With technical assistance from ICHESS under the Global Fund-financed BIRCH project, the Ministry of Health of South Sudan conducted the 2025 Community Health System Maturity Assessment (CH-SMA). The assessment measures the functional, organisational and operational maturity of the community health system, built around the Boma Health Initiative (BHI), and sets a roadmap to 2035. It builds on the 2024 baseline assessment.

Why it matters. 78% of South Sudan’s population lives in remote rural areas and 56% lives more than 5 km from a health facility. Boma Health Workers are often the only link between households and the health system, in a context of conflict, climate shocks and a cholera epidemic with more than 80,000 cases since October 2024.

Method. A national workshop brought together 59 public health experts, technical partners, field actors and community representatives. Working in thematic groups on a standardised scoring matrix, they rated each domain of the community health system and compared 2025 with the 2024 baseline.

Key findings

Domain	2025 status	Main driver
Leadership, governance & planning	Functional (up from 2024)	National community health strategy finalised and aligned with HSSP 2023–2027
Service delivery	Functional	Integrated package (malaria, nutrition, maternal and child health) delivered by BHWs, largely donor-supported
Supply chain	Improving	Better availability, but weak last-mile logistics and stock-outs at community level
Human resources	Partially functional	Remuneration, supervision and integration of BHWs into the public system
Information systems	Partially functional	Slow integration of the community health information system into DHIS2
Community engagement	Partially functional	Most Boma Health Committees inactive or underfunded
Financing	Non-functional	No community health budget line; health spending below 2% of GDP; 85% donor dependence

Overall, the system scores 15 out of 28 (“emerging” stage): governance gains are real, but they will not translate into a functional system without investment in financing, the workforce, data and logistics.

Roadmap to 2035

• Create a dedicated community health budget line in the Ministries of Health and Finance, and raise health allocations by 0.5–0.7% of GDP a year towards the Abuja target of 8% by 2035
• Integrate Boma Health Workers into the payroll, with national training, certification and a career pathway
• Standardise community health information tools and link them fully to DHIS2, with regular data feedback
• Invest in last-mile supply chain, transport and logistics
• Revitalise 80% of Boma Health Committees and formalise civil society–BHI forums
• Expand integrated outreach to underserved counties

The assessment offers the Ministry and its partners a nationally validated basis to prioritise investments in the 2026 annual operational plan and beyond.

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