South Sudan: Health Care Access for IDPs and Returnees May 2020

Analysis

IDPs and returnees are particularly vulnerable from a health perspective. Sudden population movements, whether due to displacement or population return, may strain local health services and result in underserved populations. In some cases, local health services have shut down as a result of conflict or populations have settled in remote areas perceived as being safer, but are beyond the reach of the existing health care system.

As of June 2019, 8.8 per cent of IDPs and 13.9 per cent of returnees in South Sudan lived in settlements reporting no access to healthcare, while 22.3 per cent of IDPs and 29.4 per cent of returnees lived in settlements reporting no on-site health services and located further than three kilometres away from the closest off-site health service provider. While large displacement camps often benefit from basic service provision from humanitarian actors, needs tend to be higher for IDPs living in smaller camps and camp-like settings and for IDPs and returnees living in host-community settings (see Mobility Tracking Round 6, Health Summary Report).

To identify areas with health care gaps for IDP and returnee populations, IOM’s Displacement Tracking Matrix and WHO’s Health Service Functionality units analyzed health facility-level data for March 2020 with settlement-level data on IDP and returnee populations to identify IDP and returnee settlements farther than 5km away from the closest functional health facility. The analysis provides a countrywide summary of gaps in access to health services by these two populations of humanitarian concern. Additional detail on the analysis methodology can be found in the Notes & Sources section.

Based on the results of the analysis, 32.2 percent of IDPs (536,882 individuals) and 36.8 percent of returnees (502,042 individuals) live in settlements located more than 5km from a functional health facility, while 1 percent of IDPs (16,936 individuals) and 2 percent of returnees (27,811 individuals) live in settlements that are only within the 5km range of facilities with limited functionality. An additional 3.4 percent of IDPs (56,693 individuals) and 3.2 percent of returnees (44,275 individuals) live within 5km of a health facility, but the health facility functionality status is unknown. The states with the largest absolute gaps are Upper Nile (46 percent of IDPs and returnees living in settlements more than 5km from the closest functional health facility, or 213,054 individuals), Jonglei (34.9 percent of IDPs and returnees, or 134,526 individuals) and Unity (35.3 percent of IDPs and returnees, or 134,259 individuals). Other states, while having lower absolute numbers of IDPs and returnees living in unserved settlements, show a high proportion of these populations living more than 5km away from the closest functional health facility: Upper Nile (46 percent of IDPs and returnees, or 213,054 individuals), Warrap (44.1 percent of IDPs and returnees, or 114,511 individuals), and Lakes (36.9 percent of IDPs and returnees, or 102,819 individuals). The following tables and visualizations provide summaries at the state, county, and location levels.

National & State Summary of IDPs & Returnees Farther than 5km from a Functional Health Facility

Administrative Area	IDPs & Returnees >5km from Health Facility	Total IDPs & Returnees	% IDPs & Returnees >5km from Health Facility
National	1,038,924	3,031,582	34.3
Central Equatoria	116,531	356,237	32.7
Eastern Equatoria	44,838	162,723	27.6
Jonglei	134,526	385,079	34.9
Lakes	102,819	278,467	36.9
Northern Bahr El Ghazal	63,627	245,185	26.0
Unity	134,259	380,489	35.3
Upper Nile	213,054	463,091	46.0
Warrap	114,511	259,716	44.1
Western Bahr El Ghazal	75,708	286,464	26.4
Western Equatoria	39,051	214,131	18.2

IDP & Returnee Settlements Located More than 5km from a Functional Health Facility

Counties by Number of IDPs & Returnees Farther than 5km from a Functional Health Facility

Notes & Sources

For any questions on IOM DTM data on IDP and returnee settlements, please contact southsudandtm@iom.int.

For any questions on the analysis or health service availability data, please contact Malick Gai (gaim@who.int), HSF Project Manager, or Ryan Burbach (rmburbach@gmail.com), HSF Technical Adviser.

Analysis Methodology

The joint analysis comprised identification of settlements in IOM’s DTM IDP and returnee data for round 7 which were more than 5 kilometers from any functional facility or facility with an unknown functionality status (i.e. no service availability report is available) in WHO’s Health Service Funcationality data as of 31 March 2020. Facilities with an unknown functionality status were included as this provides the most conservative estimate for health access limitations. To achieve this, the team used QGIS v3.12.1 to draw circles with 5km radii around each functional health facility (n = 1,358) or facility with an unknown functionality status (n = 292). Then, the team conducted points in polygons analysis to identify settlements from the IOM data set which did not fall within any of these 5km-radius circles. The list of these settlements more than 5km from a health facility was extracted from QGIS and analyzed with R v3.6.3 and associated packages.

DTM Mobility Tracking Methodology

DTM enumerators collect data on IDP and returnee populations at the payam and settlement level through consultation with key informants, commonly comprised of local authorities, community leaders, religious leaders, and humanitarian partners. In round 7, DTM interviewed 1,691 key informants at the payam level. Direct observation at each location in addition to the triangulation and the subsequent verification process (data received through partners and other DTM tools such as biometric registration) at various administrative levels serves to further ensure maximum accuracy of findings. DTM accessed 2,558 locations (villages / neighbourhoods and displacement sites) representing a 9 per cent increase in coverage since round 6. Accessed locations were spread across 483 payams (sub-areas) in every county (78) of all 10 states. Locations are only assessed upon confirmation of presence of targeted populations. DTM did not conduct multi-sectoral location assessments in round 7.

As of Mobility Tracking round six, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) IDP baseline is consolidated with DTM findings. The two agencies continue working together to maintain a unified baseline on IDP populations updated after each round of data collection. Mobility Tracking is implemented on a quarterly basis in order to keep track on South Sudan’s rapidly evolving displacement and return trends.

IDPs
Persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized state border. Both IDPs living in camps and camp-like settings and those living in host-community settings are included in Mobility Tracking.

Time of arrival in assessed area considered for South Sudan: 2014 to November 2019

Returnees: internal / from abroad
Someone who was displaced from their habitual residence either within South Sudan or abroad, who has since returned to their habitual residence. The returnee category, for the purpose of DTM data collection, is restricted to individuals who returned to the exact location of their habitual residence, or an adjacent area based on a free decision. South Sudanese displaced persons having crossed the border into South Sudan from neighbouring countries without having reached their home are still displaced and as such not counted in the returnee category.

Time of arrival in assessed area considered for South Sudan: 2016 to November 2019

Health Service Availability Data

Facility data for this bulletin was kindly contributed by the Health Cluster partners, Health Pooled Fund (HPF), the International Committee of the Red Cross (ICRC), Management Sciences International (MSI), UNICEF, and UNHCR. Additional service availability data was extracted from the Ministry of Health DHIS2 platform for facilities without an implementing partner report. Most data was reported as of 31 March 2020, but the report date for each facility is indicated by hovering over a facility marker on the map. Implementing partners self-report on a quarterly basis service availability based predefined, standardized service availability data points and definitions. WHO merges the respective data sets and assigns a functionality level to each facility based on the criteria below.