# Humanitarian–development nexus approach to health systems strengthening in Sudan—a policy analysis

## TL;DR

This paper analyzes how Sudan is using a combined humanitarian and development approach to strengthen its health systems amid ongoing crises.

## Contribution

The study provides new insights into the adoption and challenges of the humanitarian–development nexus in health systems within a protracted emergency context.

## Key findings

- There is uncertainty about the practical implementation of the nexus approach despite agreement on its importance.
- Global partners and coordination mechanisms have driven the introduction of the nexus in Sudan.
- Conflicts exist among actors regarding financial management, procurement, and information systems in the health sector.

## Abstract

With increasing conflict, fragility, and emergencies in many countries, health systems are being frequently weakened and require support and strengthening. To ensure the provision of lifesaving interventions while improving national health systems, the humanitarian–development nexus presents a policy solution to bridge the divide between humanitarian and development actors. Sudan represents an interesting case of the nexus of adoption in the context of protracted emergencies, a volatile political scene, and complex economic and partnership dynamics. This study aimed to explore the understanding and adoption process of the nexus approach to health systems strengthening in Sudan.

We conducted a policy analysis based on seven qualitative interviews conducted in 2022 with informants from varying humanitarian and development entities.

Our findings revealed uncertainty surrounding the meaning and practicalities of the nexus, despite a consensus on its importance. At the same time, the introduction process was driven by global partners, the Government of Sudan’s adoption of the nexus, and the presence of relevant coordination mechanisms within the health sector, which facilitated the advancement of the nexus. However, the humanitarian and development actors expressed conflicting values and disagreements about the use of the financial management, procurement, and information components of the national health system.

Sudan’s health partners have implemented various nexus-based practices to strengthen national health system capacities. However, the nexus approach has faced challenges due to conceptual ambiguities and inconsistent implementation. We call for the advancement of guidance and dialog on the approach, emphasizing the importance of ownership, coordination, and flexibility, with the belief that the humanitarian–development divide can be further bridged.