Sudan’s Health System

Sudan’s Health System Based on A Plan of Action Addressing the Identified Gaps: Naeema Al Gasseer

Haffiya Elyas

The World Health Organization (WHO) is the directing and coordinating authority for public health within the United Nations system. The WHO Regional Office for the Eastern Mediterranean is one of WHO’s 6 regional offices around the world. It serves the WHO Eastern Mediterranean Region, which comprises 21 member states and Palestine (West Bank and Gaza Strip), with a population of nearly 583 million people.
The WHO Representative’s Office in Sudan supports the Government and health authorities at the central and local level in strengthening health services, addressing public health issues and supporting and promoting research for health. *
Physicians, public health specialists, scientists, social scientists and epidemiologists provide appropriate technical support and collaboration upon the request or acceptance of national authorities.*
As the lead health agency, WHO works with many partners to support countries in reaching their national health development goals and to ensure that its efforts are coordinated? Across the Region, these include United Nations agencies, humanitarian and development partners, donors, nongovernmental organizations, WHO collaborating centers and the private sector, Sudan Vision took this opportunity and interviewed the WHO Representative in Sudan Dr. Naeema al-Gasseer *on the occasion the of *meeting of the WHO Regional Committee for the Eastern Mediterranean Region in Khartoum ,to know more about the organization work and *efforts in Sudan:
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Q: Who is Naeema Al Gasseer, can you introduce yourself more? * * * * * * * * **

A: I am. *Dr. Naeema Al Gasseer, the World Health Organization (WHO) Representative in Sudan. I *joined WHO in 1999 as Senior Scientist for Nursing and Midwifery, Geneva, responsible for the coordination and integration of nursing and midwifery issues in the work of WHO policy and programmes.*Later served as WHO Representative in Iraq, before being reassigned to the post of Assistant Regional Director in 2010, where I focused on strengthening health systems based on research and evidence.
Prior to joining WHO, I was Regional Advisor for Reproductive Health and Family Planning at UNFPA from 1996, where I conducted health system assessments including reproductive health situation analysis in countries of the Middle East.
From 1992 until 1996 I worked at the Ministry of Health planning unit on developing the strategy for health in Bahrain. *Also, active at national level in preparing documents for the UN and WHO on progress made in relation to resolutions on health and development.
I graduated with an Associate Degree in Nursing from Bahrain in 1978, and obtained a Doctorate in Nursing Sciences in the area of women’s health from the University of Illinois, Chicago, USA, in 1990.
I am the *first Arab to receive an honorary award of Doctorate of Science (DSci) from Glasgow Caledonian University, Scotland, UK in 2005 and received an American Academy of Nursing Fellowship in 2010. I have been involved with health system assessment, quality of health care programmes and developing health strategy.

Q: *What is the extent *of *cooperation between the WHO and the Government of the Sudan represented by *the Federal Ministry of Health ?

A: The WHO Representative’s Office in Sudan supports the Government and health authorities at the central and local level in strengthening health services, addressing public health issues and supporting and promoting research for health. *
Physicians, public health specialists, scientists, social scientists and epidemiologists provide appropriate technical support and collaboration upon the request or acceptance of national authorities.*
As the lead global health agency, WHO works with many partners to support countries in reaching their national health development goals and to ensure that its efforts are coordinated. Across the Region, these include United Nations agencies, humanitarian and development partners, donors, nongovernmental organizations, WHO collaborating centers and the private sector.

Q: To what extent * is Sudan committed to achieve the *universal health coverage, especially ,Sudan has signed a global commitment to universal coverage since *2011?

A: *UHC is firmly based on the 1948 WHO Constitution, which declares health a fundamental human right and commits to ensuring the highest attainable level of health for all.
WHO is supporting countries to develop their health systems to move towards and sustain UHC, and to monitor progress. But WHO is not alone: WHO works with many different partners in different situations and for different purposes to advance UHC around the world.
WHO is working together with its health partners and stakeholders to support the Federal Ministry of Health in its goal to strengthen the coordination and integration of health service delivery in Sudan.*
The task force is supported by WHO to conduct an in-depth assessment to identify strengths and gaps in the accountability in Sudan’s health system based on a plan of action addressing the identified gaps. **
WHO’s support to the development of the accountability framework to advance towards universal health coverage in Sudan is a result of the generous contributions from the Government of Japan, Gavi – the Vaccine Alliance and the European Commission.

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Q: Has malaria rates declined in Sudan and have progress been in made in combating it? * * * * *

A: A new report by the World Health Organization shows that, although in Sudan reported malaria cases have fallen since a spike in 2014, from 1.2 million to nearly 900 000 cases, additional estimates paint a different picture which indicates that caution and continued vigilance remain necessary.

Factors contributing to this stalling of progress include a lack of funding growth. Available financial resources for the global malaria response have plateaued since 2010, reaching US$ 2.7 billion in 2016 (less than half of the 2020 funding target). With current levels of funding, and current tools, the limits of what can be achieved become visible.
The report signals a clear need for greater investment in malaria control – particularly at the domestic level. Gaps in the coverage of existing tools that prevent, diagnose and treat malaria must be urgently closed. The need for robust investment in the research and development of new tools is also high.
The world, including Sudan, can get back on track: but only through concerted action by all stakeholders, with countries in the driver’s seat. The targets of WHO’s global malaria strategy are not out of reach, but they do need urgent action.

Q: What are the efforts of the WHO and the regional office to eliminate FGM in Sudan?

A: *The first two quarters from 2018 witnessed, a number of training courses that targeted the health cadres particularly nurses and midwives. More than 1500 health cadres received training courses on the review and update pre-license training with an integrated component of FGM.*

25 nurses and midwives were selected to be the trainer of the trainee on social norms change. This training is part of the preparatory work for the upcoming nursing and midwifery students against FGM campaign. 150 midwives from North Kordofan state received orientation on the accountability framework for midwives under the enforcement plan.*
WHO and FMOH in collaboration with the National Council for Medical and Health Professions reviewed the accountability framework for midwives in light of the reviewed and finalized code of ethics and code of conduct for nurses and midwives. The objective is to ensure adherence to the ethics and principles in the code of ethics and conduct and referring to WHO accountability framework.*

In North Kordofan state,Sudanese Specialist Federation for Nursing and Sudan Midwives Association have played a great role in advocating for the approval of a law that criminalize the FGM practice through their participation in an advocacy event (Anti-FGM Campaign on Celebration of the International Day of Zero Tolerance to FGM) targeting legislative council members in the state and media people as well.*

FGM prevalence is high in Sudan, with an estimated 86.6% prevalence among 15 – 49 years. This practice is mostly carried out among girls between 5-9 years old and is increasingly medicalized (55.6% to 76% from 2000-2014 among women 15-49 years, MICS, 2014).
In order to fulfill the WHO/SFFGC strategic plan and develop change agents and leaders among health cadres to lead the social movements within health community networks at all levels, WHO in collaboration with other partners has encouraged the role of medical students workers associations, governmental and nongovernmental, to advocate for the total abandonment of FGC.

WHO has provided support to MedSIN’s SCORA campaign for the celebration of international day of zero tolerance against FGM in Kordofan and in fulfillment with national counterparts focus to utilize the celebration of the event to facilitate program implementation.*
Trained medical students from SCORA members was carried out an on orientation sessions on FGM and accountability framework at midwifery schools and advocate for against medicalization of FGM. * Beside, sensitization sessions on school health manual and the FGM component.*

Thought out the SCORA campaign, the advocacy for the de-medicalization continued by collecting the signatures from medical students on declaration against FGM from students in universities at North Kordofan. MedSIN has also provided support for the obstetrics and gynecology society proceedings during the 30th congress that was running during the same period.*

In 2017, a reproductive health module with FGM content was introduced in School Health Teachers’ Manual targeting schoolchildren ages 10-17 years old. The FGM content aims to delink FGM from religion while also highlighting the immediate, long-term, obstetric, sexual dysfunction and psychological risks/complications. As a result, in 2018 program partners were encouraged to develop a rapid formative need-based assessment among stakeholders to inform the roll out the School Health Teachers’ Manual.

Q: Health in All Policies Initiative in Sudan. What are your comments on this? * * * * * * * *

A: HiAP approach is core in implementing primary health care to achieve universal health care coverage, addressing health needs, and social determinants of health. WHO will actively support Sudan’s efforts in their HiAP journey, endorsed by His Excellency President of Sudan H.E. Omar Al Bashir, towards ensuring the highest attainable health for all people and their health security accountably.”

In 2017, Sudan initiated a rapid countrywide assessment to inform its strategic roadmap of the HiAP framework, as well as contribute to the establishment of the Global Network of HiAPs (GNHiAP), which was currently chaired by H.E. Mr Bahar Idris of the former Federal Ministry of Health.

*The roadmap aims to ultimately improve the health and health outcomes of all the population and to accomplish this by the following two general objectives which are : to achieve universal health coverage to all the population across all states , to promote health and health equity for everyone in the country.

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