Strategic Health Purchasing as an Enabler of Health Systems Resilience in Fragile States: Evidence from South Sudan

South Sudan’s health system stands at a crossroads. Despite great need, it faces serious challenges: domestic funding is low, only 2- 5% of the annual budget, while over 65% of health spending comes from donors. Purchasing is fragmented, and weak governance complicates progress. Yet there is a promising way forward. Strategic health purchasing (SHP) can help South Sudan maximise its limited resources, focus spending on national priorities, and build a more resilient, accountable health system.

This policy brief draws on a recent study using the SPARC Progress Tracking Framework to assess SHP progress in South Sudan. There are bright spots: reforms like the Basic Package of Health and Nutrition Services (BPHNS) and the Health Sector Transformation Project (HSTP) are important steps. But major barriers remain. Service delivery still struggles with weak Public Financial Management (PFM), an uncosted BPHNS, inefficient provider payments, and limited autonomy for health facilities.h Sudan must strengthen governance, align SHP with practical national priorities, reform provider payments and contracting, improve data systems, and boost domestic health investment. Reducing donor dependency is vital for achieving Universal Health Coverage (UHC) and a healthier future for all.