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 Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: Dr.Elsadig Abdalla)
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1. Introduction:
1.1 The Health System
Sudan is the largest country in Africa. It has an area of 2.5 million km². It is characterized by a strategic geographical location, that links the Arab world to Sub Saharan Africa, and it shares its borders with 9 countries, where the Sudanese population and those of the neighbouring countries move freely across these borders. The environment ranges from damp rainy in the south, to desert in the northern areas.
The population of the country is estimated at 32 millions (projected from 1993 census). The population is unevenly distributed in the 26 States, the majority are concentrated in 6 States of the Central Region with a mean population density of 10 people per square kilometres, increasing to 50 at the agricultural areas. Natural disasters and the conflict resulted in high rates of rural-urban migration reaching 15%. The population growth rate is 2.6%, indicating that the population doubles every 27 years. Around 30% of the population live in urban areas due to migration which includes large numbers of internally displaced persons (IDPs) from southern Sudan
The coming period of post conflict demands availing reliable information for redesigning and rehabilitation of the health care system, the returnees need adequate and efficient services for emergency
1.2 What makes a health system?
It can be argued that in today’s complex world, it is difficult to tell exactly what a health system is, what it consists of, and where it begins and ends. Yet, and according to the WHO report for the year 2000; a health system is defined to include all the activities whose primary purpose is to promote, restore or maintain health. More specifically health systems consist of all the people, institutions and actions whose primary purpose is to improve health. They may be integrated and centrally directed, but often they are not. From this definition it is clear that the four components of the health system have an ultimate goal which is to improve peoples' health. Hence, knowledge about the different components of the health system is important if systematic analysis of the system performance and its potentials are pursuit. This is because it is widely accepted and documented that health system can contribute to the peoples' health greater than what they are doing now given their potentials. Failing to achieve and utilize the full potentials of health system imply a systemic failure rather than only technical failure. The gaps between the system potentials and its current level of performance need careful and meticulous analysis in order to identify the bottlenecks and addressing them so as to improve its performance. Countries specially those with poor system performance which can be concluded from indicators relating to effectiveness, equity, efficiency and quality should embark on rigorous and systemic analysis of the different components of their systems. They should map out the different institutions, their functional status, objectives, available systems and responsibilities and the staffing patterns. Moreover the analysis should also address how the health systems are viewed by the communities they are supposed to serve in terms of accessibility, quality and satisfaction. The over all vision, strategic direction and policy framework at the higher level (the stewardship) should be analyzed and linked to the local level where the health services are delivered and the policies, strategies and plans are implemented. This is because consistency and harmony between the different levels of the system are crucial to achieve the intended objectives and targets of the health system.
Given the perceived and evident poor performance of the Sudan health system, and enlightened by the above mentioned themes it is decided to embark in this endeavor aiming to
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 Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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draw a clear picture about our health system. However, we acknowledge fact that the aim of this study is not to evaluate and measure the health system performance. Nor it is intended to be an in-depth analysis of all the components of the health system which is out of the scope of this study. Yet, we argue based of the variable studied; this study report provides interesting and important information about the public health institutions. It sheds light on the public health facilities distribution functional status, staffing patterns and their perceived quality and performance according to the view point of those who works at and those whom they serve. In addition to that this repot provides insight about the hierarchical relations and networking of the public health facilities and main regulation and systems. Thus it is hoped to inform policies and actions that aim to improve the system performance and enhance efforts towards achieving the Millennium Development Goals.
functions of the health system (WHO framework)
The World Health Organization framework has suggested four functions for the health system. These include stewardship, creating resources for the health system, financing of the health system, and delivering health services.
1.3 Rationale:
Given that the peace is imminent, the Federal Ministry of Health (FMoH) and World Health Organisation (WHO) is embarking not only on preparing to take measures for saving the lives of returnees but also for the rehabilitation and reconstruction of the health system destroyed in the conflict – an aim requiring a solid information base and a comprehensive planning . However, in Sudan the weak information base coupled with limitations due to the continuing conflict has rendered the available data fragmented, and further the multiplicity of partners has made its standardisation difficult.
The last household survey was undertaken in 1978. Different studies like MICS (2000), Safe Motherhood (1999) undertaken since then focued on specific areas; making it difficult to establish a holistic picture of health system at any level – federal, state or locality. There is hardly information available about systems’ resources, organisation and management and support services. A study of health service in the state of Khartoum (1999) addressed some of these issues, but is limited both geographically and methodologically. Lack of systems’ approach in determining the analytical variables and indicators for defining data collection instruments leaves many questions about different components of the health system unanswered.
Overall, the country has scarce and inconsistent information on health, due mainly to the fractured system and the multiple actors operating. Further, restricted access to the non-government controlled areas limits the validity of the available information.
This study was designed , as a collaborative project between the federal ministry of health represented on the general directorate of planning and health development and WHO with a consultant in the field, Dr. Ehsanullah Tarin. The team of conduction is described below and a core group from both WHO and FMOH were coordinating and following up the work.
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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2. Objectives:
 To undertake a comprehensive situation analysis of the Sudan health system;
 To develop evidence-based health sector plans for post-conflict recovery; and
 To use the findings as a benchmark for monitoring the progress of the post-conflict developments
3. Methodology
3.1 Conceptual framework for the Sudan health system
Study Question: given the aim of the study, the question framed for directing the inquiry is that: What is the current situation of Sudan health system for evidence-based planning and as a benchmark for monitoring the progress for the post-conflict recovery?
Two major questions surrounded this question. Firstly, what is meant by the health system? Secondly, what constitutes the situation, and why it is essential to know and analyse it? To answer these questions, there is a need for conceptualising a framework for the health system, as a basis for demarcating the boundaries and identifying the study variables. The second question has two parts: (i) what encompasses the situation; and (ii) why it is essential to know it .
In order to address the first question, a framework for defining health system is developed . Accordingly, the health system comprises: (i) organisation and management; (ii) health service delivery outlets (providers); (iii) communities served (users); (iv) support services; and (v) resource generators. These components are explained briefly as below:
 Organisation and management at the federal and state levels falls into two categories: organisation and management proper and that for the other components. The former includes the portfolios for administration and finance, planning, international health and states’ affairs.
 Healthcare providers are both static and outreach programmes. The former include a range of health facilities managed by a directorate of curative medicine, while the latter denote the preventive and primary health care programmes managed by the respective directorates both at the federal and state levels.
 Communities mean people - individuals and families - living in a distinct geographic locality such as a rural town or village; in urban areas it may be a single neighbourhood served by the health service providers. They may be active users, e.g. patients visiting a facility or potential users, i.e. living in a neighbourhood.
 Support services constitute a range of instruments, largely determining the efficiency and effectiveness of the health system, and are often taken jointly with service providers, overlapping functionally in certain areas. Managed by separate directorates/sections at the federal and state level, these operate through a chain of outlets in the health facilities.
 Resource generators may be: (a) human resource institutions; (b) financial institutions/resources; (c) technology producing research organisations. While mainly out of the domain of the FMoH these have representation at the federal level and in also certain states.
 In addition, the health system operates in an environment where many more systems are also operating. These include the national and international systems. The former
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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refers to the nation state and people in terms of their history, culture, health problems, economy, welfare and political systems. The latter includes the international systems, i.e. bilateral and multilateral aid organisations, international economic agreements and non-governmental organisations.
Study variables: A set of variables embodying different components of the health system formed the basis of the study instruments. A list of such variables worked out in a workshop , which was further refined, is placed at Annexure-1.
However, given the number of facilities, physical spread of the country and the nature of the constituent institutions, the study is planned in two phases. That is, this phase will focus on health care organisation and management, primary and secondary health care and associated support services. In the second phase, health financing mechanisms, human resource development, tertiary care facilities and the national and international systems including private sector will be studied. The sampling frame, as discussed below, is therefore worked out accordingly.
3.2 Methods
How to comprehensively study the health system which is complex in terms of its ingredients, dynamics and relationships is the next challenge? In order to have a holistic view of a system of this nature, both qualitative and quantitative methods were employed. The former were needed for building a complex, holistic picture formed with words, reporting detailed views of informants and context in a natural setting. The latter, complementing the former, helped in testing theories composed of the variables, measured with numbers and analysed with statistical procedures.
3.3 Methods of data collection
A combination of data collection techniques was used; mainly individual interviews, document review and observation. In addition, workshops and group meetings were held with key informants to solicit their views and as a means to ensure engaging with the government and their participation in identifying issues and involvement in the planning process. The qualitative methods are particularly useful in eliciting such responses.
As indicated earlier all components of the Sudan health system were studied in their entirety, contemplating review of all primary health care facilities till the rural hospitals. This approach, as emphasized by the FMoH, is necessitated in order to:
 Address planning needs for post-conflict rehabilitation and development; and is not building the system on the remnants of old one.
 systematically review the existing system, about which not much is currently known, for deciding on any reform intervention; and
 Use this study as an opportunity to catalogue the available resources for any re-appropriation in the event of health sector reform.
Given the above approach, province (called Mahallia) constituted the unit for analysis. That is, 23 states were targeted for mapping the available resources and interviewing the State Director General of Health and Provincial Health Coordinator respectively. Within provinces
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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are different types of health facilities; all of these were visited for developing an inventory of the available infrastructure, equipment and manpower. However, after starting the process, a change in the structure of the country occurred whereby the provinces were changed into districts. And as the result of the irrupted conflict in some parts of the country, the survey was conducted in the accessible 19 states.
However, for assessing the performance and quality of service being offered, an adequate sample of health facilities was selected for interviewing the most senior staff. For this purpose, a two stage stratified sampling design was suggested. In the first stage health facilities forming the primary sampling unit were selected from each province. In the second stage, patients for exit poll and houses for household interview were selected to form secondary sampling unit.
For the part regarding the information about the outreach staff and beneficiaries- on average- 5 health facilities were selected at random from each province. However, in order for this sample to be the representative for different types of facilities, a weight-age is allocated, i.e. Rural Hospital get the highest followed by the Health Centers, while the Dispensaries, Dressing Station and Primary Health Care Units were given the same weight. Accordingly, the sub-sample of different types of health facilities was estimated as: Rural Hospital (81) Rural Health Centers (237), Urban Health Centers (17), Dispensaries (83), Dressing Stations (60) and Primary Health Care Unit (137).
Areas where the survey was conducted: The survey was conducted in 101 localities as the localities in the states of West, and North Darfur were unreachable for security reasons. There are 3 states that were done through the WHO office in Nairobi for the SPLA areas part (conflict areas)
From each of the selected health facilities 5 patients who received treatment were selected at random. Similarly, 5 houses were selected from the catchments area of selected health facility using EPI clustering method. Since, all types of facilities, patients and houses from across all provinces of country was included in the sample; this was the most representative.
3.4 Study instruments
The study instruments for collecting data for building a comprehensive picture of the Sudanese health system included an interview guide (open ended and closed) and observation checklist. A set of instruments used is given below:
1. Interview schedule for the state ministry of health for soliciting information about the resources available for health planning and management and to assess the overall performance at this level;
2. Interview schedule for the locality health management to gather information about the resources available for health planning and management and to assess the overall performance at this level;
3. A health facility schedule has four components:
3.1. A questionnaire to solicit the views of the health care providers and to ascertain the functioning status of health care delivery outlets focusing at the issues confronting the facilities and programmes;
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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3.2. A patient exit interview to get feedback about the services rendered at the health facilities from the users of the health services. This is meant to corroborate the information gained from interviewing of facility in charge, review of records and observation;
3.3. An observation checklist, which the enumerator uses to observe a variety of variables; and
3.4. An interview schedule for outreach workers in whose catchment area the facility selected for interview falls.
4. A household interview schedule has two components:
4.1. A questionnaire for interviewing potential users of health services to obtain their views about the health system focusing on public sector and to ascertain their health knowledge, attitudes and practices.
4.2. An observation checklist which the enumerator uses to observe and record his findings about the health condition of the house for corroborating with that obtained through interviews.
Additionally, working papers were developed for steering discussion in the workshops and group meetings. However, the nature and format for different instruments varied according to the health system component.
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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State Health Management (26)
Locality Health Management (120)
Health Facilities
Exit poll (405 (Rural Hospital + 2670 other)
Outreach Schedule (615)
Facility Observation Schedule
Rural Hospital (203)
Urban Health Centre (131)
Rural Health Centre (838)
Dispensaries (1489)
Dressing Station (1243)
PHC Unit (2438)
Facility Interview Schedule
Rural Hospital (81)
Urban Health Centre (17)
Rural Health Centre (237)
Dispensaries (83)
Dressing Station (60)
Primary Health Care (137)
Household Schedule (3075)
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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The Pilot study and finalizing the instruments
Once the preparations were completed and questionnaires were ready, a pilot test in order to ascertain the technical feasibility of the proposed study was performed in Al-Gezira state. AlGezira was chosen as it resemble a wide variety of rural areas and different ethnic and tribal community, and all the set of health service facilities are available. The facilities chosen were representative of each level and varying from rural to urban areas according to facility targeted. The criteria for the areas and facilities to be representative to different areas of the country was decided by the grouping collaboration with the local state government.
A team from the federal ministry in collaboration with the WHO and Dr. Tarin went to the field visit. Lessons came out of this exercise were used in upgrading the arrangements and finalizing study instruments in a workshop conducted in the WHO with the attendance of the data management team.
3.5 Fieldwork
In order to plan fieldwork, it is considered appropriate to have an overview of Sudan health system. This was done by drawing from the framework for the health system different components that worked out in a workshop with the Director Generals of the FMoH. The outcome of this exercise was a list of the types of institutions comprising the health system (Annex-2).
The current phase of the study, as explained above focuses on the organization and management, healthcare providers at the primary health care level, associated support service and communities, planned as below:
3.5.1 Study team
Team for the Sudan health system Survey, determined on geographical basis, consisted of a field team and another based in the FMoH Khartoum for managing the data. Field team operating at different levels collected data (Annex-2). Specifically, the enumerators collected data from health facilities and communities. Each locality had two teams (each comprising a male and a female, one of them holding senior position acting as locality team leader). That is, each team covered an average of two facilities and the associated households per day.
Enumerators were drawn from their respective localities, because this arrangement addresses the security issues, and the need for a local guide. The national service partners provided as much of young doctors as possible and then other health related staff, selecting the most experienced who participated in previous recognized surveys. Further, this exercise provided an opportunity of human resource development in the health sector – some 600 staff took part. The NGOs and other Ministry of health operating different programmes were also taken on board that their personnel are well experienced in surveys, they conduct many activities in the areas including the supervision and follow up and participated in finalizing the methodology, trainings, data collection and findings review. The constitution of both teams is given below, while the job descriptions including person specifications are placed at Annex-4:
Field Team
1 – Study Team Leader (National Counterpart)
2 - Coordinator (one for each region, north and south)
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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26 – Supervisor/Master Trainers (two for each state)
536 – Enumerators (four for each locality/county 120x4=536)
Data management team
1 - Data Manager
1 - Statistician
7- Data coders
Organization of the Study Team
The study team was organized as in figure below, whiles the job description for the individual incumbents is available at Annex-4.
While the Study Team Leader in the FMoH identified different categories of incumbents at the federal and state level, the Supervisors in consultation with the State Director General of Health and Study Coordinators selected and recruited the enumerators from localities. In this process, they were guided by the person specifications and job descriptions.
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Organization of Sudan Health System Study Team
State Health Management (26)
Locality Health Management (120)
Health Facilities
Exit poll (405 (Rural Hospital + 2670 other)
Outreach Schedule (615)
Facility Observation Schedule
Rural Hospital (203)
Urban Health Centre (131)
Rural Health Centre (838)
Dispensaries (1489)
Dressing Station (1243)
PHC Unit (2438)
Facility Interview Schedule
Rural Hospital (81)
Urban Health Centre (17)
Rural Health Centre (237)
Dispensaries (83)
Dressing Station (60)
Primary Health Care (137)
Household Schedule (3075)
Team Leader/National Counterpart
Coordinator (one for each region)
Technical Advisor
26 - Survey Supervisor (one for each State)
268 - Survey teams (two members) – two for each locality
Data manager/programmer (one)
10 - Data coders
Organization of Sudan Health System Study Team
Statistician (one)
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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3.5.2 Training
Supervisors received training to prepare them as master trainers for training enumerators in their respective states. That is, three workshops (2-days), each drawing about 15 participants were held in Khartoum, that included the federal supervisors and the states supervisor and their assistants, As federal supervisors attended the whole exercise of designing the questionnaires they were facilitating the workshops which were attended by Dr. Tarin. While 19 workshops (2-days), each drawing about twenty participants were held at state level. The federal supervisors as part of his job attended to the states revised the training with the states supervisors and their assistants before they start training the enumerators and acted as resource persons in the workshops held there. As part of the work was delayed because of the rainy season more #######ing one day workshops were held as appropriate in certain states. Training materials covered the following topics:
 Background to the study;
 Study design;
 Job description of team members;
 Common mistakes and omissions made during fieldwork;
 Interview and observation techniques;
 Orientation to the questionnaires;
 Ethics, bias and sampling frame; and
 Logistic arrangements and fieldwork details.
3.5.3 Consent and permission of authorities – and ethical requirement3
It is important that the enumerators have unimpeded access to data sources, and for that the FMoH issued a circular carried by everyone on study team for the authorities in charge of the state health administration and health facilities. Verbal permission was sought from the household to interview and enter the house for any observation.
3.5.4 Data collection
The table below indicates data sources for different variables, data collection techniques and the type of instruments used. In the case of the closed questionnaires response was recorded in the given space, while for the open ended questions, FGDs and documents’ review notes were taken for their subsequent processing and analysis. However, when recording is preferred, then allowance will be required for transcription.
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Fieldwork vis-à-vis study variables
Health system component/level Data source Data collection technique
Organisation & management
Federal, State/ Locality Documents and health managers Document review
Individual interviews
FGDs
Health service providers Documents, facility and programme in charges Document review, interviews, observation and FGDs
Communities Documents, patients the facility and households Document review, facility exit poll, observation and household interviews
Support services Documents, facility in charges Document review, interviews, observation and FGDs
Resource generators Documents, institution in charges, health managers Document review, FGDs,
Interviews and observation
Allied national systems Documents, managers Document review, FGDs, Interviews
International systems Documents, managers Document review, FGDs and Interviews
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Note: As indicated above the resource generators, national and international systems including private sector will be studied in the subsequent phase.
3.4.6 Enumeration and movement plan
The survey team leader communicated in advance with the coordinator for health and commissioner of locality requesting that the staff should be present in their respective health facilities during survey. Further, outreach staff working for different programmes was requested to be available in the facilities with their equipment and relevant documents in their respective catchment areas.
The study team arrived at the locality headquarter, where it was met by the health coordinator. Tasks to be performed included: (i) cataloguing the health resources available to health coordinator in the locality headquarter in terms of physical capacity, i.e. equipment, building, transport and manpower; (ii) identifying which health programmes are operating in the locality, sorting resource in terms of physical capacity available to the individual health programs; and (iii) finding out performance of programs, i.e. achievement vis-à-vis targets etc. The state study supervisor would perform same functions at the state level on a state health management schedule.
The teams then moved to the health facilities assigned to complete observation schedule in the health facility schedule, i.e. cataloguing the resources available at the facility. If the facility is included in sample, then it : (i) interviewed the most senior staff present in the facility for management practices, performance and the quality of services offered; conduct exit poll for the required number of patients that came to facility; (iii) interviewed one of the outreach worker on an outreach schedule; and (iv) selected the required number of houses using EPI cluster method and visited these for observing and interviewing the households using the schedule. The enumerators’ movement plan for filling up questionnaire is seen at Annex-5.
3.5 Data management
Data processing is the function of survey team in Khartoum, as indicated in the job description of individual member. Particularly, they focused on ordering the data/filled-in questionnaires, cleansing, editing & verify, coding and finally entering data into computer on the agreed software.
Results of qualitative data, will be done in a separate report.
3.6 Data analysis
Data was analysed for all three tiers of the health system, i.e. locality, state and federal level and is available for the three levels. However, for the purpose of this report the state will be taken as the unit for analysis. The results from all sources including the qualitative case data for a particular level was aggregated around key concepts and themes by drawing on the study question and variables derived from the aim of the study.
3.7 Validity and reliability
The study design is tight and the rigor in its implementation ensured the validity and reliability of data and the inferences drawn. Nonetheless, following measures were done to further augment the quality of data and improve the credibility of study:
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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 Firstly, the questionnaires are framed in a manner that is not easy to fill in without having been in the facilities. Further, each team carried a disposable camera for taking a photograph of health facility visited.
 Secondly, to ensure measuring of variables accurately, the supervisors and enumerators were trained rigorously, emphasizing inter-alia on strictly following the criteria for selection of study subjects.
 Thirdly, in addition to field supervisors, the study coordinators (federal supervisors) carried out filed visits to see the survey teams operating in the health facilities and households. Each survey team required to affix facility’s stamp they visit and leave a tracer, especially designed in two parts one to be with the questionnaires and the second half to be left at the facility for supervisors to collect afterwards.
 Finally, the credibility of data ensured at the data management level. The data manager, while cleansing established the wrongly filled in questionnaire, and ask for re-validation. Revalidation was done by verifying with the hard copies, contacting the area health management teams directly, contacting the states supervisors for some information, comparing to other reliable sources, and exclusion of any part that is inaccurately done after discussion of the core group of the study.
The information being gathered is very important in planning, decision making, and rehabilitation of the health system, especially in the coming post-conflict period. The government is very much aware of that and very keen to have the most appropriate and valid information.
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Section 1: The Health Facilities
Table (1): Numbers of expected primary healthcare facilities, Sudan 2003
State Pop. RH HC Disp DS PHCU Total Ratio/10,000
Algezeira 3,477,000 34 216 264 391 44 949 2.7
Blue Nile 655,000 7 14 40 76 46 183 2.8
Gadarif 1,515,000 10 25 72 79 70 256 1.7
Kassala 1,507,000 8 50 72 49 118 297 2.0
Khartoum 4,936,000 7 131 177 29 30 374 0.8
N. Kordofan 1,506,000 10 42 90 81 414 637 4.2
Northern 593,000 20 62 159 50 31 322 5.4
Red sea 724,000 7 24 27 18 194 270 3.7
River Nile 918,000 17 149 79 80 26 351 3.8
S. Darfur 2,859,000 7 24 53 13 295 392 1.4
S. Kordofan 1,127,000 3 30 59 0 147 239 2.1
Sinnar 1,204,000 7 29 77 205 0 318 2.6
W. Kordofan 1,144,000 8 23 34 27 261 353 3.1
White Nile 1,515,000 12 54 113 69 173 421 2.8
Baher Elgabl 2 19 14 3 55 93
East Equatoria 5 13 14 34 47 113
Unity 4 13 9 17 0 43
Upper Nile 7 10 16 0 43 76
W. Bahr Alghazal 2 2 34 2 23 63
Total 177 930 1,403 1,223 2,017 5,750
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (2): Number of found primary health facilities per State, Sudan 2003
States population RH RHC UHC DISP. DS PHCU Total
Algezeira 3,692,000 32 136 21 238 292 16 735
Blue Nile 696,000 8 4 5 19 30 0 66
Gadarif 1,621,000 10 21 18 0 54 62 165
Kasala 1,584,000 2 15 0 9 0 49 75
Khartoum 5,352,000 11 35 90 179 0 1 316
Northern 614,000 25 59 0 139 32 27 282
Red Sea 732,000 6 11 14 21 24 131 207
River Nile 954,000 23 121 22 59 50 33 308
Sinnar 1,268,000 15 29 10 105 114 0 273
White Nile 1,595,000 14 10 21 126 30 140 341
Baher Algabel - 0 9 6 7 5 62 89
E. Equatoria - 1 0 0 0 0 0 1
Unity - 0 1 3 0 0 0 4
Upper Nile - 4 9 0 13 0 34 60
W. Bahr Alghazal - 1 9 0 0 4 3 17
N. Kordofan 1,554,000 12 13 33 83 55 247 443
S. Darfour 3,064,000 9 11 5 37 0 226 288
S. Kordofan 1,158,000 8 23 13 22 0 105 171
W Kordofan 1,183,000 11 23 3 39 22 36 134
Total 192
539
264
1,096 712
1,172 3,975
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (3): % of not functioning PHC facilities from found, Sudan 2003
Type of Facility Expected Found Not Functioning Not functioning from found
RH 177 192 0 0%
HC 930 803 107 13.3%
Disp. 1,403 1,096 333 30.4%
DS 1,223 712 409 57.4%
PHCU 2,017 1,172 599 51.1%
Total 5,750 3,975
1,448
36.4%
Table (4): % of found primary healthcare facilities from expected, Sudan 2003
PHU DS Disp HC RH Total
Expected 2,017 1,223 1,403 930 177 5,750
Found 1,172 712 1,096 803 192 3,975
% 58.1% 58.2% 78.1% 86.3% 108.5% 69.1%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (5): Summary of expected, found and not functioning PHC facilities, Sudan, 2003
Type of Facility Expected Found Not Functioning Percentage
RH 177 192 0 0%
RHC
930 539 91 16.9%
UHC 264 16 6.1%
Disp. 1,403 1,096 333 30.4%
DS 1,223 712 409 57.4%
PHCU 2,017 1,172 599 51.1%
Total 5,750 3,975
1,448
36.4%
Table (6): Summary of functional status of existing primary healthcare facilities by State, Sudan, 2003 (n= 3,923)
States Functioning RH Functioning RHC Functioning UHC Functioning Disp. Functioning DS Functioning PHCU Total Functioning
Algezeira 32 118 21 151 105 6 433
Blue Nile 8 4 5 16 17 0 50
Gadarif 10 21 17 0 39 38 125
Kasala 2 14 0 9 0 35 60
Khartoum 11 35 90 153 0 1 290
Northern 25 46 0 83 8 7 169
Red Sea 6 10 13 15 11 52 107
River Nile 23 90 16 27 18 9 183
Sinnar 15 24 10 51 37 0 137
White Nile 14 8 18 91 10 30 171
Baher Algabel 0 3 6 7 2 44 62
E. Equatoria 1 0 0 0 0 0 1
Unity 0 1 3 0 0 0 4
Upper Nile 4 5 0 7 0 11 27
W. Bahr Elghazal 1 7 0 0 1 2 11
N. Kordofan 12 10 30 72 40 120 284
S. Darfour 9 11 5 32 0 135 192
S. Kordofan 8 22 11 18 0 68 127
W. Kordofan 11 19 3 31 15 15 94
Total 192
448
248
763
303
573
2527
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (7): Functional status of rural hospitals by State, Sudan, 2003 (N=192)
States Rural hospitals Not functioning Percentage
Algezeira 32 0 0
Blue Nile 8 0 0
Gadarif 10 0 0
Kasala 2 0 0
Khartoum 11 0 0
Northern 25 0 0
Red Sea 6 0 0
River Nile 23 0 0
Sinnar 15 0 0
White Nile 14 0 0
Upper Nile 4 0 0
Baher Algabel 0 0 0
E. Equatoris 1 0 0
Unity 0 0 0
W. Bahr Elghazal 1 0 0
N. Kordofan 12 0 0
S. Darfour 9 1 0
S. Kordofan 8 0 0
W. Kordofan 11 0 0
Total 192
0 0%
Table (8): Functional status of rural health centres by State, Sudan, 2003 (n=538)
States RHC Not functioning Percentage
Algezeira 136 18 13.2%
Blue Nile 4 0 0.0%
Gadarif 21 0 0.0%
Kasala 15 1 6.7%
Khartoum 35 0 0.0%
Northern 59 13 22.0%
Red Sea 11 1 9.1%
River Nile 121 31 25.6%
Sinnar 29 5 17.2%
White Nile 10 2 20.0%
Baher Algabel 9 6 66.7%
E. Equatoria 0 0 0.0%
Unity 1 0 0.0%
Upper Nile 9 4 44.4%
W. Bahr Elghazal 9 2 22.2%
N. Kordofan 13 3 23.1%
S. Darfour 11 0 0.0%
S. Kordofan 23 1 4.3%
W. Kordofan 23 4 17.4%
Total 539
91
16.9%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (7): Functional status of rural hospitals by State, Sudan, 2003 (N=192)
States Rural hospitals Not functioning Percentage
Algezeira 32 0 0
Blue Nile 8 0 0
Gadarif 10 0 0
Kasala 2 0 0
Khartoum 11 0 0
Northern 25 0 0
Red Sea 6 0 0
River Nile 23 0 0
Sinnar 15 0 0
White Nile 14 0 0
Upper Nile 4 0 0
Baher Algabel 0 0 0
E. Equatoris 1 0 0
Unity 0 0 0
W. Bahr Elghazal 1 0 0
N. Kordofan 12 0 0
S. Darfour 9 1 0
S. Kordofan 8 0 0
W. Kordofan 11 0 0
Total 192
0 0%
Table (8): Functional status of rural health centres by State, Sudan, 2003 (n=538)
States RHC Not functioning Percentage
Algezeira 136 18 13.2%
Blue Nile 4 0 0.0%
Gadarif 21 0 0.0%
Kasala 15 1 6.7%
Khartoum 35 0 0.0%
Northern 59 13 22.0%
Red Sea 11 1 9.1%
River Nile 121 31 25.6%
Sinnar 29 5 17.2%
White Nile 10 2 20.0%
Baher Algabel 9 6 66.7%
E. Equatoria 0 0 0.0%
Unity 1 0 0.0%
Upper Nile 9 4 44.4%
W. Bahr Elghazal 9 2 22.2%
N. Kordofan 13 3 23.1%
S. Darfour 11 0 0.0%
S. Kordofan 23 1 4.3%
W. Kordofan 23 4 17.4%
Total 539
91
16.9%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (9): Functional status of urban health centres by State, Sudan, 2003 (n=264)
States Found UHC Not functioning Percentage
Algezeira 21 0 0
Blue Nile 5 0 0
Gadarif 18 1 5.6%
Kasala 0 0 0
Khartoum 90 0 0
Northern 0 0 0
Red Sea 14 1 7.1%
River Nile 22 6 27.3%
Sinnar 10 0 0
White Nile 21 3 14.3%
Baher Algabel 6 0 0
E. Equatoria 0 0 0
Unity 3 0 0
Upper Nile 0 0 0
W. Bahr Elghazal 0 0 0
N. Kordofan 33 3 9.1%
S. Darfour 5 0 0
S. Kordofan 13 2 15.4%
W. Kordofan 3 0 0
Total 264
16
6.1%
Table (10): Functional status of dispensaries by State, Sudan, 2003 (n=1,096)
States Disp. Not functioning Percentage
Algezeira 238 87 36.6%
Blue Nile 19 3 15.8%
Gadarif 0 0 0.0%
Kasala 9 0 0.0%
Khartoum 179 26 14.5%
Northern 139 56 40.3%
Red Sea 21 6 28.6%
River Nile 59 32 54.2%
Sinnar 105 54 51.4%
White Nile 126 35 27.8%
Baher Algabel 7 0 0.0%
E. Equatoria 0 0 0.0%
Unity 0 0 0.0%
Upper Nile 13 6 46.2%
W. Bahr Elghazal 0 0 0.0%
N. Kordofan 83 11 13.3%
S. Darfour 37 5 13.5%
S. Kordofan 22 4 18.2%
W. Kordofan 39 8 20.5%
Total 1,096 333
30.4%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (11): Functional status of dressing stations by State, Sudan, 2003 (n=712)
States Found Not functioning Percentage
Algezeira 292 187 64.0%
Blue Nile 30 13 43.3%
Gadarif 54 15 27.8%
Kasala 0 0 0.0%
Khartoum 0 0 0.0%
Northern 32 24 75.0%
Red Sea 24 13 54.2%
River Nile 50 32 64.0%
Sinnar 114 77 67.5%
White Nile 30 20 66.7%
Baher Algabel 5 3 60.0%
E. Equatoris 0 0 0.0%
Unity 0 0 0.0%
Upper Nile 0 0 0.0%
W. Bahr Elghazal 4 3 75.0%
N. Kordofan 55 15 27.3%
S. Darfour 0 0 0.0%
S. Kordofan 0 0 0.0%
W Kordofan 22 7 31.8%
Total 712
409
57.4%
Table (12): Functional status of PHC units by State, Sudan, 2003 (n=1,172)
States PHCU Not functioning Percentage
Algezeira 16 10 62.5%
Blue Nile 0 0 0.0%
Gadarif 62 24 38.7%
Kasala 49 14 28.6%
Khartoum 1 0 0.0%
Northern 27 20 74.1%
Red Sea 131 79 60.3%
River Nile 33 24 72.7%
Sinnar 0 0 0.0%
White Nile 140 110 78.6%
Baher Algabel 62 18 29.0%
E. Equatoris 0 0 0.0%
Unity 0 0 0.0%
Upper Nile 34 23 67.6%
W. Bahr Elghazal 3 1 33.3%
N. Kordofan 247 127 51.4%
S. Darfour 226 91 40.3%
S. Kordofan 105 37 35.2%
W. Kordofan 36 21 58.3%
Total 1,172 599
51.1%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (13): Community contribution in building of rural hospitals, Sudan, 2003 (n=192)
States Rural hospitals Built by community Percentage
Algezeira 32 10 31.3%
Blue Nile 8 3 37.5%
Gadarif 10 1 10.0%
Kasala 2 1 50.0%
Khartoum 11 5 45.5%
Northern 25 13 52.0%
Red Sea 6 2 33.3%
River Nile 23 9 39.1%
Sinnar 15 9 60.0%
W. Nile 14 6 42.9%
Baher Algabel 0 0 0.0%
E. Equatoria 1 0 0.0%
Unity 0 0 0.0%
Upper Nile 4 0 0.0%
W. Bahr Elghazal 1 0 0.0%
N. Kordofan 12 4 33.3%
S. Darfour 9 3 33.3%
S. Kordofan 8 1 12.5%
W. Kordofan 11 9 81.8%
Total 192
76 39.6%
Table (14): Community contribution in building of rural health centres, Sudan, 2003 (n=539)
States RHC Built by community Percentage
Algezeira 136 74 54.4%
B. Nile 4 2 50.0%
Gadarif 21 8 38.1%
Kasala 15 7 46.7%
Khartoum 35 23 65.7%
Northern 59 30 50.8%
R. Sea 11 7 63.6%
River Nile 121 59 48.8%
Sinnar 29 14 48.3%
W. Nile 10 3 30.0%
Baher Algabel 9 1 11.1%
E. Equatoria 0 0 0.0%
Unity 1 0 0.0%
Upper Nile 9 1 11.1%
W. Bahr Elghazal 9 4 44.4%
N. Kordofan 13 5 38.5%
S. Darfour 11 6 54.5%
S. Kordofan 23 8 34.8%
W Kordofan 23 8 34.8%
Total 539
260 48.2%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (15): community contribution in building urban health centres, Sudan, 2003 (n=264)
States UHC Built by community Percentage
Algezeira 21 8 38.1%
B. Nile 5 1 20.0%
Khartoum 90 36 40.0%
Sinnar 10 5 50.0%
W. Nile 21 7 33.3%
Gadarif 18 7 38.9%
Kasala 0 0 0.0%
R. Sea 14 4 28.6%
Northern 0 0 0.0%
River Nile 22 8 36.4%
Upper Nile 0 0 0.0%
Unity 3 2 66.7%
W. Bahr Elghazal 0 0 0.0%
E. Equatoris 0 0 0.0%
Baher Algabel 6 0 0.0%
N. Kordofan 33 12 36.4%
S. Kordofan 13 5 38.5%
W Kordofan 3 1 33.3%
S. Darfour 5 2 40.0%
Total 264
98
37.1%
Table (16): Community contribution in building of dispensaries, Sudan, 2003 (n=1,096)
States DIS Built by community Percentage
Algezeira 238 93 39.1%
B. Nile 19 9 47.4%
Khartoum 179 77 43.0%
Sinnar 105 34 32.4%
W. Nile 126 28 22.2%
Gadarif 0 0 0.0%
Kasala 9 4 44.4%
R. Sea 21 5 23.8%
Northern 139 59 42.4%
River Nile 59 12 20.3%
Upper Nile 13 2 15.4%
Unity 0 0 0.0%
W. Bahr Elghazal 0 0 0.0%
E. Equatoria 0 0 0.0%
Baher Algabel 7 2 28.6%
N. Kordofan 83 45 54.2%
S. Kordofan 22 7 31.8%
W Kordofan 39 13 33.3%
S. Darfour 37 18 48.6%
Total 1,096 408 37.2%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (17): Community contribution in building dressing stations, Sudan, 2003 (n=712)
States DS Built by community Percentage
Algezeira 292 76 26.0%
Blue Nile 30 11 36.7%
Gadarif 54 22 40.7%
Kasala 0 0 0.0%
Khartoum 0 0 0.0%
Northern 32 5 15.6%
Red Sea 24 4 16.7%
River Nile 50 13 26.0%
Sinnar 114 19 16.7%
W. Nile 30 4 13.3%
Baher Algabel 5 0 0.0%
E. Equatoris 0 0 0.0%
Unity 0 0 0.0%
Upper Nile 0 0 0.0%
W. Bahr Elghazal 4 0 0.0%
N. Kordofan 55 20 36.4
S. Darfour 0 0 0.0%
S. Kordofan 0 0 0.0%
W Kordofan 22 7 31.8%
Total 712
181
25.4%
Table (18): Community contribution in building primary health care units, Sudan, 2003 (n=1,172)
States PHCU Built by community Percentage
Algezeira 16 2 12.5%
B. Nile 0 0 0.0%
Khartoum 1 1 100.0%
Sinnar 0 0 0.0%
W. Nile 140 12 8.6%
Gadarif 62 22 35.5%
Kasala 49 14 28.6%
R. Sea 131 19 14.5%
Northern 27 5 18.5%
River Nile 33 5 15.2%
Upper Nile 34 3 8.8%
Unity 0 0 0.0%
W. Bahr Elghazal 3 1 33.3%
E. Equatoris 0 0 0.0%
Baher Algabel 62 28 45.2%
N. Kordofan 247 92 37.2%
S. Kordofan 105 36 34.3%
W Kordofan 36 8 22.2%
S. Darfour 226 121 53.5%
Total 1,172
369
31.5%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (19): Summary of community contribution in building of primary healthcare facilities, Sudan, 2003 (n=3,975)
Type of HF Found Built by community Percentage
RH 192 76 39.6%
RHC 539 260 48.2%
UHC 264 98 37.1%
Disp. 1,096 408 37.2%
DS 712 181 25.4%
PHCU 1,172 369 31.5%
Total 3,975
1,392
35.0%
Table (20): Summary of community contribution by State, Sudan, 2003
States Total HFs Built by community %
Algezeira 735 263 35.8%
B. Nile 66 26 39.4%
Gadarif 165 60 36.4%
Kasala 75 26 34.7%
Khartoum 316 142 44.9%
Northern 282 112 39.7%
Red Sea 207 41 19.8%
River Nile 308 106 34.4%
Sinnar 273 81 29.7%
W. Nile 341 60 17.6%
Baher Algabel 89 31 34.8%
E. Equatoris 1 0 0.0%
Unity 4 2 50.0%
Upper Nile 60 6 10.0%
W. Bahr Elghazal 17 5 29.4%
N. Kordofan 443 178 40.2%
S. Darfour 288 150 52.1%
S. Kordofan 171 57 33.3%
W Kordofan 134 46 34.3%
Total 3,975
1,392
35.0%
Table No. (21): Existing Primary healthcare facilities needing rebuilding, Sudan 2003
States Total HF RH RHC UHC Disp DS PHCU Total HF need Rebuilding %
Algezira 735 3 0 5 39 23 3 73 9.9%
B. Nile 66 4 0 0 5 13 0 22 33.3%
Gadaref 165 0 0 0 0 21 25 46 27.9%
Kasala 75 0 0 0 0 0 3 3 4.0%
Khartoum 316 1 0 0 10 0 0 11 3.5%
Northern State 282 1 0 0 14 1 2 18 6.4%
Red. Sea 207 1 0 0 1 5 12 19 9.2%
River Nile 308 1 0 0 6 6 1 14 4.5%
Sinnar 273 1 0 1 11 10 0 23 8.4%
White Nile 341 3 0 4 36 5 18 66 19.4%
Baher Algabel 89 0 0 0 1 1 5 7 7.9%
E. Equatoria 1 0 0 0 0 0 0 0 0.0%
Unity 4 0 0 0 0 0 0 0 0.0%
Upper Nile 60 1 0 0 2 0 2 5 8.3%
W. Bahr Algazal 17 0 0 0 0 1 0 1 5.9%
N. Kordofan 443 1 0 7 16 11 64 99 22.3%
S. Darfour 288 3 0 0 6 0 31 40 13.9%
S. Kordofan 171 1 0 0 4 0 33 38 22.2%
W Kordofan 134 0 0 0 9 6 0 15 11.2%
Total 3,975
21 0 17 160 103 199 500 12.6%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table no. (22): Number of primary health care facilities without constant supply of electricity (RH, RHC, and UHC)
State Total Functioning HF RH RHC UHC Total No. of Health Facilities %
AlGezira 171 6 117 2 125 73.1%
Blue Nile 17 4 4 0 8 47.1%
Gadarif 48 3 5 2 10 20.8%
Kassala 16 0 14 0 14 87.5%
Khartoum 136 0 35 19 54 39.7%
Northern 71 1 49 0 50 70.4%
Red Sea 29 0 8 1 9 31.0%
River Nile 130 2 83 2 87 66.9%
Sinnar 49 0 9 0 9 18.4%
White Nile 40 2 8 10 20 50.0%
B. Algabal 9 0 3 1 4 44.4%
E. Equatoria 1 1 0 0 1 100.0%
Unity 4 0 0 0 0 0.0%
Upper Nile 9 3 6 0 9 100.0%
W. Bahar Algazal 8 0 6 0 6 75.0%
N. Kordofan 51 1 9 6 16 31.4%
S. Darfour 25 1 5 1 7 28.0%
S. Kordofan 41 1 20 10 31 75.6%
W. Kordofan 33 0 19 2 21 63.6%
Total 888
25 400 56 481 54.2%
Table (23): Availability of safe water supply by level of health facility
Type of Facility Functioning With water supply % of HF with water supply out of functioning HF With relatively safe supply % of HF with relatively safe water out of functioning HF
RH 192 172 89.6% 101 52.6%
RHC 448 284 63.4% 210 46.9%
UHC 248 205 82.7% 106 42.7%
Disp. 763 268 35.1% 145 19.0%
DS 303 79 26.1% 38 12.5%
PHCU 573 269 46.9% 80 14.0%
Total 2,527
1,277
50.5% 680 26.9%
Table (24): Number of PHC health facilities with safe water supply by type of facility and state
States Functioning HF RH RHC UHC Disp DS PHCU Total Health Facilities %
AlGazira 433 21 74 18 26 10 1 150 34.6%
Blue Nile 50 1 2 0 3 8 0 14 28.0%
Gadarif 125 3 3 1 0 0 0 7 5.6%
Kasala 60 0 0 0 5 0 0 5 8.3%
Khartoum 290 7 27 38 26 0 1 99 34.1%
Northern State 169 18 29 0 24 1 1 73 43.2%
Red Sea 107 2 3 8 3 2 14 32 29.9%
River Nile 183 10 37 5 5 3 1 61 33.3%
Sinnar 137 8 16 6 14 8 0 52 38.0%
White Nile 171 9 0 0 7 1 1 18 10.5%
Baher Algabel 62 0 1 2 3 0 17 23 37.1%
E Equatoria 1 0 0 0 0 0 0 0 0.0%
Unity 4 0 0 0 0 0 0 0 0.0%
Upper Nile 27 0 0 0 0 0 0 0 0.0%
W. Bahr Algazal 11 1 7 0 0 0 0 8 72.7%
N. Kordofan 284 5 2 24 13 5 17 66 23.2%
S. Darfour 192 4 3 4 10 0 11 32 16.7%
S. Kordofan 127 3 5 0 3 0 14 25 19.7%
W. Kordofan 94 9 1 0 3 0 2 15 16.0%
Total 2,527
101
210 106 145 38 80 680 26.9%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (25): Summary of Health Facilities with Functioning Sewage System
Type of Facility Functioning HF Number of HF with sewage system % with sewage system out of functioning HF Number of HF with functioning sewage system % of functioning sewage out of existing systems
RH 192 101 52.6% 82 81.2%
RHC 448 98 21.9% 82 83.7%
UHC 248 134 54.0% 116 86.6%
Disp. 763 54 7.1% 37 68.5%
DS 303 18 5.9% 16 88.9%
PHCU 573 31 5.4% 12 38.7%
Total 2,527
436 17.3% 345 79.1%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (26): Number of Health Facilities with Functioning Sewage System by state
States Total Number of HF Rural hospital Rural health center Urban health center Dispensary Dressing station PHC units
Present Functioning Present Functioning Present Functioning Present Functioning Present Functioning Present Functioning Present Functioning
B. Nile 6 5 2 2 1 0 3 3 0 0 0 0 0 0
Gezera 77 63 17 14 35 28 15 13 3 1 7 7 0 0
Khartoum 85 69 8 8 12 10 50 41 14 10 0 0 1 0
Sinnar 26 19 7 5 6 4 6 6 7 4 0 0 0 0
W. Nile 12 11 7 6 0 0 3 3 0 0 1 1 1 1
Gadaref 30 27 7 6 6 4 16 16 0 0 1 1 0 0
Kasala 6 6 1 1 0 0 0 0 5 5 0 0 0 0
R. Sea 10 7 4 2 0 0 5 4 0 0 1 1 0 0
N. State 33 28 20 15 12 12 0 1 1 0 0 0 0
R. Nile 50 43 16 14 18 17 10 7 3 2 2 2 1 1
B. Algabel 21 11 0 0 1 0 6 5 4 3 0 0 10 3
W. Bahr Algazal 1 1 1 1 0 0 0 0 0 0 0 0 0 0
N. Kordofan 55 33 3 2 1 1 16 14 12 6 6 4 17 6
S. Kordofan 4 4 1 1 2 2 0 0 0 0 0 0 1 1
W Kordofan 7 5 6 4 0 0 0 0 1 1 0 0 0 0
S. Darfour 13 13 1 1 4 4 4 4 4 4 0 0 0 0
Total 436 345 101 82 98 82 134 116 54 37 18 16 31 12
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table No. (27): Number of Health Facilities not satisfying the Minimum requirement of equipments
States Total Funct. RH RHC UHC Disp DS PHCU Total Number of HF %
AlGezeira 433 4 43 11 73 79 6 216 49.9%
Blue Nile 50 2 1 1 14 16 0 34 68.0%
Gadarif 125 3 1 3 0 35 54 96 76.8%
Kasala 60 1 6 0 6 0 30 43 71.7%
Khartoum 290 0 0 6 32 0 0 38 13.1%
Northern State 169 4 12 0 37 7 5 65 38.5%
Red Sea 107 1 3 1 8 7 52 72 67.3%
River Nile 183 6 30 6 9 10 2 63 34.4%
Sinnar 137 2 4 2 14 19 0 41 29.9%
White Nile 171 1 0 14 36 7 46 104 60.8%
Baher Algabel 62 0 2 1 3 1 36 43 69.4%
E. Equatoria 1 1 0 0 0 0 0 1 100.0%
Unity 4 0 0 0 0 0 0 0 0.0%
Upper Nile 27 4 5 0 7 0 11 27 100.0%
W. Bahr Algazal 11 0 2 0 0 2 2 6 54.5%
N. Kordofan 284 0 0 17 8 21 119 165 58.1%
S. Darfour 192 9 11 5 32 0 135 192 100.0%
S. Kordofan 127 2 5 8 8 0 77 100 78.7%
W Kordofan 94 0 5 0 15 10 24 54 57.4%
Total 2,527
40
130 75 302 214 599 1,360
53.8%
Table No. (28): Number of Health Facilities not satisfying the Minimum requirement of furniture
States Total functioning RH RHC UHC Disp DS PHCU Total HF needing furniture %
Algazeira 433 18 71 11 54 28 0 182 42.0%
B. Nile 50 4 4 3 8 2 0 21 42.0%
Gadarif 125 5 16 11 0 2 8 34 27.2%
Kasala 60 1 3 0 3 0 3 7 11.7%
Khartoum 290 8 30 73 86 0 1 197 67.9%
Northern State 169 0 30 0 31 3 1 64 37.9%
Red Sea 107 5 5 13 7 5 3 35 32.7%
River Nile 183 0 65 9 12 9 6 95 51.9%
Sinnar 137 8 13 8 14 8 0 51 37.2%
White Nile 171 4 4 11 34 1 8 54 31.6%
Baher Algabel 62 0 0 6 4 1 7 11 17.7%
E. Equatoria 1 0 0 0 0 0 0 0.0%
Unity 4 0 0 0 0 0 0 0 0.0%
Upper Nile 27 1 0 0 0 0 0 1 3.7%
W. Bahr Alghazal 11 1 2 0 0 0 0 3 27.3%
N. Kordofan 284 10 7 26 43 15 15 101 35.6%
S. Darfour 192 5 9 3 7 0 5 24 12.5%
S. Kordofan 127 4 9 5 6 4 24 18.9%
W. Kordofan 94 10 14 1 10 3 7 38 40.4%
Total 2,527
84 282 180 319 77 68 942 37.3%
Table (29): Availability of Laboratory services within the functioning health facilities (RH, RHC, UHC)
States functioning HF Lab. Present %
Algezeira 171 147 86.0%
Blue Nile 17 15 88.2%
Gadarif 48 41 85.4%
Kasala 16 12 75.0%
Khartoum 136 131 96.3%
Northern 71 43 60.6%
Red Sea 29 21 72.4%
River Nile 130 76 58.5%
Sinnar 49 42 85.7%
White Nile 40 25 62.5%
Baher Algabel 9 7 77.8%
E. Equatoria 1 0 0.0%
Unity 4 0 0.0%
Upper Nile 9 0 0.0%
W. Bahr Elghazal 8 4 50.0%
N. Kordofan 51 36 70.6%
S. Darfour 25 11 44.0%
S. Kordofan 41 16 39.0%
W Kordofan 33 21 63.6%
Total 888
648 73.0%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table No. (30): Number of Health Facilities with functioning laboratories
States Rural hospital
Rural health center
Urban Health center
Total Number Of HF
% functioning
Total present Total Functioning Total
present Total Functioning Total
present Total Functioning Lab.
Present Lab.
Functioning
AlGezeira 30 30 96 90 21 20 147 140 95.2%
Blue Nile 8 7 2 2 5 5 15 14 93.3%
Gadarif 7 7 18 16 16 16 41 39 95.1%
Kasala 2 2 4 1 0 0 6 3 50.0%
Khartoum 11 11 32 28 88 85 131 124 94.7%
Northern State 25 24 19 14 0 0 44 38 86.4%
Red Sea 6 6 2 0 13 13 21 19 90.5%
River Nile 23 23 42 32 12 12 77 67 87.0%
Sinnar 14 14 18 12 10 10 42 36 85.7%
White Nile 13 13 2 2 10 8 25 23 92.0%
Baher Algabel 0 0 1 1 6 6 7 7 100.0%
E. Equatoria 1 0 0 0 0 0 1 1 100%
Unity 0 0 0 0 0 0 0 0 0
Upper Nile 0 0 0 0 0 0 0 0 0
W. Bahr Algazal 1 0 3 2 0 0 4 2 50.0%
N. Kordofan 12 11 6 4 18 16 36 31 86.1%
S. Darfour 9 9 6 6 5 5 20 20 100.0%
S. Kordofan 6 6 4 1 6 6 16 13 81.3%
W Kordofan 11 7 7 7 0 0 18 14 77.8%
Total 179
170 262
218
210
202
651 591 90.8%
Table No. (31): Number of Laboratories (RH, RHC, UHC) with Minimum Supplies and Equipment (S&E)
States Functioning lab. Rural hospital Rural health center Urban health center Total labs with minimum (S&E) %
AlGazira 140 29 83 20 132 94.3%
Blue Nile 14 6 2 5 13 92.9%
Gadaref 39 7 15 16 38 97.4%
Kasala 3 2 1 0 3 100.0%
Khartoum 124 11 28 84 123 99.2%
Northern State 38 23 13 0 36 94.7%
Red Sea 19 6 0 11 17 89.5%
River Nile 67 21 26 10 57 85.1%
Sinnar 36 12 12 9 33 91.7%
White Nile 23 9 2 7 18 78.3%
Baher Algabel 7 0 1 6 7 100.0%
E Equatoria 1 1 0 0 1 100.0%
Unity 0 0 0 0 0 0
Upper Nile 0 0 0 0 0 0
W. Bahr Alghazal 2 0 2 0 2 100.0%
N. Kordofan 31 10 3 13 26 83.9%
S. Darfour 20 8 6 5 19 95.0%
S. Kordofan 13 6 1 4 11 84.6%
W Kordofan 14 12 6 18 128.6%
Total 591
162 201 190 554 93.7%
Table No. (32): Number of Health Facilities with Fixed and Functioning Vaccination Units
State No of functioning HF RH with vaccination unit RHC with vaccination unit UHC with vaccination unit Disp with vaccination unit DS with vaccination unit PHCU
with vaccination unit Total HF with vaccination unit %
Algezira 433 28 64 18 8 5 1 124 28.6%
Blue Nile 50 3 0 2 0 0 0 5 10.0%
Gadarif 125 6 10 16 0 2 2 36 28.8%
Kasala 60 1 3 0 1 0 2 7 11.7%
Khartoum 290 11 34 87 99 0 0 231 79.7%
Northern State 169 22 17 0 19 0 0 58 34.3%
River Nile 107 5 51 11 6 0 2 26 24.3%
Red Sea 183 17 6 4 5 1 5 87 47.5%
Sinnar 137 15 14 10 8 2 0 49 35.8%
White Nile 171 12 6 8 38 1 3 68 39.8%
Baher Algabel 62 0 1 4 1 0 3 9 14.5%
E. Equatoria 1 1 0 0 0 0 0 1 100.0%
Unity 4 0 0 0 0 0 0 0 0.0%
Upper Nile 27 2 2 0 0 0 0 4 14.8%
W. Bahr Algazal 11 1 3 0 0 0 0 4 36.4%
N. Kordofan 284 10 6 25 35 3 25 104 36.6%
S. Darfour 192 8 11 2 26 0 109 156 81.3%
S. Kordofan 127 5 13 0 5 0 1 24 18.9%
W. Kordofan 94 11 14 2 15 6 0 48 51.1%
Total 2,527 158 255 189 266 20 153 1041 41.2%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (33): Availability of blood banks in Rural Hospitals
State Total RH (functioning) Blood bank present Percentage
AlGazira 32 0 0.0%
Blue Nile 8 0 0.0%
Gadarif 10 0 0.0%
Kasala 2 0 0.0%
Khartoum 11 5 45.5%
Northern State 25 1 4.0%
Red Sea 6 0 0.0%
River Nile 23 0 0.0%
Sinnar 15 2 13.3%
White Nile 14 0 0.0%
Baher Algabel 0 0 0
E Equatoria 1 0 0.0%
Unity 0 0 0
Upper Nile 4 0 0.0%
W. Bahr Algazal 1 0 0.0%
N. Kordofan 12 2 16.7%
S. Darfour 9 3 33.3%
S. Kordofan 8 1 12.5%
W. Kordofan 11 2 18.2%
Total 192
16
8.3%
Table (34): Availability of X-ray services in rural hospitals
State Total RH (functioning) Existing X-ray services % 0f availability of X-ray services Functioning X-rays % 0f functioning units (from existing)
AlGazira 32 7 21.9% 5 71.4%
Blue Nile 8 1 12.5% 1 100.0%
Gadarif 10 1 10.0% 0 0.0%
Kasala 2 0 0.0% 0 0
Khartoum 11 7 63.6% 6 85.7%
Northern State 25 8 32.0% 6 75.0%
Red Sea 6 2 33.3% 1 50.0%
River Nile 23 3 13.0% 2 66.7%
Sinnar 15 2 13.3% 2 100.0%
White Nile 14 0 0.0% 0 0
Baher Algabel 0 0 0 0 0
E Equatoria 1 0 0.0% 0 0
Unity 0 0 0 0 0!
Upper Nile 4 0 0.0% 0 0
W. Bahr Algazal 1 1 100.0% 0 0.0%
N. Kordofan 12 2 16.7% 2 100.0%
S. Darfour 9 1 11.1% 0 0.0%
S. Kordofan 8 3 37.5% 2 66.7%
W. Kordofan 11 3 27.3% 2 66.7%
Total 192
41 21.4% 29 70.7%
Table (35): Availability of Operation Rooms in rural hospitals
State Total RH (functioning) Existing operation room % 0f availability of operation rooms Functioning operation rooms % 0f functioning rooms (from existing)
AlGazira 32 28 87.5% 28 100.0%
Blue Nile 8 4 50.0% 4 100.0%
Gadarif 10 7 70.0% 7 100.0%
Kasala 2 1 50.0% 0 0.0%
Khartoum 11 8 72.7% 8 100.0%
Northern State 25 23 92.0% 23 100.0%
Red Sea 6 4 66.7% 4 100.0%
River Nile 23 20 87.0% 20 100.0%
Sinnar 15 13 86.7% 12 92.3%
White Nile 14 11 78.6% 11 100.0%
Baher Algabel 0 0 0% 0 0
E. Equatoria 1 0 0.0% 0 0
Unity 0 0 0% 0 0
Upper Nile 4 0 0.0% 0 0
W. Bahr Algazal 1 1 100.0% 1 100.0%
N. Kordofan 12 11 91.7% 11 100.0%
S. Darfour 9 8 88.9% 8 100.0%
S. Kordofan 8 5 62.5% 5 100.0%
W. Kordofan 11 9 81.8% 9 100.0%
Total 192
153
79.7% 151 98.7%
Table (36): Availability of Delivery Rooms in rural hospitals
State Total RH (functioning) Existing Delivery room % 0f availability of delivery rooms Functioning delivery rooms % 0f functioning rooms (from existing)
AlGazira 32 26 81.3% 26 100.0%
Blue Nile 8 5 62.5% 5 100.0%
Gadarif 10 7 70.0% 6 85.7%
Kasala 2 1 50.0% 1 100.0%
Khartoum 11 11 100.0% 11 100.0%
Northern State 25 21 84.0% 21 100.0%
Red Sea 6 5 83.3% 5 100.0%
River Nile 23 20 87.0% 20 100.0%
Sinnar 15 11 73.3% 11 100.0%
WhiteNile 14 12 85.7% 11 91.7%
Baher Algabel 0 0 0 0 #DIV/0!
E. Equatoria 1 0 0.0% 0 #DIV/0!
Unity 0 0 0 0 #DIV/0!
Upper Nile 4 1 25.0% 1 100.0%
W. Bahr Algazal 1 1 100.0% 1 100.0%
N. Kordofan 12 11 91.7% 11 100.0%
S. Darfour 9 7 77.8% 7 100.0%
S. Kordofan 8 4 50.0% 4 100.0%
W. Kordofan 11 9 81.8% 9 100.0%
Total 192
152 79.2% 150 98.7%
Table (37): Availability of dental services in rural hospitals
State Total RH (functioning) Existing dental services % 0f availability of dental services Functioning dental rooms % 0f functioning rooms (from existing)
AlGezira 32 12 36.4% 9 75.0%
Blue Nile 8 3 37.5% 2 66.7%
Gadarif 10 3 30.0% 2 66.7%
Kasala 2 1 12.5% 1 100.0%
Khartoum 11 10 90.9% 10 100.0%
Northern State 25 13 52.0% 12 92.3%
Red Sea 6 5 83.3% 5 100.0%
River Nile 23 11 47.8% 9 81.8%
Sinnar 15 5 31.3% 5 100.0%
White Nile 14 6 42.9% 6 100.0%
Baher Algabel 0 0 0 0 0
E. Equatoria 1 0 0.0% 0 0
Unity 0 0 0 0 0
Upper Nile 4 0 0.0% 0 0
W. Bahr Algazal 1 0 0.0% 0 0
N. Kordofan 12 4 33.3% 2 50.0%
S. Darfour 9 5 55.6% 5 100.0%
S. Kordofan 8 5 62.5% 5 100.0%
W. Kordofan 11 7 70.0% 7 100.0%
Total 192
90 45.2% 80 88.9%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Coverage with Primary Health Care facilities: A Pre survey outlook:
It is widely believed that improvements to primary health care are essential to the revitalization of the health system. Moreover, many countries are committed to ensure that their citizens have access to the appropriate health services, by the most appropriate provider in the appropriate setting. These amputations are the core theme of the PHC principles and the international agenda such as health for all and the succeeding global initiatives.
Nonetheless, access to local primary healthcare in Sudan is very low. Population with access to local PHC services is estimated to range between 40%-66% with greater urban and rural disparities. While around 84% of urban population have access to local health services, only 58% of rural population have access to local health services. These differentials are there despite the fact that more or less 70% of the populations live in rural settings.
The county "network" of PHC health facilities is relatively large and mounts to 5,750 Primary Health Care Facilities. On average, there are 1.7 PHC facilities for each 10,000 of the population with obvious differentials between different types of health facilities and interstate inequalities (the ratio is 1.4/10,000 in south Darfour while it is 5.4/10,000 in Northern state). There is also lopsided balance between different types of health facilities, i.e. between first contact level and first referral PHC facilities (see table 1 and figure 1 & 2).
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table No (1): Pre-Survey distribution of reported Primary Health Care Facilities per State and type of facilities.
State Pop. F/10,000 PHCU DS Disp. HC RH Total
Algezeira 3,477,000 2.7 44 391 264 216 34 949
Blue Nile 655,000 2.8 46 76 40 14 7 183
Gadarif 1,515,000 1.7 70 79 72 25 10 256
Kassala 1,507,000 2.0 118 49 72 50 8 297
Khartoum 4,936,000 0.8 30 29 177 131 7 374
N. Kordofan 1,506,000 4.2 414 81 90 42 10 637
Northern 593,000 5.4 31 50 159 62 20 322
Red sea 724,000 3.7 194 18 27 24 7 270
River Nile 918,000 3.8 26 80 79 149 17 351
S. Darfur 2,859,000 1.4 295 13 53 24 7 392
S. Kordofan 1,127,000 2.1 147 0 59 30 3 239
Sinnar 1,204,000 2.6 0 205 77 29 7 318
W. Kordofan 1,144,000 3.1 261 27 34 23 8 353
White Nile 1,515,000 2.8 173 69 113 54 12 421
Bhr Elgabl ? 55 3 14 19 2 93
East Equatoria 47 34 14 13 5 113
Unity 0 17 9 13 4 43
Upper Nile 43 0 16 10 7 76
W. Bhr Alghazal 23 2 34 2 2 63
Total 2,017 1,223 1,403 930 177 5,750
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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As mentioned above the health system is believed to have a relatively huge network of PHC facilities. Nonetheless, the findings of this health system survey tells that there is a vast gap between what is believed to exist and reported in the conventional Health Management Information System (MHIS)and what exists in reality of the Primary Health Care facilities network. Overall, 3,975 (69%) out of the expected 5,750 PHC facilities were surveyed and found to be existing and 31% (1,775) of the health facilities do not exist in reality, with few % of these facilities were not surveyed for security and accessibility reasons. These are located in Kasala, Blue Nile, South Kordofan and South Drafour. with ample differential between the different types of PHC facilities. The findings of the survey bring the ratio of coverage with PHC facilities from 1.7 per 10,000 of the population to 1.17/10,000 (in 2003). With Only 58.1 % (1,172) out of the expected to be existing and reported 2,017 PHCUs; and 58.2% (712) out of the expected 1,223 dressing stations are existing. However, the gap narrows down as we move to the upper level PHC facilities; that is to say 12.9% of the dispensaries and 13.7% of the health centres do not exist. Yet the existing rural hospitals are more than what was expected thus exceeding what is in the records by 15 Rural Hospitals; almost 8.5 % higher than expected (see figure 3).
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Functional status of health facilities
In addition to the huge gap (discrepancy) between the expected number of PHC health facilities and what is found in reality it was found that about 36.4% (1,448) of the PHC facilities are not functioning. This further worsens the situation of coverage with PHC facilities and brings it down from 1.17/10,000 to 0.73/10,000.
While all the Rural Hospitals are functioning, below 15% of the health centres are not functioning and above 50% of the lower level PHC facilities (Dispensaries, Dressing station and PHC units). The percentage of none functional health facilities ranges from 51.1% for PHC units, 57.4% for dressing stations, 30.4% for dispensaries, 16.9% for Rural health centres, 6% for urban health centres. The reasons behind this deterioration in the functionality of the PHC facilities is not studied within the objectives and scope of this survey, however it can be attributed for many factors. The macroeconomic policy and funds cut to the health sector have the major implication on this deterioration. Moreover, and as a consequence of the shortage of monetary resource; the policy direction of the ministries of health regarding allocation of enough money for the maintenance and recurrent costs, functionality of these facilities, their staffing may have implication and need to be examined and explored in further studies. Also the macroeconomic policy regarding the user fees and provider incentives may have major implications in the functionality of these lower level PHC facilities. Though it is difficult to conclude, it is generally observed that the community expectation, awareness of their health needs and demand for health care might have changed that they seek healthcare at the perceived better quality higher level facilities. This is because the providers of healthcare who are working at the different types of health facilities have different capabilities and skills. Said somewhat differently, the providers of healthcare are Medical officers and medical assistant in RH and health centres, while this is not the case for most of the dispensaries and of course all the dressing stations and PHC units. This argument is supported with the findings that community participation is proportionally linked to the none-functional status in (a reverse) manner. That the more the community participation which is the case for higher level the less number of none functional health facilities, as will be elaborated on later in this discourse. This tells us a tendency of valuing higher level PHC facilities (health centres and rural hospitals) more than lower level PHC facilities (Dispensaries, Dressing Station and PHC units) (needs more elaboration and logical reasoning).
Table (4): Summary of functional status of existing primary healthcare facilities, Sudan, 2003 (n= 3,975)
Type of Facility Expected Found Not Functioning Not functioning from found
RH 177 192 0 0%
HC 930 803 107 13.3%
Disp. 1,403 1,096 333 30.4%
DS 1,223 712 409 57.4%
PHCU 2,017 1,172 599 51.1%
Total 5,750 3,975
1,448
36.4%
Ratio per 10,000 of the population 1.7 1.2 Not functioning 1,448
Functioning 2,527
36.4%
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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On the other hand these figures mask wide lower/higher level; urban rural and inter state disparities. For instance while all the existing and surveyed (192) Rural Hospitals are functioning;
As we go down the hierarchy of the PHC health facilities significant percentage of PHC facilities are not functioning. Table-2 below shows that while all the rural health centers in B. Nile, Gadarif, Khartoum state, Unity and S. Darfour are functioning, there are 91 Rural health centres (16.9%) out of (539) of the rural health centres are not function. The none functioning facilities range from 67.7% (6) in Baher Algabel, 44.4% (4) in Upper Nile, 25.6% (31) in River Nile, 23.1% (4) in N. Kordofan, , 22.2% (2) in W. Bahr Elghazal, 22% (13) in Northern state , 20% (2) in White Nile, 17.4% (4) in W Kordofan, 17.2% (5) in Sinnar, 13.2% (18) in Algezeira, 9.1% (1) in R. Sea, 6.7% (1) in Kasala, 4.3% (1) in S. Kordofan. It should be noted that there is no rural health centers existing in E. Equatoria state.
Table (2): Summary of functional status of existing primary healthcare facilities by State, Sudan, 2003 (n= 3,927)
States Functioning RH Functioning RHC Functioning UHC Functioning Disp. Functioning DS Functioning PHCU Total Functioning
Algezeira 32 118 21 151 105 6 433
Blue Nile 8 4 5 16 17 0 50
Gadarif 10 21 17 0 39 38 125
Kasala 2 14 0 9 0 35 60
Khartoum 11 35 90 153 0 1 290
Northern 25 46 0 83 8 7 169
Red Sea 6 10 13 15 11 52 107
River Nile 23 90 16 27 18 9 183
Sinnar 15 24 10 51 37 0 137
White Nile 14 8 18 91 10 30 171
Baher Algabel 0 3 6 7 2 44 62
E. Equatoria 1 0 0 0 0 0 1
Unity 0 1 3 0 0 0 4
Upper Nile 4 5 0 7 0 11 27
W. Bahr Elghazal 1 7 0 0 1 2 11
N. Kordofan 12 10 30 72 40 120 284
S. Darfour 9 11 5 32 0 135 192
S. Kordofan 8 22 11 18 0 68 127
W. Kordofan 11 19 3 31 15 15 94
Total 192
448
248
763
303
573
2,527
It is also found that out of the 261 found urban health centres, only (16) 6.1% are not functioning. The none-functioning UHC are shared among 6 states; that is to say there are 6 UHCs (27.3%) in River Nile, 3 (14.3%) in W. Nile, 2 (15.2%) in S. Kordofan, 3 (9.1%) in N. Kordofan, 1 (7.1%) in R. Sea, 1 (5.5%) in Gadarif . In the remaining 13 states where UHC exist they are all functioning. Yet it should be noted that in Kasala, Northern state, E. Equatoria, Upper Nile and W. Bahr Elghazal there are no urban health centers.
As regarding dispensaries; there are 333 (30.4%) not functioning dispensaries out of the existing (1,096) dispensaries. The distribution of non-functioning dispensaries varies from 32 (54.2%) in River Nile, 54 (51.4%) in Sinnar, 6 (46.2%) in Upper Nile, 56 (40.3%) in Northern state, 87 (36.6%) in Algezeira, 6 (28.6%) in R. Sea, 35 (27.8%) in the W. Nile, (8) 20.8% in W. Kordofan, 4 (18.2%) in S. Kordofan, 3 (15.8 %) in B. Nile, 26 (14.5%) in Khartoum, 13.5% (5) in S. Darfour and13.3% (11) in N. Kordofan. While there are no dispensaries in Gadarif, E. Equatori, Unity and W. Bahr Elghazal; all the dispensaries in Kasala (9) and Baher Algabel (7) are functioning.
Almost two thirds of the dressing stations are not functioning, that is to say 409(57.4%) out of the existing 712 dressing stations are not functioning. This range from 75 % (24) in Northern, 75% (3) in W. Bahr Elghazal, 67.5 %(77) in Sinnar, , 66.7% (20) in White Nile 64% (187) in Algezeira, , 64% (32) in River Nile, 60% (3) in Baher Algabel 54.2% (13) in Red Sea, 43.3% (13) in Blue Nile, 31.8% (7) in W Kordofan, 27.8% (15) in Gadarif, 27.3% (15) in N. Kordofan. While there is no dressing stations in 7 states that include Khartoum, Kasala, E. Equatoria, Upper Nile, Unity, S. Kordofan, S. Darfour states
As the table 12 above shows, above half of the Primary health care units are not functioning. That is 599 PHCUs out of 1,172 PHC units are not functioning. Above 50% in White Nile, Algezeira (62.5%), R. Sea (60.3%), Northern (74.1%), River Nile (72.7%), Upper Nile (67.6%), N. Kordofan (51.4%), and W Kordofan (58.3%). In four states that include Blue Nile, Sinnar, E. Equatoria and Unity state there are no existing PHC units.
Community contribution in resources available for Primary Health Care: the case of Sudan
The oxford dictionary defines community as the quality of joint or common ownership or tenure or reliability, people organized into common political, municipal or social unity. The role of the community in health is emphasized since Al Mata and the succeeding initiatives. The main reasoning behind involving the communities is to empower them in order to make use of the full potential of the health system thus improve and promote their health. Moreover, Bamako initiatives that come to live as a response to the observed rapid deterioration of access experienced in several health systems during the 1980s .
This study shows that Community participation seems to be very high and level of care related and overall 35% 1,392 out of the existing 3,975PHC facilities were built by the community. The table above shows that out of the 192 Rural Hospitals there are 76 (39.6%) rural hospitals built by the community. The community participation is 50% or above in Kasala 50% (1), Northern state 52% (13) Sinnar 60% (9), and in W. Kordofan 81.8% (9). In other 8 states including community contribution in building RH range from 31.3% in Algaezira to 45.5% in Khartoum. Alagardarif and S. Kordofan scored the lowes level of community participation with 10% (1), and 12.5% (1) for each respectively. Where as none of the few existing Rural Hospital in Upper Nile (4), W. Bahr Elghazal (1) E. Equatoria (1) is built by the community.
260 RHC (48.2%) out of the 539 RHC are built by the community, with high (30% or above) participation in almost all the states, but low levels of community contribution in Baher Algabel 1 (11%) and Upper Nile 1 RHC (11.1).
98 (37.1%) urban health enters out of the existing 264UHC are built by the community, with high level of community participation in different states. 50% (5) of the UHC in Sinnar state are built by the community, 40% (36) in Khartoum state, and 40% (2) S. Darfour. Community participation in the rest of the states ranges from 20% (1 UHC) in Blue Nile, to 38% (5) in S. Kordofan, and Algezira (8); with no community participation in Baher Algabel state. It should be noted that in Upper Nile, W. Bahr Elghazal, E. Equatoria, Northern, and Kasala there is no Urban Health Centres.
Out of the over one thousand (1,096) dispensaries there are 408 (37.2%) dispensaries are built by the community. Above 30% community participation is seen in 10 states, while it is below 30% in Baher Algabel 28.6% (2), Red Sea 23.8% (5), White Nile 22.2% (28), River Nile 20.3% (12) and Upper Nile 15.4% (2). And in four states there is no dispensary these states are E. Equatoria, W. Bahr Elghazal, Unity and Algadarif
Out of the existing 712 Dressing Stations, only 181 (25.4%) were built by the community. In Gadarif 40.7% (22) dressing stations were built by the community, 36.7% (11) in Blue Nile, 36.4% (20) in N. Kordofan and 31.8% (7) in W Kordofan. The limited number of dressing stations that exist in Baher Algabel (5) and W. Bahr Elghazal (4) were built by the government which may imply the impoverished situation of the communities in these states. With limited participation of the community in 6 states (13.3%- 26), these include ( W. Nile 13.3% (4), Northern state 15.6% (5), Sinnar 16.7% (19), Red Sea 16.7% (4), River Nile 26% (13), Algazeira 26% (76). And there are no DS in 7 states these are S. Darfour, S. Kordofan, E. Equatoria, Unity,
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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26% (76). And there are no DS in 7 states these are S. Darfour, S. Kordofan, E. Equatoria, Unity, Upper Nile, Kasala, and Khartoum.
Community contribution in building PHC units is low compared to what is seen in upper levl (Health centers and rural hospitals). About 369 PHCUs (31.5%) out of 1,172 PHCUs were built by the community. 8 states scored below 30%. These include White Nile 12 (8.6%), Upper Nile 3 (8.8%), Algezeira 2 (12.5%), Red Sea 19 (14.5%), River Nile 5 (15.2%), Northern 5 (18.5%), W. Kordofan 8 (22.2%), Kasala 14 (28.6%). Above 30% community contribution is witnessed in Khartoum 1 (100%) S. Darfour 121 (53.5%), Baher Algabel 28 (45.2%), N. Kordofan 92 (37.2%), Gadarif22 (35.5%), S. Kordofan36 (34.3%), and W. Bahr Elghazal 1 (33.3%). There are no PHCUs in Blue Nile, Sinnar, Unity, and E. Equatoria states.
Over all in most of the states the community has built over 30% of the PHC health facilities, with relatively limited participation in Upper Nile 10% (6 HFs), White Nile 17.6% (60 HFs),Red Sea 19.8% (41 HFs), W. Bahr Elghazal 29.4% (5HFs), Sinnar 29.7% (81HFs). And the only one RH existing in E. Equatoris is built by the government.
Percentage Built by community Found Type of Facility
39.6% 76 192 RH
48.2% 260 539
RHC
37.1% 98 264 UHC
37.2% 408 1,096
Disp.
25.4% 181 712 DS
31.5% 369 1,172
PHCU
35.0% 1,392
3,975
Total
Status of function health facilities and availability of different health services
Almost 500 health facilities (13%) out of the 3,930 PHC health facilities need rebuilding.
481 health facilities 54% (rural hospitals, rural health centres, and urban health centres) have no constant electricity supply.
Only 1,277 (52%) health facilities of the total (2,479) functioning HF have water supply whether it is from a safe source of water or not. Out of those (1,277) with water supply, only 680 have relatively safe water supply which means that only 27% out of the total function health facilities have save water and 53% of those with water.
Availability Laboratory services in PHC facilities:
In only 651 (73%) Health upper level health facilities (RH, RHC, and UHC) out of the existing 892 HFs there are functioning laboratories. Wide difference between the states do exists, with blow 70% in 8 states. These include Upper Nile with no lab services in the 9 function health facilities, 38% (6) in Kasala, 39% (16) in S. Kordofan, 50% (4) in W. Bahr Elghaza, 58% (21) in W Kordofan, 58% (76) in River Nile, 61% (20) in S. Darfour and 64% (25) W. Nile. While in the upper Nile there are no laboratory services. The rest of the states are better off with above 70% of their function health facilities have laboratories. 80% and above these labs are function in almost all the states with the exception of Kasala and W. Bahr Algazal and both have scored 50% of their existing labs are functioning. Out of the 594 functioning laboratories there are 553 93%laboratories with minimum supplies and equipments.
Availability of Surgical Delivery, and Dental services in PHC facilities:
Out of the 192 functioning rural hospitals there are 161 (81%) rural hospitals with operating surgical theatre and they are almost all functioning (159) except one out of 2 in Kassal and one out of 13 in Sinnar
Table (4): Availability of Delivery Rooms in rural hospitals
State Total RH (functioning) Existing Delivery room % 0f availability of delivery rooms Functioning delivery rooms % 0f functioning rooms (from existing)
AlGazera 32 25 78.1% 25 100.0%
Blue Nile 8 5 62.5% 5 100.0%
Gadaref 10 8 90.0% 8 88.9%
Kasala 2 1 50.0% 1 100.0%
Khartoum 11 11 100.0% 11 100.0%
Northern State 25 21 84.0% 21 100.0%
Red Sea 6 5 83.3% 5 100.0%
River Nile 23 19 82.6% 19 100.0%
Sinnar 15 11 73.3% 11 100.0%
White Nile 14 11 92.9% 11 84.6%
Baher Algabel 0 0 0 0 0
E. Equatoria 1 0 100.0% 0 0.0%
Unity 0 0 0 0 0
Upper Nile 4 1 25.0% 1 100.0%
W. Bahr Algazal 1 1 100.0% 1 100.0%
N. Kordofan 12 11 91.7% 11 100.0%
S. Darfour 9 6 66.7% 6 100.0%
S. Kordofan 8 4 50.0% 4 100.0%
W. Kordofan 11 6 54.5% 6 100.0%
Total 192
146 78.1% 146 97.3%
Dental units are existing in less than half (48%) (95 RH) of the 200 rural hospitals, and 85% (89) are functioning. The availability of dental service varies greatly between the states. With Khartoum state scoring 91% (10) out of the total 11 hospitals. Five states scored 50% and above
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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with dental services and these are 83% (5) in R. Sea, 63% (5) in S. Kordofan, 59% (10) S. Darfour, 52% (13) Northern State, and 50% (7) in W. Kordofan. Seven states have less than 50% of their RH have dental services. These range from 33% (4) in N. Kordofan, 33% (5) in Sinnar, 36% (12) in Algazira, 38% (3) in B. Nile, 43% (3) in Gadarif, 46% (11) R. Nile and 46% (6) in W. Nile. The rest of the states have either no dental service such as East Equatoria, and Upper Nile or there is no RH at all like W. Bahr Algazal, Unity, and B. Algabel.
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Section 2: The Outreach Health Staff
Table NO (36): Distribution of the outreach health cadre according to area of work (n = 329)
Area of work Number %
Malaria 41 12.5
Environmental health 66 20.1
Midwifery 167 50.8
Community health workers 18 5.5
Others 37 11.2
Total 329
100.0
Table NO (37): Percentage of outreach health cadre who submits reports on regular basis (n=178)
Submits reports regularly Number
Yes 161 90.4
No 17 9.6
Total 178 100.0
Table NO (38): Percentage of outreach health cadre who keeps copies of their reports in health facilities (n=178)
Copies kept Number
Yes 109 61.2
No 29 16.3
Total 138
100.0
Missing: 40
Table NO (39): Percentage of outreach health cadre who receives feedback (n=178)
Receive feedback Number
Yes 56 32
No 119 68
Total 175
100
Missing 3
Table NO (40): Percentage of outreach health cadre who receives feedback (n=178)
Receive feedback Number
Yes 56 32
No 119 68
Total 175
100
Missing 3
Table NO (41): Date of the last supervisory visit of outreach health cadre(n=240)
Date Number %
A month 112 46.7
More than three months 43 17.9
A year 48 20.0
I don't know 37 15.4
Total 240
100
Missing: 1
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table NO (42): Percentage of outreach health cadre who received training during the last year (n=328)
Received training Number %
Yes 82 25
No 246 75
Total 328
100
Table NO (43): Percentage of outreach health cadre who reside in the locality (n=310)
Residence Number %
Same locality where they work 259 83.5
Some other place 51 16.5
Total 310
100.0
Missing :19
Table NO (44): Presence of unions, civil society organizations, or non-governmental organizations (NGOs) in the area (n=329)
Present Number %
Yes 120 36.5
No 209 63.5
Total 329
100.0
Table NO (45): Percentage of programmes supported by unions, civil society organizations or NGOs (n =120)
NGO supported programmes Number %
Yes 54 45.0
No 66 55.0
Total 120
100.0
Table NO (46): Percentage of outreach health personnel working in malaria programme keeping records (n=41)
Records kept Number %
Yes 20 48.8
No 21 51.2
Total 41 100.0
Table NO (47): Types of activities conducted by health personnel working in malaria programme during the last 4 months (n=41)
Activity Number %
Home visit 10 24.4
Spraying 8 19.5
Cleaning 7 17.1
Health education 6 14.6
Burying stagnant water 5 12.2
Other 5 12.2
Total 41
100.0
Table NO (48): Activities conducted during the last 4 months by environmental health workers (N=66)
Activity Number %
Home visit 26 39.4
Spraying 18 27.3
Cleaning 25 37.9
Education 17 25.8
Burying stagnant water 16 24.2
Other 10 15.2
Table NO (49): Availability of supplies and equipments for village midwives (n: 167)
Equipments Availability %
Delivery kit 157 94.0
Gloves 77 46.1
Sphygmomanometer 22 13.2
Table NO (50): Activities conducted by village midwife during the last four months (n=167 )
Activity Number %
ANC 109 65.3
Referral of risky pregnancies 72 43.1
Birth attendance 67 40.1
Health education 53 31.7
Post natal care 90 53.9
Table NO (51): Availability of equipments and supplies for community health workers (N=18)
Equipments Yes %
Some essential drugs 9 50.0
Disposable syringes 10 55.6
Gloves 4 22.2
Boiler 6 33.3
Dressing instruments 5 27.8
Table NO (52): Activities conducted during the last 4 months by community health workers (N=18)
Activity Yes %
Home visits for immunization 15 83.3
Diagnosis and treatment of cases 15 83.3
Referral of cases 14 77.8
Health education 15 83.3
Home visits other 4 22.2
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Outreach Health Staff :Results and discussion
The main discipline forming the outreach staff of the health facilities in the study population is village midwives (50%). Accurate information about the true coverage by midwifery services is not available. However, this cadre constitutes the corner stone for implementing reproductive health policies in the country in order to reduce maternal mortality ratios (509 deaths 100,000 LB- SMS1999). The target is to increase access to basic midwifery services to reach a ratio of 1 skilled attendant per village. Some of the available indicators on this regard, (SMS 1999) are: ANC coverage 71% and Deliveries attended by skilled persons, 57%.
Malaria workers are mainly mosquito men who are responsible of malaria vector control activities in the catchments area. Malaria being a common problem with the malaria control programme adopting a multi-approach strategy with emphasis on vector control, this cadre is vital.
Community Health workers (CHW) are a minority. This cadre used to form the base for PHC services in the country.
Most of the outreach health staff doesn't have any means of transportation while doing their work. A question might be raised of whether there is a need to provide an appropriate means of transportation .
Only 55% of the outreach staff keeps records of their activities, which means that almost half of the work goes undocumented and that information is incomplete even at the grass root level. Most of the outreach staff submitting reports (99%) submits them on regular basis. This indicates that where the system exists, it performs well. However, only 32% of those who send reports got feedback. It is essential to develop the managerial capacity at the primary health facility level and train directors of health units on the importance of documentation, use of information and feedback.
Most of the outreach health workers know their work objectives. This knowledge is most commonly obtained from experience (59.4) which reflects the dominance of verbal culture over written records which contributed to 45.5%. Eighty six percent of them know their job description, mainly from supervisors (52.3%). Half of the workers even have a written document (50.4%).
Most of the outreach health workers work under direct supervision of a senior. Less than half of those supervised (46.4%) received a supervisory visit in a month time. The remaining is supervised infrequently (every three months or more).
Almost half of the supervised outreach staff perceives (47%) the last supervisory visit as at least good (scored 4 or more).
Satisfaction with the overall work of the state ministry of health is much better than that with the locality level.
Only 25% of health workers received training during last year.
Most of the outreach health workers (78.7%) reside in the same locality where they work. About 36% of them stated that there are unions, civil society organizations, or non-governmental organizations (NGOs) working in their areas. Forty five percent of the programmes in the areas where these organizations exist are supported by them.
The percentage of availability of spraying pumps for outreach health personnel working in malaria programme is 63.6% while the percentage of availability of other supplies( pesticides, bed nets, drugs, fog pumps and spraying tools) range between 19.5% to 36.6%. The study showed that 48.8% of outreach health personnel working in malaria programme keep records of their activities.
During the past four months 24.4% of outreach health personnel working in malaria programme conduct home visits, 19.5% do spraying. Other activities included cleaning (17.1%), health education (14.6%), burying stagnant water (12.2%) plus others.
Almost 40% of the environmental health workers conducted home visits, 37.9% cleaning, 27.3% spraying, 25.8% education and 25.2% burying stagnant water.
As for availability of supplies for village midwives, 94% of them have delivery kits, 46.1% have gloves while 13.2% of them had sphygmomanometer .
The main activities conducted by village midwife during the last four months were ANC (65.3%) followed by post natal care (53.9%) and referral of high risk pregnancies. The percentage of village midwives who conducted deliveries during the lat four months was 40.1%. Third of the midwives health educate.
Around 55% of the community health workers have disposable syringes to work with, while 50% of them have the essential drugs to carry on their work. Third (33.3%) have access to boilers, 27.8% to dressing instruments while 22.2% to gloves
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Section 3: Exit poll interviews
Table No. (53) Percentage of patients being told about their sickness, Sudan PHC facilities 2003 (n=1336)
Told about his/her sickness Number %
Yes 1080 80.9
No 256 19.1
Total 1336
100
Table No. (54) Percentage of patients who have been told about the diagnosis of their illness, Sudan PHC facilities 2003 (n=1080)
Told about the diagnosis Number %
Yes 1007 93.2
No 73 6.8
Total 1080
100.0
Table No. (55) Percentage of patients who have being asked to do laboratory test/s, Sudan PHC facilities 2003 (n=1007)
Asked for tests No. %
Yes 514 51.0
No 493 49.0
Total 1007
100
Table No. (56) Places where the laboratory test/s were completed, Sudan PHC facilities patients 2003 (n=514)
Place Number %
Health facility 389 79.2
Out side the health facility 86 17.5
Some inside and other/s is out side the health facility 16 3.3
Total 491 100
Missing 23
Table No. (57) Payment of fees for diagnosis, Sudan PHC facilities patients 2003 (n=389)
Paid fees Number %
Yes 312 80.2
No 77 19.8
Total 389
100
Table No. (57) Obtainment of drug/s prescribed, Sudan PHC facilities patients 2003 (n=1336)
Obtained the drug/s Number %
Yes 1212 91
No 122 9
Total 1334
100
Missing 2
Table No. (58) Percentage of patients who obtained their drug/s from the health facility, Sudan PHC facilities 2003 (n=1212)
Drug obtained from HF Number %
Yes 988 81.5
No 224 18.5
Total 1212
100.0
Table No. (59)Percentage of patients by total charge paid, Sudan PHC facilities 2003 (n=1336)
Rang Number %
0-2000 1068 80.5
2001-4000 84 6.3
4001-6000 68 5.1
6001-8000 26 2.0
8001-10000 23 1.7
Over 10000 57 4.3
Total 1326
100
Missing 10
Table No. (60) Percentage of patients by total money spent to reach the health facility, Sudan PHC facilities 2003 (n=1336)
Rang Number %
0 954 72.8
1-500 133 10.1
501-1000 61 4.7
1001-2000 36 2.7
More than 2000 127 9.7
Total 1311 100
Missing 25
Table No. (61) Percentage of patients who received explanation on how to use the drug, Sudan PHC facilities 2003 (n=1336)
Received explanation Number %
Yes 1136 85.0
No 200 15.0
Total 1336
100
Table No. (62) Percentage of patients by knowing how to use the drug/s, Sudan PHC facilities 2003 (n=1336)
Know to use the drug Number %
Yes 1160 86.8
No 176 13.2
Total 1336
100.0
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table No. (63) Percentage of patients by being informed by the staff to come back if not feeling well, Sudan PHC facilities 2003 (n=1336)
Informed Number %
Yes 961 71.9
No 375 28.1
Total 1336
100.0
Table No. (64) Percentage of patients by total number of prescribed drugs, Sudan PHC facilities 2003 (n=1336)
No. drugs Number %
0 158 11.9
1 335 25.2
2 490 36.8
3 242 18.2
4 62 4.7
5 44 3.3
Total 1331
100.0
System Missing 5
Table No. (65) Percentage of prescriptions written in generic names, Sudan PHC facilities 2003
Range Number %
Generic drugs 2652 77.4
Non generic 774 22.6
Total prescriptions 3426 100
Table No. (66)Percentage of prescriptions by types of prescribed drugs, Sudan PHC facilities 2003
Type of drug Number %
Antibiotics 810 60.6
injectable drugs 588 44.01
anti malarial 651 48.7
Table No. (67) Percentage of patients by willing to suggest the health facility to a sick relative, Sudan PHC facilities 2003 (n=1336)
Status Number %
Yes 1154 86.4
No 182 13.6
Total 1336
100
Table No. (68) Percentage of admitted patients by frequency of staff changing their bed sheet, Sudan PHC facilities 2003
Times Number %
Daily 14 11.8
Every other day 24 20.2
Weekly 33 27.7
More 48 40.3
Total 119
100.0
Results:
The study shows that 80.8% of the patients had been told about their sickness and that 93.2% were aware of their diagnosis.
About 51% of the patients had been asked at one time to do an investigation, around 76 % of them had done the requested investigation in the health facility.
Tables no. () Shows that 80% if the patients fees for having themselves diagnosed
It is also found that 91% of the patients managed to get the prescribed drug, 81% of whom from the health facility.
Fifty two percent of the patients had 1-2 drugs prescribed, most of which was prescribed in generic names (77.4%) and the most commonly prescribed drugs were the antibiotics (61%), followed by injectable and anti-malarial drugs, 44% and 49% respectively.
As regarding the patients satisfaction, 86.4% of the patients said they would recommend the same health facility to their sick relatives.
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Section 4: The Household Survey
a) Three months prevalence of diseases amongst children under 2 years of age and their place of care seeking :
Table no (69): Number of mothers who reported that their child (under 2 years) got sick in the last three months.
Child got sick Number %
Yes 1353 62.4
No 815 37.6
Total 2,168
100
Missing 6
Table no (70): Place of treatment of the sick child (n=1353)
Place Number %
Public health facility 1007 69.1
Private health facility 158 10.8
Traditional/spiritual healer 54 3.7
Home treatment 175 12.0
No treatment 64 4.4
Total 1458 100.0
b) home visits:
Table no (71): Households visited by health cadre during the last three months, Sudan 2003(n=2174)
% Number Cadre
9.1 197 Health visitor
46.6 1012 Vaccinator
3.4 75 Sanitary Overseers
a) Antenatal care
Table (72): Number of women who received at least one visit of ANC during the last pregnancy (N=2174)
% Number Received ANC
77.9 1685 yes
22.1 477 No
100 2162
Total
Missing 12
Table no (73): Distribution of women by number of ANC visits (N=1685)
% Frequency Number of ANC visits
58.0 978 1-5
37.0 624 6-10
3.4 58 11-15
1.5 25 Over15
100.0 1,685
Total
Table no (74): Place of receiving ANC (N=1685)
% No. place
66.9 1166 Public health facilities
16.6 289 home
16.5 287 Private health facilities
3.3 57 others
100.0 1742
Total
Note (more than one place)
Table no (75): Reasons for not attending ANC clinic (N=477)
% Number Reason
37.7 180 There was no complaint during pregnancy
8.8 42 Health facility is too far
18.8 90 Did not know about ANC
10.2 49 No transportation
10.2 49 Could not afford
14.3 67 Others
100
477
Total
b) Natal services and PNC:
Table no (76): Place of delivery of the last child (N=2174)
% Number place
75.3 1637 Home
21 457 Public health facility
2 44 Private health facility
1.7 36 Others
100
2174
total
Table no (77): person who attended the home delivery (N=1637)
Handled by Number %
Health visitor 279 17.0
Village midwife 1040 63.6
Other (non health professional) 318 19.4
Total 1637
100
Table no (78): percentage of women who received postnatal care (N=2174)
% No. Received postnatal care
21.6 470 yes
78.4 1704 No
100
2174
Total
Table (79): Distribution of women by number of postnatal care (PNC) visits (N=470)
Number of PNC visits Frequency %
1 130 27.7
2 208 44.2
3 55 11.7
4 21 4.5
5+ 56 11.9
Total 470
100
c) Breast feeding
Table (80): percentage of women who breastfeed their children (N=2174)
Breastfeeding No. %
Yes 2096 96.4
No 78 3.6
Total 2,174
100
Table (81): time period from delivery to initiation of breastfeeding (N=2096)
Time of initiation of Breastfeeding Number %
Immediately 1630 77.8
After One hour 261 12.5
After One day 56 2.7
After two days or more 149 7
Total 2,096
100
d) Knowledge attitude and practice towards the child ill with diarrhea
Table (82): Knowledge of mothers about ORS (n=2174)
knowledge Number %
Know about ORS 1,791 82.4
Don’t know about ORS 383 17.6
Total 2,174
100
Table (83): Knowledge of mothers about how to prepare ORS (n=1791)
knowledge Number %
knows how to prepare ORS 1,602 89.4
Can correctly prepare ORS 1,388 77.4
Table (84): Three months prevalence of diarrhea among children under 2 years of age (n=2174)
Child had diarrhea Number %
Yes 1,100 50.6
No 1,074 49.4
Total 2,174
100
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table (85): Care seeking behavior of mothers with a child suffering of diarrhea (n=1100)
Choice of seeking treatment Number %
Home 343 31.4
Public health facility 545 49.8
Private health facility 57 5.2
Traditional / spiritual healer 26 2.4
Child not treated 123 11.2
Total 1,094
100
Missing =6
Table (86):: Percentage of mothers who gave ORS to their home-treated children suffering from diarrhea (n=343)
ORS given Number %
Yes 135 39.4
No 208 60.6
Total 343
100
Table (87): Percentage children who were breastfed during the attack of diarrhea (n=1,100)
Status of breastfeeding Number %
Breast fed 969 88.1
Not breast fed 131 11.9
Total 1,100
100
Table (88): Percentage of children with diarrhea by frequency of breastfeeding during the attack, (n=969)
Frequency of breastfeeding Number %
Increased 326 33.6
Decreased 131 13.5
No change 501 51.7
Total 958
100
Missing =11
Table no. (89): Behavior of mothers towards feeding their child during the attack of diarrhea (n=1,100)
Behavior Number %
Continued semi-solid/ liquid food as before 576 54.0
Enhanced giving semi-solid/liquid food 230 21.6
Reduced giving semi-solid / liquid food 138 12.9
Completely stopped semi-solid/liquid food 60 5.6
Switched onto solid food 63 5.9
Total 1067
100
Missing 33
e) Vaccination against childhood immunizable diseases:
Table No. (90): knowledge of mothers about the time of receiving the first dose of immunization (n=2174)
Knowledge Number %
know 1379 66
Don't know 710 34
Total 2089
100
Missing=85
Table no. (91): Percent distribution of children (11-23) who are fully immunized according to age (n=2174)
Vaccinated Number %
Yes 1,509 69.4
No 665 30.6
Total 2,174
100
Table no (92): Place of receiving vaccination of the children (11-23) (n=1509)
Place Number %
Public health facility (PHF) 966 70.7
Mobile team 43 3.1
Private health facility 12 0.9
PHF + mobile team 303 22.2
PHF + Private health facility 24 1.8
Private health facility + mobile team 18 1.3
Total 1,366
100
Missing = 143
Table no (93): Percentage of children (11-23) whose vaccination cards were seen (n=1509)
Vaccination card present number %
Yes 1,014 67.2
No 495 32.8
Total 1,509
100
Table no (94): percentage of children aged (11-23) months who received the third dose of DPT (DPT3) (n=629)
Received DPT 3 Number %
Yes 449 71.4
No 180 28.6
Total 629
100
Table no (95): Percentage of children whose DPT3 vaccination was verified using their vaccination cards (n=449)
Status of verification Number %
Verified 291 64.8
Not verified 158 35.2
Total 449
100
Table no (96): Percentage of mothers who ever received a dose of TT immunization (n=2174)
Ever received TT Number %
Yes 1,684 77.5
No 490 22.5
Total 2,174
100
f) Family planning:
Table no (97): Status of mothers’ knowledge about family planning (n=2174)
Knowledge Number %
Yes 1,409 64.8
No 765 35.2
Total 2,174
100
Table no (98): Source of mothers’ knowledge about family planning (n=1409)
Through Number %
Relatives 534 13
Health worker 783 55.5
Village midwife 235 16.6
Private clinic 103 7.3
Radio 525 37.2
Television 357 25.3
Newspaper 177 12.5
Table no (99): Percentage of mothers who ever used any family planning method (FPM) (n=2,174)
Used FPM Number %
Yes 571 26.3
no 1,603 73.7
Total 2,174
100
Table no (100): Type of contraceptive method used (n=571)
Item Number %
Pill 499 87
IUD 74 13
Injection 44 8
Condom 15 3
Foam /Diaphragm/ Jelly 1 0.18
Ligation 6 1.05
Rhythm 40 7.01
Abstinence 12 2.1
Withdrawal 9 1.58
Table no (101): Reasons for not using a family planning method (n= 1,409)
Reason Number %
Husband refusal 169 12.0
Mother-in-law refusal 30 2.1
FP method not available 34 2.4
Do not know where to get it 37 2.6
Want to have babies 142 10.1
Religious reasons 82 5.8
Usage of natural methods 227 16.1
Others 173 12.3
No answer 515 36.6
Total 1,409
100
Table no (102: Percentage of women who are currently pregnant from the study population (n=1,409)
Currently pregnant Number %
Yes 191 13.6
No 1,137 80.7
No answer 81 5.7
Total 1,409
100
Table no (103): Status of current usage of any contraceptive method among women who are aware of FP (n=1,137)
Currently using FPM Number %
Yes 225 19.8
No 839 73.9
No answer 72 6.3
Total 1,136
100
Missing 1
Table no (104): Source of the family planning method the mother is currently using (n=225)
Source Number %
Health visitor 64 28.4
Village midwife 8 3.6
Health center/ hospital 92 40.9
Pharmacist 61 27.1
Total 225
100
g) Malaria:
Table no (105): Three months prevalence of malaria among children under 2 years of age (n=2174)
Had malaria Number %
Yes 1,034 47.6
No 1,140 52.4
Total 2,174
100
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Table no (106): Care seeking behavior of mothers towards treating their child suffering from malaria (n=1034)
Time of first consultation Number %
Within 24 hours 704 68.8
After 24 hours 261 25.5
No treatment 58 5.7
Total 1023
100
Missing=11
Table no (107): Knowledge of mothers about Malaria prevention (n=2174)
Knowledge number %
Knowledge about malaria prevention 1477 67.9
Knowledge about ITN 1217 55.1
h) HIV/AIDS:
Table no (108): percentage of mothers who heard about AIDS (n=2174)
Heard about AIDS Number %
Yes 1,460 67.2
No 714 32.8
Total 2,174
100
Table no (109): Knowledge of mothers about the different methods of AIDS transmission (n=1460)
Method Number %
Skin-penetrating instruments 946 64.8
Blood transfusion 891 61.0
Unprotected sexual relations 1082 74.1
Transmission from mother to child 559 38.3
Don't know 279 19.1
i) Water and sanitation:
Table no (110): Distribution of household by source of drinking water (n=2174)
Source Number %
Public network 1129 59.3
Hand pump 309 16.2
Open well 227 11.9
Water canal 112 5.9
Stagnant water 31 1.6
Hafeer 68 3.6
Well 29 1.5
Total 1905
100
Missing =269
Table no (111): Status of cleanliness of kitchen/cooking place (n=2174)
Status Number %
Clean 891 42.5
Reasonably clean 746 35.6
Dirty 233 11.1
No kitchen 227 10.8
Total 2,097
100
Missing= 77
Table no (112): Status of cleanliness of bathroom/washing place (n=2174)
Status Number %
Clean 827 39.5
Reasonably clean 626 29.9
Dirty 249 11.9
No bathroom 390 18.6
Total 2092
100
Missing=82
Table no (113): Type of toilet facility in the households surveyed (n=2174)
type Number %
Open air 631 29
Pit latrine 1,219 56
Lavatory 212 9.8
Other 112 5.2
Total 2,174
100
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Results and Discussion of Household Survey
1. Antenatal care
The study showed that 77.9% of women visited antenatal care (ANC) clinics at least once during their last pregnancy, however, over 42% had more than 5 visits. The following graph compares the percentage of women who received ANC between the Sudan Maternal & Child Health Survey 1992-93 (SMCHS), Safemotherhood Survey 1999(SMS), Multiindicators Survey 2000(MICS) and the Sudan Health System Study 2003 (SHSS).
It is obvious that the percentage of women attending ANC clinics have been increasing from year 1999.
The study found that 66.9% received ANC at public health facilities, 16.6% at home 16.5% at private health facilities and 3.3% at other facilities.( The SMCHS 1992/93 it was found that 63.4% received ANC at public health facilities,20.1% at home, 68% checked up pregnancy in a governmental health facility,19% in private health centres and 12% at home). There is a slight increase in those receiving ANC in public & private health facilities,but the number of those receiving ANC care at home has dropped by 8%
Those who failed to go to ANC (22.1%) attributed it to many reasons; 37.7% of them did not attend ANC clinics as there were no complaints during pregnancy, 18.8% were ignorant about ANC, and 14.3% gave other reasons, whilst the same percentage i.e. 10.2% either did not have a means of transportation or could not afford to pay for ANC. The minority said that the health facility is too far. This is as compare to SMCHS 1992/93 which showed that 24% indicated that the main reason for not checking up pregnancy was that they were not exposed to health problems during pregnancy). The number of pregnant women who did not attend ANC due to absence of health problems has risen from 24% to 37.7% according to SMCHS 1992-93.
2. Natal services and postnatal care (PNC)
The majority of women delivered their last child at home (75.3%), 21% at a public health facility and 2% at a private health facility. SMS 1999 found that 86% of deliveries were conducted at home,1% at a private health facility and public health facility.
SMCHS 1992/93 found that 80% of deliveries took place at home, 16% in a public health facility,2% in private health care centres.
The percentage of women who delivered their last child at home has declined by over 10%:
The largest proportion had a village midwife attending their delivery at home 63.6%, however considerable number (19.4%) delivered by non health professional.(57% of deliveries were attended by a trained cadre,31% of deliveries by a traditional MW i.e trained/untrained,14% of births by relatives or no one as seen in SMS 1999 while in MICS2000, 87% births were attended by a skilled personnel and in SMCHS 1992/93 77% of deliveries were attended by midwives,8% by physicians,4% by relatives. The percentage of women whose delivery was attended by a non health professional has fallen by 13%.
The majority of the women (78.4%) did not receive PNC, while (21.6%) did receive one or two PNC visits (44.2% received 2 PNC visits, 27.7% 1 visit, 11.9% 5 or more, 11.7% 3 PNC visits and 4.5% received 4 PNC visits while 70% did not receive PNC during the five years preceding the surveyas found in Sudan Maternal & Child Health Survey 1992-93). SMS 1999 showed that 13% received PNC. The percentage of women who did not receive PNC has risen by 8.4% from its previous values according to SMCHS 1992-93.
3. Breastfeeding:
The majority of women, i.e. 96.4% breast feed their children. 77.8% of mothers immediately initiated breast feeding after delivery, 12.5% after 1 hour, 2, 7% after 1 day and 7% after 2 days or more.(Prevalence of breastfeeding of children was 97% of births during the 5 years preceding the survey)Sudan Maternal & Child Health Survey 1992-93)
The percentage of women who breast feed their children has almost remained the same( i.e dropped by 0.4%).
4. Knowledge attitude and practice towards ill child with diarrhea
A large number of mothers with a child (0-24) with diarrhea (82.4%) have recognized ORS; the remaining 17.6% are completely ignorant about ORS.
The majority of those who recognized ORS (89.4%) are familiar with preparing it in general, but only 77.4% are capable to prepare it correctly. The following bar chart gives a comparison of knowledge about ORS between the Sudan Maternal and Child Health Survey 1992/93 (SMCHS ) and the Sudan Health System Study 2003 (SHSS)
The study showed that 50.6% of children under 2 years of age had an attack of diarrhoea during the past 3 months, whilst 49.4% did not. The Multiple Indicator Survey 2000 (MICS) showed that diarrhea in under 5 children U5C the 2 weeks preceding the survey was 28% in the northern Sudan and 25% in the southern states. SMCHS 1992/93 showed that the percentage of children who suffered from diarrhoea in the past 14 days who are in the age group 0-6 months was 29.1%, in the age group 6-11 months was 44.8% and in the age group 12-17 was 40.5%.
The majority of mothers (49.8) sought treatment for their child with diarrhoea at a public health facility, 31.4% treated their child at home, 11.2% did not seek treatment, whereas 5.2% went to a private health facility and only 2.4% were treated at a traditional/spiritual healer. Only 39.4% of those who have been treated at home were given ORS as part of treatment for diarrhoea. SMCHS 1992/93 showed that sources of consultation were health specialists (37.4%), traditional source (4.7%), or sources (0.5%) and without consultation was 57.4%.
The majority of the mothers (88.1%) continued breast feeding their child with diarrhea. Of those, 51.7% claimed no change in frequency of breast feeding their child with diarrhoea, 33.6% increased the number of breast feeds and 13.5% decreased the frequency.
Fifty four percent of mothers continued providing the same routine feeding i.e. semi solid/ liquid food as before, 21.6% enhanced giving semi-solid/liquid food, 12.9% reduced giving semi-solid liquid food and 5.9% switched onto solid food while 5.6% completely stopped giving semi-solid liquid food. In MICS 2000, 37% of the U5C with diarrhoea received one or more of the recommended home treatment (ORS and RHF) while 24% of them received increased fluids and continued eating as recommended. SMCHS 1992/93 showed that 15% of U5C with diarrhea in the past 2 weeks received more fluid and 2.6% received more food, while 34.7% received less fluids and 39% received less food and 45.9% received same amount of fluid and 42% same amount of food. SMCHS 1992/93 also showed that 25.9% received ORS only, 8% received home solution.
5. Vaccination against child hood immunizable diseases:
Almost twice as much of mothers (66%) are aware about when their child should receive the first immunization dose. The study showed that 69.4 % of the children (11-23) are vaccinated.
The following graph gives a comparison of children who are immunized between Multiple Indicator Cluster Survey 2000(MICS) and Sudan Health System Study 2003.
In this regard, SMCHS 1992/93 shows that immunization is 100% for U5C whose card is seen and for those whose card is not seen is 21.4% for the age group 0-5 months, 56.1 for the age group 6-11 months and 60.8 for the age group 12-17 months.
The public health facility is the commonest place for receiving vaccination, it accounts to 70.7 % of the studied population.
The study showed that 71.4% of the children received their DPT3 dose and 64.8 % of them were verified by their vaccination card to have received DPT3.
As regard to TT vaccination, 77.5% of the mothers received TT immunization at least once:
6. Family planning (FP):
The study revealed that 64.8 % of the mothers had an idea about family planning. This finding is comparable to what have been found by SMS 1999 as shown in the following graph:
In the SHSS , The respondents attributed the source of knowledge about FP to health worker (55.5%), followed by radio (37.2%) and television (25.3%)
Only 26.3% of the mothers ever used a family planning method:
And the most commonly used method of contraception is the pill ( 87%) followed by IUD ( 13%). Pill is most widely used as seen in MICS as well
Many reasons and beliefs contributed to not using family planning methods, for instance, husband refusal in 12%, however the largest percentage 36.6% refused to give a reason.
The study found that 13.6 % of the mothers are currently pregnant. Only (19.8% ) of those who are not pregnant and who are aware of FP are currently using a FPM
40.9 % of the current users get their contraception method from the health center\ hospital. SMCHS 1992/93 shows that the common source is the public sector which is contributing to 69% while that the private sector is contributing to 24%. SMS 1999 found that 7% are currently using any FPM.
MICS2000 showed that 7% of married woman are currently using a contraceptive. SMCHS 1992/93 shows that current use of FP was 10%.
7. Malaria:
The percentage of children under 2 years of age had at least one episode of malaria in the past three months was found to be 47.6 % the. Following the start of the symptoms, 68.8% of the mothers seek treatment for their sick child within 24 hours. . MICS2000 shows that the percentage of U5C who had fever in the 2 weeks prior to the survey was 22.8%. SMCHS1992/93 showed that 34% of U5C suffered from fever during the 2 weeks preceding the survey.
Almost 68 % of the mothers knew about Malaria prevention.
8. HIV/AIDS
The study showed that 67.2% of the mothers heard about AIDS. SMS1999 showed 71% ever heard about AIDS. More than 60% of them had a good idea about the different methods of AIDS transmission except for 19.1 % who didn't know. MICS 2000 show that 6% of the women age 15-49 correctly identified three misconceptions of HIV transmission
9. Water and Sanitation
Regarding the availability of safe water supply, 59.3% of the household had a safe water supply through a public net work while 24.5 % don’t have a clean source of water.
Arround 42% of the house hold has a clean kitchen/ cooking place, 39.5 % of the household has a clean bathroom/ washing place and 56% of the household use pit latrines, 29 % use open air and only 9.8% use lavatories. MICS shows that 40% of the population of Sudan has no access to sanitary means of excreta of disposal. SMS 1999 showed that 37% don’t have access to sanitary means of excreta of disposal. DHS showed that 33.4 use open air.
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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Annexes
Annexure-2 - Study Tiers and Institutions
Health System Areas Level Responsibility for data collection
1. Governance (Organisation and Management)
1.1. Control & Administration Federal Coordinator
1.1.1. Federal Health Organisation
1.1.1.1. Ministeriat
1.1.1.2. Secretariat
1.1.1.3. Directorate Generals of Health
1.1.1.4. Directorates of Health
1.1.2. State Health Organisation State Supervisor
1.1.2.1. Ministeriat
1.1.2.2. Directorate General of Health Services
1.1.2.3. Directorates of Health
1.1.2.4. Locality/County/Health Area
1.2. Regulating Federal/State Coordinator/Supervisor
1.2.1. Autonomous Bodies
1.2.1.1. Sudan Medical Council
1.2.2. Relevant Legislation
1.2.2.1. Federal Government Act, 1993
1.2.2.2. Public Health Law
1.2.3.
2. The Health Care Services Providers
2.1. Tertiary Care On Hold On hold
2.1.1. Teaching Hospitals
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 Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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موضوع ذو صلة كتبه زميل المنبر د.محمد يوسف أبوحريره,كان قد عرض فى sudaneseonline.com ونستأذن عرضه هنا مره أخرى,نسبة لأهميته وملامسته محور النقاش.
الشكر ل د.أبوحريره وسودانيز اون لاين
لا نملك بطبيعة الحال إرادة أو مقدرات تنزيل هذا المخزون المعرفي بضغطة زر يتنزل فيها في لحظة وتزامن واحد العطاء الفكري على الواقع العاري منه والسالب لتكوينه ولا حيلة لنا إلا اتباع سنن الكون وسيرورات فعلها في آمادها الزمنية حتى يتفاعل ما يؤخذ منه والقبول عليه في اقصر وقت يتحقق فيه مطلوبه الكلي الشامل في الواقع الذي أشرنا إليه. واقع مجتمع فزع منقسم على نفسه ساقته تراكمية العلل والـ لا تدبير إلى حالة العناية المركزة يستصرف من بنيه من يشترون الحمد بالثمن الربيح ولا اربح من فزعة الوطن عدتهم للتصدي لها وعتادهم المخزون المعرفي الديمقراطي في الحكم والنظم الأخرى المتكاملة معه وقدراتهم الإدراكية على إعادة هيكلته وقولبته في أوعية قيم التعامل المرعية في كياناته المختلفة بما يحقق توطينه وقبوله والإقبال عليه. ومعالجة شمولية علله وتحقيق أهدافه وتساوقه مع حركة المجتمع وما يستجد فيها من مشكلات. ثم تداوله نقلا وتجديدا من جيل إلى جيل.
على المبادرين أن يعوا أن ما ينقل من المخزون المعرفي للقواعد الشعبية هو علم "عين" ومشهد، وليس تنزيلا للمحتوى المعرفي العفوي على هذه القواعد. لا تتحقق القناعة بهذا العلم إلا بعد التجريب ومشاهدة نجاح الحلول في الواقع. هذا يتطلب بالضرورة منهجا تطبيقيا لهذا المخزون المعرفي، تعد له النماذج والمشاريع وكيفيات التطبيق والتنظيم والمتابعة التي تستلزم النجاح.
مهام المبادرين:
بناء على ما تقدم يمكن إجمال مهام المبادرين في الآتي:
1. الانطلاق من الواقع وعلله السالبة للنهوض وتأسيس النظام الديمقراطي وإبداع الأتي:
· تأسيس مفهوم علم "العين" ومشاهده المختلفة وإعداد النماذج المطلوبة لذلك.
· تحديد عوائق تحديد المشهد المعد للممارسة الفكرية والنفسية والسلوكية والعمل على إزالتها.
· تقريب فهم السيرورة والتكون من خلال صورهما وشواهدهما في الواقع المعاش.
· تقصير المدى الزمني الذي استغرقته سيرورات التكون في النظم الديمقراطية الأصلية، وتسريع مساره بما يحقق عدة أهداف من خلال نفس الأداء وفي نفس الوقت.
· التعددية والاختلافات الأساسية العرقية والدينية والثقافية وتفاديها من خلال إعداد المشاريع المشتركة التي تحقق النفع المشترك بالفعل المشترك من الجميع، وتأجيل كل مختلفٍ حوله, وترتيب كافة الأولويات على هذا النهج.
· اتخاذ القيم المحلية ذات الصلة بالعمل العام الموجودة في جميع كيانات المجتمع السوداني والمرعية في سلوكياتهم كأوعية لقولبة المحتوى المجلوب من المخزون المعرفي بوصفه امتداداً لتحقيق مستقبل ماضي القيم المشار إليها، التي توقف فعلها التطوري التاريخي. كما يجب اتخاذ الأدوات التي تشكلت من هذه القيم مثل الفزعة والنجدة والنفير معينات للأداء المطلوب.
2. تنظيمات المجتمع المدني:
· إعداد نماذج ومشاريع وبرامج بما يحقق الرؤية من خلال الممارسة السياسية الديمقراطية ونظام الحكم الذي تنتجه والمفهوم المفتاحي للديمقراطية كحكم للشعب وبالشعب ومن اجل الشعب وصلة التنظيم بالاحداث التحول الديمقراطي الحقيقي.
· منظمات المجتمع المدني الأخرى المرتبطة بأهداف الرؤية وتحقيقها.
3. دراسة اتفاقية السلام الشاملة وتحديد جوانبها التي لا تتوافق مع مرحلة ما بعد التحول الديمقراطي.
4. مرحلة ما بعد إعداد الرؤية وتفعيلها
بعد هذه المرحلة للمجموعة أن تقرر :
- الاستمرار كمنظمة مجتمع مدني تطوعية شمولية العضوية لكل من يرغب في الانضمام إليها من قواعد الشعب السوداني دون عزل.
- تأسيس حزب سياسي يتخذ النماذج والبرامج المعدة نظاما للحزب أو
- تشكيل جبهة سياسية متعاونة على تنفيذ المشترك من جوانب الرؤية في مكوناتهم الحزبية القائمة.
5. المخاطبون بهذه الرؤية:
· جميع المواطنين بعد التداول حولها وإقرارها من جانب المبادرين المركزيين والولائيين.
· في هذه المرحلة المخاطبون هم: أصحاب القدرات الإدراكية في موضوعها. أملنا أن يجد من يطلعون على ملخصها المعمم هذا دافعا للانضمام للمشاركين فيها كمجموعة فزعة للوطن والمواطن.
بقي أن أقول أني لا أدعي الكمال لهذا الطرح وما أجمله وانتهى إليه في موضوع خفي الدروب عميق الغور شديد الخفاء بعيد المرتقى.
لكم جميعا تقديري وإجلالي وفيكم العشم
د. محمد يوسف أبوحريرة
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Re: ركن الراحل الزميل د.عماد الامين (نقاشات وصور) أيرلندا. (Re: محمد مكى محمد)
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و يبقى على الارض ما ينفع الناس يا عماد
و هاهي سيرتك تبقى بين العالمين في منحى ذلك الدرب الذي اثرت ان تقضي حياتك القصيرة المتوهجة بيننا و أنت تسير فيه
في شأن اصلاح حياة الناس و معيشتهم و حالهم و مألهم
في دربك المر الذي كنت تجمله على الدنيا بابتسامتك دائمة الاشراق و التوهج
للقضاء على الفقر و الجوع و المرض و كل احزان الانسانية
كل ذاك الذي ينتقص من قيمة البني أدم كبني أدم كما كنت تردد
كنت عليه حرباً و له عدواً
و تبقى سيرة رحيلك وجعٌ في خاصرتنا تدفعنا للامام
و على ذات الدرب يا عماد
با عماد الأمين
نفتقدك بيننا ايها الانسان الانسان
و ايها العماد الانسان
عمــاد الأمين متحدثاً في ندوة قطاع الاطباء بالحزب الشيوعي السوداني
روى مستقبلية لاصلاح القطاع الصحي بالسودان
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محمد مكى محمد
Elmosley
Dr.Elsadig Abdalla
بخاري عثمان الامين
Nazar Yousif
Amjed
نجلاء سيد أحمد
فيس بوك
تويتر
انستقرام
يوتيوب
بنتيريست