Advancing access to sexual and reproductive health services in South Sudan – WHO | Regional Office for Africa

Report on Strengthening Sexual and Reproductive Health and Rights (SRHR) in South Sudan

A Strategic Approach to Achieving Sustainable Development Goals 3 and 5

This report details collaborative initiatives undertaken by the Ministry of Health of South Sudan, the World Health Organization (WHO), and partners to expand access to Sexual and Reproductive Health and Rights (SRHR) services. These efforts directly address critical gaps in healthcare delivery and are aligned with the global commitment to the Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 5 (Gender Equality).

Context: SRHR Crisis and its Impact on SDG Targets

Protracted humanitarian crises, driven by conflict and climate-related events, have severely disrupted South Sudan’s health systems. This has resulted in limited access to essential services, creating some of the world’s most significant challenges to SRHR and hindering progress towards key SDG targets.

Key Indicators Deviating from SDG 3 Targets

• Maternal Mortality (SDG Target 3.1): The maternal mortality ratio is estimated at 692 deaths per 100,000 live births. Approximately 10% of these deaths are linked to complications from unsafe abortions, and only 40% of births are attended by skilled personnel.
• Access to Family Planning (SDG Target 3.7): The modern contraceptive prevalence rate is approximately 6%, indicating a substantial unmet need for family planning services.
• Adolescent Health (SDG Target 3.7): The adolescent birth rate stands at 97 per 1,000 girls aged 15–19, highlighting vulnerabilities and the need for targeted health and education interventions.

Strategic Interventions to Advance Health and Gender Equality

In response to these challenges, a multi-pronged strategy has been implemented across seven states, focusing on strengthening primary health systems and building capacity to deliver rights-based care.

1. Capacity Building for Health Workers (SDG 3 & SDG 5)

Targeted training programs have been conducted to equip health workers with the skills needed to deliver quality care and advance specific SDG targets:

1. Maternal and Perinatal Death Surveillance: In 2024, 50 health workers in Warrap and Northern Bahr el Ghazal were trained in surveillance and response protocols to better identify and address the causes of maternal and newborn deaths, directly contributing to SDG Target 3.1.
2. Family Planning Services: 50 health workers in Torit and Wau were trained to expand access to voluntary contraceptive services, a core component of SDG Target 3.7.
3. Clinical Management of Rape: 94 health workers across Torit, Malakal, Renk, and Wau received specialized training to provide timely and compassionate care to survivors of gender-based violence, directly supporting SDG Target 5.2 (Eliminate all forms of violence against women and girls).

2. Improving Access to Post-Abortion Care (SDG 3.1)

Recognizing the critical role of post-abortion care in preventing maternal mortality, WHO supported the development of national guidelines for managing complications from both spontaneous and unsafe abortions.

• 15 health workers were trained on the new guidelines.
• At least 30% of 35 targeted health centres were equipped with necessary supplies, including manual vacuum aspirators.
• In the first year of the project (2024), 934 women successfully accessed care for post-abortion complications.

3. Community Engagement for Reduced Inequalities (SDG 10 & SDG 5)

To create demand and address misinformation, dialogues were held with over 540 local and religious leaders across five states. This initiative aimed to increase community awareness of available SRHR services, promoting greater health equity and empowering women and girls to exercise their reproductive rights, in line with SDG Target 5.6 and SDG 10.

Outcomes and Progress Towards the 2030 Agenda

The program has yielded significant early results, demonstrating a tangible impact on the ground and advancing South Sudan’s progress on the SDGs.

Key Achievements

• Enhanced Service Capacity: Health facilities that previously could not offer post-abortion care, such as Munuki Primary Healthcare Centre, are now equipped and staffed to perform procedures like manual vacuum aspiration.
• Expanded Service Portfolio: Through the partnership, cervical cancer screening and post-abortion care management have been successfully implemented in six health facilities in Juba County.
• Strengthened Partnerships (SDG 17): The collaboration between the Ministry of Health, WHO, and other partners exemplifies the multi-stakeholder approach required to achieve the SDGs. As stated by Vivian Hawa, Reproductive Health Coordinator, “We sincerely thank WHO and partners for this collaboration.”

Conclusion and Forward Outlook

The initiatives in South Sudan demonstrate significant strides in making SRHR services accessible, thereby upholding the dignity and rights of women and girls. Continued investment and collaboration are essential to build upon these gains and ensure long-term improvements in reproductive health outcomes. As noted by Dr. Humphrey Karamagi, WHO Representative to South Sudan, this work is vital to “ensuring that no one is left behind,” a core principle of the 2030 Agenda for Sustainable Development.

SDGs Addressed in the Article

• SDG 3: Good Health and Well-being: The article’s primary focus is on improving health outcomes in South Sudan, specifically by addressing the high maternal mortality rate, low access to family planning, and other sexual and reproductive health challenges.
• SDG 5: Gender Equality: The initiatives described aim to empower women and girls by providing them with access to sexual and reproductive health services, ensuring their right to make choices about their bodies, and offering care for survivors of gender-based violence.
• SDG 16: Peace, Justice and Strong Institutions: The article highlights how conflict has disrupted the health system. The efforts to strengthen the system by developing national guidelines, improving coordination, and training staff contribute to building more effective and resilient institutions.
• SDG 17: Partnerships for the Goals: The entire initiative is a collaborative effort. The article explicitly states that the Ministry of Health is working “with support from World Health Organization (WHO) and partners” to implement these programs.

Specific SDG Targets Identified

1. SDG 3: Good Health and Well-being

   • Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births. The article directly addresses this by citing South Sudan’s high ratio of 692 deaths per 100,000 live births and describing interventions like training skilled birth attendants and providing post-abortion care to prevent maternal deaths.
   • Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education. The article focuses on expanding these services, noting the low modern contraceptive prevalence rate (6%) and high adolescent birth rate (97 per 1000 girls), and details the training of health workers in family planning.
   • Target 3.c: Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries. The article provides concrete examples of this, mentioning the training of 50 health workers in maternal death surveillance, 50 in family planning, 94 in clinical management of rape, and 15 in post-abortion care.

2. SDG 5: Gender Equality

   • Target 5.2: Eliminate all forms of violence against all women and girls. The article addresses a critical component of this target by describing the specialized training of 94 health workers in the “clinical management of rape, ensuring that survivors of gender-based violence… can access timely, compassionate care.”
   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights. The article emphasizes a rights-based approach to care that “responds to people’s needs, choices and rights.” The development of post-abortion care guidelines and the expansion of family planning services directly support this target.

3. SDG 16: Peace, Justice and Strong Institutions

   • Target 16.6: Develop effective, accountable and transparent institutions at all levels. The efforts to strengthen the health system through improved coordination, better monitoring, and the development of “national post-abortion care guidelines” are examples of building a more effective health institution.

4. SDG 17: Partnerships for the Goals

   • Target 17.17: Encourage and promote effective public, public-private and civil society partnerships. The project is a clear example of this target in action, described as a collaboration between the “Ministry of Health, with support from World Health Organization (WHO) and partners.”

Indicators for Measuring Progress

1. For Target 3.1 (Reduce maternal mortality)

   • Maternal mortality ratio: The article provides a baseline figure of “692 deaths per 100,000 live births.”
   • Proportion of births attended by skilled health personnel: The article states a baseline of “around 40%.”
   • Number of health workers trained in maternal and perinatal death surveillance and response: The article mentions 50 health workers were trained in 2024.

2. For Target 3.7 (Universal access to SRHR)

   • Modern contraceptive prevalence rate: A baseline is given as “around 6%.”
   • Adolescent birth rate: A baseline is provided as “97 per 1000 girls between aged 15‒19 years.”
   • Number of women accessing care for post-abortion complications: The article reports that “934 women accessed care” in the project’s first year.

3. For Target 3.c (Health workforce)

   • Number of health workers trained: The article specifies the training of 50 in maternal death surveillance, 50 in family planning, 94 in clinical management of rape, and 15 in post-abortion care guidelines.

4. For Target 5.6 (Universal access to SRHR and rights)

   • Development of national guidelines: The article mentions the development of “national post-abortion care guidelines.”
   • Number of health facilities equipped for service delivery: The article states that “at least 30% of the 35 targeted health centres have been equipped with the necessary tools and supplies to deliver post-abortion care.”
   • Number of community leaders engaged: The article notes that “more than 540 local and religious leaders” were oriented on SRHR concepts.

Summary Table of SDGs, Targets, and Indicators

Source: zawya.com