Stakeholder perspectives of maternal and newborn health prioritization in South Sudan: a policy analysis

Abstract

Background: The maternal and neonatal mortality in South Sudan is among the highest in the world and among other fragile and conflict-affected countries. Within an evolving political economic context, this study aims to capture perspectives of current actors on drivers of the stagnating investments in maternal and newborn health (MNH). Methods: A descriptive case study guided by the health policy analysis triangle to explore contextual factors, policy content, actors’ roles and implementation processes for MNH policy and practice. A total of 20 key informants from government, humanitarian and development organizations, civil society, donors and health providers were interviewed. Results: According to respondents, MNH was a priority in South Sudan due to the presence of various legal and policy frameworks. However, financial investment in MNH programs was inadequate due to the government focus on peace and stabilization, and the fragmented parallel systems run by international actors. Funding for MNH was also affected by ongoing conflicts and disease outbreaks, which diverted attention away from the issue. National initiatives to expand service coverage and funding are either inadequate or not well studied. In addition, gendered attitudes and norms continue to impede care seeking, service provision and inclusivity in decision-making for improving MNH prioritization. Stakeholders highlighted the need for accountability to sustain progress and close policy implementation gaps. Conclusion: This study highlighted relevant challenges and opportunities for improving MNH outcomes in South Sudan and similar fragile contexts. Government ownership of the MNH agenda is needed, so is strengthening of national initiatives, gender equity, actor coordination and accountability mechanisms.