Maternal healthcare in South Sudan faces significant challenges due to limited infrastructure, workforce shortages, and a complex socio-political context. There is a need to document and evaluate context-specific, innovative approaches to service delivery in this setting. This study aimed to identify, describe, and assess innovative approaches to maternal healthcare in South Sudan. Its objectives were to catalogue these innovations, understand their implementation processes, and evaluate their perceived effectiveness and sustainability from the perspective of healthcare providers and stakeholders. A sequential explanatory mixed-methods design was employed. First, a quantitative cross-sectional survey was administered to healthcare facilities to map service innovations. Subsequently, qualitative data were collected via in-depth interviews and focus group discussions with midwives, clinical officers, and programme managers to explore implementation experiences and contextual factors. Survey data indicated that a majority of facilities had adopted at least one formally recognised innovative practice, most commonly mobile health outreach and task-shifting models. Qualitative analysis revealed a central theme of 'flexible adaptation', where successful innovations were characterised by their ability to be modified to local resource constraints and cultural norms, though often reliant on individual champion-driven efforts. Innovation within South Sudan's maternal healthcare sector is widespread and driven by necessity. The sustainability of these approaches is closely tied to local adaptation and staff commitment, but often remains precarious due to systemic fragilities. Policymakers and supporting agencies should develop frameworks to identify, support, and scale locally adapted innovations. Greater investment in health system strengthening is needed to provide a more stable foundation for innovative practices and to integrate successful pilot projects into routine care. Maternal health, innovation, mixed methods, South Sudan, healthcare delivery, sub-Saharan Africa This study provides a systematic assessment of context-driven maternal healthcare innovations in South Sudan, highlighting the critical role of flexible adaptation and the tension between grassroots initiative and systemic support for sustainable improvement.
Achol Deng (Mon,) studied this question.