‫بسم هللا الرحمن الرحيم‬
THE REPUBLIC OF SUDAN
IMPLEMENTATION OF
NATIONAL DEVELOPMENT
STRATEGIES; SUDAN
PRESENTATION
ECOSOC MEETING,
GENEVIA
6-10-2009
Outlines of the presentation
•
•
•
•
Sudan Background
Key Features of HS in Sudan
MDGs; indicators and efforts
Main challenges and
Recommendations
Background
Vast
country;
surface
area 2.5
million km²
Shares
borders with
9 countries;
free movement
across most of
these borders
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)
Formulation of
Formulation of
National policies,
State’s policies,
plans and strategies; plans and
resource mobilization, strategies,
overall monitoring
according to
and evaluation,
federal
coordination,
guidelines,
supervision, training funding and
and external
implementation
relations.
of plans
LOCAL/DISTRICT
(> 200)
Implementation
of
national/state
policies and
service delivery,
based on the
primary health
care approach
Three tiered health system
FEDERAL
STATE (15 N/
10 S)
Formulation of
Formulation of
National policies,
State’s policies,
plans and strategies; plans and
resource mobilization, strategies,
overall monitoring
according to
and evaluation,
federal
coordination,
guidelines,
supervision, training funding and
and external
implementation
relations.
of plans
LOCAL/DISTRICT
(> 200)
Implementation
of
national/state
policies and
service delivery,
based on the
primary health
care approach
Three tiered health system
FEDERAL
STATE (15 N/
10 S)
Formulation of
Formulation of
National policies,
State’s policies,
plans and strategies; plans and
resource mobilization, strategies,
overall monitoring
according to
and evaluation,
federal
coordination,
guidelines,
supervision, training funding and
and external
implementation
relations.
of plans
LOCAL/DISTRICT
(> 200)
Implementation
of
national/state
policies and
service delivery,
based on the
primary health
care approach
Three tiered health system
FEDERAL
STATE (15 N/
10 S)
Formulation of
Formulation of
National policies,
State’s policies,
plans and strategies; plans and
resource mobilization, strategies,
overall monitoring
according to
and evaluation,
federal
coordination,
guidelines,
supervision, training funding and
and external
implementation
relations.
of plans
LOCAL/DISTRICT
(> 200)
Implementation
of
national/state
policies and
service delivery,
based on the
primary health
care approach
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
SMOHs
$5.15
38%
Localities
$0.25
2%
Armed Forces
$2.68
20%
FMOH
$3.68
27%
Social
Security Funds
$1.73
13%
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
• High turnover (specially
doctors)
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
source.; 10 year HRH Strategy
Human resources for Heath
• Marked inequality in distribution
Distribution of Doctors
75
57
Other States
44%
Khartoum
State
56%
9
0
0
0
0
0
0
11
14
14
15
17
0
Percentage of Localities having functional organizational structure according to the standards,
Mapping survey 2008
13
Coverage and accessibility to
PHC services
• Wide disparities in
geographic
coverage with PHC
units
32
45 47
61
97 98
93
93
89
86 87
81
81
80
76
75
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)
C
en
tra
l
ar
to
um
G
Eq ezi
ua ra
to
so
ria
ut
L
h
a
Ko ke
rd s
o
N Riv fan
or
t h er N
So Kor ile
ut do
f
h
Da an
rfo
G ur
a
W da
hi rif
te
N
il
Si e
na
a
Su r
W Bl dan
es ue
tE N
qu ile
at
o
R ria
ed
S
Ea N ea
o
st rt h
Eq e
W ua rn
es t o
t D ri a
ar
fo
N W ur
or
t h arra
Da b
rf
Ka our
U ssa
pp la
er
W
es
N
il
J
t
N Ba ong e
or
ht hr E ole
Ba l-g i
hr az
El al
-g
az
al
U
ni
ty
Kh
%
Child Malnourishment
(Severe Underweight), SHHS 2006
20
18
16
14
12
10
4
22.1
8
6
9.4
23.5
0
State
Goal 2: Achieve Universal Primary
Education
Target 3: Ensure that all boys and
girls complete a full course of
primary schooling
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
Uni
ahr
ty
El-g
az a
l
We
W
st B
a rr
ab
ahr
El- g
aza
l
Jon
gol
ei
L
ake
Eas
s
t Eq
uat
oria
Upp
Ce n
er N
tral
ile
Equ
a
We
st E t oria
qua
tori
a
We
st d
arfu
r
Ka s
sal
a
Blu
eN
sou
ile
th K
ord
of a
n
Sud
Sou
a
th D n
arfu
r
Gad
a rif
Sin
a ar
Nor
th D
Nor
t h K arfur
ord
ofa
n
Re d
Sea
Wh
ite
Nile
Gez
Kha ira
rtou
m
Nor
t he
rn
Riv
er N
ile
tB
Nor
h
%
Primary School Net Attendance
Ratio (NAR) , SHHS 2006
91.1
53.7
4.3
State
Ba
hr
E
l-g
aza
l
Lak
es
Un
ity
Wa
Ea
st E rrab
We
qua
st B
tor
ah r
ia
Elgaz
We
st E
al
qu
Ce
a
to r
n tr
ia
al E
qua
tor
ia
Re
dS
ea
Riv
er N
il e
Up
per
Nil
e
Su
d an
No
r th
ern
No
r th
Da
rfu
r
Blu
eN
il e
Jon
go
lei
Wh
ite
Nil
e
Sin
aar
Ka
ssa
la
Ge
zira
We
st D
sou
arf
ur
th
Ko
rdo
fa n
So
u th
Da
No
rfu
rth
r
Ko
rdo
fan
Ga
dar
if
Kh
art
ou
m
No
rht
%
Children Reaching Grade 5 , SHHS 2006
110
100
90
80
70
60
50
40
10
90.3
98.2
30
20
13.2
0
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
tB
ahr
El-g
az a
l
We
st B
Lak
ahr
es
Elgaz
al
Wa
rra
We
st D b
sou
arf
ur
th K
ord
of a
n
Jon
gol
ei
Blu
eN
ile
Sin
a ar
Up
pe r
N il
So
e
uth
Da
rfu
r
Un
ity
Ka
ssa
la
G
ada
No
rt h
rif
Ko
rdo
We
fa
st E
qu a n
Eas
tor
ia
tE
qu a
tor
ia
Wh
ite
Nil
e
Ce
Su
ntr
dan
al E
qu a
t or
ia
Ge
z ira
Kh
a rt
oum
No
rt h
Da
rfu
r
No
rt h
ern
Riv
er N
ile
Re
dS
ea
No
rh
%
Education Gender Parity
(Primary Education ) , SHHS 2006
1.2
1
0.8
0.6
0.4
0.2
0.93
State
1.06
0.43
0
Goal 6. Combat HIV/AIDS, Malaria
and Other Diseases
Target 8: Halt and begin to
reverse the incidence of
malaria and other major
diseases
Ge
zir
a
No
rt h
ern
Kh
a rt
ou
No
m
rt h
Da
Ea
rfu
st E
r
qu
ato
ri a
Wh
i
te N
No
rt h
ile
Ko
rdo
fan
Ka
ssa
la
Sin
a ar
Riv
er
sou
N il
th
e
Ko
rdo
f an
Re
dS
ea
We
st B
Un
ity
ahr
Elgaz
al
Blu
eN
So
ile
uth
No
rht
Da
Ba
rfu
hr
r
Elgaz
al
Su
da
We
st D n
arf
ur
Ga
da
rif
Up
pe
rN
ile
Lak
es
Ce
W
a rr
ntr
ab
al E
qu
at o
ria
Jon
We
go
lei
st E
qu
a to
ria
%
Knowledge of preventing HIV
Transmission , SHHS 2006
26.0
24.0
22.0
20.0
18.0
16.0
14.0
12.0
2.0
24.6
10.0
8.0
6.0
4.0
0.0
0.0
4.0
state
ity
eN
ile
ord
m
ar
ofa
art
ou
n
Re
dS
ea
Ge
zir
a
N.
Da
rfu
r
S.
Da
rfu
r
No
rth
er n
Riv
er
Nil
C.
e
Eq
ua
tor
ia
W.
Eq
ua
t or
ia
Av
era
ge
S.
K
Kh
Sin
n
Ga
da
rif
Wh
ite
Nil
e
Jo
ng
lei
N.
Ko
rdo
fan
Ka
ss
al a
Blu
ur
La
ke
s
WB
G
W.
Da
rf
E.
E
G
qu
ato
ria
Wa
rab
Up
pe
rN
ile
NB
Un
Under-fives sleeping under
insecticide-treated nets , SHHS
2006
90
82.5
80
70
60
50
49.4
40
28.8
30
20
10
0
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
Wa
Eas
r
t Eq rab
uat
oria
Nor
J
ong
ht B
ol e
ahr
El-g i
aza
l
Uni
ty
Lak
es
Upp
We
er N
st B
ile
ahr
El- g
aza
l
Blu
eN
We
il
st E
qua e
Ce n
tori
tral
a
Equ
at
sou
th K oria
ord
of a
n
Gad
ar
Sou
th D if
arfu
r
Sin
Nor
a ar
th K
ord
ofa
n
We
st d
arfu
r
Wh
ite
Nile
Sud
an
G
Nor ezira
th D
arfu
r
Ka s
sal
Re d a
Sea
Kha
rtou
m
Nor
t he
rn
Riv
er N
ile
%
Use Of Sanitary Means Of Excreta
Disposal, SHHS 2006
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
83.2
31.4
1.9
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
73.76 80. 77
82. 40
Upp
er N
il e
73. 42
J on
gole
i
70. 99
ther
nS
tat e
s
68. 99
150.7
Nor
68. 71
arfo
ur
68. 58
th D
67. 18
Nor
63. 93
four
62. 24
Dar
60. 55
Sou
th
80.77
57. 40
Si n
aar
56. 49
ther
n
56. 29
Nor
52.37
la
240
220
200
180
160
140
% 120
100
80
60
40
20
0
Stat
Ge
zira
Kas
sa la
Wh
i te N
i le
Nor
th e
Nor
rn
th K
ord
o fa
n
Sin
aar
Uni
Sou
ty
th D
arf o
ur
Riv
er N
Nor
th D il e
arfo
ur
Kha
rtou
Nor
m
th e
rn S
t ate
Red s
Sea
Jon
go le
i
Sud
Upp an
er N
Eas
ile
t Eq
uato
ria
Ga
da r
if
L
a
kes
We
st D
We
arf o
st B
ur
a hr
El-g
sou
th K azal
ord
o fa
n
Sou Blu e N
il
ther
nS e
Cen
tat e
t ral
s
Eq u
Nor
at o
ht B
ria
ahr
El-g
a za
l
Wa
We
rra b
st E
q ua
to ri
a
160
140
120
100
80
60
40
2052.37
0
52.37
56.29
56.49
57.40
60.55
62.24
63.93
67.18
68.58
68.71
68.99
70.99
73.42
73.76
80.77
82.40
82.69
86.34
89.5
92.83
96.89
98.01
99.24
102.41
106.96
129.23
137.88
Kas
sa
Gezira
Kassala
White Nile
Northern
North Kordofan
Sinaar
Unity
South Darfour
River Nile
North Darfour
Khartoum
Northern States
Red Sea
Jongolei
Sudan
Upper Nile
East Equatoria
Gadarif
Lakes
West Darfour
West Bahr El-gazal
south Kordofan
Blue Nile
Southern States
Central Equatoria
Norht Bahr El-gazal
Warrab
ez
i ra
or
th
e
Ka rn
ss
al
a
U
n
Kh i ty
N
a
or
th rtou
Ko
m
rd
of
a
W
hi n
te
N
i le
R
i
v
N
e
r
or
th Nil
e
D
So
u t arfo
h
D ur
ar
fo
ur
N
Si
or
na
th
er
ar
n
St
at
J o es
ng
o
U
pp le i
er
N
il e
Su
da
n
Ea
La
st
ke
Eq
s
ua
W
to
es
r
t B Red ia
ah
S
So r E ea
lut
he gaz
a
rn
St l
at
es
W Ga
e s da
C
en t G rif
tra arf
o
l
s o Eq ur
u
at
N uth
o
or
ht Kor ri a
Ba do
h r fa n
E
l-g
az
W al
ar
ra
b
B
W
l
u
es
e
t E Ni
q u le
at
or
ia
N
G
%
Under-five Mortality Rate, SHHS
2006
220
200
180
160
140
120
100
192.11
80
60
112.16
40
20
62.81
0
State
Goal 5:Improve 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
ol e
i
Uni
ty
Lak
es
Wa
We
raa
st B
b
ahr
ELGaz
al
Ka s
sala
Upp
er N
ile
Eas
t Eq
Nor
uat
th B
oria
ahr
ELG az
al
Gae
rdif
Wh
it N
Ce n
aile
tera
l Eq
ua t
oria
Sud
an
Nor
th K
ord
ofa
n
Re d
Sea
Sin
nar
Gei
z ira
Riv
er N
ile
Kha
rtou
m
Not
hre
rn
We
st
Dar
f ou
r
Equ
a to
ria
Nor
th D
arfo
Sou
ur
th K
ord
ofa
Sou
n
th D
arfo
ur
Blu
eN
ile
We
st
Jon
g
%
Contraceptive Prevalence
25
20
15
10
22.4
5
7.6
0
0.1
State
Ba
hr
E
l-g
aza
l
Jon
g
Ea
ole
st E
i
q
uat
Ce
n tr
ori
a
al E
qua
tor
ia
Un
ity
We
st D
arf
ur
Up
per
Nil
e
Lak
es
We
W
arr
st B
ab
ah r
Elgaz
al
Blu
eN
So
il e
u th
Da
rfu
r
Su
We
d an
st E
qu
ato
sou
ri a
th
Ko
rdo
fa n
Ka
ssa
la
Ga
dar
No
if
rth
Da
rfu
r
S
i
n aa
No
rth
r
Ko
rdo
fan
Re
dS
ea
Ge
zira
Wh
ite
Nil
e
Kh
art
ou
m
Riv
er N
il e
No
rth
ern
No
rht
%
Births Attended by Qualified
Health Personnel
120
100
80
60
98.2
40
58.1
20
19.9
0
State
ern
G az
f our
D ar
la
f our
D ar
Kas
sa
arf o
ur
Jou
Ba h
r
%
Sud
an
2500
La k
es
We
st E
q ua
t ori
a
Al-G
aza
l
Al-G
aza
l
Wa
rab
Up p
er N
i le
oria
ngl e
i
ral E
qu a
t
We
st B
a hr
No r
th
Ce n
t
States
Un it
y
Eas
t Eq
ua to
ria
Sou
th
Nil e
G ad
a rif
Blu
e
Ko r
dof a
n
We
st D
Sou
th
ira
Wh
it e N
i le
No r
th
Sin
nar
um
Ko r
dof a
n
Sea
Nil e
Kha
rto
No r
th
Re d
Ri v
er
No r
th
Maternal Mortality Ratio
2327.2
2000
1500
1106.7
1000
500
93.6
0
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
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
Efforts and opportunities; Plans
and strategies
Expanding access to effective child
and maternity care
Graduation of VMWs by Years;
Current coverage 52.4%
16000
14898
14024
13450
14000
12148
12000
10821
9592
10000
8000
7575
7955
8228
Ряд1
6000
4000
2000
2000
0
2002
2004
2006
2008
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 (DPT+HepB+Hib
vaccine)
Expanding access to effective child and
maternity care
Expanding access to effective
child and maternity care
Rehabilitation of
Hospitals and HCs Project
• Supporting 210 Hospitals and
HCs with Furniture and
essential equipment
Expanding access to effective
child and maternity care
Rehabilitation of
Hospitals and HCs Project
Expanding access to effective
child and maternity care
• Central ambulance project; phase 1 (115
ambulances)
Increasing Political Commitment
to Maternal and Child HealthHigher Council for Child and
Maternal Mortality Reduction
• Ministerial decree
• All partners in Health
• State level councils -Wali decree (5
States)
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
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
• Mg SO4 and Hydralazine
for severe pre-eclampsia
and eclampsia
Measures
Taken to
Reduce MMR
in OMH:
• Misoprostol for PPH
•
Improvements in Blood
Bank Services
• The use of thromboprophylaxis
• 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 exist
They 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
THE REPUBLIC OF SUDAN
Thank you
ECOSOC MEETING,
GENEVIA
6-10-2009