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Health Workers' Incentives in South Sudan (IMCHA)

South Sudan has some of the worst health indicators in the world. This project will seek to address the problem by improving community health-worker motivation and performance. This, in turn, will help improve maternal and child health outcomes.

Access to health care in South Sudan
Fifty-five percent of South Sudanese live beyond walking distance to a health clinic. Poverty, limited infrastructure, lack of health information, severe shortages of health personnel, and lack of up-to-date standards of practice are seriously compromising healthcare services.

The Ministry of Health and BRAC South Sudan (a non-governmental organization) are using the support of community health workers to address the gap and extend existing health interventions to underserved communities. There is a need to improve the performance of the country's 3,000 community health workers and to sustain their services using approaches that work.

Reducing deaths, improving health
This project will provide information on sustainable methods of delivering community-based primary healthcare services in emergency settings. The project team will examine non-financial incentives that will help improve the performance of community health workers.

The study's first phase includes analyzing a qualitative evaluation of existing community health-worker programs in South Sudan and other BRAC-supported countries (Uganda, Sierra Leone, and Liberia). During the second phase, a randomized controlled trial will assess whether non-financial incentives are effective enough to sustain support of community health workers in South Sudan.

The findings from this project will address gaps in knowledge for cost-effective measures, such as non-financial incentives, to improve access to health care for mothers and children in high conflict contexts. The results will directly inform, strengthen, and scale community health-worker program efforts implemented by BRAC and the Ministry of Health in South Sudan. The research team will share its findings through scientific publications and presentations.

Project partners
This project is part of the Innovating for Maternal and Child Health in Africa program. The program is a seven-year $36 million initiative funded by Foreign Affairs, Trade and Development Canada (DFATD), Canada's International Development Research Centre (IDRC), and the Canadian Institutes of Health Research (CIHR).

Project ID
108033
Project Status
Completed
End Date
Duration
54 months
IDRC Officer
Qamar Mahmood
Total Funding
CA$ 997,962.00
Location
South Sudan
Programs
Global Health
Innovating for Maternal and Child Health in Africa
Institution Country
Netherlands
Project Leader
Jenipher TMusoke
Institution
Stichting BRAC International
Institution Country
Canada
Project Leader
Kevin McKague
Institution
Board of Governors of Cape Breton University

Outputs

Using livelihoods to support primary health care for South Sudanese refugees in Kiryandongo, Uganda

Using livelihoods to support primary health care for South Sudanese refugees in Kiryandongo, Uganda

Article

The research aimed to explore how income-generating activities and interventions can be used to support primary health care for South Sudanese refugees in Kiryandongo District, Uganda. Conflict in South Sudan has displaced 23 million people. 789,000 have taken refuge in Uganda, where they are allowed to work, own property and start businesses. Refugees have identified livelihoods and health care as key priorities to wellbeing. Village Health Teams (VHT) comprised of trained Community Health Workers could make the greatest contribution to both these priorities. The article provides detailed information regarding the study, its findings and recommendations.

Author(s): Ataria, Dominic Odwa, McKagueb, Kevin

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Language: English

Gender intentional strategies to enhance health social enterprises in Africa : a toolkit

Gender intentional strategies to enhance health social enterprises in Africa : a toolkit

Training Materials

Evidence shows that improving gender equality contributes to the achievement of health outcomes, including maternal and child health (MCH). This toolkit guides users to design gender responsive strategies by identifying and responding to key gender-based constraints that limit the effectiveness of Community Health Workers (CHW), particularly female CHWs and their patients. The material is organized around four interrelated themes: Equitable policies and systems; Gender responsive training, support and incentives; Appropriate partner engagement; Gender responsive design and marketing of MCH products and services.

Author(s): Harrison, Sarah, McKague, Kevin, Musoke, Jenipher

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Language: English

Knowledge, attitude, and practice and service barriers in a tuberculosis programme in Lakes State, South Sudan : a qualitative study

Knowledge, attitude, and practice and service barriers in a tuberculosis programme in Lakes State, South Sudan : a qualitative study

Article

The limited network of tuberculosis (TB) facilities for case detection, lack of community distribution of TB drugs, and lack of food at hospitals when patients were admitted for treatment, are key barriers to TB service delivery. This article is part of a larger project “Health Workers' Incentives in South Sudan (IMCHA).“ The study found that there are knowledge, attitude and practice (KAP) barriers in the lack of understanding and accommodation of Dinka traditions, worldview, and traditional treatments. Recommendations include incorporation of Dinka people’s worldview into TB awareness, testing, and treatment to reduce the stigma and lack of disclosure of the disease.

Author(s): Tariquzzaman, Sheikh, McKague, Kevin

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Language: English

How culture shapes the sexual and reproductive health practices among adolescent girls in Eastern Equatoria, South Sudan

How culture shapes the sexual and reproductive health practices among adolescent girls in Eastern Equatoria, South Sudan

Paper

BRAC (Building Resources Across Communities) studied attitudes and practices relating to adolescent sexual reproductive health and related topics. This paper reports the findings from this qualitative study. South Sudan has one of the world’s youngest populations with 72 percent below 30 years of age; 26 percent of adolescent girls (15 to 19 years) are mothers. One participant stated, “If a girl does not get pregnant at early age, people think she is barren.” When asked how many children a woman should have, a majority of participants said that a woman should give birth to eight to twelve children and, therefore, should start giving birth early. The article starts on page 56.

Author(s): Chowdhury, Reajul, McKague, Kevin

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Language: English

South Sudanese refugees in Uganda face overwhelming odds against COVID-19

South Sudanese refugees in Uganda face overwhelming odds against COVID-19

Article

The article focuses on reducing COVID-19 numbers within the refugee populations of Uganda. A system that is understaffed and under-resourced to begin with, such as in refugee settlements, is not well-positioned to meet the challenge of a highly infectious disease. Of the more than 800,000 South Sudanese refugees in Uganda a reported 13,500 of them arrived between January 1 and March 24 2020. Due to the pandemic, on March 25 the government made the decision to close its borders to new refugees. With the border officially closed, individuals still covertly entering Uganda are likely to forgo the UNHCR’s disease monitoring efforts.

Author(s): McKague, Kevin

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Language: English

Gender and health social enterprises in Africa : a research agenda

Gender and health social enterprises in Africa : a research agenda

Article

The rapid evidence assessment (REA) methodology was used to identify research questions at the intersection of the fields of gender equality, social enterprises and community health workers (CHW). Six key unanswered research questions were related to 1) equitable systems and structures; 2) training; 3) leadership development and career enhancement; 4) payment and incentives; 5) partner, household and community support; and 6) performance. CHW programs can potentially fill gaps in health coverage, contribute to sustainable development goals (SDG), and reach remote and marginalized communities in developing countries. REA results identified 57 articles in the academic and grey literatures that met the study inclusion criteria.

Author(s): McKague, Kevin, Harrison, Sarah

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Language: English