VZCZCXRO2191
PP RUEHGI RUEHMA RUEHROV
DE RUEHKH #0679/01 1211043
ZNR UUUUU ZZH
P 011043Z MAY 07
FM AMEMBASSY KHARTOUM
TO RUEHC/SECSTATE WASHDC PRIORITY 7042
INFO RUCNFUR/DARFUR COLLECTIVE PRIORITY
RUEHRN/USMISSION UN ROME

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 
 
 
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SUMMARY 
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¶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. 
 
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BACKGROUND 
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¶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. 
 
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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. 
 
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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