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Table of Contents
A.
EXECUTIVE SUMMARY:
3
B.
BACKGROUND
4
C.
MAJOR ACHIEVEMENTS:
8
1
Achievements by component:
Consultants: .............................................................................................................................................. 8
Fellowships: .............................................................................................................................................. 9
Supplies and equipment: ...................................................................................................................... 11
Contracts: ............................................................................................................................................... 12
National training activities: .............................................................................................................. 15
Local Cost: .............................................................................................................................................. 15
1.1
1.2
1.3
1.4
1.5
1.6
2
Achievements by programmes:
16
Health policies and management .................................................................................... 16
2.1
2.1.1
2.1.2
2.1.3
2.1.4
2.1.5
Emergency Preparedness and Humanitarian Action: .......................................... 16
Health situation and trend assessment: ............................................................... 17
Policy formulation, planning and partnership development:.............................. 17
Health and biomedical information support: ........................................................ 18
Health system research ........................................................................................... 18
2.2
Health service development:..............................................................................................................
2.2.1
2.2.2
2.2.3
2.2.4
2.2.5
Basaic development needs approach (BDN) ......................................................... 19
National drug policies and essential drugs:........................................................ 20
Development of human resources for health (HRH): ........................................ 21
Health laboratory support: ...................................................................................... 22
Traditional medicine .................................................................................................. 23
2.3
Health promotion: ..............................................................................................................................23
2.3.1
2.3.2
2.3.3
2.3.4
2.3.5
2.3.6
2.3.7
2.3.8
2.3.9
2.3.10
2.3.11
2.3.12
2.4
2.4.1
2.4.2
2.4.3
Environmental Health ................................................................................................ 23
Management of community water supply and sanitation: .................................. 23
Protection and promotion of occupational health: .............................................. 23
Chemical safety: ...................................................................................................... 24
National chemical safety profile ............................................................................ 24
Protection of healthy lifestyle: .............................................................................. 24
Mental health: ............................................................................................................. 25
Nutrition and food safety ........................................................................................ 25
Substance abuse (tobacco free initiative): .......................................................... 26
Protection and promotion of Reproductive health: ............................................ 26
Women’s health: ......................................................................................................... 26
Health of the elderly: ............................................................................................... 27
Integrated control of diseases: ......................................................................................................27
Integrated management of childhood illnesses (IMCI), ARI, CDD: .............. 27
Malaria:: ....................................................................................................................... 28
Control of other communicable and tropical diseases: .................................. 29
WHO WRO – Sudan Annual Report 2001
1
2.4.4
2.4.4.1
2.4.4.2
2.4.4.3
2.4.5
2.4.6
2.4.7
2.4.8
2.4.9
2.4.10
2.4.11
2.4.12
2.4.13
2.4.14
2.4.14.1
2.4.14.2
2.4.14.3
3.1
3.2
3.3
3.3
3.4
3.5
3.6
3.7
D.
3
Others:
37
Poliomyelitis eradication: ...................................................................................................................37
Global Alliance for vaccine and immunization : ...........................................................................45
RD visit to Sudan : ...............................................................................................................................47
Horn of Africa Initiative (HOAI): .................................................................................................48
WR Participation Outside the Country .......................................................................................... 51
Celebration of International Days: .................................................................................................52
The News Letter “Voice of WHO Sudan”: ...................................................................................52
Juba Sub-Office African Programme of Onchoserciasis Control (APOC): .......................52
ADMINISTRATIVE REPORT ......................................................................
4.1
4.2
4.3
4.4
4.5
4.6
E.
Control of endemic diseases ................................................................................ 28
Schistosomiasis....................................................................................................... 30
Lishmaniasis ............................................................................................................. 30
Trypanosomiasis: ...................................................................................................... 31
Vector control ......................................................................................................... 31
Zoonotic diseases ................................................................................................... 31
Expanded programme of immunization .............................................................. 31
Leprosy elimination:: .............................................................................................. 33
Dracunculiasis (Guinea worm) eradication ........................................................ 34
Strengthening of HIV/AIDS and STD: ............................................................ 34
Prevention of blindness: ....................................................................................... 35
Control of TB .......................................................................................................... 35
Disease surveillance and control: ....................................................................... 35
Non communicable diseases:Leprosy elimination:: .......................................... 36
Control of diabetis ................................................................................................. 36
Canser control: ....................................................................................................... 37
Sickle cell anaemia ................................................................................................. 37
Staffing and Organization Chart ....................................................................................................55
WRO Premises and Assets ................................................................................................................55
STCs and visiting missions: ...............................................................................................................55
WHO supported projects: .................................................................................................................56
Other Administrative issues: ...........................................................................................................56
Constraints and recommendations: .................................................................................................57
ANNEXES:.............................................................................................. 57
Table 1: Sudan Population Data 2000………………………………………………………………
Table 2: WHO Regular Budget 2000-2001………………………………………………………….
Table 3: Extra-budgetary researches for Sudan 2000………………………………………………...
Table 4: WHO Consultant and Staff visiting Sudan 2000………………………………………….
Table 5: Fellowships, distribution of students by, specialty, duration, region and degree…….…
Table 6: Supplies and equipment provided in 2000………………………………………………...
Table 7: Distribution of CSAs and APW by signatory, cost and purpose………………………...
Table 8: Sudanese recruited by WHO as STC/TA……………………………………………….…
Table 9: Special service agreements by programme and period…………………………………..
Table 10: NTA budget, participants and facilitators……………………………………………….
Table 11: WRO Organization chart…………………………………………………………………
WHO WRO – Sudan Annual Report 2001
2
EXECUTIVE SUMMARY:
According to the Joint Government WHO Programme Review Mission (JPRM) in September 1999,
an amount of US$ 4.6 million from WHO Regular Budget (RB) had been budgeted within the
collaborative technical and financial programme between WHO and the Government of Sudan
(GoS). An amount of US$ 2,380,000 and 2,236,000 were allocated for 2000 and
2001respectively. Similarly, over US$ 3,000,000 has been made available from extra budgetary
resources.
As it can be noted from detailed text, attached tables and annexes, 68 WHO consultants and
staff visited Sudan during 2001 for different purposes and different duration. WHO recruited
16 Sudanese for different assignments in the region and 148 participants attended different
international activities. EMRO signed 26 different contracts with individuals and institutions to
perform specific tasks or provide technical support for WHO supported programmes in Sudan, as
well as 103 Special Service Agreements (SSA). Eighty- eight candidates were awarded
fellowships in many fields of health for different periods. During the same year 47% of the
budget was allocated to the national training activities (NTAs), which was implemented locally in
almost all states of Sudan. 4,037 participants attended them.
During the period under review progress was made in Polio eradication. In 2001 more than
5,000,000 children were immunized during each round of the spring and the autumn National
Immunization Days (NIDs). It was an opportunity to distribute vitamin A to most of those
children. WHO technical, managerial and financial support was essential in polio eradication
activities in Sudan.
Notable successes were achieved in the field of IMCI implementation. In addition to
consolidating the activities in the States implementing IMCI, expansion to eleven new States was
achieved with full consideration to balancing the implementation of the three IMCI components.
Sudan is the only country as yet within the Roll Back Malaria (RBM) partnership that has gone
through the Planning Progress in a systematic fashion desk analysis, complemented by district
level situational analysis, strategy development, its documentation and discussion with the country
level partnership. This effort was highly appreciated by RBM HQ Geneva as well as RBM/ EMRO.
The National TB Programme succeeded to obtain political commitment and financial support from
the federal and states levels. The TB programme has been implemented in 22 out of 26 states
covering 23 displaced camps. The DOTS strategy has steadily expanded in Sudan, covering 75%
of the total population by the end of 2000. Human resource development for TB has also
extensively taken place. A system of quality control of smear examination has also been
established in 22 states. A reliable system of TB reporting has been stabilized. A National TB
Reference Laboratory is being established.
Year 2001 witnessed remarkable progress in implementing and advocating for BDN concept.
Following the review of the experience in early 2001. Emphasis was made to support the national
capacities, when field and training officers were assigned. Advocacy meetings and promotional
materials were developed, supplies and equipments were purchased to support national office.
WHO supported the GOS to control negative impacts of 2001 floods where 82,633 people were
affected in 13 States. WHO responded immediately control health situation by provision of
Emergency kits, bednets and environmental sanitation equipments and pesticides for IDPs from
North Bahr Elgazal State to West Darfur.
WHO WRO – Sudan Annual Report 2001
3
BACKGROUND:
Sudan is the largest country in Africa,
covering one eighth of it, with an area of 2,5
million square kilometres. Sudan lie between
latitude 3,5ْ – 22ْ North the equator and
latitude 22ْ – 28ْ to the East. Accordingly it is
classified into desert 34%, semi-desert 20%,
woodland, forest 35% agricultural land 7% and
1% swamp and wetland.
Map of the Sudan
The total population of Sudan has been
estimated to be 31.1 millions with a growth rate
of 2.6% (2000 projection). Approximately one
third lives in urban areas. The growth rate is
2.6%. Children under the age of five years
comprise 16.2%, while 0-14 years are 42.9% of
the total population. A further 24% are women in the childbearing age. People above
the age of 60 year are only 3.9% of the population. These figures indicate clearly
that youth make the major population, which required target oriented programmes
specially designed to address the health development of youth.
Sudan has a per capita GNP of US$ 330. The UN system at present accounts for
one third of all the Official Development Assistance (ODA) and 70% of the
multilateral assistance. The social and human sectors, including the health sector,
receive 16% of the ODA.
Sudan suffers from acute, complex and multidimensional health problems along
with other least developed countries (LDC). Infectious diseases, parasitic
infestation and malnutrition caused mainly by low socio-economic status, cause the
main health problems and deteriorating environmental health is also a serious health
problem. WHO is supporting Sudan in developing capacities and capabilities to
prevent and control the emerging and re-emerging diseases especially Malaria,
Tuberculosis, HIV/AIDS, Environmental hazards, Occupational concerns,
professional-related stresses, trends of cancer and heart diseases.
Alarming rate of mortality, particularly, among children and mothers. The infant
mortality rate (IMR) was estimated at 108 per 1000 live birth in 2000. The maternal
mortality rate (MMR) was estimated at 365 per 1000 live birth. Considering the
differences in access to, and utilization of, health services and the rural/urban
differences, the reliability of these figures is less than optimal. The life expectancy
in Sudan in 2000 was 54 years. (52.5 for males and 55.5 for females)
WHO WRO – Sudan Annual Report 2001
4
Health infrastructures:
The primary health care (PHC) in Sudan, according to 2000 annual
statistical report of the Federal Ministry of Health, is provided through more than
6,184 health facilities namely 2,558 PHC units, 1,236 dressing stations, 1,475
dispensaries and 915 health centers. The PHC unit is the first level of services
staffed by a community health worker and serves a catchment’s population of 1,000
to 3,000 individuals. The dressing station is staffed by a trained nurse or
experienced uncertified dresser with a catchment’s population of 1-3 thousands
population. An experienced medical assistant, a village midwife and one or two nurses
staff the dispensary. Few dispensaries have inpatient facilities for short stay and
used as a first referral level within the PHC. Each dispensary provides services to
5,000 to 10,000 persons. The health center provides maternal and child health and
family planning in addition to other medical care services. One or two medical
officers, medical assistants, health visitor or legal midwife, nutritional instructor
and a vaccinator staff it. In urban health centers, other supportive services such as
laboratory and X-ray facilities are available. A health center covers 10,000 to
15,000 or more persons.
There are 309 Hospitals providing secondary level health care. They
represent the first level of referral for emergency medical care, diagnosis and
treatment. A rural hospital is located in larger rural towns and has a catchment’s
area of 30,000-50,000 population. It’s bed capacity ranges from 50-100. In places
where Health Area System (HAS) is implemented, the rural hospital constitutes its
Headquarters.
At tertiary level there are about 46 tertiary level and teaching hospitals
located usually at the capitals of states. They are equipped and capable of providing
tertiary level care. They have got consultants of different specialities in the field
of medicine who are supported by the necessary staff, equipment, supplies and
reference laboratories that facilitate their job. The total bed capacity available at
both secondary and tertiary levels is 23076 beds, with a ratio of 74.2 beds for
100000 populations.
The network of health facilities had been expanded considerably, but in the
last few years, the speed of expansion was not matched with the population growth.
A clear policy and a plan are required to ensure equity in distribution of health
facilities. Any expansion of the health care system should emphasize disparity
reduction, and increase access in the under-served areas and communities. In the
context of the policy of decentralization, a realistic assessment of the resource
mobilization capacity of the under-served states is needed, with appropriate
financial and managerial support to reduce gaps.
With the recent development in the federal system in the Sudan, the
decentralization and bottom-up approaches are being promoted. The constitutional
WHO WRO – Sudan Annual Report 2001
5
decrees have supported and shifted almost complete execution and implementation
of promotional, preventive and curative activities to the state authorities. The
implementation of HAS is in progress. Expansion of the PHC system to achieve
universal access is a top priority.
However, efforts have been hampered by the continuous impact of the civil
strife in the south, the drought and desertification. The 1998 floods in the
northern part of the country negatively affected all infrastructures, including
health sector. The so frequent natural and man-made disasters and the prolonged
civil war resulted in massive population movement and unplanned settlements at the
outskirts of the main cities and towns.
Human resources:
According to 2000 statistical report, there are 4770 specialists and
physicians, 222 dentists, 306 pharmacists, 17526 nurses and 9290 trained midwives
and 13492 paramedical.
The available data and human resources reveal inequity in distribution of all
types of personnel, with concentration in the urban areas and extreme shortage in
the rural areas. The brain drain of medical professionals is very high. As regards the
paramedical category is a bit better off in the terms of production and loss, since
there are approximately 250 health schools and institutes, which are graduating
different paramedical personnel.
There are 23 universities with medical and health science faculties
graduating medical and public health officers, qualified nurses and laboratory
technicians. These institutions graduate about 800 doctors annually, starting 2000.
In addition, the Sudan Medical Specialization Board is continuing its role in training
doctors in different disciplines with the objective of producing specialists to work
in managing health services at the states and rural areas, mainly to deal with
emergencies, referral and general medical service needs. These will contribute
significantly to the strengthening of health services and improving the quality of
health care.
Major public health problems in Sudan:
Based on data available (F.M.O.H. Annual Report 2000) Malaria is representing 17%,
Diarrhoea diseases 13%, Respiratory infection 10%, Dysentery 8%, and Malnutrition
6% all continuing to be at the top of the outpatient attendance list. For children
under 5years, again Malaria and Respiratory infections headed the list of causes of
Hospital Admission.
For killing diseases Malaria also heads the list 19%, followed by Respiratory
Infection 6.1%, malignant diseases 4.4%, and Septicaemia 3.8%, deaths by heart
failure represent 3.8%. TB and malnutrition come after.
WHO WRO – Sudan Annual Report 2001
6
Although Schistosomiasis is counting as the 2nd public problem in Sudan. But the
exact magnitude of the problems in different states have not been studied properly.
Limited surveys undertaken during the past few years shown high prevalence rate of
Schistosomiasis is 31% in Gezira and 37% in Sinnar.
External support to health:
WHO, UNICEF and UNFPA provide the principal technical support for health
programs in Sudan. The national and international non-governmental organizations
(NGOs) are playing also a vital role in the health development in the Sudan.
WHO continued to provide its technical and financial support to Sudan in the areas
of health policy and management, health services development, health promotion and
the integrated control of disease. In 2000/2001 biennium, about 40 health
programs were included in the collaboration program between WHO and FMOH. In
2000/2001 plan of action, priority-focused approach has been adopted. Eighty
percent of the total budget was allocated for the first ten top priority areas
identified by the Round Table Conference (RTC) conducted in August 1999. The
community education and involvement has been the guiding by principle for WHO
activities.
UNICEF support programs of Health and Nutrition, Water and environmental
sanitation and Household food security through the child right approach. UNICEF
main focus was on Child Survival and Safe motherhood, Community based health
interventions and Community based Nutrition/Micronutrient interventions.
UNFPA is supporting projects related to the reproductive rights and reproductive
health. The reduction of maternal mortality and morbidity through several
interventions is the main objective of UNFPA. Insuring voluntary quality familyplanning services, prevention and treatment of sexually transmitted diseases and
eliminating harmful traditional practices are parts of its mandate.
UNDP used to support a project on early preparedness for emergencies, which was
executed by WHO. This project came to end last year.
There are many
opportunities to bring UNDP back to support health development in general and
preparedness for emergencies in particular. UNDP will play a major role in
supporting strategic planning and community development.
UNIDO showed interest to provide technical assistance to health sector in areas of
development of health care industries, local manufacturing of pharmaceuticals,
occupational health and safety in industry, testing and quality control of drugs and
application of modern information technology. The trend of encouraging private
sector to invest in health will allow more involvement of UNIDO in health sector.
The income-generating project through BDN supported by WHO could be another
area for joint collaboration between UNIDO & WHO.
WHO WRO – Sudan Annual Report 2001
7
WFP signed a letter of understanding with WHO in September 1999 to co-ordinate
and work closely in the area of school health. WFP provide food to 300,000 primary
schools children in several states. WHO will publish and introduce a health
curriculum to some of these schools. Both agencies will collaborate in the Basic
Development Need projects implemented in certain states.
A considerable number of international and national NGOs are involved in health.
They contribute very significantly in health development as well as in humanitarian
aid. The International NGOs provide their support either to control a diseasespecific problem or to assist in a specific geographic location/s. The role of national
NGOs is increasing. They need to be further encouraged by different national
authorities. More facilities and better mechanism for collaboration are required.
MAJOR ACHIEVEMENTS:
The technical and financial support of WHO to Sudan is usually discussed and
agreed upon between the Government of Sudan (GOS) and WHO during the Joint
Programme Review Mission (JPRM) which is conducted every two years. The current
biennium is 2000/2001.
The 2001 annual report discussed shortly all achievements made in the second year
of the biennium. In this chapter, an overall description of what has been achieved in
2001 will be provided briefly. Initially, general progress made in the different
components of WHO support such as consultants, fellowships, supplies and
equipment, contracts etc will be given, followed by brief statement on each WHOsupported programme.
1 Achievements by component:
The WHO financial and technical support was used mainly to meet part of the major
needs of the country in health and health related sectors. Identification of needs
that is usually followed by programming detailed planning and budgeting are basic
tasks of JBRM. Although different forms of technical support have been provided
to Sudan in 2001, the following section will describe the achievements made in
selected components of WHO collaborative programmes, namely consultants,
fellowship, supplies and equipment, contracts, national activities and local cost.
1.1
Consultants:
From its mandate as a technical agency, WHO supported Sudan with a number of
technical experts in various fields. During the second year of the biennium 20002001, sixty-eight WHO consultants and staff visited Sudan in support to the
national programmes (Table 4). Figure (1) showed that polio eradication, as a national
and global priority, received the majority of the WHO technical assistance in the
year 2001. Around 43% of the consultants and WHO staff visited Sudan have
WHO WRO – Sudan Annual Report 2001
8
supported the National Immunization Days (NIDs) and Acute Flaccid Paralysis (AFP)
Surveillance System. Control of epidemics came second (23.5% of the visitors)
followed by malaria control (7%), IMCI (6%), BDN (4%) pharmaceutical (3%), MPS
(3%).
Polio
Control of
Epidemics
Malaria
IMCI
BDN
Pharmaceutical
MPS
Figure 1: Distribution and percentage of visitors by purpose of their visits to Sudan in 2001
Others
The duration of the visits varied, Figure 2 shows that some spent short period of
time while others spent or are still spending longer periods. Most of the long-term
experts belong to polio eradication programme.
Figure 2: Distribution and percentage of visitors by their duration of stay in Sudan in 2001
4-6 months
6%
7-24 months
9%
1-3 months
1%
2-4 weeks
7%
less than 2 weeks
77%
1.2
Fellowships:
During 2001, eighty-eight candidates were awarded fellowships by WHO for
different periods in many specialities of health. Table 5 shows the distribution of
fellowships by region while figure 4 shows distribution of fellowships by duration.
WHO WRO – Sudan Annual Report 2001
9
It can be noted that 56% fellowships were in our region while 29.5% were in Asia,
8% in Europe and 6.5% in others (figure 3). Figure 4 shows that 29% less than a
month, 26% 1-6 months, 44% of fellowships were for 7-12 month, 1% more than a
year.
Percentage
Figure 3: Distribution of fellowships by region
Place of the training
Figure 4: Distribution of fellowship by duration
>12 month
6-12 month
1-6 month
< 1 month
0
10
20
Percentage
WHO WRO – Sudan Annual Report 2001
30
40
50
10
Table 5 shows the distribution of fellowship awarded in 2001 by name, duration,
field of study, and the country. It is to be noted that in addition to these
fellowships WHO has fully sponsored the studies of 475 postgraduate students
inside Sudan through contracting competent institutions, 84.2% of them are
currently enrolled in Sudan Medical Specialization Board (SMSB) as shown in
Figure 5.
Number
BNRTI
SMSB
UoK
UoG
10
400
45
20
Figure 5 Distribution of number of WHO supported postgraduates by institute, 2001
1.3
Supplies and Equipment:
The WRO is handling the administrative aspects of procurement of essential
supplies and equipment funded by regular budget, extra budgetary resources and
the government fund on reimbursement basis. During 2001, a total of 37 purchase
orders were processed by the Regional Office to provide too many items costing
approximately US$ 2,065,147 from regular and extra budgetary sources (see table
6).
WHO WRO – Sudan Annual Report 2001
11
Figure 6: Distribution of resources from regular budget, extra budgetary
Extra-budgetary
52%
Regular budget
48%
It can be noted from figure 6 that 48% of the resources were provided from the
regular budget and 52% from extra-budgetary resources.
For the sake of regular monitoring; close follow up; easy clearance of goods; proper
documentation and enhanced submission of receiving reports, an assistant logistic
officer has been recruited on SSA basis. More efforts are needed to further
strengthen the whole issue of administration of supplies and equipment including, at
a later stage, the distribution and utilization of these supplies and equipment.
1.4
Contracts:
Excluding the SSA and TSA contracts, 16 CSA/APW contracts were signed in 2001.
It can be noted that 69% of them were signed for the purpose of development of a
particular document such as policy document, curricula, guidelines, standards or a
plan of action. Approximately, 19% of contracts was signed with different
institutions to conduct training mostly for postgraduate students. Details are shown
in table 7. WHO recruited 16 Sudanese for different assignments in the region and
148 participants attended different international activities (table 8).
WHO WRO – Sudan Annual Report 2001
12
Table 9 gives details on contracts signed with individuals on Special Service
Agreement (SSA) basis to provide technical and administrative support to different
WHO-supported programmes in Sudan in 2001.
It is to be noted that the trend of the use of contracts has increased recently.
This is due to the fact that Sudan has large number of highly qualified people but
suffering of severe problems of brain drain mostly because of economic difficulties.
The contracting local experts is an approach, which on one hand gives opportunities
for competent people to provide their technical services and know-how capabilities
to different national programmes, on the other hand, it offers them a chance to
benefit from the partial contribution to their income and hence reduce the
possibilities of their migration. Among other lessons learnt, this approach was found
very useful in national development capacity. It is another form of training through
learning-by-doing.
to review or assess
programmes
6%
to conduct surveys
6%
To conduct training
19%
to develop documents
69%
Figure 7: Distribution of contracts by purpose
Figure 8 shows the distribution of investment made in terms of budget allocation
for each purpose. It is clear that training received the highest share 80%, followed
by contracts to develop documents (17%)
WHO WRO – Sudan Annual Report 2001
13
Figure 8: investments in contracts by purpose:
Figure 9 shows that EPI including poliomyelitis eradication received the highest
share of SSA contracts 52% followed by management support programmes 35% and
23% for other programmes.
Figure 9: SSA contracts by programmes
project
others
Management
EPI
0
10
20
30
40
50
60
percentage
Due to the importance of these different contracts, efforts were made to establish
a database for all consultants or potential consultants to be involved. A special form
WHO WRO – Sudan Annual Report 2001
14
was distributed to all known candidates to be included in the database. A software
programme has been already designed in WRO for easy retrieval of these different
consultants
1.5 National training activities:
As a continuation to the efforts started in the last biennium and consolidation after
the establishment of the continuing education unit in March 98, the NTAs were
given special attention during 2001 therefore, 37 programmes benefited from it.
Approximately there were 4,037 participants attended the NTAs in 2001.
As it can be noticed in (Table 10) a total amount of US$ 1,070,700 was allotted by
JPRM to cover the cost of NTAs for the biennia 2000– 2001. Subsequently revised
to US$ 409,590 (47%) from the actual budget was released for implementing
activities in 2001. giving an implementation rate of 92.7% for 2000 – 2001 biennium.
Malaria received the highest share 11%, then non communicable diseases 8%,
Pharmaceutical programmes 7.7%, secondary and tertiary Programme 7%, IMCI ,
ARI and CDD 6%, vaccine preventable disease control Programme 5%, EHA 4%.
HIV/AIDS, TB, Environmental health, Chemical Safety, HRD, Nursing and Para
medicals and Nutrition and Food Safety may require increase in their budget
allocations.
WR and/or his staff attended these training activities and in most of them a
statement in the name of WHO was delivered,
1.6
Local Cost:
WHO provided local cost to Government of Sudan to support supervision, printing
and production of materials and other advocacy issues. The funds kept under this
component for the 2000-2001 (revised) were US$ 328,388 representing 7% of
the total allocated budget for Sudan. US$ 63,490 were actually disbursed during
2000 while US$ 175,831 were actually disbursed during 2001 giving 73%
implementation rate for 2000/2001 (table11).
WHO WRO – Sudan Annual Report 2001
15
2 Achievements by programmes:
2.1 Health policies and management
2 .1.1 Emergency Preparedness and Humanitarian Action:
This Programme start with Humanitarian Aid Commission (HAC) as focal point, and
after reprogramming a very productive partnership established with Civil Defence
Authority of Ministry of Interior, which
lead to the followings:
 Advance compact training course
(one month) for the Aquatic Rescue
Team (30 professional and 16
volunteer) to deal with floods
emergencies,
 Training
of
40
professionals
representing 12 NGO and institutions
on Emergency Preparedness and
Humanitarian Actions.
Photo 1:methods
WHO/Civil
rescueAssessment
team in actionin
 Training of 60 participants on the updated
ofDefence
the Rapid
Disaster and Emergencies.
As a result, significant progress has been made to boost all events related to EHA in
Sudan.
 The WRO respond immediately to
Government call for assisting the war
victims who has been displaced from
Raja (North Bahr Elgazal) to Eldaein in
Southern Darfur State, Emergency
Kits including medicine, environmental
sanitation material and impregnated
bednets was delivered to beneficiaries
directly by the WR and WRO staff.
 The joint venture elaborated between
Photo
2: The and
WR distribute
bednets to Raja
IDPs
WHO, UN agencies, International / Local
NGO’s
local authorities
has
been
clearly
evident,
dealing
with
communicable diseases and controlling
outbreak of meningitis and the
management of the influx of 82,633
persons displaced in 13 States as
result
of
floods.
To
further
consolidate
its
involvement
in
humanitarian field,
 WHO supported training of personnel
in disaster management in terms of
Photo 3: WHO Circle of Friends loading Health Kits
fellowships and strengthening the
WHO WRO – Sudan Annual Report 2001
16
administrative frame of Humanitarian Aid Commission (HAC) by providing
supplies and equipment and offering three fellowships to build the capacity in
regard to EHA.
 Formation of WHO Circle of Friends from different NGOs like the scouts,
Zubair Charity Foundation, IARA, ALBIR etc and medical students from
Khartoum, Juba. Alahfad, Elnileen and Gezira University who participate in
different EHA activities with WHO in the field and participate effectively in
the Polio independent monitoring.
2.1.2
Health situation and trend assessment:
 The programme two main objectives are: to strengthen the Information System
and promote available data in health decision making process and to develop a
national health statistical information data base and enhance the reporting
system of produced data, In this connection 4 training courses were conducted
in 3 states to build the capacity of health personnel in using health information
for planning and decision making at different health system levels.
 Contractual service agreement was signed to up-grade the data system for the
National Health Information Center, report submitted.
 Two nationals were contracted to update the database system of the National
Health Information Center and to connect it with 3 units at State level.
 Equipment and supplies were received to establish units at State level to be
connected to the national centre.
2.1.3
Policy formulation, planning, management and partnership development:
This is the 9th year of the Sudan National Comprehensive Strategy.
 The programme plan focused on developing capacities in planning and management
and to initiate 6 planning directorates at State level.
 Three nationals were contracted to design training modules and conduct the
training courses.
 Supervisory visits showed that states are still lacking technical capacities and
financial resource to support strategic planning which is based mainly on the
external support.
 The MOH initiated the process of developing the forth-coming strategic plan,
using the reviews conducted in 2001.
 More efforts and technical support needs to be done to build capacities of
states and districts programmes managers.
WHO WRO – Sudan Annual Report 2001
17
2.1.4
Health and biomedical information support:
The Information Resources Center (IRC), which was established in 1999 in the
FMOH, is showing great progress in providing the universities, hospitals with health
information literature through its library.
 All the departments of the FMOH are connected to the center. Developing
home page for the FMOH is about to finish.
 In collaboration with Global Health Care Communications Group (GHCCG), the
(IRC) is processing installation for 15 sites in Sudan.
 The Health Directory will also be developed in collaboration with different
interested sectors.
 Two librarian from the center were trained in EMRO to Build their capacities,
and to improve the perfection of library staff at FMOH.
2.1.5
Health system research:
The health system research unit expanded its activities beyond the health system
to accommodate all activities related to strengthening of health research, since
1998. By the end of the year 2000, the research directorate accomplished more
than 98% of its activities. During 2001 a manual for research methodology training
was developed, printed and distributed. A course for training of trainers’ was
conducted, to cover 22 university teachers.
 Supervisory visits covered only 4 out of the targeted 10 States, due to the
lack of transportation means. The information unit continued its efforts, to
formulate a database on research institutes, as well as to compile different
research abstracts since 1940. A number of 3000 abstracts were made
available in electronic forms. Ethical and technical committees were formed
to review and approve health research protocols.
 Quarterly bulletins were issued and distributed in addition to monthly
seminars, to review proposals to present results of selected researches, as
an advocacy to create interest for health research.
2.2
Health Service Development:
WHO is supporting the country through three programmes, these are, PHC system
development, secondary and tertiary care support, and health system research, in
addition to human resources development, which will be highlighted later.
 Sudan is implementing Health Area System (HAS), in support of PHC to
decentralize the health care services, and to increase access to the health
system. Many activities were planned to build capacities of health area
WHO WRO – Sudan Annual Report 2001
18
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management teams, however little was achieved due to the low managerial
capacities at both the national and state levels.
Six orientation workshop were conducted in six States selected for
consolidation of HAS.
An in-depth review for PHC was done during August and September 2001. The
results of the review were used for the new planning cycle. FMOH is focusing on
the integrated package of PHC service during next biennium.
The government has allocated considerable budget to improve capacities of
secondary and tertiary care facilities, mainly in terms of supplies and equipment.
Emphasis was given to quality management (QM), translated by initiation of QM
directorate within the FMOH structures. One tertiary care hospital was
selected as a pilot for implementation of Total Quality Management (TQM).
Further more standard operating procedure covering 17 dispensaries were
developed, written and endorsed in several workshops attended by more than
1000 participants, the standard will be printed and distributed soon.
With the technical assistance of WHO many training activities, and orientation
workshops were conducted to strengthen the concept of QM among decision
makers and staff of secondary and tertiary facilities.
200 physician, 500 general practitioner, 1200 nurse, 400 administration staff,
600 PHC personnel were trained.
2.2.1
Basic Development Needs Approach (BDN) As Sustainable
Development:
Early 2001, an evaluation of BDN experience was carried out, with the technical
assistance of WHO. Three international consultants and a local consultancy agency
have undertaken this activity with the assistance of the Regional and Country
offices. The results of the evaluation were presented in a consensus meeting that
included all actors interested in community development. Moreover, these results
were used as a tool to improve programme management
for the rest of the biennium and for the forthcoming
biennium 2002-2003.
 BDN Planning and Management Support;
Major support was provided by WHO to improve the
technical capacity of the national BDN team. An
acceleration plan was prepared with the technical
assistance of the Regional Advisor (RA) during his last
visit to Sudan. The plan focused on consolidation of
activities, with paced expansion in three more areas.
Eleven nationals were contracted as Planning, training,
monitoring, and information officers to build the
technical capacity of the national team.
WHO WRO – Sudan Annual Report 2001
Photo 4: BDN water tank in
Dar-Mali
19
 BDN Coordination and partnership development;
An advocacy meeting was held with high government officials, donors, and heads of
UN Agencies, under the patronage of H.E. the Federal Minister of Health. The
meeting has successfully created interest among partners specially governments
sectors. Intra and inter-departmental committees, both at Federal and State
Levels, are under the process of formulation and reactivation of the existing ones.
 BDN as a tool to Improve Income of the Poor;
Income Generation Projects were distributed to cover 225 needy families in
different BDN areas.
 Women Empowerment Under BDN;
Gender balance within BDN local structure was reviewed, and separate women
development committees were formed , where necessary. Women share IGPs was
also considered to improve women income, and
hence facilitate their access to essential health
care, and to enable them to meet their other
special basic needs.
 More than 80 basic school children including
girls were seated in Dar Mali Village.
 Teachers of girls’ basic school in Arashkoal
continued their leading role in preparation and
distribution of a subsidized breakfast meal to
Photo 5: BDN illiteracy class in Om
bada
the students, mainly girls.
2.2.2
National drug policies and essential drugs:
WHO supported pharmaceutical programme initiated in 1963 and remains as one of
important priority WHO/GOS collaborative program, the main objective of the
programme in 200-2001 biennium was the implementation of the National Drug
Policy, which officially adopted in May 1997.
 The draft of the National Pharmaceutical Master plan, was reviewed in a national
workshop, H.E. the Federal Minster of Health, senior officials of the FMOH and
other concerned parties participated in this meeting and agreed on the out lines
of the plan.
 Equipment for computerization of drug registration system was provided; it will
be followed by visit of experts from WHO HQ.
 Essential supplies and equipment were delivered to improve performance and
strengthen the capacity of the National Drug Quality Control laboratory.
 Four nationals were awarded Fellowships, two for QC laboratory personnel each
of 3 months in microbiological analysis, cosmetics and herbal drug analysis has
been to NODKAR Cairo, the third on QC packaging in GLAXO drug factory in
WHO WRO – Sudan Annual Report 2001
20
Cairo, and the fourth in bio-equivalence testing in Tunisia.
 WHO provide STC in regards to
improvement of drug quality control, a
manual for inspection of drug factories
was developed.
 To improve essential drugs, the
Pharmaceutical Programme is initiating
data base-system on accessibility and
affordability of essential drugs .
 The National list of Essential drugs
(NLED) was Updated, reviewed, and
ready for printing.
2.2.3
Photo 6: the workshop for endorsing the NLED
Development of Human Resources for Health:
The MOH recognized HRH development as a major challenge for improving health
system performance since years. Ninety-nine Doctors from different specialties
were graduated from Sudan Medical Specialization Board. More doctors will be
graduated by 2002. Twenty-five will finalize MSc in basic sciences in few months.
Ten doctors were partially supported to obtain MSc in public health and 16 in other
medical disciplines. Eight nurses were trained in Malaysia as master trainers in
Nursing Continued Education. Ten health personnel from the MOH has obtained a
diploma in health economics at Health Economics Center Khartoum University and
were distributed to States.
 A national training center for continued education is at the early stages of
initiation. A considerable number of supplies and equipment were purchased to
equip the national center.
 WHO has been actively involved both at Regional and Country level in the process
of reform of nursing and allied health resources. Experts and concerned parties
in different disciplines from both Ministries of Health and Higher Education are
forming working groups to bring the reform to reality in short time. This process
is fostered by high political support.
 Twenty health visitors, medical assistants and nursing teachers were trained for
6 weeks in educational planning, at the EDC of Khartoum University.
 To improve nursing services at state level 27 senior nurse were trained on quality
management of nursing services. The training covered 7 States and 6 academic
institutes.
 Three national consultants finalized an evaluation on the nursing and mid-wifery
training activities.
 Two nationals were awarded fellowships, on continued education in EMR.
WHO WRO – Sudan Annual Report 2001
21
2.2.4
Health Laboratory Support and Blood Safety:
The directorate of national health and medical research coordinates the national
network of health laboratory services, it controls 260 peripheral labs, 50
intermediate and 6 central laboratories.
 The current lab legislation was reviewed and updated by three national
experts.
 A national training for trainers was conducted to improve lab recording and
reporting system.
 A national training course was conducted for quality control officers
 Supplies and equipments for lab quality control were purchased and provided
by WHO.
 One lab technician was sent to Bahrain to learn about lab equipment
maintenance technology.
 The national training activity on lab management, which was suppose to be
conducted by a short term consultant from NAMRO 3 was not implemented
due to the sanction.
 National training course on updated screening policies on use of blood
products was done
 WHO provides to FMOH technical supplies and equipments, kits for blood
screening
 Supervisory visits were done to various local blood banks at State level.
2.2.5
Traditional medicine:
 The traditional medicine programme was initiated under the National
Scientific Research Center and now it is running under the directorate
general of pharmacy in the Federal Ministry of Health.
 The programme was established to assist in compiling knowledge on use,
safety and efficacy of local herbal medicine and to select safe and useful,
widely used medical plants.
 Training on local production and manufacturing of medical plants was
conducted successfully in 2001.
 The programme is planning to include medicinal plants and traditional
medicine in the national drug policy with broad scope.
WHO WRO – Sudan Annual Report 2001
22
2.3
Health promotion:
2.3.1
Environmental Health
2.3.2
Management of Community water supply and sanitation:
WRO has been actively participating and supporting issues related to ensuring
provision of safe water supply and sanitation, in particular provision of advisory
services on standards and guidelines related to safe drinking water and its quality.
 The National Health Water Chemical Laboratory carry out routine
examination of water samples from municipal and rural sources according to
laid down procedures.
 WRO work in good collaboration with the UNESCO Chair in Water, which is
carrying out studies in water resources, economic and health components and
social and cultural attitudes towards water.
 Training courses for Public Health Officers, Sanitarians and Sanitary
overseers were conducted during the year and attended by participants from
water authorities as well.
 CEHA contribution is valuable in the form of availing quick technical advice,
sending qualified STCs, provision of IEC materials which has being integrated
with school health programmes, MCH, Consolidated Inter-Agency Appeal and
BDN.
2.3.3
Protection and promotion of Occupational health:
WHO continued to support occupational health services of FMOH in matters related
to capacity building of Occupational Health personnel of all categories employed by
public and private sectors e.g. doctors, nurses, factory inspectors, sanitary officers,
sanitary engineers etc.
 Updating of legislation to respond to the increasing industrialization and the
new petroleum era to manage the industrial waste and protection of water
resources and control of land and air pollution.
 WHO sent two professional from FMOH to Iran to study occupational health
problems related to petroleum industry.
 A National Seminar on Occupational Health development for occupational
health personnel was conducted. National Training Courses for doctors,
nurses, Public Health officers and Sanitarians for development of
Occupational Health services in Pilot States was also implemented.
WHO WRO – Sudan Annual Report 2001
23
2.3.4
Chemical safety:
 Chemical Safety is regulated by legislation covering the followings;
a. Registration.
b. Importation.
c. Application.
d. Storage.
e. Disposal.
 Many agencies are involved in chemical safety regulations; Ministry of Health,
Agriculture, Industry, Trade, Irrigation, Interior and National Strands
Measures and Quality Authority.
 The Pesticide Act of 1974 and the 1975 package Acts of Environmental Health,
Food Safety, Pharmacy and Poisons and Ionizing Radiation are now in operation.
 The Updated Public Health Law of 1997, still under revision, includes more
emphasis on chemical safety e.g. Petroleum Industry.
 WHO continue to support chemical safety programmes through capacity building
of personnel engaged in inspection and laboratory work. Training courses and
fellowships were awarded and development of guidelines on safe use of
pesticides and other chemicals continues with assistance of STC.
 National Registry of Toxic and Hazardous Chemicals was developed by a national
consultant.
 S&E to insure the quality of chemical safety were provided.
 Survey to identify the currently used pesticides in vegetables was conducted.
2.3.5
National Chemical Safety Profile:
 A Programme work on the formulation of the National Chemical Safety
Profile has been performed with the task groups and committees formed by
representatives of all agencies concerned with chemicals, hazardous and
toxic materials.
 The presence of Dr. Rathor, WR who had been Regional Advisor on Chemical
Safety at the Regional Office has been a valuable resource for the work of the
Programme.
2.3.6
Promotion of Healthy Lifestyle:
Three programmes are included under this sector, those are:
1. Health Education.
2. School Health.
3. Oral Health.
WHO WRO – Sudan Annual Report 2001
24
 A national planning workshop was conducted, aiming at expanding School Health
Programme into 6 new states, benefiting from the experience of the 4 states
implemented the programme during last biennium.
 Training of trainers to train primary school teachers were conducted, as well as
training of school-teachers in health education methodologies.
 Health Education Materials to be used in training and for exhibitions was
developed and ready for printing.
 Activities to enhance improved school health services were revitalized between
WHO and WFP, MOH, Ministry of Education. This activity is going to be
implemented in BDN areas as well.
 Training of health workers on data collection and on preventive oral health
measures was conducted.
 Supplies and equipment to upgrade school health units at state level and to
establish oral health center were provided.
2.3.7
Mental health promotion:
 Short term consultant from Iran visited
the country to revise the national plan of
mental health and integrate it within the
PHC, national workshop was conducted.
 Still lack of qualified psychiatrists is the
main problem in Sudan. Only 28
psychiatrists are available in the country.
 The strategy to overcome these
problems will be through introducing
focussed and intensified training of Photo 7: the WR addressing World Health Day
medical officer, medical assistance, will be needed to meat gaps identified in
mental health services.
 The celebration of the World Health Day on Mental Health held in Elzubair
Conference Hall attended by H.E. Federal Minister of Health and the WR, to
maximize the use of the theme for “Mental Health”.
2.3.8
Nutrition and food safety:
 Training activities addressing laboratory staff and nutritionist on food safety
took place.
 Different supplies and equipment were procured for laboratory analysis.
 Still iodine deficiency in west of Sudan is a major health problem.
 Comparatively expensive price of iodised salt as well as overlapping
administrative management, constituting challenges to overcome iodine
deficiency in the country
WHO WRO – Sudan Annual Report 2001
25
2.3.9
Substance abuse (tobacco free initiative):
Besides the activities indicated in the JPRM, many other activities took place.
 During RD Dr. Hussein A. Gezairy last visit to Sudan in April 2001 he agreed with
the Minister of Finance to increase the prices of the Tobacco and the surplus
will go for endemic diseases.
 Faculty of Medicine at El Rabat University conducted a campaign of anti-smoking
during the last Holy month of Ramadan.
 The National coordinator represented the government of Sudan in negotiation
body at HQ Geneva for Agreement of Anti-Smoking.
 Khartoum State Ministry of Health one of the first States which issued and
applied decree prohibiting smoking in the premises of the Ministry of Health
(Ministry- Hospitals, Medical centers etc)
 MOH Khartoum State called for Anti- smoking seminar in collaboration with
National programme and WHO. Where WHO suggested nomination of focal point
for anti-smoking at State level and agreed upon.
2.3.10
Protection and promotion of Reproductive Women’s health:
Making pregnancy safer (MPS) was fully adopted by the MOH as an initiative and a
strategy to reduce women and neonatal morbidity and mortality rates. In this
respect an advocacy national workshop was conducted in August 2001 was
formulated.
 High government officials attended the workshop and expressed their
commitment to MPS and safe motherhood initiatives. Plans of action for selected
states, for the early implementation phase, were set by the technical working
groups during the last days of the workshop.
 Initial steps to conduct a baseline survey were initiated in the two states
selected for the early implementation phase for “MPS”.
 Equipment and supplies were distributed to hospitals to improve the maternal
health care delivery.
 Moreover, Omdurman health visitors and nurse midwifery schools were
supported by WHO to produce 60 health visitors and 30 nurse midwives, to
improve the quality of care provide to women and neonates both at facility and
community levels.
 The Government has allocated US$ 400,000 to rehabilitate village mid-wifery
schools all over the country, to increase the production of service providers.
WHO has also provided technical assistance to the national Programme through
STC visits and contractual agreements with national consultants.
WHO WRO – Sudan Annual Report 2001
26
2.3.11 Women’s health and Development:
Interest in gender issues with reference to health as gear for development is now
growing, mainly among NGOs and CBOs, however more efforts need to be exerted to
create the same concern within Government’ institutes.
 Focusing activities mainly for advocacy and promotion could better be created
under community based development Programme during 2002-2003.
 Situation analysis on women health was recently finalized and broad guidelines
for a national plan were set. The report is still under review.
 Technical assistance may be needed from the regional office at this stage to
review the national Programme and assist in finalizing of the national plan of
action.
2.3.11
Health of the elderly:
 In accordance with the Regional efforts to promote the health of the special
groups, and in response to the increasing magnitude of health needs of the
elderly groups, a national plan, was designed based on the results of the survey
conducted in 2000.
 Moreover, guidelines for health care and case management of the old people
were also drafted to improve the health care delivery system, however they
need more review and reinforcement.
 Two training courses were conducted to build capacities of doctors and medical
assistants, to provide care for the old people.
2.4
2.4.1
Integrated Control of Diseases
Integrated Management of Childhood Illness (IMCI), Control of
Acute Respiratory Infections (ARI), and Control of Diarrhoeal
Diseases (CDD).
 IMCI continued to be the most acceptable and appropriate integrated package
of interventions to reduce childhood health problems.
 WHO has played the major role in improving the case management skills of
health workers in the old implementing districts and in the newly expanding
districts, through standard case management courses and follow-up after
training visits.
 The national task force, with the assistance of the WHO Regional and Country
offices, has finalized its activities related to introduction of IMCI in preservice
training, in three universities as an early phase, in attempt to expand in other
WHO WRO – Sudan Annual Report 2001
27
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four universities in the next biennium. A student manual was developed and IMCI
CM Courses were conducted to participating universities’ staff.
Second adaptation of IMCI material was also finalized and the training material
is under printing. Six nationals were awarded study tour to exchange experience
of IMCI pre-service training with Alexandrian University.
WHO is technically supporting the Programme management capacity through
two APWs, one for the Programme manager, and the second one for an
information officer.
Health facilities implementing IMCI and training sites in the expanding districts
and HQ of the States are equipped to play their expected roles.
The Government has allocated US$ 80000 in terms of supplies and equipment to
support IMCI facilities.
IMCI list of drugs was introduced in the National List of Essential Drugs at first
level health facilities, only in areas of implementation as a trial.
To strengthen interventions in support of family and community practices
improvement, the volunteers’ training and trainers’ manuals are reviewed and
tested; it is under printing and will be ready for use in early 2002.
Practical steps were taken to introduce IMCI within BDN areas, starting by Dar
Mali village in River Nile State as an example to be replicated in other areas
within forthcoming biennium.
The health worker in Dar Mali health center was trained in IMCI CM and the
facility was supported with equipment and drugs.
Three training courses were approved by WHO to train BDN local structures,
using the volunteer’s manual.
IEC materials were developed, and child health weeks were conducted in a
number of States, to support IMCI advocacy and promotion.
The preliminary findings of the operational research on” Evaluation of family
response to recommendation of Referral and follow-up” were finalized and were
presented in Regional Consultation meeting in Syria, October 2001. The final
report is under review by both the Regional and HQ offices of WHO.
2.4.2
Malaria:
Roll Back Malaria (RBM)
The Ministry of Health is fully aware of the burden of Malaria situation,
considerable efforts has been made regardless of limited resources.
 The objective of RBM strategic plan for Sudan is to reduce the morbidity and
mortality of Malaria 50% by year 2010.
 Specific objectives are to improve the capacity for and access to early diagnosis
and adequate treatment of Malaria to all levels of the health system through the
WHO WRO – Sudan Annual Report 2001
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institution of systems for early recognition and appropriate management of
Malaria cases at the individual, family, community and health facility levels.
WHO continued to provide the technical assistance to the country through
series of visits of the regional advisor as well as the assignment of STP at WRO.
Country and inter-country courses in vector control were conducted in Blue Nile
Research and Training Institute (BNRTI) in Wad Medani.
Plans of action for Khartoum and Gezira States were drafted.
To achieve the above objectives the
following
interventions
were
indicated;
 Early forecast and follow up of
malaria epidemics monitoring and
evaluation.
 Disease management
 Multiple prevention
Main priorities for the coming two
years;
 Building partnership in RBM
Photo 8: malaria microscopic examination
 National political commitment and
financial support
 Capacity building for Malaria Administration at federal and state levels
2.4.3
Control of other communicable and tropical diseases:
The international health community has been sounding the alarm against a total
complacency, which is costing millions of lives every year (13.3 million out of a
worldwide total of almost 54 million in 1998)
After 1950s a period of development of new vaccines and anti-microbial agents
encouraged a transfer of resources and public health specialists away from
infectious disease control, optimism is now being replaced by an understanding that:
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Climate changes can result in the speed of parasites and viruses to new areas.
Diseases within animal populations are crossing into human populations with
increasing frequency especially as humans export new ecological zones.
Poverty uncontrolled urbanization and population displacement have led to
concentrations of human populations in conditions that favour major epidemics
(e.g. urban slums, refuge camps).
The weakening of health infrastructures after political changes or their
destruction as a result of natural disasters or civil strife and war is a major
cause of the resurgence of infection diseases.
The potential for spread of diseases has increased markedly with the
globalization of travel and trade.
WHO WRO – Sudan Annual Report 2001
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Ineffective vector control programmes have led to a proliferation of vectors
that are resistant, and the overuse of antibiotics has led to anti-microbial
resistance that now threatens to make once curable diseases incurable.
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WHO Priorities in the Area of Communicable Diseases are to: reduce the impact of
malaria and tuberculosis through global partnership, to continue to strengthen
surveillance and monitoring of communicable problems of international health
importance and effective response to these problems, to reduce the impact of
communicable diseases through intensified and routine prevention and control and to
generate new knowledge tools, intervention methods, implementation strategies and
research capabilities for use in developing endemic countries.
Up to 45% of death in Africa and South East Asia are thought to have been due to
infectious diseases. While world wide 48% of Premature deaths (under age 45) are
thought to have an infection.
2.4.4 Control of Endemic Diseases:
A reform of the structure of the endemic diseases control programme was initiated
by the FMOH, aiming at an integrated control approach for the vector control,
Schistosomiasis, Leishmaniasis were all housed under one general directorate with
individual programme coordinator.
2.4.4.1 Schistosomiasis:
 Different surveys planned to be conducted, so far one was conducted already in
Gezira State which showed high prevalence of Schistosomiasis among school
students.
 National coordinator received one month fellowship training at the MOH Egypt
granted by the WHO.
 Improvement was observed after his arrival. By the next year we are expecting
new strategy to guide drafting the national plan for Schistosomiasis.
 Government improved its financial contribution to the programme.
 Better coordinator with other academic institutions and multi sectoral started
in bilharzias
2.4.4.2 Leishmaniasis:
 A new coordinator was appointed; the first coordinating meeting took place.
During this meeting a technical task force was formed, WHO is an active
member.
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Many activities are expected to be implemented during forthcoming biennium.
WHO WRO – Sudan Annual Report 2001
30
2.4.4.3 Trypanosomiasis (Sleeping Sickness)
 Survey was conducted in Southern Sudan (Bahr El Gabal State), aiming at case
detection and Drug distribution.
 Three health workers were trained in Zaire in Control and Management of the
Disease.
 At the Federal level new coordinator has been appointed.
 New sprit of coordination started with Tropical Disease Institute in Khartoum.
2.4.5
Vector Control
 Although the funding was allocated during the reprogramming for this
programme in order to bring STCs for situation analysis and plan of action,
however unfortunately the fund was not used.
 As mentioned with the new policy of FMOH. The programme now is attached to
the National Malaria Administration.
2.4.6
Zoonotic Diseases
 WHO contributed to upgrading of the national laboratory to improve the quality
of anti-rabbis vaccine took place, the supplies and equipments provided by WHO
received.
 Short Term Consultant visited the country to assist in provision local vaccines
production, the mission very successful.
2.4.7
Expanded programme of immunization:
 In 2001 WHO in co-operation with Sudan Ministry of Health continued the
operation of EPI through three programmes of vaccine preventable diseases
control. These are polio eradication, neonatal tetanus elimination and other
vaccine preventable disease control, which were measles Diphtheria, TB tetanus
and whooping cough.
 In February with a change of administration in Ministry of Health the work plan
formulated in January 2000 was updated for 2001 in consideration of the
progress of 2000.
 In 2001 WHO assisted the government to review the EPI programme
highlighting the strengths and weakness of the programme. Following the review
a five-year plan was developed, which set out strategies and a plan of action that
WHO WRO – Sudan Annual Report 2001
31
will allow the EPI to increase coverage of all antigens to at least 85% and ensure
sustainability of the coverage.
Strategies was set out to allow five-year plan, its main objectives are:
1. To raise immunisation coverage among children <1yr to >85% by 2005 for all
targeted diseases.
2. To reduce measles morbidity and mortality by 60% and 40% respectively by
the year 2005
3. To reduce the incidence of NNT to less than 1/1000 live births by the year
2005
4. To ensure safety of injections including the programme disposal of used
injection equipment
5. To improve surveillance system for the EPI targeted diseases in al 26 states
6. To integrate Hepatitis B vaccine into the EPI to cover 20% of the targeted
population by 2005
7. To ensure community involvement and sustainable finance of the programme
8. To strengthen the management and logistical capacity of the programme.
 In September the five- year plan was submitted to the Global Alliance for
Vaccine Immunisation (GAVI) for funding. In November the funding was granted
and WHO will support the implementation of this plan with increased technical
support.
 The supplementary immunisation activities for polio eradication and neo-natal
tetanus continued in 2001. Polio eradication continues to be a priority for WHO
and in 2001 two OPV rounds of supplementary immunisation days (SIAs) took
place in March-April and November –December. The coverage for March and
April was 5,613,274 and 5,536,375 and coverage for November and December
5,524,483 and 5,820,266 respectively.
 MNT Elimination SIAs were conducted among WCBA (15-49 years) in 16
localities in 4 states. In Gezira, Sinnar and White Nile three rounds were
conducted in February, March, April and October. In Khartoum the first and
second round were conducted in June and August/September with the third
expected in February/March 2002. The reported coverage for the first two
rounds for all 4 states shows that from a total target of 1,106,288 for the three
rounds 713,075 women (64%) were vaccinated.
 Following acceleration of EPI activities in 14 lagging behind states, coverage
increased from 2000. The following graph shows the coverage for all six antigens
for the year compared to 2000.
WHO WRO – Sudan Annual Report 2001
32
Figure 1 Vaccination Coverage by the six antigens 2000-2001
90
80
70
60
50
%
2000
2001
40
30
20
10
0
BCG
OPV3
DPT3
Mealses
Antigens
 Although EPI continues to have ongoing problems with a weak infrastructure and
lack of operational budget the situation did improve from 2000. A change of
management in the Federal Ministry of Health and in EPI saw a change of
strategy and increased support to the programme.
 WHO continues to increase national capacity within EPI by providing technical
and material assistance. In 2001, 11 national medical officers and 6 state EPI
officers were added to the existing EPI staff. This brings the total number to
forty -eight personnel under SSA contracts. WHO also provided support to the
cold chain system with the purchase of equipment costing 1,000,000.
2.4.8
Leprosy elimination:
 The issue of the integration of leprosy with TB
raised again by the new team at the FMOH. So
the leprosy and TB become one directorate.
 The WHO elimination target for leprosy (less
than one case per 10 000 population) was achieved
at level of State.
 Next biennium will concentrate on elimination at
the level of Sub-States (Provinces)
WHO WRO – Sudan Annual Report 2001
Photo 9: leprosy patient on MDT
33
2.4.9
Dracunculiasis (Guinea worm) eradication :
 Sudan is still a head amongst the Endemic countries with (45785 cases) as
represented 80% from its cases although Sudan has reduced their cases by 36%.
 Different efforts continuing in order to ensure safe water for the endemic
areas.
 Insecurity is one of the major constrains facing the implementation of the
programmes activities.
 A taskforce is working actively for preparation for the international meeting
which will take place in Khartoum during March 2002, where the two WHO
Regional Directors will attend EMRO and AFRO.
 Guinea worm eradication programme still remained one of the active programmes
in communicable diseases area.
 Other programmes sleeping sickness, filariasis with Guinea worm now and
accordingly to MOH integration views are under one directorate led by an
active manager of Guinea worm.
2.4.10
Strengthening of HIV/AIDS and STD:
 The estimated asymptomatic HIV infection is 400,000; all states are
affected but mostly Southern States, Eastern and Khartoum States.
 Regional Director Dr Hussein Gezairy during his last visit, April 2001 one of
the main topics discussed with H.E. the President and other high officials
was the AIDS situation in Sudan. He stressed that the Government should
acknowledge the problem and to get prepared to avoid any epidemic.
 The RD visit hammered on the concern of the government about HIV/AIDS
at the highest level.
 New team jointed SNAP (Sudan AIDS Programme) as a national coordinator
and his assistant. Many activities were conducted to finalize the national
strategic plan.
 UNAIDS continue to provide its support to SNAP.
2.4.11
Prevention of blindness:
 Sudan has a large number of cataract backlogs (around 300,000 cases) the
prevalence of blindness is around 1.5%. The number of blind population is
increasing every day mainly because of cataract back log will double if no action
is taken.
WHO WRO – Sudan Annual Report 2001
34
 A Short Term Consultant from EMRO visited the country and discussed the
preparation for vision 2020 through a meeting at WHO office attended by many
partners.
 To improve the coverage and the shortage of ophthalmic care services, a 9
months diploma is proposed to be undertaken by Sudan National Board for
Medical Specialization to produce more ophthalmologists.
 Many international NGOs are working in the blindness prevention through eye
campaign.
 Seven main hospitals well be equipped with basic surgical instruments, in an
attempt to improve the services.
2.4.12
Control of tuberculosis:
 Sudan is considered to be one of the countries in the Region with highest
prevalence TB smear positive cases are estimated to be 90 /100,000
 More than 25000 cases are expected to
be covered during 2002. According to
National
Tuberculosis
programme
reports more than 93.6% is the current
DOTS coverage.
 Further steps are taken to integrate TB
with leprosy at Central, Southern
States, and Khartoum is expanding day
by day at provincial level.
 16 States were covered by and many
personnel were trained.
 Government
contributions
were Photo 10: Celebration of World TB Day in WRO
improved compared to last year.
2.4.13
Disease surveillance and control:
 An in-depth review of surveillance was conducted by the EMRO and MOH with.
 Five-year plan was drafted.
UNF Project for Surveillance in Southern Sudan:
 The United Nations Funds (UNF) project for Southern Sudan was established
according to the agreement between the Government of Sudan (FMOH) and
various partners (WHO, UNICEF/OLS… etc). The aim of the project to
coordinate and consolidate the efforts of various agencies operating in Southern
WHO WRO – Sudan Annual Report 2001
35
Sudan in the field of vaccine preventable and epidemic prone diseases
surveillance and response system; this coordination is expected to strengthen
the system.
The following activities were carried out:
 Contracts with partners were carried out, to highlight in sense of enlightment on
the objectives and strategies of UNF Project.
 Training Workshops were conducted in Juba, Malakal and Wau, where 48 persons
were formulate for trained.
 Weekly reports, on priority diseases were produced in addition to monthly
feedback reports, which had been distributed to all partners.
 Supervisory visits were paid, twice in both Malakal and Wau.
 Computers were provided, two for FMOH/Epidemiology Department and one for
Juba.
 Reagents and supplies for laboratories was provided
 Spare parts (batteries) for radios in Malakal and Wau were provided to support
communication.
2.4.14 Non communicable diseases:
During this biennium, an amount of USD 138,750 was allocated for non-communicable
diseases. Four main health problems were given priority during this biennium. These
are diabetes, cancer, sickle cell anaemia and prevention of blindness.
2.4.14.1 Control of Diabetes:
 In Sudan, DM constitutes a growing health problem with a major impact and
increasing incidence in all socio-economic classes. Although the crude prevalence
rate is 3.4% but the number of people with diabetes grows to 80% in some
Sudanese communities and even more alarming is the prevalence in northern
Sudan.
 Almost all patients receive the minimum of diabetes care but exhibit a high
incidence of acute and chronic complications. The poor metabolic control of
Sudanese diabetic patients is attributed to poor compliance and poor knowledge
of diabetes and the problems associated with its drugs.
 Insulin availability, affordability and storage play an important role in increased
morbidity and mortality among Sudanese patients.
 The awareness is increased, more diabetic workers and educators are highly
needed at PHC level standardization of treatment protocol is needed.
WHO WRO – Sudan Annual Report 2001
36
2.4.14.2 Cancer Control:
 The problem of the cancer is increasing day by day and cancer is considered as
one of the important killers in Sudan. Progress has been made in cancer registry
and there is increase of awareness about breast and cervix cancer to enhance
the early detection.
 One of the main constraints are shortage of medical supplies, and limited
financial resources are very limited.
 Programme targeting to reduce mortality and morbidity and to improve the
cancer surveillance and to standardize protocol for treatment.
2.4.14.2 Sickle Cell Anaemia:
 Sickle cell anaemia is a major health problem in several areas of the Sudan with
up to 34% prevalence among the Missairia Tribes in west Kordofan.
 A CSA for national experts to formulate national plan for prevention and control
of sickle cell anaemia was issued. Anther CSA to develop manual and guidelines
for case management of sickle cell anaemia was issued to 3 nationals.
3
Others:
3.1 Poliomyelitis eradication:
1.
Background:
Polio eradication activities started in Sudan in 1994. The first activity was NIDs
that lasted more than two weeks. Since then Sudan conducted a yearly double-round
NIDs campaign until 1999. Each campaign recorded better implementation than the
previous one. In 1995 Sudan did not conduct NIDs but the campaigns were resumed
in 1996. The number of children vaccinated against poliomyelitis increased from 3
million in 1994 up to 4.8 million in 1999. In 1999, two extra sub-national NIDs
(SNIDs) rounds targeted the border provinces were conducted. During those
SNIDs, 701,799 and 652,069 children were immunized in the first and second round
respectively. The purpose of these SNIDs was to immunize children across the
borders. Since 2000, the polio eradication activities including the supplementary
immunization activities were intensified. The year 2000 witnessed 4 rounds of NIDs
and one extra round of SNIDs targeted the risky areas in Sudan. In the recent
NIDs campaign the duration of NIDs was reduced to 3 days in each round with a
few variations in the western and southern states. The delivery strategy of
immunization during the NIDs was through the fixed vaccination centre and some
mobile teams but this strategy was changed since May 2000. The new strategy was
a house-to-house immunization strategy in order to ensure reaching and immunizing
WHO WRO – Sudan Annual Report 2001
37
all children and stopping the poliovirus transmission. In 2001, Sudan conducted 4 and
2 rounds of NIDs and SNIDs respectively. The following table shows the results of
the NIDs and SNIDs from 1996 through 2000. The results of 2001 OPV
immunization campaigns are described in a separate section in this report.
Year
1996
First round
Second round
NIDs
1998 *
1997
3,354,951
3,523,796
3,790,393
4,080,307
4,915,063
5,127,238
1999
2000
4,478,849
4,822,700
4,887,682
5,036,843
SNIDs
Year
1999
2000
First round
701,799
2,073,381
Second round
652,069
* Figures from OLS southern Sudan were added to the Northern figures.
While the supplementary immunization activities started early as 1994, the AFP
surveillance has been established later as of 1996. In 1999 the national polio
laboratory was accredited as a WHO-collaborating polio laboratory. The system was
developing slowly until the year 2000 where it received a substantial support from
WHO. The support was in terms of additional human resources (international and
national-SSA holders), material, equipment, financial and transportation means
(cars, motorcycles and bicycles). The main indicators of the AFP surveillance during
the period 1998-2000 are shown in the tables.
Indicator
Reported AFP
cases
Clinical polio
cases
Wild virus
polio cases
AFP cases
with adequate
stool samples
Stool
specimens
with good
condition
AFP cases
investigated
within 48
hours
AFP rate
1996
No(Percent)
54
1997
No(Percent)
51
1998
No(Percent)
80
1999
No(Percent)
90
2000
No(Percent)
210
49(91%)
26(51%)
39(49%)
43(48%)
52(25%)
2(4%)
7(14%)
5(6%)
9(10%)
4(2%)
10(19)
21(41%)
28(35%)
34(38%)
108(51%)
(19%)
(41%)
(35%)
(89%)
(88%)
12(22%)
19(37%)
59(73%)
19(21%)
154(73)
0.02
0.13
0.26
0.49
1.14
WHO WRO – Sudan Annual Report 2001
38
The performance of AFP surveillance system has undergone slow but steadily
improvement until the year 2000 where it’s AFP rate jumped from 0.49 to 1.14 as
well as the other performance indicators.
2.
4
Technical development
Supplementary immunization activities
The supplementary immunization activities during the year 2001 were different
from that of 2002 in number and quality. While in 2000 Sudan conducted one
SNIDs round in generic risky localities, two SNIDs rounds were conducted in Unity
and Kordofan region driven by AFP surveillance finding. The prominent finding was
the detection of wild poliovirus in a conflict-affected area in Unity state (or Ruweng
county). The quality of all NIDs round in 2001 improved very much because of the
following reasons:
 The presence of international staff in the field improved the quality of
microplanning process at the locality and province levels;
 increased number and quality of supervisors helped to take corrective
measures on spot;
 introduction of independent monitors gave an opportunity to ensure good
quality of work in high risk areas and helped to validate the reporting
coverage figures;
 The new MOH and EPI management was an added input to the programme;
 The substantial external financial support helped to fill the funding gap due
to increased cost of operation;
 Better NIDs synchronization between Sudan and neighbouring countries;
 Vitamin A supplementation was also piggybacked on the OPV NIDs twice in
2001.
The target children in March-April campaign were 5,504,648. The coverage rate was
102% and 103.5% during the March and April round respectively. The instable
denominator in Sudan due to the war and lack of recent population census could
explain the phenomenon of achieving more 100%. After each round a review meeting
was conducted in order to evaluate the implementation of the campaign. The
participants of these meetings were the state DGs of health, EPI officers, nutrition
officers, WHO STCs, UNICEF staff and federal personnel. The following positive
and negative aspects were discussed.
In November-December campaign, more target children were calculated because of
the improved access to several areas in various states. As the experience of
microplanning accumulated in the states and the wide presence of WHO STCs, the
reach to un-reached children was the prominent achievement during the previous
campaign. The number of children targeted was 5,739,433. The coverage rates
during the two rounds were 5,536,872(96.5%) and 5,820,266(101%) respectively.
The rain in some areas and an unexpected harvest season in other areas were the
WHO WRO – Sudan Annual Report 2001
39
main reason for not reach all targeted children during November round. As
December round was commenced all plans were put in place to overcome these
obstacles. The result then came satisfactory. Vitamin A was distributed to
4,090,420 from a target of 4,634,086 children between 6-59 months during the
November round.
Two initiatives were observed during the 9th NIDs. These were the use of
independent monitors to enhance the NIDs quality and intensifying the cross-border
coordination activities between Sudan and neighboring countries, especially Chad,
CAR and Eritria.
In July 2002 a case of wild poliovirus was detected in an area under the SPLM in
Unity state (Ruweng county). Both teams (Northern and Southern) went to
investigate and formulated plans to immunize children in all areas around the
affected village. Therefore polio team in Unity and Kordofan states conducted
SNIDs using house-to-house strategy to immunize all under 5 children. The
campaign was conducted in two rounds during August and Octobert 2002. The
number of children immunized during August and October SNIDs were 37,994 and
54,358 respectively.
5
Acute Flaccid Paralysis (AFP) surveillance
AFP surveillance system witnessed great improvement in 2001. The system
structure in terms of manpower and logistics were fully established. The necessary
guidelines and forms were printed and distributed to all states. Educational material
(Arabic and English) targeting medical professionals and public were designed,
produced and distributed to all states. The results of the all these efforts have
been reflected in achieving better performance indicators. Based on the level of
performance in 2000, Sudan was applying the clinical classification until the end of
2001 where improved indicators led WHO/EMRO to recommend the shift to the
virological classification.
The total of AFP cases reported were 214 cases out of which one case was
classified as a “compatible case” because the expert committee did not find a
sufficient evidence to discard it. No wild virus was detected in the Governmentcontrolled areas (the majority of Sudan). There was one wild polio case in the SPLMcontrolled area detected in May 2001 and confirmed as wild polio in July. Genotyping analysis could not show a definite and strong relationship to the Sudan
poliovirus.
The following tables show the major performance indicators.
Indicator
Compatible case
Wild virus polio cases
WHO WRO – Sudan Annual Report 2001
Value
One
One in the SPLM area
40
Sabin-like virus
Non-polio enterovirus
AFP cases with adequate stool samples
Stool specimens with good condition
AFP cases investigated within 48
hours
AFP rate
Type of
Poliovirus
P1
P2
P3
Total
Age in months
0-11
12-23
24-35
36-47
48-59
Total
Seven
23 cases (10.7%)
179 cases (84%)
416 specimens (97%)
203 (95%)
1.5 (per
U15)
100,000
children
Year
1996
1997
1998
1999
2000
2001
2
0
0
2
5
0
0
5
5
0
0
5
8
0
2
10
4
0
0
4
1
0
0
1
Number of wild
poliovirus cases
6
7
8
5
1
27
Percentage Cumulative
percentage
22%
22$
26%
48%
30%
78%
195
96%
45
100
100%
WHO WRO – Sudan Annual Report 2001
41
Based on the scarce surveillance data, one can trace the wild poliovirus since 1996.
The following maps show the places of occurrence of the detected wild poliovirus.
The age distribution of all wild poliovirus cases shows that young children (less than
3years) were more affected by the disease. The following table demonstrate the
number, percentage and cumulative percentage of all wild poliovirus cases reported
in Sudan since 1996.
WHO WRO – Sudan Annual Report 2001
42
The comparison of age distribution of the AFP cases reported in 2001 with the age
of the wild polio cases shows a similar pattern, i.e. a large number of reported cases
were small children. This implies that the AFP surveillance system has been
improved to pick all possible AFP cases and was able to pick wild polioviruses cases if
they were circulating (see the below graph).
45
Age distribution of non-polio AFP cases(2001) and wild
polio cases(1996-2001) in Sudan
40
Number of cases
35
30
25
20
AFP cases
Wild polio
15
10
5
011
12
-2
3
24
-3
5
36
-4
7
48
-5
9
60
-7
1
72
-8
3
84
-9
5
96
-1
0
10 7
811
12 9
013
13 1
214
14 3
415
15 5
616
16 7
817
9
0
Age in months
The other useful AFP surveillance indicator that helped to evaluate the NIDs
performance is the percentage of OPV doses received by under 5 children who were
reported as having non-polio AFP. The below graph shows the high percentage of
children under 5 who received 3 or more OPV doses and contrasted with the small
proportion with zero dose or partial immunization status. This picture supports the
effectiveness of the previous NIDs. In 2001, around 12% of children has received
between 10 and 17 OPV doses.
3.
6
Initiatives
Independent monitors
Independent Monitoring was introduced into the National Immunization Days in
Sudan during the November 2001 NIDs. In Sudan it was decided that the role of
independent monitors would be to make an informal but reliable assessment of the
vaccination activity by actively looking for unvaccinated target age children only.
Independent monitors would not check implementation of the NIDs in the state and
they would operate independently of the supervisory structure. The independent
WHO WRO – Sudan Annual Report 2001
43
monitoring was to be organized through
the
state
NIDs
coordinating
committee. However, most states were
reluctant to introduce the process, as
there was confusion in regard to
certain aspects of the process.
In the 7 states that undertook the
Independent Monitoring process it was
implemented successfully. The results
did indicate the weak areas in the
states and in general at the review
Photo 11: WHO Circle of Friend member during the
meeting it was considered a successful
independent monitoring
and helpful process. The independent
monitors were chosen mainly from the medical colleges and NGOs (WHO Circle of
Friends).
Following the review meeting of the 9th NIDs the guidelines were further
discussed with a small working group. The guidelines were updated to give a clearer
understanding of the process and to incorporate the states’ suggestions on
improving the process.
Independent monitoring was introduced into all states for the second round
successfully. In 173 areas 31,850 children were seen of which 30,960(97%) were
vaccinated. The below table summarizes the result of independent monitors activity.
State
No of
Independent
monitors
No of high-risk
No of target
No of childen
areas targeted
children seen
vaccinated
Blue Nile
16
8
1084
1052
97%
Sennar
20
7
2408
2206
92%
Gerdarif
3
3
116
113
97%
Red Sea
8
10
435
408
94%
Kassala
18
11
100
981
981%
Gezira
34
8
3411
3281
96%
6
10
321
309
96%
Khartoum
42
4
4406
3785
86%
River Nile
65
3
643
612
95%
Northern
8
8
364
359
99%
N. Kordofan
28
27
1735
1697
98%
S. Kordofan
17
16
597
591
99%
W.
Kordofan
26
13
911
852
94%
White Nile
WHO WRO – Sudan Annual Report 2001
% Coverage
44
N. Darfur
48
21
7324
7075
97%
S. Darfur
3
3
5706
5407
95%
W. Darfur
20
12
1567
1540
98%
Bahr El
Gabal
Upper Nile
10
2
247
232
94%
10
4
151
151
100%
Jongli
3
1
190
174
92%
Unity
2
2
143
135
94%
State
387
173
31859
30960
97%
3.2 Global Alliance for Vaccines and Immunizations (GAVI)
The Global Alliance for Vaccines and Immunization (GAVI) is an international
coalition of partners. It includes national governments, international organizations
such as the United Nations Children's Fund
(UNICEF), the World Health Organization
(WHO) and the World Bank; philanthropic
institutions, such as the Bill and Melinda
Gates Children's Vaccine Program and the
Rockefeller Foundation; the private sector,
represented
by
the
International
Federation
of
Pharmaceutical
Manufacturers Associations (IFPMA);
Photo 12: WHO STCs assisting in
and
research
and
public
health
preparation of GAVI proposal
institutions. The Alliance was officially
launched in Davos, Switzerland in January 2000.
The Alliance has set five strategic objectives:





Improving access to sustainable immunization services.
Expanding the use of all existing safe and cost-effective vaccines.
Accelerating the development and introduction of new vaccines.
Accelerating research and development efforts on vaccines and related products
specifically needed by developing countries, especially those against HIV/AIDS,
malaria and tuberculosis.
Making immunization coverage an integral part of the design and assessment of
international development efforts, including deep debt relief.
Based on recommendation of GAVI board the Global Fund support to countries
takes two forms:
 provision of new and under-used vaccines with safe immunization equipment;
 funding to help governments strengthen their basic immunization services.
WHO WRO – Sudan Annual Report 2001
45
All countries with less than US$ 1000 GNP per capita are eligible for support from
the Global Fund. As Sudan has less than US$ 1000 GNP per capita, it was an
opportunity to get benefit from this new source of support to strengthen its
routine immunization services. With an assistance from WHO, MOH could prepare
a proposal that has been submitted to GAVI in 2001. In order to meet the
requirements for the approval of GAVI, Sudan made a EPI programme review
including safety injection assessment, prepared a 5-year plan and formed a new
Inter-agency Coordination Committee (ICC). The first proposal was rejected
because of some deficiencies in the 5-year plan. WHO/EMRO sent again 2 STCs to
assist the national authority to strengthen the proposal. Country office of WHO
and UNICEF also participated in this process. The updated proposal was submitted
again to GAVI board, which was accepted.
The amount of fund supported by the Global Fund was based on the following
assumptions:
Number of DTP3
vaccinated
children
Baseline 2000
Target 2002
Additional children
vaccinated
659,662 children
813,391 children
153,729 children
According to GAVI policy, US$ 10 is allocated for each additional child immunized.
Therefore Global Fund has granted the total amount of US$ 1,537,200.
From its mandate, WHO decided to help EPI by recruiting a new national medical
officer who will be assigned to follow up the implementation of the planned activities
in order to vaccinate the additional 153,729 children according to the proposal
submitted to GAVI. By this new source of support, the future of EPI is promising.
WHO WRO – Sudan Annual Report 2001
46
Dr. Gezairy Launches the 2nd Round of the 8th NIDs
Regional Director’s Visit to WHO—Sudan
April 2001
 Dr H. A. Gezairy the Regional Director
(RD) of WHO Eastern Mediterranean
(EMRO) visited Sudan on Thursday the
26th of April 2001 to participate and
launch the second round of the 8th
National Immunization Day NIDs at El
Nuba locality, Kamilin Province. Also Dr
Helmy Wahdan, Special Advisor for
Polio, and Dr Fatin Kamil Medical
Officer for Polio Eradication and Dr
Photo(WR)
12: RDand
inaugurate
the 9th NID
in Sudan
H.R. Rathor WHO Representative in Sudan
the acting
UNICEF
Representative attended the launching and from the Government of Sudan Dr
Muabarak El Magzoub Acting Federal Minister of Health. The Wali of Gezira
State Mr. Al Shareef Ahmed and the President of El Nuba locality also
attended inauguratation.
 There was an operational task force group at El Nuba locality of 26 teams with
6 supervisors, 4 vehicles which targeted to vaccinate 15988 child. During the
period from Oct – Nov 2000, polio coverage was 5,320,185. This year they plan
to promote environmental health and rehabilitation of hospitals beside
eradication of Polio and other diseases. The Regional Director was stressined
on the importance of vaccination of all children under five, efficient AFP
Surveillance and also stressed on the importance of vitamin A supplements, and
routine EPI for the six diseases. RD requested all the people of Sudan to work
together for elimination of the Poliovirus and thanked all partners UNICEF,
CDC, Rotary, all participants and volunteers who reached each house and each
child.
 During his visit, Dr. Gezairy met with various Ministers individually. H.E. Prof.
Moubarak Magzoub, Minister of Higher Education, H.E. Dr Mustafa Osman
Ismail, Minister of External Relations, H.E. Dr Abdel Rahim Hamdi, Minister of
Finance and Economic Planning and Wali of Khartoum Dr. A/Halim El Mutafi.
The main aim of the meetings was to emphasize on the role of WHO as
technical UN agency with the main aim to provide support to the country in
overall health matters and
policies. The RD also meet with Heads of
Agencies Mr. Roger Guarda, Resident Coordinator, Dr Zahidul Huque,
Representative of UNFPA, Mrs. Angela Karney, Representing UNICEF, Mr.
Nicholas Siwingwa, Representing WFP, Ms. Jane Muigai, Representing UNHCR
confirmed that UN agencies should not get involved in Politics and maintain
their neutral position by restricting themselves to the humanitarian agenda
and transparency.
WHO WRO – Sudan Annual Report 2001
47
 Dr Hussein Gezairy was honorary a doctorate degree at the University of
Khartoum, the ceremony was inaugurated by the Minister of Higher Education,
Vice Chancellor, Deputy Vice and Chancellor. Dr Gezairy discussed the main
role of universities is to introduce the concept of preventive medicine to the
Students particularly in Sudan. He also met with the National Manager of
Expanded Programme for Immunization (EPI), DG of PHC Dr. Ahmed F. Shadoul
and met with the National Coordinator of AFP surveillance at the PHC building
and briefed about the cold chain at the headquarters and he observed the cold
rooms and their temperatures and also briefed about the activities going on in
the EPI Information Center, followed by a presentation on EPI/Polio and on
BDN.
 The RD also met with the Khartoum Malaria Free Initiative, and discussed the
issue of reduction of malaria, cases through mass treatment and micro
planning in addition to community
mobilization. researches.
 On the second day of Dr Gezairy’s
visit to Sudan, he met with H.E.
Omer Hassan Ahmed El Bashir
President of the Republic of Sudan
at the Presidential Palace. The
President ensured his support for
NIDs in Sudan and informed the RD
that there will be a prize for the
state which scored higher level of
Photo 13: RD and WR with H.E. Omer Elbashir
coverage
of
immunization.
 Ministry of Interior graduated of 30 professionals from and 16 volunteers
from the Scouts, who participated in an intensive training course for one
month on aquatic civil defense techniques including diving, marine rescues first
aid. The RD observed a the life demonstration covering different fields of
trainings mastered by the troop he also visited Sahiroon hospital of the
Ministry of Interior (MOI) and viewed the advance medical services that the
hospital offers daily to thousands of people from the sector of police and
civilians as well.
3.4 Horn of Africa Initiative (HOAI):
Recognizing the needs for regional collaboration to insure the health and safety of
people who live in border area, in March 1998 health ministers of countries of
Horn of Africa attended a conference on public health where they signed a
protocol of cooperation enabling cross border control of major health problems
WHO WRO – Sudan Annual Report 2001
48
including malaria, TB, HIV/AIDS. Sudan participated in most inter-country
activities related to this initiative, the WR participated in Gondar’s meetings
Ethiopia in June 2000 and in the HOAI informal meeting with WR in Nairobi
March 2001.
7
Cross-Border coordination initiative
In January 2001 in recognition of the threat that international borders poise to the
efforts to eradicate polio Sudan organized a meeting of all its neighboring countries
in Khartoum.
Representatives from the Ministries of Health from Central Africa Republic, Chad,
Egypt, Ethiopia, Eritrea, Kenya, Libya and Uganda attended this meeting. The main
objective of the meeting was to obtain political and operational commitment from
the respective countries to eradicate polio from the region by accelerating the
efforts towards polio eradication by coordination of cross border immunization,
surveillance and information sharing activities. During the three days, all countries
worked with their bordering district personnel to identify areas of co-operation and
developed plans of action for each bordering district for the above activities.
As a follow-up to that meeting, several district meetings have taken place between
Sudan, Eritrea, Chad and Central Africa Republic. This has resulted in synchronized
NIDs/ SNIDs with Chad CAR and Eritrea.
 Sudan, Eritrea and Ethiopia
On the eastern side two meetings took place with Eritrea, one in Sudan in March
and the second in Eritrea in July 2001. At these meetings areas of cooperation
were identified especially in the March meeting. Focal points were identified and
agreement was reached in synchronizing twice yearly NIDs and to hold further
discussion on the need for SNIDs in certain border areas.
In April, Eritrea was unable to synchronize as agreed however SNIDs were held in
May two weeks after the NIDs in Sudan.
The plan of action implemented between Sudan and Eritrea was as follows for the
March-April and November 2001 NIDs:
1. Sudanese Teams covered three Eritrea areas, Gallouge, Adebara and Garoura
vaccinating 2504 children.
2. Nine fixed outreach sites were established on the Sudanese side to provided
OPV during NIDs at all cross border points.
3. Areas and time of nomadic movement was identified, showing that Sudan is
responsible for the nomadic tribes between February and June.
WHO WRO – Sudan Annual Report 2001
49
4. Localities that need synchronization, health facilities in border areas and
focal points for exchange of information were identified.
5. Two check points were established at Golsa and Ellafa to exchange
information about refugees movements and active AFP surveillance
6. Training of 70 persons in AFP surveillance was held in the refugee camps in
Kassala before repatriation in May.
7. Two sensitization workshop held in Kassala in March included 64 members of
bordering villages community leaders and home visitors for the refugee camp.
8. Political commitment reached high levels as reflected by the participation of
the Wali and Ministries of Health from bordering districts.
District Meetings with Ethiopia have not taken place this year but planning is now
ongoing for a meeting in April 2002. The January 2001 meeting in Khartoum did
highlight the villages and the nomadic population at the borders, showing that
Sudan is responsible for nomadic tribes between January –June. Fixed posts have
also been set up at various border crossing points and on the Sudan side in MarchApril and November NIDs Vaccination teams boarded all buses cars etc. crossing
the borders.
8
Sudan Chad and Central Africa Republic
The first meeting took place with Chad in February in West Darfur1 and was
attended by all district EPI personnel from Chad and Darfur Zone. As a result of
this meeting over 20,000 children were vaccinated in border areas and special
nomadic population were targeted by either Chad or Darfur
The plan of action implemented during the April NIDs between Chad and Sudan was
as follows:
1.


2.
NIDS dates in Chad and Sudan
March: Chad 24-28, Sudan: 26-28
April: Chad 26-30, Sudan: 26-28
Six villages of Chad have been identified as unreachable from Chad side. Sudan
covered these villages. These were as follows:
 3 villages-Saraf Borgo, Machou Borgo and Dressa have been covered
from Umijikouti dispensary of Umjikouti locality, West Darfur state
 3 villages-Kedet, Haraze Goto and Siki have been covered from Bindissi
dispensary of Bindissi locality, West Darfur state
3. The NIDs of the border villages and settlements took place on the 27 March for
first round and 27 April for the second round.
4. A meeting took place on 28 March at Harare Market in Chad to review results.
1
CAR was invited but was unable to attend
WHO WRO – Sudan Annual Report 2001
50
5. The local chiefs did social mobilization in six villages one week before the day of
vaccination. The local chiefs and the villagers were informed by the Chad health
authorities that Sudanese vaccination team will be coming on 27 of March for
the first round and 27 of April for the second round to provide OPV to all
children below 5 years of age.
6. Two health centres; Tissi in Chad and Amdokhoun in Sudan have been identified
to regularly exchange data and information on AFP surveillance. The same
channel is used to send this information as well as the status of OPV vaccination
of the nomads to the Salamat province in Chad.
7. Respective localities supervisors did the supervision of the villages and the
evaluation findings were shared at the meeting on the 28th of March at Hazare
market.
8. The resources for the social mobilization and the training of the vaccinators was
allocated 2 weeks before the NIDS
In October 2001 another meeting took place with Chad, CAR and Sudan in Dougla,
Chad and was attended by national and district personnel. More detailed microplans were developed for the implementation taking into the considerations the
constraints of the April NIDs at this meeting. Chad, CAR and South Darfur
identified high-risk villages and special population and developed a detailed microplan for implementation. Sudan agreed to vaccinate 9 villages inside CAR borders
and to vaccinate 15 villages in Chad compared to 6 in the NIDs of April
Although agreement was reached to synchronize NIDs neither Chad nor CAR were
able to carry out NIDs in November. The Sudanese teams vaccinated the villages
inside Chad and CAR as agreed, reaching 5,596 children. There were implementation
difficulties for the Sudanese teams to cross the Chad check points. In December
round both countries synchronized the immunization activities. Sudanese teams
vaccinated 5390 children and 3037 children in Chad and CAR villages respectively in
December NIDs.
3.4 WR Participation Outside the Country
In addition to his continuous presence and participation in the country the WR
participated in the 2nd Global Meeting of WRS and
LO’s, Geneva, 26-30 March
th
and the Pre-retirement meeting 4 April in Geneva. He also attended the meeting of
Regional Advisors for Vector Control WHO/HQ 11-13 June in Geneva, Horn of
Africa Initiative, 3-7 July in Nairobi, Sub-regional Training Course on Environmental
Protection from Disease Vector use of Insecticide impregnated Bednets and other
materials14-16 May, Performance Management and Development System and
Negotiation Skills Workshop in Cairo 11-15 November 2001.
WHO WRO – Sudan Annual Report 2001
51
4.5 Celebration of International Days:
WHO office, Sudan has participated in the
celebration of many international and World
days, which were related to health. The WR
or his staff attended these days and in most
of them a statement in the name of WHO
was delivered, During 2001, seven occasions
were attended namely; World Water Day,
22nd March; World TB Day, 24 March; World
Photo 14: the ER addressing the World Water Day
Health Day, 7 April; African Malaria Day, 24
April; No Tobacco Day, 31 May; Mental
Health, 10 October; and World AIDS day, 1 December.
In addition to the following events the WR attended and delivered a speech during
the:
-
-
Round Table Meeting for Roll Back Malaria (RBM) 27th February 2001.
Basic Development Needs Review seminar 3rd March.
Inter – country Training Course on Vector Control Management, 1st Sept26th October 2001. Dr Rathor delivered several lectures during this
course.
Basic Development Needs advocacy meeting, 21st October 2001.
Essential Drugs meeting 4th November 2001.
4.6 The News Letter “WHO Newsletter”:
During 2001, four WHO News Letters were published, a special issue was published
during the visit of Dr Hussien A. Gezairy’s to Sudan in April 2001. The newsletter
was edited by Ms. Hania Abdelmageed and Dr Atif Abdelmageed under the
direction of Dr Rathor. The Newsletter was widely distributed to all Faculties of
Medicines in Sudan, all FMOH officials and directors general, Ministry of External
Relations, Ministry of Internal Affaires all UN agencies, in Sudan and other
partners interested in health. In addition copies were sent to all WHO offices in
the region, to all departments of the Regional Office and WHO/HQ.
4.7 Juba Sub-Office (Summary of Main Activities)
 Cerebrospinal Meningitis:
Sporadic cases were reported in January 2001, 30 cases and 03 death. A plan
of action was adopted to vaccinate the target population. No more cases
were reported.
WHO WRO – Sudan Annual Report 2001
52
 UNF Project:
Was established in the last quarter of 2002 with main objectives to
“Strengthen Surveillance and Control System of Vaccine Preventable and
Epidemic Prone Diseases”. Dr. Hashim Dalil was appointed, the Public Health
Coordinator of the project, assisted by three persons from Juba, Malakal
and Wau in addition to one Statistics Clerk in Juba.
 A review meeting was held in Khartoum from Feb. 26 -28 and attended by
different coordinators from HQ, Geneva, RA, CSR WHO EMRO and WHO
sub-office, Nairobi.
 The Eights’ NIDs Polio Campaign:
Two days training of Trainees held on March 15 to 30 participants on NID’s
strategy and locality plans. The participants are to train, in turn, local
providers.
 The medical officer, WHO sub-office, Juba paid a two days visit to
Kapoeta on March 26 to supervise first round of 8th NIDs.
 NIDs Supervisors Meeting:
Was held at the end of the first round of 8th NIDs from April 11- 20 in
Khartoum to discuss various aspects and to find solutions to some problems.
 Malaria Day 25th April:
MOIC, WHO sub-office Juba made a statement over Radio-Juba on 25th
April. MOIC highlighted the commitment of GOs and WHO and pointed out
that Malaria as the main cause of illness and death in the Sudan and assured
them of continued WHO’s support.
 Orientation Workshop on Malaria for Laboratory Assistants:
The six days workshop started on May 21st for 34 laboratory assistants. All
were from Juba Town. The workshop was very successful.
 Workshop on Malaria Vector Control:
This was for one day, held on 21st May, for 40 Community Leaders. The
workshop focused on how to identify and control the spread of Malaria.
 Workshop on HIV/AIDs for Women Leaders:
Held on 19th June and for 5 days. There were lectures on different topics
such as basic facts on HIV/AIDs/STDs, Mother To Child HIV Transmission,
Counseling HIV positive cases, use of condoms etc..
These were supported by film shows, group discussions, songs and drama.
 Orientation Workshop on EPI
A five days workshop starting June 20th, attended by over 30 supervisors,
from the whole of Equatorial Zone.
 Nutritional Anthropometric Surveys in Juba Town:
Two separate pre-harvest surveys concurrently done in Juba Town and
surrounding villages with target population of under 5 years of 23, 108 and 3,
203 respectively. Minimum samples of 900 children required for each survey.
 Orientation Workshop on AFP Surveillance:
WHO WRO – Sudan Annual Report 2001
53








A one day workshop held on 8th August for Senior Health Personnel.
Objectives and Strategy for Surveillance for Global Polio Eradication were
covered.
PHC In-Depth Review:
The three weeks review started on 20th August. Three random clusters were
chosen in Nyakuron, Kator and officials quarters in Juba Town.
Training Workshop on Trypansomiasis:
Two orientation workshops, of 5 days duration each were held for General
Medical Assistants and Lab. Medical Assistant, including Microscopist in
sleeping sickness from 19th to 24th Sept.. MOIC pledged continued support, as
sleeping sickness is a major public health problem in the Equatoria States.
Meeting of the Equatoria Relief and Rehabilitation Committee (ERRCC):
First meeting held on 13th June and attended by 26 participants representing
State Governments, Heads of UN Organization, International and Local
NGOs. The meeting also reviewed verification of IDPs’ who were identified in
1997. ERRCC also met on 28th July to discuss floods in Bahr El Jebel State
and OLS Annual Needs Assessment(ANA).
High Delegation of the National Assembly:
Head of UN organizations, INGOs and LNGOs met the five man delegation.
They stressed on the important health problems particularly AIDs and
sleeping sickness.
Equatoria Zonal Onchocerciasis Task Force (ZOTF):
Formed on 19th Sept. With objectives to supervisor O.V. Control Activities
and implementation of Community Directed Treatment with Ivermectin
(CDTI) in accessible areas.
Basic Nutritional Survey:
Two weeks survey were conducted in all accessible areas of Bahr ElJebel
State on August 20th .
The 9th NIDs Polio Campaign (First Round) in Imatong and Magwi
Provinces, Torit:
MOIC supervised the above campaign which started on 13th November.
Twenty Teams were involved in the six localities.
HIV/AIDs Awareness Campaign in Torit:
During 9th NIDs Campaign, MOIC participated in the AIDs awareness
campaign with Boy Scouts.
Condoms were distributed to personnel of the organized forces and public.
WHO WRO – Sudan Annual Report 2001
54
4 ADMINISTATIVE REPORT
1- Staffing and Organization Chart:
The assignment of Dr H. Rathor, the present WHO Representative for Sudan,
would come to an end by 28 February 2002 as he reached retirement age. The
Regional Office has not announced who will replace Dr Rathor yet. Also, the
office two Administrative Assistants would not continue their services with the
WRO as Ms. Vivian has resigned from work with WHO effective 1 December
2001 and Mr. A. Abdalla is expected to be transferred to work under the SCR
986 WHO project in the Northern Governorate of Iraq. The office has already
initiated the administrative formalities to fill the above two posts which would
be finalized in Consultation with the Regional Office. Mrs. Salwa S. Saif,
Secretary WRO, has discontinued her work with WRO as she moved finally to
live in USA. Ms. Mona Murtada has been recruited under SSA to replace her
until a proper contract is finalized in consultation with Regional Office.
 Three staff joined the work with WRO during 2001, Dr. Atif
Abdelmageed under SSA as National Programme Officer for Emergency
Preparedness and Humanitarian Action as well as Advocacy, Mr. Mahmoud
Wais, who will be working as STP/RBM and Mr. Mohanned Osman who has
been recruited under SSA as IT Assistant.
 As stated in previous report for 2000 more than 250 SSA holders still
working under WRO Sudan the majority is working in the area of polio
eradication including unaccessable areas in Southern Sudan.
 The current revised Organization chart is attached as table (11)
2- WRO Premises:
Some additional engineering/constructional work has been made in the WRO
premises during 2001 to make the best use of the limited office space. One
small room has been renovated to accommodate the IT assistant and another
small space has been organized to accommodate the Senior Driver whose
work is directly connected with the Administrative Unit. Also the available
office space has been, further utilized by constructing a decent store room
behind the security guards room and establishing a small and neat place for
prayers in the 1st floor near the Library room.
3- STCs And WHO Sponsored travellers:
The Administrative unit in the WRO continued to provide needed assistance
to travelling national STCs/temporary advisors and other participants as well
WHO WRO – Sudan Annual Report 2001
55
as visiting STCs such as exit/entry visas, travel permit, hotel
accommodations air booking … etc the details of those travellers are given on
table (1, 5 and 8).
4- WHO supported projects:
Administrative support has, also extended to WHO supported
Programmes and the Administration Unit maintained close collaboration
with the technical Unit in the WRO to accelerate Programme activities.
During 2001 more than US$ 5,000,000 have been released through WRO
imprest account for different Programme activities including polio
activities.
5- Other Matters:
a- During 2001 twenty two (22) Toyota Hilux, Double Cabine, have been
received by WRO to be used by Poilo STCs and national (SSA holders).
These Vehicles are under the Custody of the WRO and received UN
traffic plates. Also, three Toyota Land Cruisers were ordered during
2001, two for BDN and one for RBM: the three vehicles will be under
the custody of WRO. This increased the total number of vehicles
under WRO pool to 38
b- The Regional Office has kindly approved the recruitment of an IT
assistant who is now providing a valuable assistant to WRO staff. Also
we received new computers equipment to replace the old and obsolete
ones. The cooperation of the Regional Office in this respect and their
endeavor to equip the WRO with the latest technology in the field of
electronic communication has been highly appreciated by all WRO
staff.
c- We would like to thank the RPO and RD for their efforts to assist our
office to shift the contracts of some of our short-term contract holders, staff members to a fixed-term contracts. This has been very
much appreciated by our office staff and hopefully this action will
have a positive reflection on their performance. We hope that our
cooperation with the Regional Office should continue in this direction
to resolve the problems of the remaining short-term contract holders
in the WRO.
WHO WRO – Sudan Annual Report 2001
56
6-
Constraints:
 The basic challenge now facing WRO (and may be all WROs) is the limited
capacity of the imprest returns system. The limitation of the system
results from the fact that it would not give a chance to enter some useful
information like allotment, activity code or AMS Code. As a result it
would not be possible to make print out of some useful and proper reports
for the different allotment components e.g. you can not get a report of
actual activities funded vide imprest account under specific allotment and
specific activity code during a given period, such as local cost, NTAs,
Contractual … etc.
 It is quite imperative that the current system be reviewed and upgraded
to serve the above purposes and give ready reports which would be very
useful for monitoring and verification purposes
 This problem has been brought to the attention of Mr. Mohamed Nur,
ISM/EMRO during his visit to WRO during 2000 and he told us that HQ
was working on this subject and soon we may receive revised impress
software. However, we are still waiting and wish to hear soon on this
important issue.
ANNEXES:
Table 1: Sudan Population Data 2000
Table 2: WHO Regular Budget 2000-2001
Table 3: Extra-budgetary researches for Sudan 2000
Table 4: WHO Consultant and Staff visiting Sudan 2000.
Table 5: Fellowships, distribution of students by, specialty, duration, region and
degree
Table 6: Supplies and equipment provided in 2000
Table 7: Distribution of CSAs and APW by signatory, cost and purpose
Table 8: Sudanese recruited by WHO as STC/TA
Table 9: Special service agreements by programme and period
Table 10: NTA budget, participants and facilitators
Table 11: WRO Organization chart
WHO WRO – Sudan Annual Report 2001
57
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