SOUTHERN SUDAN - HEALTH SECTOR TRANSITION UPDATE

UNCLAS SECTION 01 OF 03 KHARTOUM 001832 SIPDIS AIDAC SIPDIS STATE FOR AF/SPG, PRM, AND ALSO PASS USAID/W USAID FOR DCHA SUDAN TEAM, DCHA/OFDA, AND AFR/SP NAIROBI,USAID/DCHA/OFDA,USAID/REDSO,USAID/SFO ,FAS GENEVA FOR NKYLOH NSC FOR PMARCHAM AND MMAGAN USUN FOR TMALY BRUSSELS FOR PBROWN E.O. 12958: N/A TAGS: EAID PREF PGOV PHUM SOCI UN SU SUBJECT: SOUTHERN SUDAN - HEALTH SECTOR TRANSITION UPDATE REF: KHARTOUM 0679 KHARTOUM 00001832 001.2 OF 003 -------------- Summary -------------- ¶1. Over the past three fiscal years, USAID has been able to steadily and responsibly decrease its non-food humanitarian budget from USD 88.3 million in Fiscal Year (FY) 2005 to USD 69.5 million in FY 2006 and USD 61.9 million in FY 2007 in anticipation of the eventual transition from relief to development in Sudan, excluding Darfur. In FY 2007, USAID's humanitarian investments focused on preparing for the transition from relief to development, including transitioning projects to USAID's development programs, the Multi-Donor Trust Fund (MDTF),other development donors, and the Government of Southern Sudan (GOSS). These efforts have concentrated on the health sector, but transition planning discussions and efforts are also underway in the food security sector. This cable provides a progress report on health sector transition efforts to date for USAID programs in Southern Sudan. End Summary. -------------- Health Sector Transition Efforts to Date -------------- ¶2. For two and a half years USAID -- including USAID's Office of U.S. Foreign Disaster Assistance (USAID/OFDA),the Bureau of Global Health, Africa Bureau, and USAID/Sudan's development health team -- have worked together to plan a step-by-step transition of USAID's health programs in Southern Sudan. USAID/Sudan and USAID/OFDA jointly organized transition workshops with the Ministry of Health (MOH) and USAID implementing partners in March and August 2005, as well as in June 2006. The August 2005 workshop produced relief-to-development checklists for use by all humanitarian health partners, and laid the groundwork for transitioning a few counties from USAID/OFDA funding to USAID/Sudan funding. Under this plan, one county transitioned in 2005, two in 2006, and one more county is planned for 2008. ¶3. In FY 2007, the USAID transition planning process made significant progress: --The first-ever National Health Assembly for Southern Sudan helped illuminate gaps in the sector, particularly the need to focus on strengthening health systems management, capacity building, salaries, and service delivery at the county level. --Between FY 2006 and FY 2007, USAID/OFDA was able to go from supporting 322 health facilities to 232 health facilities in Southern Sudan. Very few of these 90 facilities have shut down as a result. Those facilities that did shut down did so because of reasons other than the loss of USAID/OFDA funding, such as insecurity and the migration of IDPs. Facilities have been handed over to longer-term forms of support, including the GOSS MOH and other donors. It is important to continue to monitor the success of this handover and analyze lessons learned. --In June 2007, USAID bought into a contract with the health non-governmental organization (NGO) consortium BASICS that will analyze the health sector in Sudan. BASICS will identify and analyze potential transition funding gaps, facilitate coordination among USG stakeholders, conduct a health facility mapping exercise, and organize a transition workshop for all stakeholders in early ¶2008. BASICS has facilitated similar transition efforts for USAID programs in LIBERIA with positive results. --In the coming weeks, BASICS will produce a prioritization matrix for USAID to use in making funding decisions for the health sector in FY 2008. The matrix is based on factors including the volume of returns to target areas, potential for conflict, and availability of health care. ¶4. USAID believes that the transition dialogue should be centered on providing the most strategic assistance possible in the health sector, capitalizing on the strengths of each office, and ensuring that planned humanitarian and development investments complement each other and facilitate effective transition to Sudanese structures and achieve maximum impact. This effort is larger than the context of USG health programs, involving all stakeholders under the leadership of the GOSS MOH, including other donors, the UN, and the NGO community. KHARTOUM 00001832 002.2 OF 003 -------------- Transition: Opportunities and Obstacles -------------- ¶5. The current state of the health sector in Southern Sudan presents several opportunities for transition: --The GOSS MOH has a unified vision and sense of ownership at the central level. For example, the MOH has developed seven national policies and guidelines, including the infectious disease and surveillance response guidelines developed in conjunction with the U.S. Centers for Disease Control and Prevention (CDC),the Maternal and Reproductive Health Policy developed by a USAID implementing partner, and the Human Resources for Health Policy developed with assistance from USAID/Sudan. --The MOH is staffed by a strong cadre of officials at the central level. --The health sector enjoys an active and committed group of implementing partners. --Stakeholders and donors have committed program funding that will continue through the end of 2008/2009. --There exists the strong potential for state-level coordination through the MDTF Health Umbrella Program and its mechanisms. This program will contract lead agencies for each state to coordinate the health sector for that state. --Sound transition models have been developed and will be tested. ¶6. While opportunities for success exist, the prospects for a smooth transition of the health sector in Southern Sudan do face significant obstacles: --Funding to the GOSS MOH, in both the regular budget and the MDTF funds, is not adequate for primary health care services and systems at the county level. Currently, most of the available funding is committed to the central and state levels. --No funding has been committed or budgeted by the GOSS MOH to pay health worker salaries at clinics. --There is an acute shortage of qualified Sudanese health personnel, even taking into consideration candidates who might be found in the diaspora. This problem is compounded by the lack of funding for salaries as it is hard to retain even existing qualified staff. --Localized conflict continues to impede access and implementation of health services. --Managerial and technical capacity among MOH staff at all levels is still fairly low. --Logistical challenges and high costs will continue into foreseeable future and impede sustainable health care service delivery as well as transition. --Delays in contracting lead agencies in the ten states have slowed efforts to coordinate health services and plan for transition. ¶7. Despite the opportunities, there are major short- and long-term gaps that need to be addressed before the MOH can realistically be expected to assume full responsibility for the health system. These gaps need to be addressed in a parallel and coordinated fashion, which will take considerable coordination among donors, implementing partners, central and state ministries of health, and the MTDF lead agencies. USAID is working to facilitate this coordination and promote a broader dialogue on transition among all stakeholders during the health transition workshop planned for early 2008. -------------- Next Steps -------------- ¶8. In the coming weeks, transition planning will continue as USAID and BASICS staff continue to collect, interpret, and analyze data to build a transition database that will reveal the transition funding gap among USG-supported facilities. BASICS and USAID will also conduct a facility-by-facility analysis to examine issues of access, underserved populations, and adherence to the basic package of health services standards. This analysis will be based on KHARTOUM 00001832 003.2 OF 003 methodology used by BASICS in the LIBERIA health transition planning process. The database containing the USG facility analysis will be handed over to the MOH for incorporation into the common database that contains information on other facilities. BASICS will create graphical depictions, such as maps and charts, of information to illustrate the current state of the health sector and guide the transition process. ¶9. In preparation for the transition workshop planned for early 2008, USAID and BASICS will prepare background material and develop and design the workshop approach alongside the GOSS MOH and other donors. USAID has met with the MOH and identified a preliminary timeframe for the workshop, scheduled for February 2008 in Juba, and in the coming weeks will work together to identify a venue and organize other logistics, including finalizing the participant list. USAID and the Joint Donor Team in Juba will convene a meeting of all relevant donor representatives in the next few weeks to discuss support for the workshop. The workshop will begin by focusing on the four states for which lead agencies will soon be contracted by the MDTF and will include all stakeholders, including donors, NGOs, and representatives from the central, state, and county ministries of health. FERNANDEZ