Report on the proposed Sudan health sector support project; suggested augmentation of maternal and child health & nutrition aspects

Assessment is based on site visits and interviews with health officials. A number of problems within the health sector were identified. There is a lack of baseline data, especially nutrition information, for health planning purposes. Preventive and promotive aspects of training for community health workers and their tutors and for medical assistants are limited. Supervision of health workers is weak. Community involvement in the Primary Health Care Program (PHCP) is often short-lived. Vertical organization of the government prevents communication between ministries with overlapping programs and between programs within the Ministry of Health. The lack of fuel, poor transportation, blocked supply routes, and limited storage facilities present serious logistical problems. In particular, unreliable cold storage facilities prevent the mounting of an effective immunization campaign. The goals of the maternal and child health care program are perhaps overly ambitious given existing manpower constraints. A review of the training of health workers providing MCH services revealed a need for more thorough primary and in-service training in supervisory skills and preventive care. To this end, examples of job task analyses and competency based training are provided. Traditional birth attendants provide a significant portion of maternal care in rural areas; upgrading their skills level would be a helpful stopgap measure for improving health care delivery. A number of MCH components are suggested as a guide in developing MCH policies and procedures for the SHSSP. Areas of expertise needed to assist the SHSSP in implementing MCH goals include nurse midwifery, public health nursing, and health logistics; provision of additional food and drugs needed to upgrade MCH services is also suggested. Detailed recommendations are made for incorporation into the SHSSP regarding improving delivery of services and commodities under the PHCP; strengthening rural maternal and child health services; improving central, regional, and provincial planning, management, and information systems; improving health communications for the PHCP; and expanding the rural water supply.