VZCZCXRO2661
PP RUEHGI RUEHMA RUEHROV
DE RUEHKH #1832/01 3251603
ZNR UUUUU ZZH
P 211603Z NOV 07
FM AMEMBASSY KHARTOUM
TO RUEHC/SECSTATE WASHDC PRIORITY 9270
INFO RUCNFUR/DARFUR COLLECTIVE PRIORITY
RUEHRN/USMISSION UN ROME

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