WORLD HEALTH ORGANISATION
ORGANISATION MONDIALE DE LA SANTE
WHO priorities and needs for the
second half of 2002
June 2002
HEALTH SECTOR IN SUDAN
The overall health status of the people in the Sudan continues to be low. As a result of the
ongoing conflict in the country, natural disasters like drought and flood and the consequent
large-scale population displacement, a significant proportion of the population, especially
children and women, continue to be affected by food insecurity due to crop failure; inadequate
access to safe drinking water and worsening environmental and hygienic conditions. Poor
access to health care services, along with malaria, diarrhoeal disease, acute respiratory
infections (ARI) inadequate pre-natal, delivery and post-partum care have compounded the
health situation of a large proportion of the population of the country.
Malaria, diarrhoeal disease and ARI account for 70% of all hospital admissions. The
estimated annual number of malaria cases in the GoS-controlled areas is 7.5 million and
around 35,000 malaria-related deaths occur annually. In the SPLM/A controlled areas,
malaria affects 24-36% of the population. It is estimated that 65% of all under five children
visiting health facilities in GoS- controlled areas have malaria. Malaria case fatality rate in
pediatric hospitals is 8%. The Multiple Indicator Cluster Survey (MICS) 2000 conducted in the
northern States and Government controlled areas in the South, indicated that only 24% of
under- five children in the north and 34% in the urban towns of the south use bed nets. Of this
number, 7.5% and 13.4% respectively are impregnated with insecticide.
MICS 2000 showed ARI and diarrhea prevalence rates of 17 and 28%, respectively among
under-five children nation-wide. Diarrhoea prevalence in some states, however, was as high
as 40%.
The same survey showed that the percentage of children who received all vaccines was only
25% with major disparities in coverage between states. It is estimated that one-third of the
cold chain needs rehabilitation or replacement. Virtually all the vehicles provided for outreach
during UCI need to be replaced. Intensive polio eradication efforts reached more than five
million children under five in the national immunisation days in 2000 and 2001. In 2000, only
four cases of wild poliovirus were confirmed.
The Sudan continues to suffer outbreaks of epidemics such as meningitis, measles and
watery diarrhoea. Acute gastro-enteritis is common occurrence, particularly after floods and
other natural disasters as experienced in 1994, 1998 and 1999.
Women have little access to reproductive health services. In GoS controlled areas, the fertility
rate is 5.9 and contraceptive use is 8%. More than 40% of deliveries in GoS-controlled areas
and over 60% in SPLM/A controlled areas are not assisted by a trained person. The maternal
mortality rate (MMR) stands at 509 per 100,000 live births in GoS -controlled areas. The
estimated MMR for urban areas in SPLM/A -controlled areas can be as high as 865.
Obstaetric complications, stemming from lack of proper care during pregnancy, influence
death or long-term morbidity among women. Safe motherhood practices contribute directly to
a reduction in maternal morbidity and mortality and also in bringing down peri-natal and infant
mortality levels. Under the Safe Motherhood Initiative, all pregnant women are supposed to
receive basic and professional ante-natal care (ANC). Only 38% of women are immunised
against Tetanus and the number of women receiving antenatal check-up is decreasing.
HIV/AIDS is on the rise in the Sudan. The Sudan National Aids Programme (SNAP) estimates
that nationally between one and three percent of the population is HIV positive, with marked
regional variations – the highest rates being in the war zones. In rebel controlled areas, it is
assumed that areas bordering neighbouring countries with significant HIV infection rates are
equally affected. From there, the disease is likely to spread to currently less affected areas,
given the rapid development of trade links and road infrastructure in the relatively stable parts
of southern Sudan. Continuing large-scale internal displacement, the movement of soldiers
around the country and war-induced destitution are also key factors in the spread of
HIV/AIDS. The pandemic will intensify quickly unless decisive action is taken without delay.
Of grave concern is the significant lack of public knowledge or awareness of HIV/AIDS in both
north and south, inside and outside the war zones. Level of awareness on condoms and their
use is low in all parts of the Sudan and condoms are largely unavailable to the majority of the
population. In the south there is extremely limited indigenous institutional capacity to work on
HIV/AIDS with the result that a concerted effort by all partners will be undertaken.
The national prevalence rate of malnutrition in the Sudan is significant and rose from 18% in
1995 to 23% in 1999. The situation is more serious in southern Sudan, where the level is
28%, of which about 15% are severely malnourished. FAO data indicates that the food intake
of about 30% of the total population provides less than their minimum energy requirements of
2,100 Kcal. The MICS 2000 data show that 30% of all new-born babies were of low birth
weight, indicating low nutritional status of mothers.
Nutritional status among infants is poor due to low adherence to exclusive breastfeeding (only
30% of all infants are exclusively breastfed for the first three months), and early introduction
of supplementary feeding and inappropriate complementary feeding. The Baby Friendly
Hospital Initiative (BFHI), designed to address these issues, is only implemented in a few
hospitals and maternity facilities in the main cities. Since more than 80% of all deliveries
occur at home, there is a need to redesign strategies for dealing with the nutritional status of
infants, e.g. a community-based strategy.
Micronutrient deficiency is a serious health problem that contributes significantly to high
morbidity and mortality rates. One exception is that the national rate for Vitamin A deficiency
has declined due to repeated supplementation during polio National Immunisation Day
campaigns. According to MICS 2000, Vitamin A deficiency rates are highest in western and
southern parts of the country. Iodine deficiency leads to mental retardation, goitre and lower
resistance against infections. The national goitre rate is 22%. The two factories in Port Sudan
and Nyala producing iodised salt face difficulties in sustaining continuous production, resulting
in negligible levels of household consumption.
Based on this situation, and the need for continuous interventions in the health and nutrition
sectors, health agencies will continue to provide assistance to vulnerable populations. Health
and nutritional interventions can provide a valuable avenue for conflict transformation and
peace building. For example, the National Immunisation Days (NID) proved to be effective
tools for cross-line corridors of peace and periods of tranquillity. Within a community-based
approach, participatory management of such interventions can promote tolerance and
reconciliation.
Goal
Ensure appropriate and timely response to health-related emergencies based on the
Emergency Preparedness Plans and enhance access to basic health care services,
especially for population groups in areas affected by conflict and natural calamities.
Operational Objectives

Ensure that at least 5.5 million children under five receive at least two doses of OPV for
polio eradication and one dose of measles vaccine combined with two doses of Vitamin A
supplementation.

Increase immunisation coverage to ensure immunisation of over 90% of children under
one year of age with all primary EPI antigens in disadvantaged localities in Governmentcontrolled areas and with measles and tetanus in SPLM/A controlled areas.

Immunise at least 3 million women of childbearing age in neonatal tetanus high-risk areas
with three doses of Tetanus Toxoid.

Establish an effective disease surveillance and epidemics’ early warning system.

Reduce mortality due to malaria, acute respiratory infection, diarrhoea, measles and
malnutrition;

Ensure that at least 900,000 pregnant women in selected areas receive proper antenatal
care.

Ensure that at least 900,000 births are delivered by skilled health persons.

Reduce Protein Energy Malnutrition in under-five children in selected high-risk areas.

Significantly reduce malnutrition amongst high-risk populations in emergency situations.

Ensure that at least 100,000 malnourished pregnant and lactating mothers have access
to supplementary feeding.

Increase by 20% the use of Iodised salt at the household (HH) level.



Ensure that at least 900,000 pregnant women in selected high-risk areas receive iron
supplementation.
Support special actions (like provision of income generating activities) to reduce the
vulnerability of groups at high risk of infection (especially adolescent girls, female heads
of households and sexually exploited persons).
Increase by 20% HIV/AIDS prevention and counselling services for high-risks
populations.
Strategies

Strengthen the capacity of counterparts, NGOs and CBOs with special emphasis on
emergency preparedness, planning and implementation of interventions to increase
access to basic health care services, provide reproductive health services to vulnerable
groups, monitor and assess the nutritional status of under-five children; to support
therapeutic and supplementary feeding programmes for the most vulnerable, and to
establish an effective disease surveillance and epidemics’ early warning system.

Support the provision of essential drugs and vaccines to the most vulnerable groups and
expand the implementation of the Integrated Management of Childhood Illnesses (IMCI)
concept to improve early recognition and effective case management (or referral when
needed) of the major childhood diseases.

Pre-position supplies to ensure rapid response to ensure access to health care services
in emergency situations in accordance with emergency preparedness plans.

Develop community capacity to strengthen community based malaria control
interventions including environmental actions, vector control, sustainable use of
impregnated bed nets, and inputs for the prevention, proper diagnoses and treatment of
malaria.

Strengthen coordination with all partners working in emergency areas, Government/local
authorities, UN agencies, CBOs and NGOs and civil society to mobilise the financial,
human and organisational resources required for polio eradication effort, to improve the
quality of health care services, to respond to acute emergencies, and to avoid overlap and
enhance efficiency.

Promote and expand reproductive health services in order to widen access to confidential
HIV/AIDS testing and counselling and widen access to information and education on
HIV/AIDS for women, adolescents, men (and vulnerable groups) to bring about changes
in attitudes, values and practices at the family and community levels to prevent HIV/AIDS
transmission.

Provide vulnerable populations with access to income generation and food for work
schemes.

Continue advocacy for ensuring access to health care services for vulnerable populations
in conflict-affected areas, areas affected by natural calamities, camps for IDPs as
strategic priorities, and for adoption of proven approaches.

Support the provision of emergency reproductive health services to 100,000 women.
Indicators

Number of children under-five immunised with a minimum of two doses of OPV.

Number of AFP and polio cases reported.

Number of children under the age of one fully immunised against the six childhood
diseases.

Number of pregnant women who have received TT2.

Number of pregnant women who received ante-natal care.

Number of deliveries attended by skilled health personnel.

Number of WHO-identified diseases and cases reported.

IMCI with home case management for malaria and diarrhoea.

Malnutrition rate among children under five years of age.

Number of children who received Vitamin A supplementation.

Number of persons supported by supplementary and therapeutic feeding programmes.

Number of growth monitoring units established and functioning.

Increase in use of iodised salt at household level.

% population that can correctly state at least three ways of preventing the transmission of
HIV/AIDS.

% health personnel offering community friendly counselling and proper conducted testing.




% increase in trained health, media and community volunteers engaged in information
dissemination and HIV/AIDS.
Number of communities reached with HIV/AIDS education.
Number of HIV positive persons who serve as advocates for HIV/AIDS awareness.
Number of female heads of household registered in income generating and food for work
activities.
Appealing Agency
Project Title
Project Code
Sector
Themes
Objective
Target Beneficiaries
(total # and description)
Implementing Partners
Project Duration
Total Project Budget
Funds Requested
WORLD HEALTH ORGANIZATION
Health
SUD-02/H05
Health
EP&R, IDPs, Peace-building
To reduce mortality and morbidity rate in children under 5 years and
women, and increase opportunities for children and women’s survival
750,000 person in Kassala, Red sea, South Darfur, Bahr El Jabal, Bahr
El Gazal, Nahr El-Nile and Gazera states
Local health authorities, UNICEF, UNFPA and NGOs
January – December 2002
US$ 6,996,000
US$ 6,996,000
BACKGROUND
Malaria, diarrhoea and ARI are widespread and head the list of endemic diseases, accounting
for 70% of all hospital admissions. This is mainly due to poor sanitation, unsafe water, overcrowding and poor ventilation. The level of education is generally regarded as one of the
prime determinants of maternal and child health. The 1999 IMR reported 82 per thousand live
births, and 132 U5MR. These figures are much higher in the southern states for which there is
little reliable data.
The estimated annual number of malaria cases in the country is 7.5 million and around
35,000 deaths occur annually. It is estimated that 65% of all children under five who consult
health facilities have malaria. MICS 2000 indicated that only 24% of children under five in the
north and 34% in southern towns use bed nets of which, 7.5% and 13.4 % respectively are
impregnated with insecticide.
MICS 2000 conducted in the northern states and Government-controlled areas in the south,
showed ARI and diarrhoea prevalence rates of 17 and 28%, respectively among children
under five nation-wide however diarrhoea prevalence in some states goes up to 40%.
MICS 2000 showed that the percentage of children who received all vaccines had declined to
about 25% with major disparities in coverage between states. It is estimated that one-third of
the cold chain needs rehabilitation or replacement and virtually all the vehicles provided for
outreach during UCI need to be replaced. The intensive polio eradication efforts have shown
success and have reached more than five million children under five during the national
immunisation days in 2000 and 2001. In 2000, only four cases of wild poliovirus were
confirmed.
According to the Sudan National AIDS Programme, cumulative cases of HIV/AIDS reached
more than 6,000 case in July 2000. The prevalence of sero-positively is above 1% in the
general population. Interventions are focusing on education and social counseling. In the
southern sector, the 1999 Multiple indicator Cluster showed very low community awareness
on HIV/AIDS.
The Sudan continues to suffer outbreaks of epidemics such as meningitis, measles and
watery diarrhea. Acute gastro-enteritis is a sporadic, endemic disease, especially after floods
and other natural disasters as experienced in 1994, 1998, 1999 and 2001. Responses to
these outbreaks are often late due to lack of a nation-wide early warning system. Even when
responses are mounted, they are constrained by lack of supplies, laboratory support and
trained staff. A WHO supported early warning and response network programme has shown
that a coordinated response can considerably reduce epidemic mortality. Funding is being
sought to expand this approach to other parts of the Sudan.
Women give birth frequently, with little access to reproductive health services. The fertility rate
is 5.9% and contraceptive use rate 8%. More than 40% of deliveries are not assisted by a
skilled birth attendant. The maternal mortality rate (MMR) stands at 509 per 100,000 live
births in areas under Government control indicating improvement compared to the rate of 556
reported in the Sudan Demographic and Health Survey (SDHS) of 1990. The estimated MMR
for urban areas in southern Sudan is 763. Obstaetric complications stemming from lack of
proper care during pregnancy influence death or long-term morbidity among women. Safe
motherhood practices contribute directly to a reduction in maternal morbidity, mortality and
reducing peri-natal and infant mortality levels. Under the Safe Motherhood Initiative, all
pregnant women are supposed to receive basic professional antenatal care (ANC). Although
the level of immunisation against tetanus has gone up to 38%, the ante-natal check-up
service ratio has slightly decreased as well as rates of TBA and health assistant services.
Micronutrient deficiency is a serious health problem that contributes significantly to high
morbidity and mortality rates. It is estimated that the national rate for Vitamin A deficiency has
declined due to repeated supplementation during polio National Immunisation Day
campaigns. According to MICS data, Vitamin A deficiency rates are highest in the western
and southern parts of the country. Iodine deficiency leads to mental retardation, goiter and
lower resistance against infections. The national goiter rate is 22%. The two factories in Port
Sudan and Nyala producing iodised salt face difficulties in sustaining continuous production
resulting in negligible levels of household consumption.
Emergencies that require immediate humanitarian response to alleviate suffering are virtually
certain in the complex emergency situation of the Sudan. The ongoing conflict in the south is
expected to continue to result in displacement of people. In addition to that, poor and erratic
rainy seasons causing droughts and floods every year result in large-scale displacement. The
victims, especially children and women are left exposed to the weather elements, unhygienic
conditions and disease outbreaks for unknown periods.
Health and nutritional interventions provide a valuable bridge for conflict transformation and
peace building. Within a community-based approach, participatory management of such
interventions would promote tolerance and reconciliation. National Immunisation Days are
effective tools for cross-line corridors of peace and periods of tranquility.
Goal
To reduce morbidity and mortality rate in infants, children under five and women, and
increase opportunities for survival of children, mothers and vulnerable communities.
Objectives

Reduce mortality caused by the five main killer diseases (malaria, ARI, diarrhoea,
measles, TB, malnutrition and HIV/AIDS).

Increase immunisation coverage of children less than one year of age with the six
antigens in weak states in the northern sector and with measles and tetanus in the
southern sector.

Ensure that at least 80% of children under five are covered with at least two doses of
OPV, one dose of measles and Vitamin A in emergency situations.

Immunise at least 80% of women at child-bearing age with three doses of Tetanus Toxoid
in neonatal tetanus high-risk areas.

Ensure that at least 80% of pregnant women in selected areas receive proper ante-natal
care.

Establish an effective disease surveillance and epidemics early warning system.

Prevent Protein Energy Malnutrition in selected high-risk areas of northern and southern
Sudan.

Significantly reduce malnutrition in high-risk populations in emergency situations.

Provide a minimum of two doses of vitamin A to more than 80% of children under five.

Ensure that 70% of malnourished pregnant and lactating mothers have access to
supplementary feeding.

Increase by 20% the use of iodised salt at household (HH) level.

Ensure that 80% of pregnant women in selected high-risk areas receive iron
supplementation.
Strategies
In collaboration with sister agencies, health authorities and NGOs, to:













Strengthen community based environmental action, including insecticide sprays,
application of impregnated bed nets and other materials for prevention and proper
diagnoses and treatment with anti-malaria drugs.
Strengthen the capacity for emergency preparedness and response by pre-positioning
supplies according to emergency preparedness plans.
Strengthen coping mechanisms in emergency prone areas by building capacity,
increasing awareness and encouraging community participation.
Apply the health area system and support provision of essential drugs and vaccines to
the most vulnerable group.
Support Government efforts to eradicate polio.
Coordinate health interventions including response to acute emergencies with UN
agencies, health authorities, counterparts, NGOs and civil society.
Expand and strengthen the Integrated Management of Childhood Illnesses (IMCI) to
improve early recognition and effective case management (or referral when needed) of
the major childhood diseases, in collaboration with the health authorities, UNICEF and
other partners.
Strengthen the capacity of Government and counterparts to monitor and assess the
nutritional status of children under five to improve the quality of services provided to them.
Strengthen the capacity of the Government to support therapeutic and supplementary
feeding programmes for the most vulnerable.
Support the Baby Friendly Hospital (BFH) initiative and breastfeeding.
Ensure the decrease of iron deficiency among pregnant women and vitamin A deficiency
among children by supporting provision of iron supplements and vitamin A respectively.
Expand the DOTs programme to the south for treatment of an additional 6,000 TB
patients with 85% cure rates.
Support 11 existing small scale TB treatment centres with technical supervision, drugs
and laboratory.
Indicators

Morbidity and mortality rates of infants and children under the age of five, maternal
mortality rate.

Number of WHO reportable diseases identified and cases actually reported.

Number of children under the age of one fully immunised against the six EPI diseases.

Number of children under the five who have received a minimum of two doses of OPV.

Number of AFP and polio cases reported.

Number of people sleeping under impregnated bed nets in malaria endemic areas.

Number of people protected by insecticide spray coverage and environmental
management action.

Number of pregnant women who have received TT2.

Number of children who have received Vitamin A supplementation.

Number of supplementary and therapeutic feeding programmes supported.

Strengthened growth monitoring.

Number of nutrition surveys conducted.

IMCI with home case management for malaria and diarrhoea.

Number of new TB patients put on DOTs and centres attaining 85% cure rates.
FINANCIAL SUMMARY
Budget Items
Malaria control and preventive measures
Containment of epidemics
Emergency obstetric care units and training
Essential drugs (WHO Emergency Health Kits)
North
US$
750,000
300,000
150,000
450,000
South
US$
350,000
100,000
25,000
200,000
IMCI training
Strengthening surveillance system including Early Warning
Technical back-up missions
Health education campaigns
HIV/AIDS prevention and production of IEC materials
TB case detection and prompt treatment
Training EPI / Polio operational cost
Project Sub-total
Monitoring, project management & reporting
Programme Support Cost (6%)
Total north/south Budget
Total Project Budget
150,000
650,000
100,000
100,000
150,000
600,000
500,000
3,900,000
390,000
257,400
4,547,400
25,000
550,000
100,000
100.000
50,000
400,000
200,000
2,100,000
210,000
138,600
2,448,600
6,996,000
A.
WATER AND ENVIRONMENTAL SANITATION
Inadequate access to safe water and sanitation as well as poor hygiene practices, such as
open defecation, (still a common practice in many parts of the country) are a major cause of
several diseases leading to the high levels of infant and child mortality and morbidity in the
Sudan. Epidemics of water–related diseases such as diarrhea (causing 40% of under-five
child deaths) are widespread. The Sudan is host to over 73% of the total guinea worm cases
(in 2000) with 99% of cases being in the south Jonglei State is the most endemic area in the
country (Guinea Worm wrap-up # 109).
Recent studies1 have shown that while in the GoS-controlled areas, 79% of the population in
urban areas and 47% in rural areas have access to improved water sources, in SPLM/A
controlled areas, the percentage is as low as 25%. Sanitary means of excreta disposal are
scarce throughout the country, only 46% of the rural population and 80% of the urban
population in GoS-controlled areas and only 35% in SPLM/A controlled areas have access to
adequate sanitation.
The ongoing conflict and natural disasters like droughts and floods, resulting in large-scale
internal displacement of people; economic difficulties (negligible Government investment and
the decline in external support); rapid population growth; and institutional problems have
seriously affected public water and sanitation facilities. The drought in Darfur and Kordofan,
and three consecutive years of late rains in East Equatoria and parts of Bahr El Ghazal
further exacerbated the situation in 2001. Significant water shortages resulted in large-scale
population movements, increased vulnerability and caused further pressure on existing and
functional water sources especially in the transitional zones. The on-going intra and intercommunal clashes are expected to continue in the coming year, as pastoral groups compete
over scarce water and pastureland, since many water schemes in the affected areas require
rehabilitation.
Much of the limited investment in this sector over the past decades was directed towards
better-off urban areas. The displaced and poor communities in peri-urban Khartoum pay as
much as 40% of their income for small quantities of poor quality water. The frequent
breakdown of existing water systems (especially the more sophisticated groundwater and
surface water schemes in rural areas) has added to the problem. Lack of rural water systems
and access to safe water sources has led to population movements towards towns, creating
undue pressure on existing weak systems, which cannot cope with the increase in demand
and consequently breakdown.
However, provision of water and sanitation facilities alone will not achieve the desired
improvement in health status: hygiene and environmental sanitation awareness need to be
addressed simultaneously. Thus, humanitarian action aims to provide safe water and
adequate sanitary facilities and health/hygiene education to populations in war-affected
zones, IDP camps and Guinea Worm endemic areas. This will include the installation and/or
rehabilitation of water supply systems and sanitation infrastructure where feasible, with the
provision of hygiene education and training for operation and maintenance through schools
and village health committees.
In 2001, UNICEF concentrated its efforts on a few selected geographical areas based on
sustainability and ownership of the water points and the need to mitigate the effects of the
acute drought emergency. The strategy prioritised rehabilitation and maintenance of existing
water sources coupled with construction of new water points, promotion of hygiene and
sanitation awareness and capacity building. As a result there was no outbreak of cholera, a
decrease in guinea worm infection rate and an increase in access to safe water by
populations affected by acute emergencies. WES will continue with the same strategy, with
focus on populations affected by war, insecurity and natural disasters, in selected
geographical areas, identified as the most disadvantaged, having the worst social indicators.
The project will continue its collaboration with Global 2000 for guinea worm eradication. WES
interventions will be used as a lever to promote grass roots peace building initiatives, gender
1 MICS
2000 and Survival to Thrival
disparities and reduce conflict over resources to promote peaceful co-existence and target
areas identified by the peacebuilding project and other partners.
Goal
To ensure access to safe drinking water and improved environmental sanitation and hygienic
conditions for vulnerable populations affected by war, insecurity, natural calamities, and in
guinea worm endemic villages.
Operational Objectives

Increase access to safe drinking water for 500,000 persons in the selected geographical
areas identified as the most disadvantaged, and in guinea worm endemic areas.

Increase access to and use of improved sanitation facilities and hygienic conditions for
150,000 persons in the selected geographical areas identified as the most disadvantaged,
and in guinea worm endemic areas.

Promote the increased acquisition of knowledge, skills and values required to facilitate
adoption of hygienic practices and to prevent guinea worm transmission in endemic
communities.

Ensure provision of water and sanitation services to populations affected by rapid onset
emergencies according to Emergency Preparedness Plans.
Strategies

Strengthen the capacity of counterparts, with special emphasis on emergency
preparedness, planning and monitoring of interventions, water quality testing; and the
development and adoption of locally relevant, affordable and sustainable technology.

Support community-based initiatives/interventions to ensure access to safe water and
improved sanitation facilities.

Support for rehabilitation of existing water sources, construction of new water and
environmental sanitation facilities, and the provision of filter cloth in Guinea Worm
endemic villages.

Pre-position supplies to ensure rapid response to ensure water supply and sanitation
facilities in emergency situations in accordance with emergency preparedness plans.

Advocacy for ensuring access to safe drinking water and improved environmental
sanitation and hygienic conditions for vulnerable populations in selected geographical
areas identified as the most disadvantaged, as strategic priorities, and for adoption of
proven approaches including affordable and sustainable technology.

Community capacity development and mobilisation to facilitate enhanced community
involvement in the planning, design and monitoring as well as the operation, maintenance
and management of all water and sanitation interventions.

Programme support communication to bring about changes in attitudes, values and
practices at the family and community levels to promote adoption of proper sanitation and
hygienic practices and to prevent HIV/AIDS transmission.

Strengthen coordination with all partners working in emergency areas, Government/local
authorities, UN agencies, CBOs and NGOs for the mobilisation of the human and financial
resources required for implementation of water supply and sanitation interventions and
delivery of services and to avoid overlap and enhance efficiency.

Establish new water supply facilities in areas which have conflicts over water sources for
human beings and live stock, to promote community partnerships for the planning, design
and monitoring as well as the operation, maintenance and management of all water and
sanitation interventions in order to contribute to grass roots peace building, peaceful coexistence and conflict resolution.
Indicators

Number of safe water sources constructed or rehabilitated

Number of sanitary facilities constructed and used

Number of affected people who benefited from the interventions

Number of filter cloths distributed

Number of hygiene education/surveillance sessions conducted

Number of people aware of how guinea worm disease is transmitted
Appealing Agency
Project Title
Project Code
Sector
Themes
Objectives
Target Beneficiaries
(total # and description)
Implementing Partners
Project Duration
Total Project Budget
Estimated Funds Available
Funds Requested
WORLD HEALTH ORGANIZATION
Granting Basic Human Needs (Water and Sanitation) for IDPs in North
Kordofan, Allah Kareem, Al Jihad camps
SUD-02/WS01
Water and Sanitation
EP&R, IDPs, Peace Building
To minimise water-borne and sanitation-based diseases among deprived
IDPs specifically among most vulnerable groups.
To improve environmental health, focusing on water, sanitation and
vector control.
150,000 IDPs in North Kordofan (Allah Kareem and Al Jihad Camps)
WHO Regional Center for Environmental Health Activities (CEHA),
FMOH, IDP Community and NGOs in the field of W&S
January – December 2002
US$ 647,363
US$ 15,000 covering CEHA technical staff supervision (not included
in the request)
US$ 647,363
BACKGROUND
IDPs in North Kordofan face a serious problem of water scarcity resulting in a lot of time and
energy being spent on fetching water. IDPs in this area generally come from the Nuba
Mountains and southern Sudan.
Most of the IDPs live in cottages in Allah Kareem camp, which was created in 1984. This
camp is still expanding but its environmental situation is very bad. IDPs cannot afford five
liters of water per day despite existence of a network of a water supply system taking good
quality water from an underground basin.
The project will include a main delivery pipe to take water from the nearest point in the
network and carry it to the camp, where a set of water distribution points will be built. The
water will be chlorinated at the distribution tank and distributed to the people at an affordable
cost covering only operational costs and management of the water distribution posts.
As stated in the objective, to maximise benefit from the water, family latrines will be built and
community latrines in schools and any other community centres. (In the first phase, 500
latrines will be built in Aljihad camp, one per family or two, depending on the conclusions of
the social study and visibility.)
The community will be supplied with a fogging machine and required chemicals to combat
mosquitoes. A hygiene education campaign targeting households will be carried out from
house to house. A low cost method for solid waste disposal will be developed and
implemented.
Activities
Water supply

Purchase and installation of the required pipe to carry water from the nearest network to
the camps.

Build a distribution point 1 km in diameter to serve part of the population. Each one will
have a reservoir above the ground (4-5 meters) and filling distribution points. Depending
on the pressure on the main pipe, the need to build underground reservoirs with lifting
pumps will be investigated.

Build a stand post for the camp school with an emergency water tank as a reservoir
enough for student use for one week.

Purchase required chlorine powder / tabs and required comparators and chlorine free
residual testing tablets.
On-site excreta disposal system

Latrines will be built (one per family or more depending on the social and visibility study).
Low cost type will be built according to WHO un-reinforced squatting plates (WHO/ Afg.
design).
Solid waste collection and disposal

A system of temporary storage places will be developed and the community will be
organised to dispose solid waste in collection spaces (a space of area surrounded by halfmeter height mud walls) and to use a sanitary trench for final disposal.
Malaria prevention
Community based interventions of Environmental Management of disease vectors.
Application of space sprays with insecticides using a ULV fogging machine, loaded on a pick
up. One of the local people will be trained on the proper application procedures. Families with
children under five will be further protected with impregnated mosquito bed nets and other
materials.
Malaria control
Strengthen diagnosis and treatment centres, training of doctors, supervisors, PHC workers
and mothers at home on recognition and treatment of malaria cases.
Health education and impart the hygiene behave
The WHO/UNDP publication titled “Food, Water and Family Health: A Manual for Community
Educators 1994 ” will be translated into Arabic and used to train ten women from camps.
These ten educators will visit each family in the camps to educate inhabitants about right
behaviors.
A. Water Supply Project
FINANCIAL SUMMARY
Budget Items
Carry out preparatory work, survey and delineate the right route and
locations of distribution points
2
Excavate trenches to install water transportation and distribution pipes
3
Purchase and installation of main water transportation pipe and fittings
4
Construction of required filling stations and distribution points
5
Construction of a water tank for the girls school with stand posts
6
Purchase required chlorine powder / tabs and required comparators and
chlorine free residual testing tablets
7
Training of IDPs in maintenance, management and operation of the system
8
Carry out a house to house training course for households on how to
prepare the ORS in the house and how to prevent cholera and diarrhoea (10
women trainers will be trained to carry out the house to house training)
9
Technical engineering administration for CEHA project management and site
engineer and supervision team for all project components
Sub-total
Project management, monitoring & reporting
Programme support cost at 6%
Total cost of water project
SN
1
US$
5,000
18,000
125,000
40,000
5,000
3,000
2,900
10,000
15,000
223,900
22,390
14,777
261,067
B. Solid Waste Project
1
2
3
4
5
FINANCIAL SUMMARY
Budget Items
Purchase five pickups for the project
First, clean up campaign for the camp and surrounding areas from solid
waste and excreta
Construct solid waste collection areas (50 points)
Excavate and operate sanitary ditches for one year
Running cost for one year
US$
75,000
4,000
25, 000
5,000
6,000
Sub-total
Project implementation, monitoring and reporting
Programme support 6%
Total cost of Solid waste project
115,000
11,500
7,590
134,090
C. Appropriate Excreta Disposal Project
FINANCIAL SUMMARY
Budget Items
1
Excavation for under ground pits, 1,000 units
2
Construct underground structure and latrines
3
Construct upper structure
4
Construct slab
Sub-total
Project implementation, monitoring & evaluation
Programme support 6%
Total cost of the Excreta Disposal Project
US$
20,000
20,000
10,000
5,000
55,000
5,500
3,630
64,130
D. Malaria Prevention Project
FINANCIAL SUMMARY
Budget Items
1
Purchase two fogging machines (Spraying equipment-ULV)
2
Purchase two pickups
3
Purchase required chemicals
4
Train local people on how, and frequency of using fogging machines
and how to impregnate bed nets
5
Secure impregnated mosquito bed nets for families with children
under-five
6
Operational cost for environmental management and spraying
activities
7
Purchase of environmental management equipment
8
Carryout health education campaigns on malaria diagnosis and
prevention. Design and print and distribute posters using a simple
sketch (comic strip) on malaria prevention
9
Running cost for one year
Sub-total
Project implementation, monitoring & evaluation
Programme support 6%
Total cost of the Malaria Prevention Project
US$
38,000
17,000
3,000
31,200
5,000
900
5,000
3,000
8,000
111,100
11,110
7,333
129,543
E. Health Education to Impart the Hygiene Behaviours Project
FINANCIAL SUMMARY
Budget Items
Translate and print the WHO/UNDP publication titled “Food, Water and
Family Health: A Manual for Community Educators 1994 ” into Arabic. The
ten educators will visit each family in the camp
Train ten women from the camps to be trainers and work as educators and
prepare them to carry out the house to house training course
Purchase a van to transport educators from their houses to the camps
Carry out an education campaign for one year to educate inhabitants about
right hygiene and behaviours
Cost of sustaining a van and driver
Sub-total
Project implementation, monitoring & evaluation
Programme support 6%
Total cost of the Health Education Project
Total budget for Projects Components
US$
3,700
4,500
15,000
20,000
7,000
50,200
5,020
3,313
58,533
647,363