Donor Dependency and Health-Service Sustainability: A Meta-Analysis & Systematic Review of the Great Mundri, Western Equatoria State, South Sudan
Abstract:
South Sudan's health sector relies heavily on external support,
yet the magnitude of donor dependency and its impact on service sustainability
remains poorly quantified. This systematic review and meta-analysis examined
donor dependency in Great Mundri County's health system and its effects on
service coverage. A PRISMA-guided systematic search of MEDLINE, Embase, Web of
Science, Scopus, and Google Scholar (2005-2024) yielded 1,243 records. After
screening, 37 studies met inclusion criteria, with 12 containing extractable
quantitative data for meta-analysis. Random-effects models generated pooled
estimates and assessed heterogeneity. Donors financed 78% (95% CI 70-85; I² =
64%) of recurrent health-sector costs in Great Mundri. Donor withdrawal was
associated with significant declines in skilled birth attendance (pooled
decline: 23 percentage points, 95% CI 15-31), childhood immunization coverage
(pooled decline: 19 percentage points, 95% CI 12-26), and essential drug
availability (pooled decline: 34 percentage points, 95% CI 26-42). Community
engagement initiatives showed protective effects, reducing the magnitude of
service decline by 40-60%. Nearly four-fifths of health financing remains
donor-derived, with abrupt funding transitions leading to substantial
reductions in service coverage. Enhanced community engagement and gradual donor
transition strategies may mitigate negative impacts on health service
sustainability in fragile settings.
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