UNFPA Reproductive Health Management Workshops in Darfur: UNFPA Sudan Newsletter, August 2004

As Reproductive Health services are commonly ignored during conflicts, UNFPA Country office has organized seminars on Reproductive Health Management in Emergency settings to provide an in depth overview of RH services in addition to the correct use of RH kits UNFPA is supplying to many NGOs operating in the 3 Darfurs. The region suffers very high maternal and infant mortality, as well as periodic drought and malnutrition.

Some organizations are working on RH but without a clear understanding of MISP (Minimum Initial Service Package) and the Kits to address RH in a comprehensive way. The Minimum Initial Service Package (MISP) is a series of actions needed to respond to the reproductive health needs of populations in the early phase of a refugee situation. The MISP is not just kits of equipment and supplies; it is a set of activities that must be implemented in a coordinated manner by appropriately trained staff. The MISP prevents excess neonatal and maternal morbidity and mortality, reduces HIV transmission, prevents and manages the consequences of Gender Based Violence, and includes planning for the provision of comprehensive reproductive health services integrated into the primary health programme in place.

The seminars attracted a total 35 health workers and representatives from UN Agencies, NGOs and other State authorities, "During emergencies Health of people must be a primary concern for everybody. We are happy UNFPA is committed in helping women and actively contribute in improving Reproductive Health services in Darfur", remarked H.E. Dr. Omer Abdul Jabbar, South Darfur Minister of Health during the opening session of the seminar in Nyala. The workshops, which included sessions on RH components in conflicts, prevention of the spread of HIV during conflict, Universal precautions, use of RH Kits, GBV and Monitoring and Evaluation systems, allowed the participants to actively deepen the topics and agree on possible strategies on how to better tailor planned activities in culturally sensitive manners acceptable to the beneficiaries.

UNFPA/UNHCR Reproductive Health Services Joint Project

In full compliance with the ICPD spirit, and following the Memorandum of Understanding signed between UNFPA and UNHCR earlier last April, a new joint project had been signed for the provision of Reproductive Health services in the Refugee Camps of Kilo 26, Um Gargur, Wad Sherifey, Shagarab 1, 2, 3, Girba, Wad Hilleaw, Abuda, and Suki where 107,000 Refugees live in Eastern states of Kas-sala and Gedaref. Although many Eritrean refugees have gone back to their country, estimations show that still approximately 300,000 refugees remain in the Sudan of which 110,000 are camp-based, mainly in the two states of Kassala and Gedaref. The situation of forced migration for a prolonged period of time and short-term planning as dictated by refugee status, has a profound negative impact on the quality of life.

Due to donor fatigue, resources for the delivery of services to the camp based refugees has been declining, over the years, leading to inadequate provision of social services including their education and health care, which has contributed to their low health status in general. For new arrivals who are at their early stage of reproductive age, they endure physical hardship and fatigue as well as psychological trauma during the process of displacement.

Women refugees, however, face additional stresses. In addition to the high prevalence of early, untimely and poorly outcome of pregnancies and childbirths, the very high risk for STDs/HIV/AIDS is coupled by the potentiality of Gender-Based Violence (GBV), which may be pressured to exchange sexual favours for food and thus increase the exposure to the risk of infectious disease including sexual transmitted infections (STI) in refugees. Refugee women in Sudan face additional social/cultural and religious obstacles that impose restrictions on movement and accessibility to potential job opportunities that increase their vulnerability. In this context, UNFPA and UNHCR intend to address the main Reproductive Health aspect as early and untimely pregnancy, poor outcome of pregnancy of childbirth, high risk of STDs/HIV/AIDS, and GBV.

Beside UNFPA's technical assistance in many activities such as the monitoring and evaluation, improvement of statistics information, development and production of appropriate education materials, and training of Midwives and Health Care providers. 21 girls will be attend the government's midwifery school in Kassala and Gedaref states for then being reintroduced to their communities to raise the quality of home births through quality ANC, safe delivery and postnatal care including Family Planning. UNFPA will also supply appropriate contraceptives, Reproductive Health kits, macro nutritious supplement (iron folate, and Vitamin A), Emergency contraceptives and Ambulances. These commodities are delivered to service points through UNHCR and COR, responsible for distribution and logistical support through their field networks.

UNHCR will also have responsibility for providing RH information and services to persons of its concern and it will jointly develop with UNFPA field manuals on the provision of RH information and services, including RH counselling, clinical activities. IEC efforts will concentrate on reducing perceived barriers to service use (such as norm and misconceptions), broadening public awareness of services availability and will include topics related to FP, maternal and newborn care, STDs/HIV/AIDS, elimination of harmful traditional practices (such as negative consequences of FGM, gender equality etc), also in the form of dramas, video shows and music competitions.

UNFPA/OPEC Project on HIV/AIDS Awareness

With the highest rate in North Africa and the Middle East Region, the estimated number of People Living with AIDS (PLWHA) in Sudan is between 500,000-600,000, according to UN statistics. With the HIV/AIDS generalized prevalence rate of 1.6%, the country is currently considered under epidemic as the rate has reached 2.6% among the adult population. Infection rates are particularly higher among vulnerable groups such as truck drivers, sex workers, tea sellers, internally displaced persons (IDPs) and refugees.

HIV surveillance shows that HIV/AIDS had moved into groups at higher risk by the late 1980s. Data from the mid-1990s onwards, suggest that HIV had spread more extensively to parts of the country, with rapidly rising trends. Many factors contributed to the increasing vulnerability of the population to the HIV/AIDS pandemic in the Sudan. War, massive poverty , inadequate and insufficient health care facilities around the country have in turn created a population of migrants ranking Sudan as number one world-wide for its number on internally displaced people and making the country increasingly vulnerable to communicable diseases. In this light, the fact that many Sudanese will return their homes from countries where the HIV/AIDS prevalence is very high, will doubtless increase the likelihood of a further spread of the epidemic.

Although most people had ever heard of HIV/AIDS, general access to proper information about the prevention method of STDs/HIV/AIDS is not universal, and misconception and social bias exist, that in turn contributes to reluctances seeking health care. Other factor that contributes to difficulty of STDs/HIV/AIDS prevention is that demanding condom is socially/religiously not acceptable among the people living in the community. In Sudan, poor health services and the unavailability of supplies are contributing factors to the increasing numbers of HIV/AIDS carriers and infected persons. Most of the health facilities, mainly hospitals involved in blood transfusion, are lacking the essential medical equipment and trained health personnel to implement counselling, rapid blood testing and screening.

Also, Health workers in most of health facilities are subjected to infection as they lack the motivation, knowledge and supplies to implement the blood testing measures in order to protect them from cross infection. According to a national prevalence and behaviour survey conducted in 2002, HIV infection prevalence is 4.0% among the pregnant attending ANC clinic in the refugee camps, compared to national average of 1.6%. Consequences of reproductive transmitted infection (RTI) including STDs cause many health problems such as enhancing HIV transmission, infertility and ectopic pregnancy among women.

UNFPA/OPEC Project

In addition to the several project aimed at raising awareness on HIV/AIDS, UNFPA is collaborating with OPEC to facilitate the overall national response programme to reduce HIV/AIDS/STIs transmission and strengthen the capacity of States MOH. With a total budget of 150,000 US $, the project will increase awareness and understanding in the next six months of the community/religious leaders and decision makers as well as it will improve the technical capacities of 125 medical assistants and health providers through the conduction of TOTs on STIs Syndromic management, safety procedures and infection control, the procurement of STIs/HIV kits diagnostics, the organization of STI/HIV/AIDS clinical/syndromes management and counselling as well as the production and distribution of culturally sensitive IEC materials including audio-visuals directed towards general public and special groups.

UNFPA Sudan Newsletter is issued every month as a part of the Advocacy Sub programme. It is intended to provide monthly information on the activities of UNFPA Sudan.

Source: UN Population Fund