The place of family medicine and primary health care in South Sudan’s fragile health system

Abstract

Since independence in 2011, South Sudan has faced recurrent conflict, economic collapse and a protracted humanitarian crisis. The health system is fragile, underfunded and donor dependent, with only 40% – 45% of the population accessing functioning facilities. Primary health care (PHC) forms the foundation of service delivery but is constrained by poor infrastructure, shortages of skilled workers and a narrow service scope. Medical education is similarly limited, with few specialist training opportunities and a critical shortage of family physicians. This review synthesises national health system data, literature on family medicine (FM) in sub-Saharan Africa and contextual analysis of South Sudan’s PHC and medical education landscape to explore opportunities for integrating FM into the national system. Evidence from other African countries shows FM improves access to continuous, person-centred care; strengthens integration; and builds resilience during crises. In South Sudan, FM could address high maternal and child mortality, expand community-based care, and enhance workforce capacity. Opportunities include: (1) the large share of healthcare needs met at primary level, (2) existing undergraduate Community Medicine programmes as a foundation for FM training and (3) the establishment of the South Sudan Association of Family Physicians (SSAFP) to promote advocacy, postgraduate training and regional collaboration. Integrating FM into South Sudan’s PHC system offers a strategic pathway towards equitable, sustainable and resilient healthcare. Building on existing structures, fostering partnerships and investing in postgraduate FM education could accelerate progress towards universal health coverage and long-term health system recovery in a post-conflict context.