IMPLEMENTATION OF NATIONAL DEVELOPMENT STRATEGIES; SUDAN PRESENTATION

IMPLEMENTATION OF NATIONAL DEVELOPMENT

STRATEGIES; SUDAN PRESENTATION

الرحيم الرحمن الله بسمTHE REPUBLIC OF SUDAN

ECOSOC MEETING, GENEVIA6-10-2009

Outlines of the presentation

• Sudan Background• Key Features of HS in Sudan• MDGs; indicators and efforts• Main challenges and

Recommendations

Background

Shares borders with9 countries; free movement across most of these borders

Vast country; surface area 2.5 million km²

Background• 40 millions population (2008

census), scattered scanty populated settings

• Massive population movement and displacement (civil conflict, drought, desertification and major floods)

Background• High adult illiteracy rate

(mainly women)

• Low population awareness on health issues

Three tiered health system/ Decentralized federal system

FEDERAL STATE (15 N/10 S)

LOCAL/DISTRICT (> 200)

Formulation of National policies, plans and strategies; resource mobilization, overall monitoring and evaluation, coordination, supervision, training and external relations.

Formulation of State’s policies, plans and strategies, according to federal guidelines, funding and implementation of plans

Implementation of national/state policies and service delivery, based on the primary health care approach

Three tiered health systemFEDERAL STATE (15 N/

10 S)LOCAL/DISTRICT

(> 200)Formulation of National policies, plans and strategies; resource mobilization, overall monitoring and evaluation, coordination, supervision, training and external relations.




10 S)LOCAL/DISTRICT





10 S)LOCAL/DISTRICT




Financing of the health system

• Low public health spending;– 13.5 US$/ capita

(around 5% of government expenditure)

– high out of pocket expenditure > 60%

– Fragmentation (multiple providers e.g. MOH, Police, HI, ……………)

Public Health Spending, 2006

FMOH$3.6827%

SMOHs$5.1538%

Localities$0.252%

Armed Forces$2.6820%

Social Security Funds

$1.7313%

Multiple Actors/Partners

Heath Coordination Councils, at all levels of the health system, with adequate representation of all

partners to oversee the development of health policies and strategies and monitor the

implementation

Human resources for Health

• 1.5 care providers/1000 population

• Disproportional production of HRH (6 doctors to one nurse) with huge gap specially for AH W Catego

ryCurren

t estima

tes

Target by 2013

Gap

Doctors (speciali

st)

1000 5000 4000

Nurses 16,000 80,000

64,000

Midwives

16,629 26,000

9,371

Other AHWs

6,000 26,000

20,000

Total 47,663 144,400

96,737

source.; 10 year HRH Strategy

• High turnover (specially doctors)

Human resources for Heath

Khartoum State56%

Other States44%

Distribution of Doctors

• Marked inequality in distribution

Coverage and accessibility to PHC

services• Wide disparities

in geographic coverage with PHC units

Percentage of Pop. Living within 5 Km from the nearest functioning health facility, Mapping survey 2008

Goal 1: Eradicate Extreme Poverty and Hunger

Target 2: Reduce by half the proportion of people who suffer from hunger

Indicator 4: Prevalence of Underweight Children Under Five Years of Age (UNICEF)

Child Malnourishment (Severe Underweight), SHHS 2006

3.5

22.1

9.4

0

2

4

6

8

10

12

14

16

18

20

Kharto

umGez

ira

Centra

l Equ

atoria

Lake

s

south

Kord

ofan

River N

ile

North K

ordofa

n

South

Darfour

Gadari

f

White N

ile

Sinaar

Sudan

Blue N

ile

Wes

t Equ

atoria

Red Sea

Northe

rn

East E

quato

ria

Wes

t Darfo

ur

War

rab

North D

arfou

r

Kassa

la

Upper

Nile

Jong

olei

Wes

t Bah

r El-g

azal

Norht B

ahr E

l-gaz

alUnit

y

State

%

Goal 2: Achieve Universal Primary Education

Target 3: Ensure that all boys and girls complete a full course of primary schooling

Primary School Net Attendance Ratio (NAR) ,

SHHS 2006

4.3

91.1

53.7

05

101520253035404550556065707580859095

100

State

%

Children Reaching Grade 5 , SHHS 2006

13.2

98.290.3

0

10

20

30

40

50

60

70

80

90

100

110

Norh

t Bah

r El-g

azal

Lake

sUn

ityW

arra

bEa

st E

quat

oria

Wes

t Bah

r El-g

azal

Wes

t Equ

ator

iaCe

ntra

l Equ

ator

iaRe

d Se

aRi

ver N

ileUp

per N

ileSu

dan

North

ern

North

Dar

fur

Blue

Nile

Jong

olei

Whi

te N

ileSi

naar

Kass

ala

Gezir

aW

est D

arfu

rso

uth

Kord

ofan

Sout

h Da

rfur

North

Kor

dofa

nGa

darif

Khar

toum

State

%

Goal 3:Promote Gender Equality and Empower Women

Target 4: Eliminate gender disparity in primary and secondary education preferably by 2005, and at all levels by 2015

Indicator 9: Ratio of Girls to Boys in Primary, Secondary, and Tertiary Education

Education Gender Parity (Primary Education ) , SHHS

2006

0.43

1.060.93

0

0.2

0.4

0.6

0.8

1

1.2

State

%

Goal 6. Combat HIV/AIDS, Malaria and Other Diseases

Target 8: Halt and begin to reverse the incidence of malaria and other major diseases

Knowledge of preventing HIV Transmission , SHHS 2006

4.0

24.6

0.00.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

22.0

24.0

26.0

state

%

28.8

82.5

49.4

0102030405060708090

Unity

NBG

E. E

quat

oria

War

abUp

per N

ile

WBG

Lake

sW

. Dar

fur

Blue

Nile

Gad

arif

Whi

te N

ileJo

ngle

iN.

Kor

dofa

nKa

ssal

aSi

nnar

Khar

toum

S. K

ordo

fan

Red

Sea

Gez

iraN.

Dar

fur

S. D

arfu

rNo

rther

nRi

ver N

ileC.

Equ

ator

iaW

. Equ

ator

iaAv

erag

e

Under-fives sleeping under insecticide-treated nets ,

SHHS 2006

Goal 7: Ensure Environmental Sustainability

Target 10: Reduce by half the proportion of people without sustainable access to safe drinking water

Use of improved water sources, SHHS 2006

56.1

Use Of Sanitary Means Of Excreta Disposal, SHHS 2006

1.9

83.2

31.4

05

1015202530354045505560657075808590

State

%

Goal 4: Reduce Child Mortality

Target 5: Reduce by two thirds the mortality rate among children under five

Indicators 13, 14: Infant &Under-Five Mortality Rate

Infant Mortality Rate, SHHS 2006

Gezira 52.37Kassala 56.29White Nile 56.49Northern 57.40North Kordofan 60.55Sinaar 62.24Unity 63.93South Darfour 67.18River Nile 68.58North Darfour 68.71Khartoum 68.99Northern States 70.99Red Sea 73.42Jongolei 73.76Sudan 80.77Upper Nile 82.40East Equatoria 82.69Gadarif 86.34Lakes 89.5West Darfour 92.83West Bahr El-gazal 96.89south Kordofan 98.01Blue Nile 99.24Southern States 102.41Central Equatoria 106.96Norht Bahr El-gazal 129.23Warrab 137.88West Equatoria 150.7

56.29 56.49 57.40 60.55 62.24 63.93 67.18 68.58 68.71 68.99 70.99 73.42 80.77 82.40 82.69 86.34 89.5 92.83 96.89 98.01 99.24 102.41 106.96129.23 137.88

52.37

150.7

73.760

20406080

100120140160180200220240

Stat

%

52.3780.77

150.7

020406080

100120140160

Under-five Mortality Rate, SHHS 2006

62.81

112.16

192.11

0

20

40

60

80

100

120

140

160

180

200

220

Gezira

Northe

rn

Kassa

laUnit

y

Kharto

um

North K

ordofa

n

White N

ile

River N

ile

North D

arfou

r

South

Darfou

r

Sinaar

Northe

rn Stat

es

Jong

olei

Upper

Nile

Sudan

Lake

s

East E

quator

ia

Red S

ea

West Bahr

El-gaz

al

Southe

rn Stat

es

Gadar

if

West Garf

our

Centra

l Equ

atoria

south

Kord

ofan

Norht B

ahr E

l-gaz

al

Warrab

Blue N

ile

West Equa

toria

State

%

Goal 5:Improve Maternal Health Target 6: Reduce by three quarters the

maternal mortality ratioIndicators;16: Maternal Mortality Ratio17: Proportion of Births Attended by Skilled Health

Personnel19c: contraceptive prevalence

Contraceptive Prevalence

0.1

22.4

7.6

0

5

10

15

20

25

State

%

Births Attended by Qualified Health Personnel

19.9

98.2

58.1

0

20

40

60

80

100

120

Norh

t Bah

r El-g

azal

Jong

olei

East

Equ

ator

iaCe

ntra

l Equ

ator

iaUn

ityW

est D

arfu

rUp

per N

ileLa

kes

War

rab

Wes

t Bah

r El-g

azal

Blue

Nile

Sout

h Da

rfur

Suda

nW

est E

quat

oria

sout

h Ko

rdof

anKa

ssal

aGa

darif

North

Dar

fur

Sina

arNo

rth K

ordo

fan

Red

Sea

Gezir

aW

hite

Nile

Khar

toum

Rive

r Nile

North

ern

State

%

Maternal Mortality Ratio

93.6

2327.2

1106.7

0

500

1000

1500

2000

2500

North

ern

Rive

r Nile

Red

Sea

North

Kor

dofa

n

Khar

toum

Sinn

arNo

rth D

arfo

ur

Gaz

iraW

hite

Nile

Sou t

h Ko

rdof

an

Blue

Nile

Gad

arif

Wes

t Dar

four

Kass

ala

Sout

h D

arfo

ur

Unity

East

Equ

ator

ia

Joun

glei

Cent

ral E

quat

oria

Uppe

r Ni le

War

abNo

rth B

ahr A

l-Gaz

alW

est B

ahr A

l-Gaz

al

Lake

sW

est E

quat

oria

Suda

n

States

%

Efforts and opportunities; Policies

• National Health, RH and Child health policies

• Making life-saving care free:• Declaration of free treatment for U5s, CSs and delivery

care• Revision of the midwifery curriculum toward

SBA– 2 pathways identified• Midwifery technician (2 years)• BSC midwifery curriculum (4 years• Gradual phasing out of old VMW curriculum in

order not to affect coverage

• Road Map for Maternal and Child mortality reduction – Keys steps undertaken for operationalization -

detailing, costing and implementing the Road Map

• RH Communication strategy to guide all partners in implementing community interventions

Efforts and opportunities; Plans and strategies

Expanding access to effective child and maternity care

Efforts and opportunities; Plans and strategies

Graduation of VMWs by Years; Current coverage

52.4%

• ACSI Jump and pulse campaigns; Start in 15 States targeting 3.7 million U5s (Measles Vaccine, Polio Vaccine, Vitamin A, Iodine Tablets, De-worming, ITN and Health education massages

• Introduction of Penta-vaccine (DPT+HepB+Hib vaccine)



Rehabilitation of Hospitals and HCs Project

Expanding access to effective child and

maternity care


maternity care

Rehabilitation of Hospitals and HCs Project


maternity care • Central ambulance project; phase 1 (115

ambulances)

Increasing Political Commitment to Maternal and

Child Health-Higher Council for Child and

Maternal Mortality Reduction• Ministerial decree• All partners in Health • State level councils -Wali decree (5 States)

Attracting External ResourcesUN agencies; WHO, UNFPA, UNICEFGAVI AllianceHMNMDTFGFATMIDBBilateral relations; Chinese, Turkish and Japanese support

More coordination and focus on Health System issues is needed

Improving Quality of Services through Child and maternal death reviews

Recommendation of the Maternal Mortality

Reduction workshop – February 2007

The experience of Omdurman Maternity Hospital

Measures Taken to Reduce MMR in OMH:

• Mg SO4 and Hydralazine for severe pre-eclampsia and eclampsia

• Misoprostol for PPH

• Improvements in Blood Bank Services

• The use of thrombo-prophylaxis

• Audit meetings and quality control

Results of intervention (2003 – 7) in OMH

year Deliveries MD MMR

2003 18,462 40 216

2007 24,913 7 28

Effective interventions existThey need to reach more

people…..As we count down to

2015,

we need to strengthen health systems by unlocking the talent and resources that should be available to all mothers and

children….

In this forum, you are that talent….

Use your talent & knowledge to improve the quality of care that mothers and

children receive By doing this, at the very least, you will honour those of Sudan who died earlier

than they should have

Thank you

THE REPUBLIC OF SUDAN

ECOSOC MEETING, GENEVIA6-10-2009

IMPLEMENTATION OF NATIONAL DEVELOPMENT STRATEGIES; SUDAN PRESENTATION

Documents

development of health

nationalstate policies

formulation of states

health issues

federal guidelines

n10 slocaldistrict

overall monitoring

external relations