IMPLEMENTATION OF NATIONAL DEVELOPMENT STRATEGIES; SUDAN PRESENTATION

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IMPLEMENTATION OF NATIONAL DEVELOPMENT
STRATEGIES SUDAN PRESENTATION

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• THE REPUBLIC OF SUDAN

ECOSOC MEETING, GENEVIA 6-10-2009
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Outlines of the presentation

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

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Background
Shares borders with 9 countries free movement
across most of these borders
Vast country surface area 2.5
million km²
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Background

• 40 millions population (2008 census), scattered
  scanty populated settings
• Massive population movement and displacement
  (civil conflict, drought, desertification and
  major floods)

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Background

• High adult illiteracy rate (mainly women)
• Low population awareness on health issues

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Three tiered health system/ Decentralized
federal system
FEDERAL STATE (15 N/ 10 S) LOCAL/DISTRICT (gt 200)
Formulation of National policies, plans and strategies resource mobilization, overall monitoring and evaluation, coordination, supervision, training and external relations. Formulation of States 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

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Three tiered health system
FEDERAL STATE (15 N/ 10 S) LOCAL/DISTRICT (gt 200)
Formulation of National policies, plans and strategies resource mobilization, overall monitoring and evaluation, coordination, supervision, training and external relations. Formulation of States 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

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Three tiered health system
FEDERAL STATE (15 N/ 10 S) LOCAL/DISTRICT (gt 200)
Formulation of National policies, plans and strategies resource mobilization, overall monitoring and evaluation, coordination, supervision, training and external relations. Formulation of States 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

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Three tiered health system
FEDERAL STATE (15 N/ 10 S) LOCAL/DISTRICT (gt 200)
Formulation of National policies, plans and strategies resource mobilization, overall monitoring and evaluation, coordination, supervision, training and external relations. Formulation of States 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
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Financing of the health system

• Low public health spending
• 13.5 US/ capita (around 5 of government
  expenditure)
• high out of pocket expenditure gt 60
• Fragmentation (multiple providers e.g. MOH,
  Police, HI, )

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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

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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

Category Current estimates Target by 2013 Gap
Doctors (specialist) 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

• High turnover (specially doctors)

source. 10 year HRH Strategy
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Human resources for Heath

• Marked inequality in distribution

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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
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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)

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Child Malnourishment (Severe Underweight), SHHS
2006
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Goal 2 Achieve Universal Primary Education

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

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Primary School Net Attendance Ratio (NAR) , SHHS
2006
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Children Reaching Grade 5 , SHHS 2006
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Goal 3Promote 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

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Education Gender Parity (Primary Education ) ,
SHHS 2006
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Goal 6. Combat HIV/AIDS, Malaria and Other
Diseases

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

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Knowledge of preventing HIV Transmission , SHHS
2006
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Under-fives sleeping under insecticide-treated
nets , SHHS 2006
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Goal 7 Ensure Environmental Sustainability

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

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Use of improved water sources, SHHS 2006
56.1
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Use Of Sanitary Means Of Excreta Disposal, SHHS
2006
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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

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Infant Mortality Rate, SHHS 2006
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Under-five Mortality Rate, SHHS 2006
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Goal 5Improve Maternal Health

• Target 6 Reduce by three quarters the maternal
  mortality ratio
• Indicators
• 16 Maternal Mortality Ratio
• 17 Proportion of Births Attended by Skilled
  Health Personnel
• 19c contraceptive prevalence

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Contraceptive Prevalence
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Births Attended by Qualified Health Personnel
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Maternal Mortality Ratio
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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

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Efforts and opportunities Plans and strategies

• 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

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Efforts and opportunities Plans and strategies

• Expanding access to effective child and maternity
  care

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Graduation of VMWs by Years Current coverage
52.4
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Expanding access to effective child and maternity
care

• 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 (DPTHepBHib
  vaccine)

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Mobile Clinics Project
Expanding access to effective child and maternity
care

• phase 1 (4 out of 20 Clinics)

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Rehabilitation of Hospitals and HCs Project
Expanding access to effective child and maternity
care

• Supporting 210 Hospitals and HCs with Furniture
  and essential equipment

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Expanding access to effective child and maternity
care
Rehabilitation of Hospitals and HCs Project
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Expanding access to effective child and maternity
care

• Central ambulance project phase 1 (115
  ambulances)

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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)

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Attracting External Resources
UN agencies WHO, UNFPA, UNICEF GAVI
Alliance HMN MDTF GFATM IDB Bilateral relations
Chinese, Turkish and Japanese support More
coordination and focus on Health System issues is
needed
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Improving Quality of Services through Child and
maternal death reviews

• Recommendation of the Maternal Mortality
  Reduction workshop February 2007

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• The experience of Omdurman Maternity Hospital

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• 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

• Measures Taken to Reduce MMR in OMH

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Results of intervention (2003 7) in OMH
MMR MD Deliveries year
216 40 18,462 2003
28 7 24,913 2007
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• Effective interventions existThey need to reach
  more people..
• As we count down to 2015,

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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
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Thank you

• THE REPUBLIC OF SUDAN

ECOSOC MEETING, GENEVIA 6-10-2009