IMPLEMENTATION OF NATIONAL DEVELOPMENT STRATEGIES; SUDAN PRESENTATION

1. IMPLEMENTATION OF NATIONAL DEVELOPMENT STRATEGIES; SUDAN PRESENTATION بسم الله الرحمن الرحيم THE REPUBLIC OF SUDAN ECOSOC MEETING, GENEVIA 6-10-2009

2. Outlines of the presentation Sudan Background Key Features of HS in Sudan MDGs; indicators and efforts Main challenges and Recommendations

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

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

5. Background High adult illiteracy rate (mainly women) Low population awareness on health issues

6. Three tiered health system/ Decentralized federal system

7. Three tiered health system

8. Three tiered health system

9. Three tiered health system

10. 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, ……………) Financing of the health system

11. 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

12. 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) source.; 10 year HRH Strategy

13. Distribution of Doctors Human resources for Heath • Marked inequality in distribution

14. Wide disparities in geographic coverage with PHC units Coverage and accessibility to PHC services Percentage of Pop. Living within 5 Km from the nearest functioning health facility, Mapping survey 2008

16. 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)

17. Child Malnourishment (Severe Underweight), SHHS 2006

18. Goal 2: Achieve Universal Primary Education Target 3: Ensure that all boys and girls complete a full course of primary schooling

19. Primary School Net Attendance Ratio (NAR) , SHHS 2006

20. Children Reaching Grade 5 , SHHS 2006

21. 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

22. Education Gender Parity (Primary Education ) , SHHS 2006

23. Goal 6. Combat HIV/AIDS, Malaria and Other Diseases Target 8: Halt and begin to reverse the incidence of malaria and other major diseases

24. Knowledge of preventing HIV Transmission , SHHS 2006

25. Under-fives sleeping under insecticide-treated nets , SHHS 2006

26. Goal 7: Ensure Environmental Sustainability Target 10: Reduce by half the proportion of people without sustainable access to safe drinking water

27. Use of improved water sources, SHHS 2006 56.1

28. Use Of Sanitary Means Of Excreta Disposal, SHHS 2006

29. 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

30. Infant Mortality Rate, SHHS 2006

31. Under-five Mortality Rate, SHHS 2006

32. 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

33. Contraceptive Prevalence

34. Births Attended by Qualified Health Personnel

35. Maternal Mortality Ratio

36. 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

37. 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

38. Efforts and opportunities; Plans and strategies Expanding access to effective child and maternity care

39. Graduation of VMWs by Years; Current coverage 52.4%

40. 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)

41. Expanding access to effective child and maternity care Mobile Clinics Project • phase 1 (4 out of 20 Clinics)

42. Expanding access to effective child and maternity care Rehabilitation of Hospitals and HCs Project • Supporting 210 Hospitals and HCs with Furniture and essential equipment

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

44. Expanding access to effective child and maternity care • Central ambulance project; phase 1 (115 ambulances)

45. 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)

46. 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

47. Improving Quality of Services through Child and maternal death reviews Recommendation of the Maternal Mortality Reduction workshop – February 2007

48. The experience of Omdurman Maternity Hospital

49. 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:

50. Results of intervention (2003 – 7) in OMH