1. Strengthening Health Systems in Fragile and
Conflict Affected States – South Sudan ++
ACHAP Conference 2015
DRAFT

2. About us: Charlie Goldsmith Associates delivers practical
systems, using appropriate technology, to support basic
services in post-conflict and emerging contexts
● We work in health and education sectors and on cross-government systems.
● We build systems using appropriate technology, and train civil servants and
national staff on-the-job to use, sustain and develop them.
● Functional areas for which we have produced policy and systems, and supported
implementation at scale include HR, payroll, staff and user attendance,
operational finance down to school and clinic level.
● Countries we have recently worked in or are currently engaged in include: South
Sudan, where senior team members have been working since 2006, Sierra
Leone, Somalia, Nigeria, Rwanda, Ethiopia, Nigeria, Tanzania, Malawi.
● Current major programmes Girls’ Education South Sudan (with BMB Mott +),
Health Pooled Fund South Sudan (with Crown Agents +), funded by UK aid – but
speaking in personal capacity today.
● There are 40 of us, including two, soon to be three, full-time coders/ developers/
programmers. Several of our senior staff previously worked for church/faith-based
organisations.
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3. Fragile and Conflict-Affected States (FCAS) need stronger
management systems than ‘steadier’ places, because the
services offered, and who delivers and pays for them, are
more fluid in FCAS, and because systems can partially
substitute for capacity. Systems must be robust for
connectivity and skills environment...
● South Sudan Electronic Payroll System (SSEPS): started in education (2008) and health
(2009), now payroll processing for 150,000 public servants, including all government-
funded health staff
● South Sudan HRIS for health ++ (www.hrissrss.org – 2014-): in four months, roll out has
been completed in four States; system (also in use by Government of Somalia) is non-
sector specific, education expected to be next adopter; now linking up attendance
monitoring
● South Sudan education capitation grants: funds flowing to almost 3000 schools’ individual
bank accounts in 2014; all the budgets and accountability on www.sssams.org/sbrt;
same approach now being rolled to health facilities
● District Health Information Systems 2: a multi-country standard
● IMA delivering geo-coded data and images for 1000s of individual net distribution
recipients in DRC: https://imaworldhealth.org/ima-drc-revolutionizing-bed-net-
distributions-and-taking-accountability-to-another-level/
● Sierra Leone HR and Attendance (2010-2012): improved data supported recruitment by
government of >1000 volunteer health workers to staff up ahead of launch of President’s
Free Health Care Initiative; low-tech but tightly monitored attendance reporting 2

4. ...Church and Faith-based service providers can be a ‘light
on a hill’ piloting management systems, and a committed
accompanier to governments in rolling them out nationally.
● IMA South Sudan delivered first harmonised NGO health worker salary scale,
now adopted by MoH-GRSS.
● IMA South Sudan pilot of practical/hurdle-based funding to facilities.
● IMA in DRC leading roll-out of cloud-based iHRIS with a view to national
implementation.
● RC Diocese of Rumbek Education Department (South Sudan) drove
development of South Sudan curriculum and examinations.
● South Sudan lessons:
○ SSEPS and HRIS deliberately designed to be cross-sectoral, to build ‘safety in
numbers’ and a community of users who can support each other and cross-cover, in
an environment where staff turnover is high. In some States, education and health
technical staff have been promoted up to/act up to centre-of-government roles.
○ Technical staff as change agents: bright junior technical staff can gain experience of
driving change, while being protected by their technical status – one former payroll
manager is now State Minister of Finance, another is a County Education Director!
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5. Getting health and other basic services delivered is a way
in which legitimacy can be won in FCAS. Getting services
delivered can offer legitimacy for political leaders and
political settlements....
● Household surveys across African FCAS reveal the extreme investment poor
people in these countries make in health and education (Girls’ Education South
Sudan household survey 2014).
● Examples of service delivery from a range of places as a means of political
legitimacy:
○ Uganda free health care (1980s edition)
○ Kenya free maternity care
○ Indonesia Free Health Care – part of Jokowi’s manifesto as (successful)
challenger
○ President’s Free Health Care initiative, Sierra Leone, 2010
○ Government funding for écoles conventionnées, DRC
○ Announcement of funding of church teachers’ wages, South Sudan 2006-
● Churches cannot do party politics; but can and should engage about priorities,
about Christian social teaching, and educate the people about how to evaluate
what politicians promise
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6. ...Service delivery can be, and has been, a way for churches
and FBOs to serve peoples and communities, promote
positive social change and justice, and provide honest
good value. Vigilance is needed about whether services are
benefiting the poorest.
● Somalia: ‘education umbrella groups’ – non-governmental equivalents of local
education authorities, delivered by mosque groups
● Pakistan: church schools preferred education for children of Muslim élite!
● South Sudan: churches building schools for 1/3 of the unit cost delivered by World
Bank and UNICEF/UNESCO
● What begins as missional service can end up as an élite club: need for vigilance
about:
○ Who can access, and on what terms, arrangements for fee remission
○ Moving towards the peripheries
○ Using finite missional and skilled personnel to best and boldest effect
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7. Church and faith-based service delivery is often strong in
FCAS, filling a void where government services are absent,
or incapable or unwilling to scale up coverage or provide
quality services....
● South Sudan education: 200+ major schools are church run; majority of the
State partners for Girls’ Education South Sudan (nation-wide DFID programme)
are church-based. Teachers’ wages in church schools funded by government in
some States; all church schools eligible for GRSS/UK aid school capitation
grants.
● South Sudan health: perverse effects of funding regime – long term ‘crisis’ donor
funding of primary health care (to which GRSS at one point gave <20% of health
funding) has attracted high cost international NGOs where they sometimes lack
comparative advantage; Catholic Dioceses have been sustaining principal County
hospital services without programmatic external funding – from 2014 these are
now beginning to be funded by Health Pooled Fund. Limited national-level
coordination of church health work.
● Accès aux Soins de Santé Primaires DRC, funded by DFID: “quadruples the
number of beneficiaries (now around 9 million), through a doubling of funds” – UK
Independent Commission on Aid Impact: IMA programme manager, mostly
church implementing partners (including Sanru and Caritas Congo) in the Zones
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8. ...Churches, FCAS governments and institutional donors
all want services delivered at scale, but have not always
worked together as effectively as they need to, to deliver
at scale for the poor.
FBOs and churches:
● Making it easy to engage: national coordination that has the mandate of Bishops/church
leaders, up-to-date websites, audited accounts
● Working with funders: quality, timely reports, tracking funding opportunities systematically;
engaging strategically; looking for the harder, long term, development money, not the easy
humanitarian ‘fix’
● The right engagement with government: voluntary aided/convention approaches; retaining
independence and voice
● The right structures for executive management of service delivery work: Bishop ≠ CFO!
Institutional Donors:
● Meaningful policy on engaging with churches and faith-based organisations...
● ... in FCAS, donors sometimes deal with less authentic civil society because they fail to
understand social role of church
● Sometimes create unintentional procurement barriers to churches/FBOs
Governments:
● Leaving suspicions of Marxist-Leninist past behind!
● Funding to deliver services, not build a power-base
Partners (fund managers and other implementers):
● Recognising churches as authentic, capable and offering sustainability
DRAFT 7

9. Open for business in Somalia?!
● Demand for health services far outstrips supply in Somalia
● Long term faithful engagement in Somalias by FBOs, including Diakonie, Swiss
Group, various Italian organisations
● Security risks are serious, but are they insuperable? Anglican Remembrance
Service in Hargeisa in November hopefully the first of more
● Can the church play a positive, and witnessing, role in transformation of Somalia?
DRAFT 8

10. Thank you
For more information: www.charliegoldsmithassociates.co.uk
Email: enquiries@charliegoldsmithassociates.co.uk
Photo: Andreea Campeaanu
Photo: Andreea Campeaanu