South Sudan 2024. Community Health System Maturity Assessment (Boma Health Initiative)
With ICHESS technical assistance under the Global Fund–funded BIRCH project, South Sudan’s Ministry of Health assessed the maturity of its community health system under the Boma Health Initiative (BHI) at a three-day workshop in July 2024 with 42 participants from national and state levels. This assessment is the baseline for the 2025 follow-up assessment.
Why it matters. Only 44% of South Sudan’s population lives within reach of a health facility, and about 75% of child deaths are caused by preventable diseases such as malaria, pneumonia and diarrhoea. Launched in 2017, the BHI deploys Boma Health Workers to bring a basic package of health, nutrition and WASH services to the most remote communities.
Method. Review of published and grey literature, inventory of foundational elements, and scoring with the Global Fund maturity assessment tool (converted into an Excel template) across 7 domains, with bottleneck analysis and the “5 whys” technique.
Key findings
| Domain | 2024 status | Key finding |
|---|---|---|
| Service delivery | Functional | Boma Health Workers are poorly integrated into health plans, which leads to unclear targets and workloads |
| Governance and leadership | Partially functional | Weak local governance structures and limited political will |
| Human resources | Partially functional | Roles not formalized, BHWs left out of HR planning, inconsistent pay and training |
| Supply chain | Partially functional | Frequent stock-outs and poor logistics infrastructure |
| Information systems | Partially functional | Fragmented, underused system with inconsistent data collection |
| Community engagement | Partially functional | Limited participation and low awareness of services |
| Financing | Non-functional | Inadequate and inconsistent funding, heavily reliant on external sources |
The system is rated partially functional (aggregate score 14). Since the assessment, the BHI has been repositioned as a department under the Primary Health Care Directorate.
Recommendations
- Strengthen governance structures and leadership capacity at all levels
- Formalize BHW roles, with consistent training, pay and career paths
- Integrate BHWs into every UHC and health security plan
- Develop a financial sustainability plan with a costed annual BHI operational plan
- Improve forecasting, procurement and distribution
- Build a community-based HMIS integrated with national systems
- Involve communities in priority setting, planning and decision-making