SUDAN - HEALTH SECTOR RELIEF TO DEVELOPMENT TRANSITION

UNCLAS SECTION 01 OF 02 KHARTOUM 000679 SIPDIS AIDAC SIPDIS STATE FOR AF/SPG, PRM, AND ALSO PASS USAID/W USAID FOR DCHA SUDAN TEAM, AFR/SP NAIROBI FOR USAID/DCHA/OFDA, USAID/REDSO, AND FAS GENEVA FOR NKYLOH NAIROBI FOR SFO NSC FOR PMARCHAM, MMAGAN, AND TSHORTLEY ADDIS ABABA FOR USAU USUN FOR TMALY BRUSSELS FOR PLERNER E.O. 12958: N/A TAGS: EAID PREF PGOV PHUM SOCI UN SU SUBJECT: SUDAN - HEALTH SECTOR RELIEF TO DEVELOPMENT TRANSITION UPDATE KHARTOUM 00000679 001.2 OF 002 -------------- SUMMARY -------------- ¶1. (U) Nearly two decades of civil war in Southern Sudan has resulted in a region with some of the worst health indicators in sub-Saharan Africa. As USAID prepares to transition its assistance in the region from relief assistance to development programming, USAID's health sector non-governmental organization (NGO) partners are encountering significant challenges. To assist with this difficult transition, USAID is developing a comprehensive transition plan for assistance to Sudan in the health sector. As part of this effort, the Health, Disaster, and Complex Emergencies Advisor of the USAID's Bureau of Global Health's Office of Health, Infectious Diseases, and Nutrition traveled to Sudan and Nairobi, Kenya, from February 25 to March 15. The USAID staff found that the potential for development of strong partnerships with local health officials is currently limited. In addition, implementation of centrally controlled development funding such as the Multi-Donor Trust Funds (MDTF) are behind schedule. Despite high morbidity and mortality rates in the region, opportunities exist to transition from relief to development assistance. End Summary. -------------- BACKGROUND -------------- ¶2. (U) After decades of war in Sudan, many regions of the country have some of the worst health indicators in sub-Saharan Africa. Massive destruction of health infrastructure and erosion of human resources have resulted in a maternal mortality ratio (MMR) estimated at 1,700 maternal deaths per 100,000 live births and an under-five mortality ratio (U5MR) close to 250 deaths per 1,000 live births, according to the findings of the Joint Assessment Mission in ¶2005. In 2000, the sub-Saharan Africa MMR average was 920 per 100,000 live births. In 2003, the U5MR was 175 per 1,000 live births. Despite these dismal health statistics, significant progress has been made since the signing of the Comprehensive Peace Agreement (CPA) in both development and humanitarian assistance arenas to address the needs of the people in Southern Sudan. ¶3. (U) From February 25 to March 15, USAID staff met with implementing partners, other donors, the Government of National Unity (GNU) Federal Ministry of Health (FMOH),and the Government of Southern Sudan (GOSS) Ministry of Health (MOH). This assessment was the first in a series that will inform the development of a comprehensive transition plan for USAID's assistance in the health sector. The purpose of the assessment was to gather information on the status of the health sector in Sudan. In addition, USAID staff reviewed USAID development and humanitarian funding for the health sector, other donors' plans and initiatives, GOSS and GNU health policies and funding plans, and the country plans of NGOs. -------------- OVERVIEW AND KEY FINDINGS -------------- ¶4. (U) In meetings with stakeholders, USAID staff focused discussions on current health activities, sources of funding, and challenges and opportunities in transitioning health services. Stakeholders expressed several common themes that are summarized below. --LIMITED CAPACITY OF STATE AND LOCAL MINISTRIES OF HEALTH: NGO partners noted the lack of trained health care workers as a significant challenge in Sudan. In some areas, especially those formerly controlled by the Government of Sudan (GOS) during the war, the state MOH has been able to provide health care workers and salaries to support NGO-led health programs. However, in areas formerly controlled by the Sudan People's Liberation Movement (SPLM) there is limited MOH capacity to second health staff or pay salaries, causing NGOs to pay "incentives" and recruit staff from outside the area. Consequently, prospects for transitioning programs to the MOH in former SPLM-controlled areas are limited. As the GOSS is still in the process of organizing state and county administrations, forging effective partnerships with the GOSS is difficult. The health sector in Southern Sudan faces a human resource gap due to the migration of workers out of the health sector to more lucrative positions. All NGO partners include capacity building for state and local MOH staff counterparts, but KHARTOUM 00000679 002.2 OF 002 additional needs exist. --LIMITED MEDICINE SUPPLY MECHANISMS: Partners report a fragmented medicine supply system with most partners accessing pharmaceuticals through the UN Children's Fund (UNICEF). Some organizations that receive medicine through UNICEF have experienced delays in delivery and have noted significant medicine wastage since the medicine package is standardized and does not always reflect local needs. UNICEF is currently the principle provider of medicine to health partners in the Three Areas. However, at the end of 2007, UNICEF reportedly plans to cease this service. In 2007, the FMOH will need to assume this responsibility using Multi-Donor Trust Fund resources. --UNCERTAINTY SURROUNDING THE MULTI-DONOR TRUST FUNDS: Per the CPA, the GNU has established Multi-Donor Trust Funds for Southern Sudan and the conflict-affected states in northern Sudan. The funds are managed by the World Bank in cooperation with GNU ministries and implemented in multiple phases. MOH officials plan to use Multi-Donor Trust Fund resources to contract NGOs for health services delivery. In the north, the FMOH believes it can manage the health sector transition from being donor-supported to public sector-supported, especially in the former garrison towns. However, GOSS MOH officials openly acknowledge that they have limited experience in managing such an undertaking. Additionally, the process for distributing funds under the Multi-Donor Trust Fund process has been slow and confusing. A significant limitation of the Multi-Donor Trust Fund for Southern Sudan is the GOSS MOH's assumption that the funds are meant to augment current humanitarian and bilateral funding in the health sector, and not replace donor investments. --LIMITED DEVELOPMENT FUNDING OPTIONS: Sudan's health sector has limited development funds currently available. USAID partners report a "quiet crisis" in the remote areas of non-Darfur Sudan, where morbidity and mortality rates remain at emergency levels. These communities may begin to experience a "peace penalty" in health services as emergency-focused agencies begin to close-out operations. The reduced services coupled with inadequate MOH presence and capacity to manage health activities at the county level are likely to have a negative impact on already vulnerable communities. Aside from the GNU or Multi-Donor Trust Funds, other long-term health sector development programs are limited to: smaller European Union-funded programs; some bilateral funding from the Netherlands, Ireland, and Denmark; the UK's Department for International Development (DFID); the Common Humanitarian Fund (CHF); and the USAID/Sudan Health Transformation Project (SHTP). USAID's Office of U.S. Foreign Disaster Assistance (USAID/OFDA) and USAID/Sudan's health team staff are working together to identify potential transition opportunities from USAID/OFDA funding to SHTP development programming. ¶5. (U) Despite the challenges, opportunities for transition exist, especially in urban and peri-urban areas and in states where the Multi-Donor Trust Funds are likely to commence in 2007. -------------- NEXT STEPS -------------- ¶6. (U) The next steps for health sector transition planning include further assessment of current USAID partner activities and the development of specific recommendations on future USAID investments, both humanitarian and developmental. ¶7. (U) Convening a transition planning workshop for the health sector would be extremely timely and beneficial in the coming quarter. The purpose of the workshop would be to bring together all the relevant partners in the GOSS MOH to identify gaps, opportunities, and needs in health as the sector transitions from relief to development in 2007 and 2008. It is envisioned that the meeting would be chaired by the MOH and would bring together the donors, NGOs, and state-level MOH staff to discuss the current status of the health sector and plan the way forward. POWERS