemented the community-based Maternal and Child Health Transformation (MaCHT) Project from September 2010 to September 2014 in fragile-state South Sudan. To document and measure health-related activities executed by an international nongovernmentalo rganisation to sustainably strengthen the capacity of the health system in delivering essential health services to pregnant women and children under two years of age, including new-borns and infants. A range of mixed methods, including in-depth interviews, focus group discussions, observation, and uncontrolled cross-sectional before-and-after surveys using Henderson’s method were carried out. The unit of analysis was mothers of children under two years of age, and community health workers (CHWs). An estimated 39 000 children under age two were attended to by CHWs. Coverage of essential maternal and childhealth care (MCH) increased in all single interventions, ranging from a minimum of 5% points to a maximum of 49% points during the implementation period. The capacity of the health system to deliver essential MCH services improved by building the supply and performance of the health workforce through task-shifting and in-service training. Likewise, operational linkages between community structures and local health services were strengthened. In conclusion, this program supported health system strengthening, mainly in the areas of service delivery, health workforce, and medical products, vaccines, and technologies. The project also informed policy at district and national levels and repositioned the maternal, neonatal, and child health (MNCH) agenda to further scale up these activities. An evaluation of a four year USAID-funded child survival project implemented by an international non-governmental organisation (NGO) in fragile-state context showed progress and challenges in health system strengthening for maternal health practices and community case management of diarrhoea, pneumonia, and malaria in children under five.