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Alliance for Action Aid: a community-led approach to healthcare

South Sudan is the world’s newest country, having declared independence from Sudan in 2011. It has approximately the same land area as Texas, though has a vastly different demography; approximately 80% of the population live in rural areas and nearly half are under the age of 15. The land of the ‘Mountain Nile’, South Sudan has a tropical climate and is home to both Africa’s largest wetland and the continent’s largest intact savannah – almost 12,000 square miles untouched by human activity. South Sudan’s unique landscapes make it one of the most biodiverse locations in the world.

Also a culturally diverse country, South Sudan is a melting pot of at least 60 different ethnic groups. Facial scarification, an ancient practice involving marking the skin, often to signify tribal affiliation, remains relatively common among certain tribal groups in South Sudan, though it is now officially forbidden and is becoming far less common. The country’s heritage is understudied internationally. This is partly because oral histories are the source of most knowledge about South Sudanese heritage and they yet to be adequately recorded, documented, and archived such that they are accessible for communities outside of the country.

South Sudan has an extremely rich and diverse cultural heritage.

Sadly, the country is increasingly being defined by its overlapping humanitarian and climate crises. The area that comprises South Sudan has a history of protracted conflict, including a civil war that began in 2013. Whilst a ceasefire was signed in 2018, this most recent conflict has displaced approximately 4.5 million people, 2.2 million of which remain in South Sudan. Conflict and political instability have severely hindered the formation of national institutions in this newly independent country and have made much of the population dependent on humanitarian assistance.

South Sudan is also identified by the United Nations as one of the five countries most vulnerable to climate change globally. Total rainfall has reduced and become more concentrated, making areas of the country extremely vulnerable to both flooding and droughts. The changing climate has impacted the landscape and infrastructure; areas previously accessible by land are now regularly cut off by seasonal flooding.

A BBC report on the severe flooding in South Sudan in 2022:

Healthcare Challenges

Healthcare services have been consistently undermined by conflict and flooding. At only 55 years, life expectancy in South Sudan is amongst the lowest globally. Shockingly, girls in South Sudan are more likely to die in childbirth than to finish secondary school. 67 out of 80 counties in South Sudan have inadequate or no official healthcare services at all. It is widely recognised that the stock of trained healthcare workers is not large enough to provide for the needs of the population. As a result, non-governmental organisations (NGOs) are responsible for the delivery of over 80% of health services.

Payinjiar County

Payinjiar county, in the far south of Unity State, mostly falls within the biodiverse but ecologically fragile Sudd Wetlands. Four consecutive years of severe floods continue to affect communities in Payinjiar, isolating communities and making them inaccessible by land. The county is also home to thousands of people internally displaced by conflict, and experiences acute food insecurity on an annual basis due to a combination of these factors. Primary healthcare is an urgent need in Payinjiar, and a community led response is being provided by the local NGO the Alliance for Action Aid (AFAA)

AFAA works in Payinjiar, a county in the South of Unity State (highlighted)

AFAA's Approach

Aiming to address this complex set of needs, Alliance for Action Aid (AFAA) was formed in 2016 by Michael Gatluak, a doctor originating from the Payinjiar area, alongside other board members, Payinjiar community leaders and medical professionals from Juba. Their knowledge of the community’s needs led them to identify healthcare as the biggest challenge the county faces.

AFAA’s approach has three main strands:

A. Direct Healthcare Provision

AFAA has set up stationary primary healthcare units which provide basic, first point of contact healthcare, as well as a mobile health clinic. These facilities are staffed by a team of South Sudanese medical professionals with different specialisations. AFAA’s team is the only reliable provider of health services in the county: it diagnoses and treats diseases, carries out immunizations, conducts malnutrition screening, provides antenatal care, and facilitates hygiene education.

The mobile clinic also responds to emergencies across Payinjiar county and carries out disease surveillance, producing early warnings of wider health threats if required. If AFAA did not conduct the work it did, healthcare would be inaccessible to communities in Payinjiar or would require a multi-hour journey by boat

AFAA’s community health workers work closely with AFAA’s primary health care unit

B. Training the Community

As well as intervening directly, AFAA provides training to a network of local community health workers (CHWs) across Payinjiar. This builds their capacity, ensuring that they can effectively deliver healthcare at the household level. As per national government strategy, these community health workers are nominated by their community.

The health workers visit households within their community regularly, treat diseases such as pneumonia, malaria and diarrhoea, screen children for malnutrition and provide education on how to prevent disease. They are also responsible for recording and reporting instances of disease, so that the government can better understand the situation on the ground.

C. Strengthening healthcare nationally

AFAA plays a key role in coordinating other health actors in South Sudan, including government ministries, international bodies, religious leaders, and NGOs. It regularly attends meetings at the national, state and county level. AFAA shares information about the needs on the ground and points out gaps which need to be filled. This collaboration also helps to ensure that the services AFAA implements are in line with the national ministry of health guidelines.

AFAA is now a trusted voice in policy discussion and works beyond just health service provision and beyond just the Payinjiar region; it has branched out and now regularly collaborates on projects relating to sanitation, food security and peace building, nationwide. The close connections it has made with other policy makers and actors also mean that it has the authority to encourage the responses that are used in Payinjiar to be used elsewhere too.

AFAA’s role in the coordination of health actors helps ensure that the relevant resources reach the right place

Why is AFAA's approach sustainable?

In a country dependent on international aid and UN actors, AFAA’s community-led model health model demonstrates an alternative. Its approach is underpinned by community members who have an in-depth understanding of the context of local needs.

Working from the ground up, AFAA’s health model actively builds the capacity of communities to help themselves and take ownership over their healthcare, reducing the risk of long-term dependency on external actors. It comprises the best of humanitarian and development work: an immediate response to pressing health needs but conducted in a way that helps to develop long-term health institutions.

The benefits of AFAA will extend far beyond the organisation’s lifetime.

More information about AFAA can be found on their website:

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