WHO Priorities and Needs for the Second Half of 2002

WORLD HEALTH ORGANISATION ORGANISATION MONDIALE DE LA SANTE

WHO priorities and needs for the second half of 2002

June 2002 HEALTH SECTOR IN SUDAN

The overall health status of the people in the Sudan continues to be low. As a result of the ongoing conflict in the country, natural disasters like drought and flood and the consequent large-scale population displacement, a significant proportion of the population, especially children and women, continue to be affected by food insecurity due to crop failure; inadequate access to safe drinking water and worsening environmental and hygienic conditions. Poor access to health care services, along with malaria, diarrhoeal disease, acute respiratory infections (ARI) inadequate pre-natal, delivery and post-partum care have compounded the health situation of a large proportion of the population of the country.

Malaria, diarrhoeal disease and ARI account for 70% of all hospital admissions. The estimated annual number of malaria cases in the GoS-controlled areas is 7.5 million and around 35,000 malaria-related deaths occur annually. In the SPLM/A controlled areas, malaria affects 24-36% of the population. It is estimated that 65% of all under five children visiting health facilities in GoS- controlled areas have malaria. Malaria case fatality rate in pediatric hospitals is 8%. The Multiple Indicator Cluster Survey (MICS) 2000 conducted in the northern States and Government controlled areas in the South, indicated that only 24% of under- five children in the north and 34% in the urban towns of the south use bed nets. Of this number, 7.5% and 13.4% respectively are impregnated with insecticide.

MICS 2000 showed ARI and diarrhea prevalence rates of 17 and 28%, respectively among under-five children nation-wide. Diarrhoea prevalence in some states, however, was as high as 40%.

The same survey showed that the percentage of children who received all vaccines was only 25% with major disparities in coverage between states. It is estimated that one-third of the cold chain needs rehabilitation or replacement. Virtually all the vehicles provided for outreach during UCI need to be replaced. Intensive polio eradication efforts reached more than five million children under five in the national immunisation days in 2000 and 2001. In 2000, only four cases of wild poliovirus were confirmed.

The Sudan continues to suffer outbreaks of epidemics such as meningitis, measles and watery diarrhoea. Acute gastro-enteritis is common occurrence, particularly after floods and other natural disasters as experienced in 1994, 1998 and 1999.

Women have little access to reproductive health services. In GoS controlled areas, the fertility rate is 5.9 and contraceptive use is 8%. More than 40% of deliveries in GoS-controlled areas and over 60% in SPLM/A controlled areas are not assisted by a trained person. The maternal mortality rate (MMR) stands at 509 per 100,000 live births in GoS -controlled areas. The estimated MMR for urban areas in SPLM/A -controlled areas can be as high as 865. Obstaetric complications, stemming from lack of proper care during pregnancy, influence death or long-term morbidity among women. Safe motherhood practices contribute directly to a reduction in maternal morbidity and mortality and also in bringing down peri-natal and infant mortality levels. Under the Safe Motherhood Initiative, all pregnant women are supposed to receive basic and professional ante-natal care (ANC). Only 38% of women are immunised against Tetanus and the number of women receiving antenatal check-up is decreasing.

HIV/AIDS is on the rise in the Sudan. The Sudan National Aids Programme (SNAP) estimates that nationally between one and three percent of the population is HIV positive, with marked regional variations – the highest rates being in the war zones. In rebel controlled areas, it is assumed that areas bordering neighbouring countries with significant HIV infection rates are equally affected. From there, the disease is likely to spread to currently less affected areas, given the rapid development of trade links and road infrastructure in the relatively stable parts of southern Sudan. Continuing large-scale internal displacement, the movement of soldiers around the country and war-induced destitution are also key factors in the spread of HIV/AIDS. The pandemic will intensify quickly unless decisive action is taken without delay. Of grave concern is the significant lack of public knowledge or awareness of HIV/AIDS in both north and south, inside and outside the war zones. Level of awareness on condoms and their use is low in all parts of the Sudan and condoms are largely unavailable to the majority of the population. In the south there is extremely limited indigenous institutional capacity to work on HIV/AIDS with the result that a concerted effort by all partners will be undertaken.

The national prevalence rate of malnutrition in the Sudan is significant and rose from 18% in 1995 to 23% in 1999. The situation is more serious in southern Sudan, where the level is 28%, of which about 15% are severely malnourished. FAO data indicates that the food intake of about 30% of the total population provides less than their minimum energy requirements of 2,100 Kcal. The MICS 2000 data show that 30% of all new-born babies were of low birth weight, indicating low nutritional status of mothers.

Nutritional status among infants is poor due to low adherence to exclusive breastfeeding (only 30% of all infants are exclusively breastfed for the first three months), and early introduction of supplementary feeding and inappropriate complementary feeding. The Baby Friendly Hospital Initiative (BFHI), designed to address these issues, is only implemented in a few hospitals and maternity facilities in the main cities. Since more than 80% of all deliveries occur at home, there is a need to redesign strategies for dealing with the nutritional status of infants, e.g. a community-based strategy.

Micronutrient deficiency is a serious health problem that contributes significantly to high morbidity and mortality rates. One exception is that the national rate for Vitamin A deficiency has declined due to repeated supplementation during polio National Immunisation Day campaigns. According to MICS 2000, Vitamin A deficiency rates are highest in western and southern parts of the country. Iodine deficiency leads to mental retardation, goitre and lower resistance against infections. The national goitre rate is 22%. The two factories in Port Sudan and Nyala producing iodised salt face difficulties in sustaining continuous production, resulting in negligible levels of household consumption.

Based on this situation, and the need for continuous interventions in the health and nutrition sectors, health agencies will continue to provide assistance to vulnerable populations. Health and nutritional interventions can provide a valuable avenue for conflict transformation and peace building. For example, the National Immunisation Days (NID) proved to be effective tools for cross-line corridors of peace and periods of tranquillity. Within a community-based approach, participatory management of such interventions can promote tolerance and reconciliation.

Goal Ensure appropriate and timely response to health-related emergencies based on the Emergency Preparedness Plans and enhance access to basic health care services, especially for population groups in areas affected by conflict and natural calamities.

Operational Objectives  Ensure that at least 5.5 million children under five receive at least two doses of OPV for polio eradication and one dose of measles vaccine combined with two doses of Vitamin A supplementation.  Increase immunisation coverage to ensure immunisation of over 90% of children under one year of age with all primary EPI antigens in disadvantaged localities in Government- controlled areas and with measles and tetanus in SPLM/A controlled areas.  Immunise at least 3 million women of childbearing age in neonatal tetanus high-risk areas with three doses of Tetanus Toxoid.  Establish an effective disease surveillance and epidemics’ early warning system.  Reduce mortality due to malaria, acute respiratory infection, diarrhoea, measles and malnutrition;  Ensure that at least 900,000 pregnant women in selected areas receive proper antenatal care.  Ensure that at least 900,000 births are delivered by skilled health persons.  Reduce Protein Energy Malnutrition in under-five children in selected high-risk areas.  Significantly reduce malnutrition amongst high-risk populations in emergency situations.  Ensure that at least 100,000 malnourished pregnant and lactating mothers have access to supplementary feeding.  Increase by 20% the use of Iodised salt at the household (HH) level.  Ensure that at least 900,000 pregnant women in selected high-risk areas receive iron supplementation.  Support special actions (like provision of income generating activities) to reduce the vulnerability of groups at high risk of infection (especially adolescent girls, female heads of households and sexually exploited persons).  Increase by 20% HIV/AIDS prevention and counselling services for high-risks populations.

Strategies  Strengthen the capacity of counterparts, NGOs and CBOs with special emphasis on emergency preparedness, planning and implementation of interventions to increase access to basic health care services, provide reproductive health services to vulnerable groups, monitor and assess the nutritional status of under-five children; to support therapeutic and supplementary feeding programmes for the most vulnerable, and to establish an effective disease surveillance and epidemics’ early warning system.  Support the provision of essential drugs and vaccines to the most vulnerable groups and expand the implementation of the Integrated Management of Childhood Illnesses (IMCI) concept to improve early recognition and effective case management (or referral when needed) of the major childhood diseases.  Pre-position supplies to ensure rapid response to ensure access to health care services in emergency situations in accordance with emergency preparedness plans.  Develop community capacity to strengthen community based malaria control interventions including environmental actions, vector control, sustainable use of impregnated bed nets, and inputs for the prevention, proper diagnoses and treatment of malaria.  Strengthen coordination with all partners working in emergency areas, Government/local authorities, UN agencies, CBOs and NGOs and civil society to mobilise the financial, human and organisational resources required for polio eradication effort, to improve the quality of health care services, to respond to acute emergencies, and to avoid overlap and enhance efficiency.  Promote and expand reproductive health services in order to widen access to confidential HIV/AIDS testing and counselling and widen access to information and education on HIV/AIDS for women, adolescents, men (and vulnerable groups) to bring about changes in attitudes, values and practices at the family and community levels to prevent HIV/AIDS transmission.  Provide vulnerable populations with access to income generation and food for work schemes.  Continue advocacy for ensuring access to health care services for vulnerable populations in conflict-affected areas, areas affected by natural calamities, camps for IDPs as strategic priorities, and for adoption of proven approaches.  Support the provision of emergency reproductive health services to 100,000 women.

Indicators  Number of children under-five immunised with a minimum of two doses of OPV.  Number of AFP and polio cases reported.  Number of children under the age of one fully immunised against the six childhood diseases.  Number of pregnant women who have received TT2.  Number of pregnant women who received ante-natal care.  Number of deliveries attended by skilled health personnel.  Number of WHO-identified diseases and cases reported.  IMCI with home case management for malaria and diarrhoea.  Malnutrition rate among children under five years of age.  Number of children who received Vitamin A supplementation.  Number of persons supported by supplementary and therapeutic feeding programmes.  Number of growth monitoring units established and functioning.  Increase in use of iodised salt at household level.  % population that can correctly state at least three ways of preventing the transmission of HIV/AIDS.  % health personnel offering community friendly counselling and proper conducted testing.  % increase in trained health, media and community volunteers engaged in information dissemination and HIV/AIDS.  Number of communities reached with HIV/AIDS education.  Number of HIV positive persons who serve as advocates for HIV/AIDS awareness.  Number of female heads of household registered in income generating and food for work activities.

Appealing Agency WORLD HEALTH ORGANIZATION Project Title Health Project Code SUD-02/H05 Sector Health Themes EP&R, IDPs, Peace-building Objective To reduce mortality and morbidity rate in children under 5 years and women, and increase opportunities for children and women’s survival Target Beneficiaries 750,000 person in Kassala, Red sea, South Darfur, Bahr El Jabal, Bahr El (total # and description) Gazal, Nahr El-Nile and Gazera states Implementing Partners Local health authorities, UNICEF, UNFPA and NGOs Project Duration January – December 2002 Total Project Budget US$ 6,996,000 Funds Requested US$ 6,996,000

BACKGROUND Malaria, diarrhoea and ARI are widespread and head the list of endemic diseases, accounting for 70% of all hospital admissions. This is mainly due to poor sanitation, unsafe water, over- crowding and poor ventilation. The level of education is generally regarded as one of the prime determinants of maternal and child health. The 1999 IMR reported 82 per thousand live births, and 132 U5MR. These figures are much higher in the southern states for which there is little reliable data.

The estimated annual number of malaria cases in the country is 7.5 million and around 35,000 deaths occur annually. It is estimated that 65% of all children under five who consult health facilities have malaria. MICS 2000 indicated that only 24% of children under five in the north and 34% in southern towns use bed nets of which, 7.5% and 13.4 % respectively are impregnated with insecticide.

MICS 2000 conducted in the northern states and Government-controlled areas in the south, showed ARI and diarrhoea prevalence rates of 17 and 28%, respectively among children under five nation-wide however diarrhoea prevalence in some states goes up to 40%.

MICS 2000 showed that the percentage of children who received all vaccines had declined to about 25% with major disparities in coverage between states. It is estimated that one-third of the cold chain needs rehabilitation or replacement and virtually all the vehicles provided for outreach during UCI need to be replaced. The intensive polio eradication efforts have shown success and have reached more than five million children under five during the national immunisation days in 2000 and 2001. In 2000, only four cases of wild poliovirus were confirmed.

According to the Sudan National AIDS Programme, cumulative cases of HIV/AIDS reached more than 6,000 case in July 2000. The prevalence of sero-positively is above 1% in the general population. Interventions are focusing on education and social counseling. In the southern sector, the 1999 Multiple indicator Cluster showed very low community awareness on HIV/AIDS.

The Sudan continues to suffer outbreaks of epidemics such as meningitis, measles and watery diarrhea. Acute gastro-enteritis is a sporadic, endemic disease, especially after floods and other natural disasters as experienced in 1994, 1998, 1999 and 2001. Responses to these outbreaks are often late due to lack of a nation-wide early warning system. Even when responses are mounted, they are constrained by lack of supplies, laboratory support and trained staff. A WHO supported early warning and response network programme has shown that a coordinated response can considerably reduce epidemic mortality. Funding is being sought to expand this approach to other parts of the Sudan.

Women give birth frequently, with little access to reproductive health services. The fertility rate is 5.9% and contraceptive use rate 8%. More than 40% of deliveries are not assisted by a skilled birth attendant. The maternal mortality rate (MMR) stands at 509 per 100,000 live births in areas under Government control indicating improvement compared to the rate of 556 reported in the Sudan Demographic and Health Survey (SDHS) of 1990. The estimated MMR for urban areas in southern Sudan is 763. Obstaetric complications stemming from lack of proper care during pregnancy influence death or long-term morbidity among women. Safe motherhood practices contribute directly to a reduction in maternal morbidity, mortality and reducing peri-natal and infant mortality levels. Under the Safe Motherhood Initiative, all pregnant women are supposed to receive basic professional antenatal care (ANC). Although the level of immunisation against tetanus has gone up to 38%, the ante-natal check-up service ratio has slightly decreased as well as rates of TBA and health assistant services. Micronutrient deficiency is a serious health problem that contributes significantly to high morbidity and mortality rates. It is estimated that the national rate for Vitamin A deficiency has declined due to repeated supplementation during polio National Immunisation Day campaigns. According to MICS data, Vitamin A deficiency rates are highest in the western and southern parts of the country. Iodine deficiency leads to mental retardation, goiter and lower resistance against infections. The national goiter rate is 22%. The two factories in Port Sudan and Nyala producing iodised salt face difficulties in sustaining continuous production resulting in negligible levels of household consumption.

Emergencies that require immediate humanitarian response to alleviate suffering are virtually certain in the complex emergency situation of the Sudan. The ongoing conflict in the south is expected to continue to result in displacement of people. In addition to that, poor and erratic rainy seasons causing droughts and floods every year result in large-scale displacement. The victims, especially children and women are left exposed to the weather elements, unhygienic conditions and disease outbreaks for unknown periods.

Health and nutritional interventions provide a valuable bridge for conflict transformation and peace building. Within a community-based approach, participatory management of such interventions would promote tolerance and reconciliation. National Immunisation Days are effective tools for cross-line corridors of peace and periods of tranquility.

Goal To reduce morbidity and mortality rate in infants, children under five and women, and increase opportunities for survival of children, mothers and vulnerable communities.

Objectives  Reduce mortality caused by the five main killer diseases (malaria, ARI, diarrhoea, measles, TB, malnutrition and HIV/AIDS).  Increase immunisation coverage of children less than one year of age with the six antigens in weak states in the northern sector and with measles and tetanus in the southern sector.  Ensure that at least 80% of children under five are covered with at least two doses of OPV, one dose of measles and Vitamin A in emergency situations.  Immunise at least 80% of women at child-bearing age with three doses of Tetanus Toxoid in neonatal tetanus high-risk areas.  Ensure that at least 80% of pregnant women in selected areas receive proper ante-natal care.  Establish an effective disease surveillance and epidemics early warning system.  Prevent Protein Energy Malnutrition in selected high-risk areas of northern and southern Sudan.  Significantly reduce malnutrition in high-risk populations in emergency situations.  Provide a minimum of two doses of vitamin A to more than 80% of children under five.  Ensure that 70% of malnourished pregnant and lactating mothers have access to supplementary feeding.  Increase by 20% the use of iodised salt at household (HH) level.  Ensure that 80% of pregnant women in selected high-risk areas receive iron supplementation.

Strategies

In collaboration with sister agencies, health authorities and NGOs, to:

 Strengthen community based environmental action, including insecticide sprays, application of impregnated bed nets and other materials for prevention and proper diagnoses and treatment with anti-malaria drugs.  Strengthen the capacity for emergency preparedness and response by pre-positioning supplies according to emergency preparedness plans.  Strengthen coping mechanisms in emergency prone areas by building capacity, increasing awareness and encouraging community participation.  Apply the health area system and support provision of essential drugs and vaccines to the most vulnerable group.  Support Government efforts to eradicate polio.  Coordinate health interventions including response to acute emergencies with UN agencies, health authorities, counterparts, NGOs and civil society.  Expand and strengthen the Integrated Management of Childhood Illnesses (IMCI) to improve early recognition and effective case management (or referral when needed) of the major childhood diseases, in collaboration with the health authorities, UNICEF and other partners.  Strengthen the capacity of Government and counterparts to monitor and assess the nutritional status of children under five to improve the quality of services provided to them.  Strengthen the capacity of the Government to support therapeutic and supplementary feeding programmes for the most vulnerable.  Support the Baby Friendly Hospital (BFH) initiative and breastfeeding.  Ensure the decrease of iron deficiency among pregnant women and vitamin A deficiency among children by supporting provision of iron supplements and vitamin A respectively.  Expand the DOTs programme to the south for treatment of an additional 6,000 TB patients with 85% cure rates.  Support 11 existing small scale TB treatment centres with technical supervision, drugs and laboratory.

Indicators  Morbidity and mortality rates of infants and children under the age of five, maternal mortality rate.  Number of WHO reportable diseases identified and cases actually reported.  Number of children under the age of one fully immunised against the six EPI diseases.  Number of children under the five who have received a minimum of two doses of OPV.  Number of AFP and polio cases reported.  Number of people sleeping under impregnated bed nets in malaria endemic areas.  Number of people protected by insecticide spray coverage and environmental management action.  Number of pregnant women who have received TT2.  Number of children who have received Vitamin A supplementation.  Number of supplementary and therapeutic feeding programmes supported.  Strengthened growth monitoring.  Number of nutrition surveys conducted.  IMCI with home case management for malaria and diarrhoea.  Number of new TB patients put on DOTs and centres attaining 85% cure rates.

FINANCIAL SUMMARY Budget Items North South US$ US$ Malaria control and preventive measures 750,000 350,000 Containment of epidemics 300,000 100,000 Emergency obstetric care units and training 150,000 25,000 Essential drugs (WHO Emergency Health Kits) 450,000 200,000 IMCI training 150,000 25,000 Strengthening surveillance system including Early Warning 650,000 550,000 Technical back-up missions 100,000 100,000 Health education campaigns 100,000 100.000 HIV/AIDS prevention and production of IEC materials 150,000 50,000 TB case detection and prompt treatment 600,000 400,000 Training EPI / Polio operational cost 500,000 200,000 Project Sub-total 3,900,000 2,100,000 Monitoring, project management & reporting 390,000 210,000 Programme Support Cost (6%) 257,400 138,600 Total north/south Budget 4,547,400 2,448,600 Total Project Budget 6,996,000 A. WATER AND ENVIRONMENTAL SANITATION

Inadequate access to safe water and sanitation as well as poor hygiene practices, such as open defecation, (still a common practice in many parts of the country) are a major cause of several diseases leading to the high levels of infant and child mortality and morbidity in the Sudan. Epidemics of water–related diseases such as diarrhea (causing 40% of under-five child deaths) are widespread. The Sudan is host to over 73% of the total guinea worm cases (in 2000) with 99% of cases being in the south Jonglei State is the most endemic area in the country (Guinea Worm wrap-up # 109).

Recent studies1 have shown that while in the GoS-controlled areas, 79% of the population in urban areas and 47% in rural areas have access to improved water sources, in SPLM/A controlled areas, the percentage is as low as 25%. Sanitary means of excreta disposal are scarce throughout the country, only 46% of the rural population and 80% of the urban population in GoS-controlled areas and only 35% in SPLM/A controlled areas have access to adequate sanitation.

The ongoing conflict and natural disasters like droughts and floods, resulting in large-scale internal displacement of people; economic difficulties (negligible Government investment and the decline in external support); rapid population growth; and institutional problems have seriously affected public water and sanitation facilities. The drought in Darfur and Kordofan, and three consecutive years of late rains in East Equatoria and parts of Bahr El Ghazal further exacerbated the situation in 2001. Significant water shortages resulted in large-scale population movements, increased vulnerability and caused further pressure on existing and functional water sources especially in the transitional zones. The on-going intra and inter- communal clashes are expected to continue in the coming year, as pastoral groups compete over scarce water and pastureland, since many water schemes in the affected areas require rehabilitation.

Much of the limited investment in this sector over the past decades was directed towards better-off urban areas. The displaced and poor communities in peri-urban Khartoum pay as much as 40% of their income for small quantities of poor quality water. The frequent breakdown of existing water systems (especially the more sophisticated groundwater and surface water schemes in rural areas) has added to the problem. Lack of rural water systems and access to safe water sources has led to population movements towards towns, creating undue pressure on existing weak systems, which cannot cope with the increase in demand and consequently breakdown.

However, provision of water and sanitation facilities alone will not achieve the desired improvement in health status: hygiene and environmental sanitation awareness need to be addressed simultaneously. Thus, humanitarian action aims to provide safe water and adequate sanitary facilities and health/hygiene education to populations in war-affected zones, IDP camps and Guinea Worm endemic areas. This will include the installation and/or rehabilitation of water supply systems and sanitation infrastructure where feasible, with the provision of hygiene education and training for operation and maintenance through schools and village health committees.

In 2001, UNICEF concentrated its efforts on a few selected geographical areas based on sustainability and ownership of the water points and the need to mitigate the effects of the acute drought emergency. The strategy prioritised rehabilitation and maintenance of existing water sources coupled with construction of new water points, promotion of hygiene and sanitation awareness and capacity building. As a result there was no outbreak of cholera, a decrease in guinea worm infection rate and an increase in access to safe water by populations affected by acute emergencies. WES will continue with the same strategy, with focus on populations affected by war, insecurity and natural disasters, in selected geographical areas, identified as the most disadvantaged, having the worst social indicators. The project will continue its collaboration with Global 2000 for guinea worm eradication. WES interventions will be used as a lever to promote grass roots peace building initiatives, gender

1 MICS 2000 and Survival to Thrival disparities and reduce conflict over resources to promote peaceful co-existence and target areas identified by the peacebuilding project and other partners.

Goal To ensure access to safe drinking water and improved environmental sanitation and hygienic conditions for vulnerable populations affected by war, insecurity, natural calamities, and in guinea worm endemic villages. Operational Objectives  Increase access to safe drinking water for 500,000 persons in the selected geographical areas identified as the most disadvantaged, and in guinea worm endemic areas.  Increase access to and use of improved sanitation facilities and hygienic conditions for 150,000 persons in the selected geographical areas identified as the most disadvantaged, and in guinea worm endemic areas.  Promote the increased acquisition of knowledge, skills and values required to facilitate adoption of hygienic practices and to prevent guinea worm transmission in endemic communities.  Ensure provision of water and sanitation services to populations affected by rapid onset emergencies according to Emergency Preparedness Plans.

Strategies  Strengthen the capacity of counterparts, with special emphasis on emergency preparedness, planning and monitoring of interventions, water quality testing; and the development and adoption of locally relevant, affordable and sustainable technology.  Support community-based initiatives/interventions to ensure access to safe water and improved sanitation facilities.  Support for rehabilitation of existing water sources, construction of new water and environmental sanitation facilities, and the provision of filter cloth in Guinea Worm endemic villages.  Pre-position supplies to ensure rapid response to ensure water supply and sanitation facilities in emergency situations in accordance with emergency preparedness plans.  Advocacy for ensuring access to safe drinking water and improved environmental sanitation and hygienic conditions for vulnerable populations in selected geographical areas identified as the most disadvantaged, as strategic priorities, and for adoption of proven approaches including affordable and sustainable technology.  Community capacity development and mobilisation to facilitate enhanced community involvement in the planning, design and monitoring as well as the operation, maintenance and management of all water and sanitation interventions.  Programme support communication to bring about changes in attitudes, values and practices at the family and community levels to promote adoption of proper sanitation and hygienic practices and to prevent HIV/AIDS transmission.  Strengthen coordination with all partners working in emergency areas, Government/local authorities, UN agencies, CBOs and NGOs for the mobilisation of the human and financial resources required for implementation of water supply and sanitation interventions and delivery of services and to avoid overlap and enhance efficiency.  Establish new water supply facilities in areas which have conflicts over water sources for human beings and live stock, to promote community partnerships for the planning, design and monitoring as well as the operation, maintenance and management of all water and sanitation interventions in order to contribute to grass roots peace building, peaceful co- existence and conflict resolution.

Indicators  Number of safe water sources constructed or rehabilitated  Number of sanitary facilities constructed and used  Number of affected people who benefited from the interventions  Number of filter cloths distributed  Number of hygiene education/surveillance sessions conducted  Number of people aware of how guinea worm disease is transmitted Appealing Agency WORLD HEALTH ORGANIZATION Project Title Granting Basic Human Needs (Water and Sanitation) for IDPs in North Kordofan, Allah Kareem, Al Jihad camps Project Code SUD-02/WS01 Sector Water and Sanitation Themes EP&R, IDPs, Peace Building Objectives To minimise water-borne and sanitation-based diseases among deprived IDPs specifically among most vulnerable groups. To improve environmental health, focusing on water, sanitation and vector control. Target Beneficiaries 150,000 IDPs in North Kordofan (Allah Kareem and Al Jihad Camps) (total # and description) Implementing Partners WHO Regional Center for Environmental Health Activities (CEHA), FMOH, IDP Community and NGOs in the field of W&S Project Duration January – December 2002 Total Project Budget US$ 647,363 Estimated Funds Available US$ 15,000 covering CEHA technical staff supervision (not included in the request) Funds Requested US$ 647,363

BACKGROUND IDPs in North Kordofan face a serious problem of water scarcity resulting in a lot of time and energy being spent on fetching water. IDPs in this area generally come from the Nuba Mountains and southern Sudan.

Most of the IDPs live in cottages in Allah Kareem camp, which was created in 1984. This camp is still expanding but its environmental situation is very bad. IDPs cannot afford five liters of water per day despite existence of a network of a water supply system taking good quality water from an underground basin.

The project will include a main delivery pipe to take water from the nearest point in the network and carry it to the camp, where a set of water distribution points will be built. The water will be chlorinated at the distribution tank and distributed to the people at an affordable cost covering only operational costs and management of the water distribution posts.

As stated in the objective, to maximise benefit from the water, family latrines will be built and community latrines in schools and any other community centres. (In the first phase, 500 latrines will be built in Aljihad camp, one per family or two, depending on the conclusions of the social study and visibility.)

The community will be supplied with a fogging machine and required chemicals to combat mosquitoes. A hygiene education campaign targeting households will be carried out from house to house. A low cost method for solid waste disposal will be developed and implemented.

Activities

Water supply  Purchase and installation of the required pipe to carry water from the nearest network to the camps.  Build a distribution point 1 km in diameter to serve part of the population. Each one will have a reservoir above the ground (4-5 meters) and filling distribution points. Depending on the pressure on the main pipe, the need to build underground reservoirs with lifting pumps will be investigated.  Build a stand post for the camp school with an emergency water tank as a reservoir enough for student use for one week.  Purchase required chlorine powder / tabs and required comparators and chlorine free residual testing tablets. On-site excreta disposal system  Latrines will be built (one per family or more depending on the social and visibility study). Low cost type will be built according to WHO un-reinforced squatting plates (WHO/ Afg. design).

Solid waste collection and disposal  A system of temporary storage places will be developed and the community will be organised to dispose solid waste in collection spaces (a space of area surrounded by half- meter height mud walls) and to use a sanitary trench for final disposal.

Malaria prevention Community based interventions of Environmental Management of disease vectors. Application of space sprays with insecticides using a ULV fogging machine, loaded on a pick up. One of the local people will be trained on the proper application procedures. Families with children under five will be further protected with impregnated mosquito bed nets and other materials.

Malaria control Strengthen diagnosis and treatment centres, training of doctors, supervisors, PHC workers and mothers at home on recognition and treatment of malaria cases.

Health education and impart the hygiene behave The WHO/UNDP publication titled “Food, Water and Family Health: A Manual for Community Educators 1994 ” will be translated into Arabic and used to train ten women from camps. These ten educators will visit each family in the camps to educate inhabitants about right behaviors.

A. Water Supply Project

FINANCIAL SUMMARY SN Budget Items US$ 1 Carry out preparatory work, survey and delineate the right route and 5,000 locations of distribution points 2 Excavate trenches to install water transportation and distribution pipes 18,000 3 Purchase and installation of main water transportation pipe and fittings 125,000 4 Construction of required filling stations and distribution points 40,000 5 Construction of a water tank for the girls school with stand posts 5,000 6 Purchase required chlorine powder / tabs and required comparators and 3,000 chlorine free residual testing tablets 7 Training of IDPs in maintenance, management and operation of the system 2,900 8 Carry out a house to house training course for households on how to 10,000 prepare the ORS in the house and how to prevent cholera and diarrhoea (10 women trainers will be trained to carry out the house to house training) 9 Technical engineering administration for CEHA project management and site 15,000 engineer and supervision team for all project components Sub-total 223,900 Project management, monitoring & reporting 22,390 Programme support cost at 6% 14,777 Total cost of water project 261,067

B. Solid Waste Project

FINANCIAL SUMMARY Budget Items US$ 1 Purchase five pickups for the project 75,000 2 First, clean up campaign for the camp and surrounding areas from solid 4,000 waste and excreta 3 Construct solid waste collection areas (50 points) 25, 000 4 Excavate and operate sanitary ditches for one year 5,000 5 Running cost for one year 6,000 Sub-total 115,000 Project implementation, monitoring and reporting 11,500 Programme support 6% 7,590 Total cost of Solid waste project 134,090 C. Appropriate Excreta Disposal Project

FINANCIAL SUMMARY Budget Items US$ 1 Excavation for under ground pits, 1,000 units 20,000 2 Construct underground structure and latrines 20,000 3 Construct upper structure 10,000 4 Construct slab 5,000 Sub-total 55,000 Project implementation, monitoring & evaluation 5,500 Programme support 6% 3,630 Total cost of the Excreta Disposal Project 64,130

D. Malaria Prevention Project

FINANCIAL SUMMARY Budget Items US$ 1 Purchase two fogging machines (Spraying equipment-ULV) 38,000 2 Purchase two pickups 17,000 3 Purchase required chemicals 3,000 4 Train local people on how, and frequency of using fogging machines 31,200 and how to impregnate bed nets 5 Secure impregnated mosquito bed nets for families with children 5,000 under-five 6 Operational cost for environmental management and spraying 900 activities 7 Purchase of environmental management equipment 5,000 8 Carryout health education campaigns on malaria diagnosis and 3,000 prevention. Design and print and distribute posters using a simple sketch (comic strip) on malaria prevention 9 Running cost for one year 8,000 Sub-total 111,100 Project implementation, monitoring & evaluation 11,110 Programme support 6% 7,333 Total cost of the Malaria Prevention Project 129,543

E. Health Education to Impart the Hygiene Behaviours Project

FINANCIAL SUMMARY Budget Items US$ Translate and print the WHO/UNDP publication titled “Food, Water and 3,700 Family Health: A Manual for Community Educators 1994 ” into Arabic. The ten educators will visit each family in the camp Train ten women from the camps to be trainers and work as educators and 4,500 prepare them to carry out the house to house training course Purchase a van to transport educators from their houses to the camps 15,000 Carry out an education campaign for one year to educate inhabitants about 20,000 right hygiene and behaviours Cost of sustaining a van and driver 7,000 Sub-total 50,200 Project implementation, monitoring & evaluation 5,020 Programme support 6% 3,313 Total cost of the Health Education Project 58,533

Total budget for Projects Components 647,363