USAID: Sudan FY 2002 Congressional Budget Justification

PROGRAM: Sudan
TITLE & NUMBER: Enhanced Primary Health Care Through Greater Reliance on Local Capacities, 650-003
STATUS: New
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: $500,000 DA, $500,000 CSD
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: $500,000 DA, $500,000 CSD
INITIAL OBLIGATION: FY 2001 ESTIMATED COMPLETION DATE: FY 2003

Summary: Health care systems in opposition-controlled areas of Sudan have disintegrated with the ongoing conflict. Access to adequate health care services for the majority of southern Sudanese is extremely limited as infrastructure has disappeared, skilled health workers have fled or been killed, and international NGOs providing emergency health care services remain concerned about security. Given that visible health care centers, such as hospitals, often appear to be the target of GOS bombing attacks and given the widely dispersed population as a result of the violence and drought, health care has tended to be limited to emergency efforts, such as vaccinations campaigns.

Beginning in 1997, the international community initiated efforts to improve locally provided health services and increase local participation in construction and maintenance of water and sanitation infrastructure. Sudanese community health workers have been trained, and training centers have been established and maintained in the south. Coverage has been expanded through the creation of primary health care centers and primary health care units staffed by Sudanese. Civil administrations created by opposition movements in local communities have established county-level health departments and promoted health policies.

Under this Objective, USAID will continue to expand primary health care through greater reliance on local capacities. A transfer of responsibility for service-provision and coordination from the international community to Sudanese communities will enhance the level of care provided, including the availability of water and sanitation services.

In FY 2001, $500,000 in economic growth and $500,000 in child survival and disease (CSD) funds will be used to fund activities under this Objective.

Requested resources for FY 2002 are DA $500,000 and CSD $500,000 and activities are expected to continue, as described above, to enhance primary health care through strengthening of local capacities.

Key Results: Basic health coverage has been expanded to 60% of southern Sudan. Vaccination coverage has been increased to an estimated 30% of children in southern Sudan, despite the difficulty of reaching many of them due to conflict. As a result of this improved coverage, malnutrition and mortality rates have decreased in communities that have received assistance.

Performance and Prospects: Community participation in provision of health services is already common in current programs through the support of village health committees and the provision of labor and in-kind support to primary health care units. Cost-sharing has been initiated in some humanitarian NGO programs for war-affected populations in both northern and southern Sudan. Cost-sharing in the development assistance program will be encouraged where appropriate. In specific pilot areas, local health administrators are also being assisted in setting local health policies and ensuring that realistic standards are set and met.

CSD activities will continue to address the needs of the most vulnerable populations through the timely delivery of basic primary health care services. Coverage will be expanded to reach previously unserved areas under opposition control, as the security situation allows. In FY 2001, USAID DA economic growth funds will begin to be used to encourage the delivery of health services in stable areas by Sudanese private-sector entrepreneurs and non-profit organizations. Building on previous successes in encouraging the restart of private economic growth, USAID will provide limited financing to indigenous Sudanese firms and organizations to deliver health services in stable areas of southern and eastern Sudan. Beneficiary firms will be required to provide more than 51% of the investment necessary for each business project. Targeted activities may include pharmacies, health training institutes, health clinics, referral hospitals and associations of private health service providers.

Possible Adjustments to Plans: Access to vulnerable populations will remain a major factor in adjusting activities. As security allows, USAID will target activities to respond to the areas of greatest need.

Other Donor Programs: Operation Lifeline Sudan is the umbrella organization, managed by UNICEF and the World Food Program, that aggregates and provides the majority of humanitarian aid to war-affected Sudanese throughout the country. The United Nations Development Programme, the U.N. Population Fund, the U.N. High Commissioner for Refugees and the World Health Organization also operate in Sudan. These programs are funded primarily through the United Nations Consolidated Inter-Agency Appeal in response to the emergency and humanitarian needs of internally displaced people and refugees. Other major contributors in the health sector, primarily through contributions to United Nations humanitarian programs, include the European Union, Germany, the Netherlands, Norway, Sweden, United Kingdom, Canada, Italy, Belgium, Finland, Switzerland and Japan.

Principal Contractors, Grantees or Agencies: Development assistance programs in health are implemented in southern and eastern Sudan by the International Rescue Committee, a U.S. private and voluntary organization (PVO).

Selected Performance Measures: This is a new Strategic Objective. Performance measures are being developed.

U.S. Financing

(In thousands of dollars)

	Obligations		Expenditures		Unliquidated
Through September 30, 1999	0	DA	0	DA	0	DA
	0	CSD	0	CSD	0	CSD
	0	ESF	0	ESF	0	ESF
	0	SEED	0	SEED	0	SEED
	0	FSA	0	FSA	0	FSA
	0	DFA	0	DFA	0	DFA
Fiscal Year 2000	0	DA	0	DA
	0	CSD	0	CSD
	0	ESF	0	ESF
	0	SEED	0	SEED
	0	FSA	0	FSA
	0	DFA	0	DFA
Through September 30, 2000	0	DA	0	DA	0	DA
	0	CSD	0	CSD	0	CSD
	0	ESF	0	ESF	0	ESF
	0	SEED	0	SEED	0	SEED
	0	FSA	0	FSA	0	FSA
	0	DFA	0	DFA	0	DFA
Prior Year Unobligated Funds	0	DA
	0	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
Planned Fiscal Year 2001 NOA	500	DA
	500	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
Total Planned Fiscal Year 2001	500	DA
	500	CSD
	0	ESF
	0	SEED
	0	FSA
	0	DFA
			Future Obligations		Est. Total Cost
Proposed Fiscal Year 2002 NOA	500	DA	500	DA	1,500	DA
	500	CSD	500	CSD	1,500	CSD
	0	ESF	0	ESF	0	ESF
	0	SEED	0	SEED	0	SEED
	0	FSA	0	FSA	0	FSA
	0	DFA	0	DFA	0	DFA

SUDAN

Activity Data Sheet

U.S. Financing