a pvo perspective

1. a pvo perspective lessons learned from southern sudan

2. background • long term emergency response & transitional programs • Tonj County since April 1993 • Gogrial County since April 1998 • routine nutrition monitoring & annual food economy assessment used to inform food security projections and program design • this work conducted within the context of post 1998 famine conditions and emerging issues with SPLA in 1999/2000.

3. background • could program planning & implementation be improved by monitoring mortality rates in conjunction with other key indicators • how to keep Sudan on donor agendas by being able to provide accurate information on severity of the emergency • decided to research monitoring CMR and U5MR in conjunction with routine nutrition surveys

4. survey • combined HH census with routine 30 cluster nutrition survey (done routinely every 6 months) • “harvest” was chosen to delineate a 1 year recall period • respondents were asked about • live births in previous 1 year (since the end of the last harvest) • persons living in the house before the last harvest • household members died since the last harvest, (including age, gender & cause – verbal autopsy)

5. challenges / lessons learned can it be done ?? planning • access to standardized methods for data collection and examples from literature • reliable demographic / population data (rapid changes in Sudan due to famine, migration, war) • lack of public HIS & insufficient secondary data • access issues introduced selection bias • cultural sensitivities and ethical implications

6. challenges / lessons learned implementation • translation / back translation • low sample size (adequate for nutrition, but not mortality) • qualifications of available enumerators (in Sudan staff have often not even completed primary school) • recall period / age & dates • intensive training required – more than usual 5 days Many of these issues represent the usual issues with respect to survey work in these environments

7. challenges / lessons learned miscellaneous • attrition of agencies and staff from CHEs has implications for training and retaining competency • cost ($$, time, human resources) vs benefit with respect to program management & planning • important to report back to communities – high importance placed on death and particularly children – opportunities for greater participation

8. recommendations • establish policy on when to measure mortality & why • methods need to be as simple as possible / realistic • need tools for establishing demographics in CHE (measuring & triangulating) • provide training resources together with method (competencies can be developed in-house over time)

9. recommendations • tactical knowledge management strategies should accompany implementation of these types of initiatives • develop guidelines for reporting back to communities & major stakeholders • develop programming guidelines for field staff (programming options)

10. references • World Vision Sudan. Cross-sectional study of a rural population in Southern Sudan. Nairobi: World Vision Sudan, 1998. • World Vision Sudan. Nutritional Survey, Tonj County, Bahr el Ghazal, Southern Sudan. November 1999. Nairobi: World Vision Sudan, 1999. • World Vision Sudan. Nutritional Survey, Gogrial County, Bahr el Ghazal, Southern Sudan. November 1999. Nairobi: World Vision Sudan, 1999. • Medecins Sans Frontières. Refugee Health: An approach to emergency situations. London: Macmillan Education Ltd, 1997.