Successful implementation of community-based health services in conflict- Lessons from the Central African Republic and South Sudan

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Abstract Background The delivery of quality healthcare for women and children in conflict-affected settings remains a challenge that cannot be mitigated unless global health policymakers and implementers find an effective modality in these contexts. CRC and ICRC used an integrated public health approach to pilot a program for delivering community-based health services in the Central African Republic (CAR) and South Sudan in partnership with National Red Cross Societies in both countries. This study explored the feasibility, barriers, and strategies for context-specific agile programming in armed conflict affected settings. Methods A mixed-methods study design was used for this study. Focus groups with community health workers/volunteers, community elders, men, women, and adolescents in the community and key informant interviews with program implementers were conducted in CAR and South Sudan. Additional data related to program activities and qualitative data to validate findings from focal group discussions and key informant interviews were extracted from program implementation reports. Data were analyzed using a content analysis approach and triangulated during the study analysis and inference. Results In total, 15 focus groups and 16 key informant interviews were conducted, and 169 people participated in the study. Engaging community elders emerged as an overarching theme underpinning the importance of gaining community trust. The feasibility of service delivery in armed conflict settings depends on well-defined and clear messaging, community inclusiveness and a localized plan for delivery of services. Security and knowledge gaps, including language barriers and gaps in literacy, impacted service delivery. Empowering women and adolescents and providing context-specific resources can mitigate some barriers. Community engagement, collaboration and negotiating safe passage, comprehensive delivery of services and continued training were key strategies identified for agile programming in conflict settings. Conclusion Using an integrative community-based approach to health service delivery in CAR and South Sudan is an effective approach for humanitarian organizations operating in conflict-affected areas. To achieve successful, agile, and responsive implementation of health services in a conflict-affected setting, decision-makers should focus on effectively engaging communities, bridge inequities through the engagement of vulnerable groups, and contextualize service delivery with the support of local actors.

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