Sudan's health sector partnership: From confined progression to openness and hope to uncertain demise

Motivation Despite the signature of the 2005 Paris Declaration on Aid Effectiveness and subsequent adoption of the principles of effective development co‐operation (EDC) for better health co‐operation, there is a gap in documenting the challenges to implement these commitments at country level. Sudan represents an interesting case study. The country adopted a local health compact in 2014, but for much of the time since the regime had been under sanction. Sudan witnessed a revolution in 2018, followed by a counter‐coup in 2021. Purpose: We aim to explore the evolution of the relationships, perspectives, and compliance of Sudan's health sector partners in terms of the EDC principles of ownership, alignment, and harmonization, while accounting for underlying processes and context changes between 2015 and 2022. Methods and approach We collected data through two rounds of interviews, in 2015 (16) and 2022 (8), with stakeholders within the Sudan Health Sector Partnership. We used the framework method for data analysis where responses are coded and then sorted into themes. Findings Before the 2019 revolution, co‐operation was progressive but restricted, with civil society marginalized and a dominating government. The EDC principles, especially ownership, were misused and misaligned with national priorities driven by donors' interests and conditions. The transition period (post‐revolution) witnessed an influx of partners, characterized by their openness, but unstable leadership and subsequent changes in priorities led to wasted opportunities. Following the coup, donors adopted a no‐contact policy towards the de facto government. The expectation was that civil society organizations would replace the government as the main implementers. Overall, limited co‐ordination capacity and no sustainability measures were present throughout. Policy implications Much of what was observed was due to the often complicated and difficult context of the governance of Sudan. However, general issues arose, including the government's ability to co‐ordinate policy and implementation; the need for stable, legitimate arrangements; and the need to define the role of civil society and empower civil society organizations. In a complex and volatile context, revisiting partners' commitments through joint compact reviews and transparent EDC progress monitoring is crucial.