Abstract

South Sudan’s health sector remains one of the most aid-dependent in sub-Saharan Africa, with over 80% of essential services financed by external partners. This reliance on Official Development Assistance (ODA) undermines national ownership, fiscal resilience, and long-term sustainability. In response, the Ministry of Health—supported by ICHESS and development partners—has developed the Domestic Health Financing Strategy (2025–2035), a comprehensive roadmap for transitioning to a domestically financed, community-driven health system. Anchored in the Boma Health Initiative (BHI), the strategy employs a mixed-method policy and fiscal review to propose a phased implementation plan grounded in political commitment, community engagement, and innovative financing instruments, including blue bonds, sin taxes, and diaspora health investment platforms. Key targets include increasing government health spending to 15% of the national budget by 2035, integrating 70% of Boma Health Worker (BHW) salaries into the public payroll, and scaling revolving drug funds nationwide. This paper critically analyzes the strategy’s design, contextual challenges, financing pillars, and governance mechanisms, arguing that domestic resource mobilization—underpinned by equity, transparency, and accountability—is essential for sustainable health system transformation. The framework also offers a replicable model for other fragile and low-income countries seeking to strengthen community health financing.