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

Introduction: Health financing is a critical constraint to health systemperformance in fragile and post-conflict settings. Despite global and regionalcommitments such as the Abuja Declaration, South Sudan allocates less than2% of its national budget to health, resulting in heavy dependence on donorsand high out-of-pocket expenditure. Understanding the determinants of healthfinancing from a stakeholder perspective is essential for informing sustainablereforms.Method: This study employed a qualitative case design to explore stakeholderperspectives on the determinants of health financing in South Sudan. Primarydata were collected through key informant interviews (n = 17) from selectedstakeholders and were analysed using reflexive thematic analysis followingthe Braun and Clarke framework.Results: Findings reveal a health financing system in South Sudan that iswidely perceived as inadequate, unsustainable, and heavily donor-dependent.Key determinants identified include insufficient domestic budget allocation,weak public financial management, limited risk-pooling mechanisms, andlow political prioritization of health. Socio-economic fragility, insecurity, andconstraints on institutional capacity further undermine domestic resourcemobilization.Conclusion: Health financing in South Sudan remains dominated by shortterm humanitarian funding rather than nationally anchored, sustainablepublic financing. Stakeholders emphasized the urgent need for increasedgovernment budget allocation, strengthened financial management systems,improved donor alignment, and a phased transition toward domestic financingmechanisms.