Sudan Health Sector Needs Assessment 24 The Health and Nutrition sector aims to improve service delivery and to strengthen the operational environment. The sector plans to scale up humanitarian interventions in under-served regions by improving access to essential health services: communicable disease surveillance, outbreak control and support to referral services for internally displaced persons, host communities and other vulnerable groups. In Southern Sudan, the transitional areas and the eastern states, the lack of infrastructure and qualifi ed human resources are the most important factors impeding healthcare delivery, while the deteriorating security situation in Darfur continues to shrink social services and humanitarian space. Water- and vector-borne diseases continue to be a major threat across the country and require strengthening emergency management, preparedness, disease control, prevention and response capacities of the health system in north and south Sudan. Estimates on HIV prevalence vary greatly, although it is clear that Southern Sudan already faces a generalized epidemic of HIV/ AIDS, requiring the scaling up of appropriate health and nutrition responses for vulnerable groups and affected populations. Maternal mortality in Southern Sudan is the highest in the world at 2037/100 000 live births. Lack of access to health facilities and of qualifi ed assistance at birth as well as the correlation between maternal and infant mortality also contribute to the high infant and under-fi ve mortality rates, estimated at 150 and 250/1000 live births respectively (SHHS 2007). The provision of maternal and child care services (IMCI, EPI, HIV, EmOC) will therefore continue to be a focus for the humanitarian response in the sector both in the north and south. In 2008, priorities for nutrition interventions address both humanitarian and early recovery initiatives; they include strengthening the operational environment through facilitating implementation of national policies, supporting emergency preparedness and response and ensuring service delivery at ground level. Humanitarian interventions also aim to reduce the global acute malnutrition rate from its current level to less than 15% (emergency threshold) among children under fi ve by strengthening the treatment of acute malnutrition and improving nutrition surveillance. In Southern Sudan and Darfur, the focus will also be extended to women and other vulnerable groups including people living with HIV/AIDS. Nutrition interventions will also concentrate on the prevention, control and treatment of micronutrient defi ciency diseases. This will be accomplished through diet supplementation, fortifi cation and dietary diversifi cation, including the provision of vitamin supplements to pregnant and lactating women and children under fi ve. Other interventions will focus on increasing the
percentage of households using adequately iodized salt, providing iodized oil capsules to women of childbearing age and children under fi ve in high risk areas., and implementing the minimum nutrition package and integrated child survival interventions, including growth monitoring and optimal infant and young child feeding. Further capacity development in the health and nutrition sectors include (1) human resources training in the Ministry of Health to expand the management of emergency responses and service delivery, (2) support to early warning systems, (3) decentralization, coordination of resources and communication mechanisms, (4) development of regional health information management systems, (5) improvement of nutrition information systems (including surveys) and (6) strengthening state level surveillance systems. SUDAN Health Sector Priorities for 2008 To reduce avoidable mortality and morbidity among the populations affected either by confl ict, communicable disease outbreaks or natural disasters, the following priority objectives have been identifi ed: Strengthen emergency management, preparedness and response capacity; Improve access and quality of essential health care services including communicable disease surveillance and control of outbreaks; Increase coverage of health services for maternal and child health care, focusing on emergency obstetric care and family planning; Reduce global acute malnutrition among children under fi ve; Prevent, control and treat micronutrient defi ciency. WHO Projects for the Work Plan 2008 Increased access to health care services in the Abyei area for returnees, IDPs vulnerable groups and host community, through establishment and strengthening of a sustainable local health care system SUD-08/HN158 Improvement of health care access and quality ensuring availability of timely care HIV/AIDS affected population SUD-08/HN159 Abyei (Humanitarian) 570 000 MoH, UNICEF, GOAL, SUDAN AID, NDO, PANCARE 566 000 SMoH, UNICEF, UN- AIDS, working 25
Blue Nile (Humanitarian/Early recovery) Improve access to quality health care services for affected population and host community by strengthening the health care delivery system SUD-08/HN160 Improvement of health care access and quality ensuring availability of timely care for HIV/AIDS among affected population SUD-08/HN161 Blue Nile (Recovery and Development) Develop decentralized health system at state and locality level to improve the emergency preparedness and response mechanism at the state level SUD-08/HN162 Darfur (Humanitarian/Early recovery) Darfur ensuring equitable and timely care for vulnerable and confl ict affected population SUD-08/HN163 Darfur ensuring equitable and timely care for HIV/ AIDS affected population SUD-08/HN164 Increase access to and utilization of quality health services of IDPs, rural affected and local vulnerable populations in the three states of Darfur SUD-08/HN165 Secondary health care for IDPs in Darfur SUD-08/HN38 Promotion of water/environmental health services to pre-empt/control water and environmental sanitation related disease incidences in Darfur SUD-08/WS134 Eastern States (Humanitarian/Early recovery) Provision of health care services to the local population including the vulnerable groups of host communities, returnees, IDPs through strengthening and establishment of a sustainable health care system SUD-08/HN166 eastern Sudan ensuring equitable and timely care for HIV/AIDS affected population SUD-08/HN167 500 000 BNS, SMoH, UNFPA, SNAP, GOAL, Samaritan Purse, UNHCR 300 000 SMoH, UNICEF, UN- AIDS. working 500 000 BNS SMoH, UNFPA, SNAP, GOAL, Samaritan purse, UNHCR 8 500 000 SMoH, UN agencies, working in the fi eld of health 1 500 000 SMoH, UNICEF, UN- AIDS, working 6 000 000 SMoH, UN agencies, working in the fi eld of health 487 700 SMoH, international and local NGO 1 258 737 SMoH, WES, UN agencies, WASH implementing 970 000 FMoH, SMoH, UNICEF, GOAL, IRC, SRCs, Plan Sudan, Accord 850 000 SMoH, UNICEF, UNAIDS and working in the fi eld of health 26
Eastern States (Recovery and Development) Strengthen and sustain access to/delivery of health care services to the local population including vulnerable groups of host communities, returnees, IDPs SUD-08/HN168 330 000 FMoH, SMoH, UNICEF, GOAL, IRC, SRCs, Plan Sudan, Accord Khartoum and Northern States (Humanitarian/Early recovery) Improve access to provision of quality health care for IDPs and host communities SUD-08/HN206 400 000 FMoH, SMoHs, UNICEF, UNFPA, IOM, UNHCR, EMDH, MSF, MEDAIR, IFRC, GHF, SNAP, WV, ICRC and other Khartoum and Northern States (Recovery and Development) Strengthening emergency preparedness and response mechanism in health care management SUD-08/HN207 Southern Kordofan (Humanitarian/Early recovery) Increase access to health care services through strengthening and establishment of a sustainable health care system SUD-08/HN208 South Kordofan ensuring equitable and timely care for HIV/AIDS affected population SUD-08/HN209 Southern Kordofan (Recovery and Development) Strengthen health care system to sustain access and delivery of health care services SUD-08/HN210 400 000 FMoH, SMoH, UNICEF, UNFPA, IOM, UNHCR, EMDH, MSF, MEDAIR, IFRC, GHF, SNAP, WV, ICRC and other 2 400 000 SMoH, SOH, FAO, UNDP, UNICEF, UNF- PA, WFP, Medair, SC US, NCA, FAR, PANCARE, Mubadroon 566 000 SMOH, UNICEF, UNAIDS and working in the fi eld of health 800 000 SMoH, SOH, FAO, UNDP, UNICEF, UNF- PA, WFP, Medair, SC US, NCA, FAR, PANCARE, Mubadroon Southern Sudan (Humanitarian/Early recovery) Strengthening a comprehensive and integrated health information system SUD-08/HN121 450 000 MoH (National & State) Basic curative services for returnees in Southern Sudan SUD-08/HN122 Health sector coordination, emergency preparedness and humanitarian action in Southern Sudan SUD-08/HN123 789 880 MoH, UN agencies, IOM, and NGO Partners 1 602 384 GoSS/MoH, SMoH, UN agencies and NGO Partners, Red Cross/ Crescent, IFRC SUDAN 27
Disease control/prevention and epidemic preparedness and response programme for Southern Sudan SUD-08/HN124 Preparation of fi ve qualifi ed nursing and midwifery trainers in a BSc. course for Southern Sudan SUD-08/HN125 Training of Juba Teaching Hospital nurses and midwives on nursing, midwifery and management skills for six months SUD-08/HN126 Support to health training institutions, nursing and midwifery training for Southern Sudan SUD-08/HN127 Routine immunization and vaccine preventable diseases surveillance SUD-08/HN128 Health systems development in Southern Sudan SUD-08/HN130 Capacity building on Integrated Essential Child Health Care for health personnel in Southern Sudan SUD-08/HN131 Rolling out the new treatment policy for malaria (ACTs and RDTs) in Warrap, Bor, Jonglei and Western Equatoria SUD-08/HN132 Improvement of diagnosis and treatment of selected neglected tropical diseases SUD-08/HN133 Polio Eradication Program SUD-08/HN134 Increasing access to maternal health services in Southern Sudan SUD-08/HN135 2 480 000 SMoH, CDC and 603 900 160 430 GoSS/MoH 207 400 GoSS/MoH, SMoH of the six states 1 800 000 MoH, UNICEF, health 960 000 GoSS/MoH, SMoHs, UNICEF, UNFPA, 250 000 TEARFUND, IRC, DOR, ADRA, IMC, MERLIN, NPA, AAH, WV, DOT, GOAL 370 000 GoSS/MoH, CHD/ SMoH and in the states 607 994 GoSS/MoH, MoHs in all ten Southern States, CHDs and NGO as appropriate 3 000 000 MOH, UNICEF, health 345 595 GoSS/MoH, SMoH, Southern Sudan (Recovery and development) Scaling up HIV/AIDS services for populations of humanitarian concern in Southern Sudan SUD-08/HN129 840 000 NOH, Strengthening sexually transmitted infection prevention and control, blood safety and universal precautions in Southern Sudan SUD-08/HN136 * Amounts given in US dollars. 860 000 GoSS/MoH, NGO supporting health facilities, UN agencies working in programme areas 28 Total funds requested: US$ 42 226 020