Community Participation in Primary Healthcare in the South Sudan Boma Health Initiative: A Document Analysis

Document Type : Original Article


1 CIET-PRAM (Participatory Research at McGill), Department of Family Medicine, McGill University, Montreal, QC, Canada

2 Grupo de Estudios en Sistemas Tradicionales de Salud, Universidad del Rosario, Bogotá, Colombia

3 Department of Reproductive Health, Ministry of Health, Juba, South Sudan

4 Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico


Community participation is central to primary healthcare, yet there is little evidence of how this works in conflict settings. In 2016, South Sudan’s Ministry of Health launched the Boma Health Initiative (BHI) to improve primary care services through community participation.

We conducted a document analysis to examine how well the BHI policy addressed community participation in its policy formulation. We reviewed other policy documents and published literature to provide background context and supplementary data. We used a deductive thematic analysis that followed Rifkin and colleagues’ community participation framework to assess the BHI policy.

The BHI planners included inputs from communities without details on how the needs assessment was conducted at the community level, what needs were considered, and from which community. The intended role of communities was to implement the policy under local leadership. There was no information on how the Initiative might strengthen or expand local women’s leadership. Official documents did not contemplate local power relations or address gender imbalance. The policy approached households as consumers of health services.

Although the BHI advocated community participation to generate awareness, increase acceptability, access to services and ownership, the policy document did not include community participation during policy cycle.


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Volume 11, Issue 12
December 2022
Pages 2869-2875
  • Receive Date: 21 July 2021
  • Revise Date: 09 January 2022
  • Accept Date: 27 March 2022
  • First Publish Date: 28 March 2022