The Integrated Community Health Systems Institutionalization Framework (ICHS-IF): A Strategic Model for Strengthening Primary Health Care and Universal Health Coverage in South Sudan
Abstract:
Community health systems are central to achieving Universal Health Coverage (UHC), particularly in fragile and conflict-affected settings. In South Sudan, fragmented community-based programmes, parallel implementation structures, weak governance, and inconsistent financing have constrained the sustainability and effectiveness of community health services. To address these challenges, the Ministry of Health developed a Community-Based Networks (CBNs) Integration Strategy within the Revised Boma Health Initiative (2024–2028). This study presents a strategic framework for institutionalising CBNs within South Sudan's national community health system to strengthen Primary Health Care (PHC), improve service integration, and advance UHC. A qualitative Health Policy and Systems Research approach was applied through review and thematic analysis of national policies, strategic frameworks, programme reports, technical working group documents, stakeholder consultation reports, and relevant international literature. The analysis identified fragmented governance, parallel community structures, inconsistent supervision, inadequate financing, and weak accountability as major barriers to effective community health service delivery. In response, the study proposes the Integrated Community Health Systems Institutionalization Framework (ICHS-IF), which integrates governance and leadership, service delivery, community health workforce development, sustainable financing, digital health information systems, community accountability and participation, and multisectoral coordination within a unified institutional model. Institutionalizing CBNs within existing government systems offers a practical and potentially scalable approach for strengthening resilient community health systems. The ICHS-IF provides an evidence-informed framework for South Sudan and other fragile and resource-constrained settings seeking to strengthen PHC, improve health system resilience, and accelerate progress toward UHC.References:
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