South Sudan Qualitative Learning on Routine Immunization Strengthening Program Implementation
Funder: Gates Foundation
Project location: South Sudan
Background
Routine immunization coverage in South Sudan’s Greater Upper Nile (GUN) region remains among the lowest globally, leaving children vulnerable to recurrent outbreaks of preventable diseases. Fragility, displacement, access constraints, and system capacity gaps continue to undermine service delivery in this humanitarian context.
Between 2019 and 2023, the Gates Foundation supported a Routine Immunization Strengthening Program (RISP) implemented by Access for Humanity (AFH), guided by a Theory of Change (ToC). In 2024, the ToC was revised to prioritize four core interventions tailored to the evolving realities in GUN, which AFH implemented between 2024 and 2025. To inform future humanitarian settings programming and investment decisions, DDP was engaged to capture lessons from the 2024–2025 implementation phase.
Project Objectives and Approach
The project’s core objective is to document and analyze the implementation experience of the 2024–2025 RISP in hard-to-reach areas in South Sudan’s Greater Upper Nile region, to inform the Foundation RISP team and Immunization PST’s strategy in humanitarian settings.
Learning was generated through two complementary workstreams. First, a qualitative learning component used in-depth interviews, focus group discussions, and a multi-case study approach to capture implementation experiences, challenges, and adaptive strategies. Second, documentary filmmaking was employed to visually capture lived experiences and frontline realities, translating complex program lessons into accessible, human-centered narratives.
The project engaged policymakers, implementing partners, frontline health workers, community actors, and beneficiaries across seven hard-to-reach counties in Jonglei and Unity states: Koch, Panyijar, Rubkona, Bor, Twic East, Fangak, and Ayod.
Results
The project is delivering high-quality, multi-format learning products designed to support strategic decision-making across global, national, and sub-national levels.
Four case study reports will be generated that synthesize practical lessons on what worked, what did not, and why, providing evidence to inform future routine immunization strategies in humanitarian contexts. Two documentary films complement these insights by presenting grounded, candid accounts of implementation realities, highlighting both enablers and persistent barriers.
Together, these products strengthen collective understanding of how routine immunization systems can be adapted and sustained in fragile settings, supporting more responsive programming and smarter investment decisions.
Funders and Partnership Acknowledgement
This work is supported by the Gates Foundation, with engagement from the Immunization Program and Communications teams.
The project benefits from collaboration with federal-level partners including WHO, Gavi, AFENET, and UNICEF, as well as South Sudan’s Ministry of Health, particularly the PHC Directorate and EPI leadership. Sub-national governments and implementing partners in Jonglei and Unity states, including Access for Humanity (AFH), McKing Consultants, and LiveWell, played critical roles. Acknowledgement also goes to county and community-level actors, including County Health Department EPI Managers, facility staff, Boma Health Workers, and Community Influencers, whose frontline efforts made this learning and documentation exercise possible.
