Stakeholders’ perspectives on determinants of health financing in South Sudan: a qualitative assessment

Abstract

Introduction: Health financing is a critical constraint to health system
performance in fragile and post-conflict settings. Despite global and regional
commitments such as the Abuja Declaration, South Sudan allocates less than
2% of its national budget to health, resulting in heavy dependence on donors
and high out-of-pocket expenditure. Understanding the determinants of health
financing from a stakeholder perspective is essential for informing sustainable
reforms.
Method: This study employed a qualitative case design to explore stakeholder
perspectives on the determinants of health financing in South Sudan. Primary
data were collected through key informant interviews (n = 17) from selected
stakeholders and were analysed using reflexive thematic analysis following
the Braun and Clarke framework.
Results: Findings reveal a health financing system in South Sudan that is
widely perceived as inadequate, unsustainable, and heavily donor-dependent.
Key determinants identified include insufficient domestic budget allocation,
weak public financial management, limited risk-pooling mechanisms, and
low political prioritization of health. Socio-economic fragility, insecurity, and
constraints on institutional capacity further undermine domestic resource
mobilization.
Conclusion: Health financing in South Sudan remains dominated by shortterm humanitarian funding rather than nationally anchored, sustainable
public financing. Stakeholders emphasized the urgent need for increased
government budget allocation, strengthened financial management systems,
improved donor alignment, and a phased transition toward domestic financing
mechanisms.