Post-conflict Strategic Framework for WHO in Sudan

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Natalie Oliver
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1 Post-conflict Strategic Framework for WHO in Sudan EHA, September

2 Background to Sudan (1) Since Independence in 1956 only 11 years of peace second-tier conflicts for control of resources regional instability, spill-over (LRA, etc) largest IDP population in the world ( 4.3 M) international interest (oil, religion, terrorism, etc) 2

3 Affected / Vulnerable population IDPs GoS areas 2,732,720 Non-GoS areas 1,585,000 sub-total IDPs 4,317,720 In-country in 18 Easter Sudan 102,180 refugees camps urban based refugees 218,682 sub-total refugees 320,862 Total 4,638,582 Vulnerable population HIV/AIDS 500,000 HIV/AIDS 3,500 orphans Food insecure 2,967,112 Flood affected 25,000 Total 3,495,612 Estimated tot. population 31,100,000 source: OCHA Khartoum, September

4 Background to Sudan (2) Government committed to a structural adjustment programme Economic growth: 5% per year Oil revenues increasing BUT 27% of total government spending for defence Debt stock: 16 Bn$ = 170% of GDP 4

5 Background to Sudan (3) Recent peace initiatives: Cease-fire in the Nuba Mountains April 2002: publication of the Danforth (US envoy) report Egypt & Libya IGAD + troika Machakos protocol signed in July Peace talks interrupted after the fall of Torit presently 9-day ban of humanitarian flights in the South 5

6 The Health Status North South (GoS) IMR per 1, U 5 MR per 1, MMR per 100, CMR of 26 per 10,000 per day in Ajiep in 1998 Guinea Worm: 80% of all cases worlwide HIV/AIDS: 1-10% 6

7 The Health Delivery System (1) Overall, developed network: 6,200 first level h.facilities, 300 referral hospitals, but low, and decreasing capacity : 0.7 beds per 1,000 pop. Overall, strong workforce: 45,000 h.workers, of which 5,000 doctors, 6,200 MA, 17,500 nurses, 9,300 midwives; low productivity & high attrition Overall, health spending not bad, at 30$ per capita per head, but recurrent costs only partially covered 7

8 The Health Delivery System (2) Federal system (high devolution): Federal MoH State MoH Health Area System (local council + HAMT) Wide gap, double financing mechanisms, insufficient management capacity at local level Mixed financing system: tax-based social insurance cost recovery 8

9 The Health Delivery System (3) Low utilisation of services: coverage estimated at 40-60% 0.8 outpatient consultations per capita/year Inequity is a problem Very low efficiency in service provision average 40% of bed occupancy 9

10 The Health Delivery System (3bis) State N. of hospital beds per 100,000 population N. of hospital per 100,000 population Northern (best ratio) South Darfour (worst ratio) Country average Distribution of some categories of health workers by state State with Doctors per best/worse ratio 100,000 population Medical assistants per 100,000 population Nurses per 100,000 population Khartoum 35 Northern South Darfour Source: Federal MoH, Annual Statistical Report,

11 WHO in Sudan Small country office (except polio) 2 sub-offices 32 ongoing programmes 11

12 Inter-sectoral issues Obstacles to humanitarian assistance: denied access security bureaucratic impediments Equity in access to basic services IDPs decentralisation North-South divide Coordination 12

13 Post-conflict Strategic Framework for WHO in Sudan Assumptions: medium-term peace scenario, with progressive opening up of the humanitarian space, but with persisting insecurity two-year timeframe 13

14 Consequences preparedness to start immediately need for scaling up relief and start initial recovery increasing aid, especially for rehabilitation, unsynchronised with needs increasing number of agencies (further fragmentation) 14

15 Uncertainty Arrangements in relation to administration in the South Role & structure of UN Aid channels 15

16 Reference Tools for the Strategy UNDHAF CCCs 16

17 Strategic framework (1) Requirements preparedness increased access increasing needs sustainability ensuring equity Strategy information management, advocacy and leadership readiness, field presence, visibility advocacy, technical guidance (norms, standards) support to national authorities, advocacy technical assistance for sector reform, advocacy 17

18 Strategic framework (2) Requirements administration in the South, demobilisation Strategy lesson learned, technical assistance expansion of the network technical assistance in sector s needs assessment, planning & financing 18

19 Priority Areas of Work 1. Ensuring that interventions targeting the main causes of illness &n death (CD, RH, malnutrition) are scaled up 2. Providing technical assistance in health system reform 3. Ensuring that contingency planning starts (needs assessment, monitoring, etc) 19

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