Health Sector Sudan - World Health Organization · Data source: State Ministries of Health, WHO and...

Data source: State Ministries of Health, WHO and Health Partners in Darfur, as March 2017 pg. 1

Health Sector Sudan

[HeRAMS] Health Resources Availability Mapping System

Darfur Region Report

Report: Quarter 1 - 2017


HeRAMS (Health Resources Availability Mapping System) is a standardized approach supported by a

software-based platform that aims at strengthening the collection, collation and analysis of information

on the availability of health resources and services in humanitarian context. It aims to address the

needs/gaps expressed by the health sector on coordination and management by providing timely,

relevant, and reliable information.

HeRAMS started in Sudan early 2008 and has been jointly developed by Health Information Service Unit

of WHO Sudan Office and Health Action in WHO-HQ and approved by Ministry of health. Darfur crisis

context was taken as model by using its data to test the system. Since then, HeRAMS has evolved to be

one of the key information management tool that the global health cluster is using to assist the

implementation of the Health Cluster/Sector approach at country level. HeRAMS has been further

implemented in many crises situations such as; Haiti 2009, Pakistan Floods 2010, Syria conflict, etc.

HeRAMS provides a tool for assessing, monitoring, and processing a comprehensive set of available data

collected at health facility level. It covers; exact geographical location of the HF, demographic data on

catchment area, type, functionality, building type, inpatient capacity, managing and supporting partners,

health personnel, access and security, and health services provided at different levels of healthcare.

This report provides a summary of the analysis of the available health resources and services in Darfur

region, which consists of five states and 63 localities; it is considering the key parameters covered by the

system. The report is produced with the data provided mainly by State Ministries of Health and also by

national and international non-governmental organizations working in, and members of the Health

Sector in Darfur region. The list of NGOs is shown in the annex 1.

Further information could be provided upon request.

Dr. Salah Eldin Mubark Elkhalifa

Director, Health Emergency & Epidemic Control

Federal Ministry of Health

Telephone: +249 123 399 997

Email: [email protected]

Dr. Naeema Al Gasseer Dr. Camilo Valderrama

WHO Representative Health Cluster Coordinator

World Health Organization World Health Organization

Khartoum Khartoum

Email: [email protected] Email : [email protected]

mailto:[email protected]




Table of Contents 1. Darfur Region - (All States) ........................................................................................................................ 6

1.1 Primary Health Care System Composition .......................................................................................... 6

1.2 Health Partners in Darfur .................................................................................................................... 7

1.3 Health Personnel Gap Analysis ........................................................................................................... 8

1.3.1 Rural Hospitals ...................................................................................................................... 8

1.3.2 Primary Health Care Centre .................................................................................................. 9

1.3.3 Basic Health Unit ................................................................................................................. 10

1.4 Health Services in Darfur .................................................................................................................. 11

1.4.1 Provision of Minimum Basic Health Package (MBHP) ........................................................ 11

1.4.2 Provision of Basic Essential Obstetric Care (BEOC): ............................................................ 12

1.4.3 Provision of Maternal & Newborn service at PHCC Level ................................................... 13

1.4.4 Provision of health services at community level ................................................................ 13

1.4.5 Provision of services at primary health care level .............................................................. 14

2. North Darfur ............................................................................................................................................ 16

2.1 Distribution of Primary Health Care facilities: .................................................................................. 16

2.2 Management of health facilities ....................................................................................................... 17

2.3 Health Partners in North Darfur........................................................................................................ 19

2.3.1 NGO health partners .................................................................................................................. 20

2.4 Health Personnel in North Darfur ..................................................................................................... 21

2.3.1 Health Personnel Gap Analysis .................................................................................................. 23

2.5 EWARS reporting HFs in North Darfur .............................................................................................. 25

2.6 Provision of Minimum Basic Health Package in North Darfur .......................................................... 26

3. South Darfur ............................................................................................................................................ 27

3.1 Distribution of Primary Health Care facilities ................................................................................... 27


3.3 Health Partners in South Darfur........................................................................................................ 29


3.4 Health Personnel in South Darfur ..................................................................................................... 31

3.4.1 Health Personnel Gap Analysis in South Darfur ......................................................................... 33

3.5 EWARS reporting HFs in South Darfur .............................................................................................. 35

3.6 Provision of Minimum Basic Health Package in South Darfur .......................................................... 36


4. East Darfur .............................................................................................................................................. 37

4.1 Distribution of Primary Health Care facilities: .................................................................................. 37


4.3 Health Partners in East Darfur .......................................................................................................... 39


4.4 Health Personnel in East Darfur ........................................................................................................ 40

4.4.1 Health Personnel Gap Analysis in East Darfur ........................................................................... 41

4.5 EWARS reporting HFs in East Darfur ................................................................................................. 43

4.6 Provision of Minimum Basic Health package in East Darfur ............................................................. 44

5. West Darfur ............................................................................................................................................. 45

5.1 Distribution of Primary Health Care facilities ................................................................................... 45


5.3 Health Partners in West Darfur:........................................................................................................ 47


5.4 Health Personnel in West Darfur ...................................................................................................... 48

5.4.1 Health Personnel Gap Analysis in West Darfur .......................................................................... 49

5.5 EWARS reporting HFs in West Darfur ............................................................................................... 51

5.6 Provision of Minimum Basic Health package in West Darfur ........................................................... 52

6. Central Darfur ......................................................................................................................................... 53

6.1 Distribution of Health facilities ......................................................................................................... 53


6.3 Health Partners in Central Darfur ..................................................................................................... 55


6.4 Health Personnel in Central Darfur ................................................................................................... 56

6.4.1 Health Personnel Gap Analysis in Central Darfur .................................................... 58

6.4 EWARS reporting HFs in Central Darfur ............................................................................................ 59

6.5 Provision of Minimum Basic Health package in Central Darfur ........................................................ 60

Annex-: List of Health Partners working in Darfur per State


Acronyms

BHU Basic Health Unit

CD Central Darfur

CHW Community Health Worker

ED East Darfur

EWARS Early Warning Alert and Response System

Func Functional

HeRAMS Health Resources Availability Mapping System

HF Health Facility

HP Health Partner

MA Medical Assistant

MBHP Minimum basic health package

MO Medical Officer

Mob Clinic Mobile Clinic

MW Midwife

ND North Darfur

Non-func Non functional

Nut. Staff Nutritionist / Nutrition staff

PHCC Primary Health Care Center

PHO Public Health Officer

RH Rural Hospital

SD South Darfur

SMOH State Ministry of Health

VTMW Village Trained Midwife

WD West Darfur


1. Darfur Region - (All States)

1.1 Primary Health Care System Composition

Primary Health Care System in Darfur states is composed of Rural Hospitals, Primary Health Care

Centers, Basic Health Units and Mobile Clinics. In some states however, there are also State Hospitals

with teaching faculties, these are excluded from this report.

Following decreasing trends in 2015, 2016 witnessed increases in both the total number of HFs (Health

Facilities) and those functional type. In 2016, the number of HFs slightly increased to 1,181. In Q/Q4

2016, the total functional was 813 which increased to 826 in Q1 2017.

In Q1, of the 359 non-functional HFs, 296 were supposed to be managed by State Ministry of Health

(SMoH) while 59 were supposed to be run by NGOs and the remaining four (4) by the community. The

HF type Basic Health Units (BHUs) are the most affected category of non-functional, accounting for 287

of the 359 non-functional health facilities. Followed by PHCCs with 41 facilities, mobile clinics with 29

and Two RH are non-functional.

North Darfur is the worst hit state with 144 non-functional HFs followed by South Darfur with 83,

Central Darfur and 44 ,West Darfur 58 and East Darfur with 30. Partners on the ground consistently note

less funding, insecurity, inaccessibility and shortage of health workers as the main reason for the

facilities not functioning. The graphs and charts below depict this elaboration.

Figure 1: Type and Status of HFs in Darfur region

Absolute Numbers, by Health Facility Type

47

309

427

39 2

41

287

29 0

100

200

300

400

500

600

700

800

RH PHCC BHU Mob Clinic

Func Non-Func


Figure 2: Functioning HFs by State

Absolute Numbers, by Health Facility Type

Figure 3: HFs Types (%) in Darfur region Figure 4: HFs Status in Darfur region

1.2 Health Partners in Darfur SMoH and 42 partners including UN, INGOs and NNGOs operate in the Health Sector in Darfur region.

The specific number and names of partners are indicated in the state breakdown in the preceding

sections. (See Annex I, for health partners list).

RH, 47

PHCC, 309 BHU,

427

Mob clinic,

39

70%

30%

Func Non-func

5 6 14 17

5

48

31

122

65

43

36

41

147 152

51

14 9 15

1

0

40

80

120

160

CD ED ND SD WD

RH PHCC BHU Mob Clinic


Figure 5: Summary of the health actors and the number of managed functioning HFs by type

1.3 Health Personnel Gap Analysis

Below is a brief analysis of the gaps in health staff availability against the national health standards for different types of health facilities. Detailed analysis follows in each state sections in the document. Based on the HeRAMS data, gaps in health staffing has been analyzed against the local Health System standards set by the Sudan’s Federal Ministry of Health (FMoH).

1.3.1 Rural Hospitals

In Rural hospitals, the minimum standard set is at least one Medical Officer (MO), one Medical Assistant (MA), three Nurses, one Midwife (MW), one Vaccinator, one Nutrition staff (Nut. Staff), one Public Health Office (PHO) and one Laboratory personnel (lab personnel). This is the bare minimum, more is recommended. Minimum Standard: MO+ MA+ 3 nurses or more + MW+ Vaccinator+ Nutrition staff + PHO + Lab. Personnel

Information gathered from the field as in the graph below shows that, on average there are more

personnel, apart from PHO than the required standard to run the 47 RHs in Darfur States. The biggest

challenge however is the disparity between RHs located in urban centers and those in the rural areas.

For example, there are more than required MOs in Ed Daein and Zalingi but none in Niteaga, Kerinik , El

Ferdous and Mohjrea RHs. This disparity applies to other core medical staff as well. Details of the

specific facilities are in the states analysis below.

1

144

59

27

231

46

159

346

12

563

6 22 28

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

RH PHCC BHU Mob clinic Total

NGO Govt(SMoH and NHI) Community


Figure 5: Comparison of available personnel and standards in RHs in Darfur region

Data collected indicated that there are only 42 PHOs to run the 47 RHs, which is less than the required

minimum standard of 47. In addition to the disparity based on location, the situation gets dire.

1.3.2 Primary Health Care Centre

The minimum standard set for a PHCC is at least one Medical Officer, one Medical Assistant, two Nurses,

one Midwife, one Vaccinator, one Nutrition staff and one Laboratory personnel. This is the bare

minimum, more is recommended.

Minimum Standard: MA, 2 Nurse or more, PHO, MW, Vaccinator, Nutrition staff and Lab. Personnel

The challenge gets more pronounced as the type of facility changes from RH to PHCC. As was with RHs,

disparity of the location of the facility was the biggest challenge. In addition to this, PHCCs have less staff

in key areas. There are fewer Nurses, PHOs and Lab. personnel to run the 309 PHCCs. The standard set

for nurses is 618 but there are only 552 available nurses. Likewise, for PHOs, the standard is 309 but only

86 are available, same with lab personnel, the standard is 309 but only 142 are available.

47 47 141

47 47 47 47 47

78 127

508

42

175

109 129

68

0

100

200

300

400

500

600

700

MO MA Nurse PHO MW Vacc Nut Staff Lab Person

Standard Available


Figure 6: Comparison of available personnel and standards in PHCCs in Darfur region

1.3.3 Basic Health Unit

The minimum standard set for a BHU is at least one Medical Assistant, one Nurse, one Midwife, one

VTMW, one Nutrition staff and one vaccinator. This is the bare minimum, more is recommended.

Standard is: MA, Nurse, MW, VTMW, Nutrition staff and Vaccinator.

Further down the pecking order, the challenge gets more pressing as the type of facility changes from RH to PHCC and to BHUs despite the lower requirements. BHUs have difficulty in attracting and maintaining qualified staff because they are under-resource financially and technically.

Data collected from the field shows that 125 of the 427 functioning BHUs are run by community based personnel, most of whom are only trained in basic health care. They often work part time at their homes or business locations.

309

618

309 309 309 309 309

442

552

86

758

369 362

142

0

200

400

600

800

1000

1200

1400

MA Nurse PHO MW Vacc Nut Staff Lab Person

Standard Available


Figure 6: Comparison of available personnel and standards in BHUs in Darfur region

The chart above shows that all the 427 BHUs in Darfur states operate with inadequate staff except the presence of VV and MW , but Nut. Staff, Vacc and VTMW personnel are far from meeting the standard.

1.4 Health Services in Darfur

Provision of healthcare services is monitored at both health facility and community levels. At each level, the services are assessed against the FMoH standard list of healthcare service packages. The following subsections demonstrate provision of some selected key services.

1.4.1 Provision of Minimum Basic Health Package (MBHP)

The minimum set of services that should be basically provided by any HF is: -

Outpatient services

EPI: routine immunization against all national target diseases and adequate cold chain in place

Antenatal care: assess pregnancy, birth and emergency plan, respond to problems (observed

and/or reported), advise/counsel on nutrition & breastfeeding, self-care and family planning,

preventive treatment(s) as appropriate.

A total of 361 of the 822 or 44% functioning HFs provide MBHP in Darfur. Proportionally to the available

HFs in each state, West Darfur has the highest percentage of offering MBHP while South Darfur has the

least.

427 427 427 427 427 427 427 427 427

217 208

431

22 112

177

338

476

355

0

100

200

300

400

500

600

700

800

900

1000

MA Nurse MW LabPerson

Nut Staff Vacc CHW VV VTMW

Standard Available


Figure 7: Darfur states showing number and percentage of HFs offering MBHP

* Percentage of HFs providing the MBHP out of the total functioning HFs

1.4.2 Provision of Basic Essential Obstetric Care (BEOC):

Parenteral antibiotics + oxytocic/anticonvulsant drugs + manual removal of placenta + removal of

retained products with Manual Vacuum Aspiration (MVA) + assisted vaginal delivery 24hours a day and

7 days a week.

Figure 7: Darfur states showing number and percentage of HFs offering BEOC

* Percentage of HFs providing the BEOC out of the total functioning HFs

Ministry of Health regulation states that any health facility should provide the full elements of BEOC

services otherwise to be reported zero if only partially provided.

Overall in Darfur states the provision of BEOC coverage is at 26.5%. West Darfur, has the least coverage

and East Darfur, with the most coverage

126

65

27 70

73

172

38

60 164

27

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ND CD ED SD WD

With Without

75 25 34

71

13

223 78 53

163

87

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ND CD ED SD WD

With Without


1.4.3 Provision of Maternal & Newborn service at PHCC Level

This service includes antenatal care, skilled care during childbirth, basic emergency obstetric care and

post-partum care, a detailed composition is in the table below.

Figure 8: Darfur states showing percentage of PHCCs providing maternal and newborn services

* Percentage of HFs providing the maternal and newborn services out of the total functioning PHCCs

PHC

Level

P62 Antenatal care: assess pregnancy, birth and emergency plan, respond to problems (observed


preventive treatments) as appropriate P63 Skilled care during childbirth for clean and safe normal delivery

P65 Basic emergency obstetric care (BEmOC): parenteral antibiotics + oxytocic/ anticonvulsant drugs

+ manual removal of placenta + removal of retained products with manual vacuum aspiration

(MVA) + assisted vaginal delivery 24 hours a day and 7 days a week. P66 Post-partum care: examination of mother and newborn (up to 6 weeks), respond to observed

signs, support breast feeding, promote family planning

Basic emergency obstetrics care is the maternal and newborn service less provided across all PHCCs in

Darfur states but specifically in Central Darfur, West Darfur and North Darfur. Conversely, antenatal

care is the service provided in most PHCCs and evenly distributed across the states.

1.4.4 Provision of health services at community level

Provision of health service at community level includes services under the broader category of collection

of vital statistics, child health, nutrition, communicable diseases and maternal and new born as shown in

the table below.

In general, the lowest coverage for the services provided at community care level is reported from North

Darfur state, where the interventions are provided in less than 50% of the HFs. Conversely, West Darfur

has the best coverage; all the community level services are provided in more than 64% of the HFs in the

state.

92%

71%

84% 85%

95%

64% 61% 58%

81%

88%

35%

61%

25%

60%

12%

69%

42%

70%

85%

74%

0%

25%

50%

75%

100%

CD ED ND SD WD

P62 P63 P65 P66


Table 1: Provision of services at community care level:

Type of Service Health Service Provision of service in each state

North Darfur South Darfur East Darfur West Darfur Central Darfur

Collection of Vital

Statistics Deaths and births 135(45%) 44(19%) 24(27%) 66(66%) 70(52%)

Child Health

IMCI community component: IEC of child

care taker + active case findings 63(21%) 60(26%) 20(23%) 68(69%) 33(33%)

Home-based treatment of: fever/malaria,

ARI/pneumonia, dehydration due to acute

diarrhea.

110(37%) 177(76%) 68(78%) 75(75%) 59(57%)

Nutrition Screening of acute malnutrition (MUAC) 127(43%) 66(28%) 13(15%) 65(65%) 69(67%)

Communicable

Diseases

Community mobilization for and support to

mass vaccinations and/or drug

administration/treatments

106(35%) 196(84%) 63(72%) 81(81%) 94(91%)

Maternal &

Newborn Health

Clean home delivery, including distribution

of clean delivery kits to visibly pregnant

women, IEC and behavioral change

communication, knowledge of danger signs

and where/when to go for help, support

breast feeding

126(43%) 75(32%) 28(32%) 73(73%) 80(78%)

*Percentage of HFs providing the service out of the total functioning HFs in each state

1.4.5 Provision of services at primary health care level

Out of 62 health services monitored through the HeRAMS check list, the following services are selected

as examples of the service availability in Darfur states at primary health care level.

Table 2: shows the distribution of HFs providing health services at primary health care level

Type of Service Health Service Provision of service per state

North Darfur South Darfur East Darfur West Darfur Central Darfur

General Clinical Services

Outpatient services 263(88%) 219(93%) 79(91%) 95(95%) 89(86%)

Referral capacity: referral procedures, means of communication, transportation

142(48%) 71(30%) 21(24%) 81(81%) 81(79%)

Child Health


129(43%) 78(33%) 30(34%) 81(81%) 78(76%)

Under 5 clinic conducted by IMCI-trained health staff

96(32%) 70(30%) 34(39%) 56(56%) 62(60%)

Nutrition Management of severe acute malnutrition 48(16%) 55(23%) 34(39%) 20(20%) 41(40%)

Communicable Diseases

Diagnosis and treatment of malaria 152(51%) 174(74%) 54(62%) 95(95%) 91(88%)

Diagnosis and treatment of TB 15(5%) 23(10%) 22(25%) 11(11%) 14(14%)

STI & HIV/AIDS Syndromic management of sexually transmitted infections

119(40%) 205(88%) 80(92%) 66(66%) 71(69%)

Sexual Violence Clinical management of rape survivors (including psychological support)

48(16%) 50(21%) 11(13%) 21(21%) 23(22%)

Non Communicable Diseases and Mental Health

Mental health care: support of acute distress and anxiety, front line management of severe and common mental disorders

4(1%) 13(5%) 20(23%) 12(12%) 0(0%)

Environmental Health

Health facility safe waste disposal and management

117(39%) 104(44%) 21(24%) 83(83%) 86(83%)

*Percentage of HFs providing the service out of the total functioning HFs in each state


The table above depicts the distribution of HFs providing health service at primary health care level.

General Clinical services which includes outpatient services and referral services are provided in most of

the HFs in Darfur. Up to 93% of HFs in South Darfur state provides this service, making it the best

performing state. The least performing state in providing this service is Central Darfur with 86%.

Conversely, mental health care service is provided in fewest HFs in the region. All the HFs in Central

Darfur doesn’t provide this service. Only four HFs (1%) in North Darfur does, while 13(5%) in South

Darfur and 20 (23%) in East Darfur.


2. North Darfur

2.1 Distribution of Primary Health Care facilities

Health Facilities are classified into different standard categories based on the provision of services, staffing and population coverage; they are

Rural Hospitals (RH), Primary Health Care Centers (PHCC), Basic Health Units (BHU), and Mobile Clinics. The following table provides the

distribution of the existing health facilities (static and mobile); showing the number and percentage of the functional facilities out of total. See

acronyms for the initials used.

Table 3: Distribution of HFs in North Darfur by locality and facility type

State Locality

RH PHCC BHU Mob Clinic Total

Func Total % Func Func Total % Func Func Total % Func Func Total % Func Func Total % Func

No

rth

Dar

fur

Ailliet 1 1 100% 7 7 100% 21 21 100% 0 0 0% 29 29 100%

Alwaha 1 1 100% 4 5 80% 7 8 88% 2 2 100% 14 16 88%

Dar el Salam 1 1 100% 5 7 71% 4 8 50% 0 0 0% 10 16 63%

El Fasher 0 0 0% 42 48 87% 23 33 70% 5 7 71% 70 88 80%

El Kuma 0 0 0% 4 4 100% 3 7 43% 0 0 0% 7 11 64%

El Malha 1 1 100% 9 9 100% 6 11 54% 0 0 0% 16 21 76%

El Taweisha 2 2 100% 7 8 88% 7 11 64% 0 0 0% 16 21 76%

El Tina 1 1 100% 0 0 0% 1 2 50% 0 0 0% 2 3 67%

ElSeraif 1 1 100% 1 1 100% 2 12 17% 0 0 0% 4 14 28%

Kalemando 0 1 0% 2 3 67% 14 14 100% 0 0 0% 16 18 89%

Kebkabiya 1 1 100% 7 9 78% 8 28 28% 1 1 100% 17 39 43%

Kornoi 1 1 100% 0 1 0% 2 13 15% 0 0 0% 3 15 20%

Kutum 1 1 100% 14 14 100% 8 24 33% 0 0 0% 23 39 59%

Mellit 1 1 100% 9 9 100% 14 14 100% 6 6 100% 30 30 100%

Saraf Omra 1 1 100% 1 1 100% 10 0% 0 0 0% 2 12 17%

Tawilla 0 0 0% 3 6 50% 7 24 29% 0 7 0% 10 37 27%

Um Buru 0 0 0% 1 2 50% 5 6 83% 1 1 100% 7 9 78%

Umm Keddada 1 1 100% 6 6 100% 15 18 83% 0 0 0% 22 25 88%

Total 14 15 93% 122 140 89% 147 264 56% 15 24 63% 298 443 67%


Following an increase from 440 to 443 between Q4 2016 and Q1/Q2 2017, the number functioning HFs slightly decreased from 299 (68% of total

Q4 – 2016 facilities) to 298 (67% of total Q1 – 2017 facilities) . These changes are noted as below: -

The increases were noted in Kornoi locality, after Kornoi RH began operation.

Furthermore, in El Malha locality, One BHU and One PHC began operation thereby increasing the number of facilities in the locality to 16.

A further increase due to one BHU which began operation in Kabkabiya locality , and decreased of One PHCC and One BHU in El Fasher locality ,

also One BHU in El Seraif Locality , One PHCC in Kalemando and Um Baro localities were decreased during Q1 2017 .

The rest of the localities didn’t experience any change in health facilities status.

2.2 Management of health facilities

Management of health facilities means the primary focal entity who takes charge of admission and providing services to the patients. The below

graph shows the respective entities that manage the health facilities.


Figure 9: Distribution of HFs by management - North Darfur

*Figures in bars show the number of HFs Figure 10: Percentage of HFs by management - North Darfur

14

70 100

2

186

2 2

44 25

13

82

6 22

28

0%

20%

40%

60%

80%

100%


SMoH NHI NGOs Community

60% 62% 63%

30% 28% 28%

10% 10% 9%

0%

10%

20%

30%

40%

50%

60%

70%

Q1/Q2 2016 Q3/Q4 2016 Q1 2017

Govt(SMoH and NHI) NGOs Community


2.3 Health Partners in North Darfur

Several health partners operate in North Darfur. The table below shows the facilities which they either

manage or support.

Table 4: Distribution of Functioning HFs in different localities in North Darfur State by managing and supporting partners

Locality

Health partners Health Facilities Total Management Support RH PHCC BHU Mob Clinic

Ailliet

CDO

SMoH, CDO, IOM

1

1

SMoH, WHO, UNICEF, UNFPA

3

3

Community SMoH

1 8

9

SMoH SMoH 1 3 12

16

Alwaha

GOAL GOAL

2 1

3

SMoH

SMoH

2 6 2 10

SMoH, WHO, UNICEF, UNFPA 1

1

Dar el Salam

Anhar CHF

3

3

KPHF WHO, UNFPA, SMoH, KPHF

1

1

SMoH

SMoH

1 4

5

UNFPA, UNICEF, WHO 1

1

El Fasher

BVO BVO, WHO

1

1

Community SMoH

4

4

HAD CHF, WHO, UNFPA, UNICEF

3

3

KPHF WHO, UNICEF, UNFPA

1

1

NHI NHI

1

1

RI

UNICEF, UNFPA, WHO, RI

1 2

3

UNICEF, UNFPA, WHO, RI, ECHO

1 5 6

WHO, UNICEF, UNFPA

1

1

Community RI, WHO, UNFPA, UNICEF

1

1

SMoH

BVO, WHO

1

1

CHF

1

1

Elshaheed organization

1

1

NHI

1

1

NHI, WHO, UNICEF

1

1

SMoH

19 13

32

SMoH, NHI

2

2

SMoH, WHO

2

2

SMOH, WHO, UNFPA, UNICEF

1

1

UNICEF

1

1


1

1

WHO, UNICEF, UNFPA

2

2

WHO, UNICEF

1

1

Um Elrahma WHO, SMoH

1

1

ZDPO WHO, CERF, UNICEF

1

1

El Kuma

SMoH

SMoH

3 3

6

SMoH, HI

1

1

El Malha

RI WHO, UNICEF, UNFPA

1

1

SMoH

SMoH

8 4

12

WHO, UNFPA, UNICEF 1

1

El Taweisha

CDO SMoH, WHO, UNICEF, UNFPA

2

2

Community SMoH

2

2

SMoH SMoH 2 5 5

12

El Tina

SMoH

SMoH

1

1

WHO, UNFPA, SMOH 1

1

El Seraif

Massar WHO, MoH

1

1

MSF-E MSF-E

1

1

SMoH

SMoH

1

1

WHO, UNICEF, UNFPA 1

1

Kalemando

RI UNICEF, UNFPA, WHO, RI

1 1

2

SMoH ECHO, SC-S, BALSM

2 12

14


SMoH

1

1

Kebkabiya

Anhar

UNICEF

1

1

WHO

1

1 2

Massar WHO, MoH

2

2

MSF-E MSF-E

1

1

NHI NHI

1

1

SMoH

SMoH

4

4

UNICEF, UNFPA, WHO

2

2


1

ZDPO UNICEF, UNFPA, WHO

2

2

Kornoi SMoH SMoH 1

2

3

Kutum

Ayadi Elrahma WHO

1

1

GOAL GOAL

10 3

13

SMoH

SMoH

1 4

5

SMoH, WHO, UNICEF

1

1

UNICEF, UNFPA

1

1

UNICEF, UNFPA, WHO

1

1


1

Mellit

Community SMoH

1 6

7

RI


1

1

UNICEF, UNFPA, WHO, RI, OFDA

3 3

SMoH

SMoH

3 3

6

UNICEF, WHO

1

1


1

SRCS ECHO, UNICEF, WFP

3 5 3 11

Saraf Omra

SMoH

SMoH

1

1


1

Tawilla

Community SMoH

1

1

MSF-E MSF-E

1

1

SAEKAR WHO, UNICEF, SAKAR

1

1

SMoH

SMoH

5

5

WHO, SMoH

1

1

WHO, UNICEF

1

1

Um Buru

Anhar WHO

1 1

SMoH

SMoH

1 3

4

WHO

2

2

Umm Keddada

Community SMoH

2 3

5

RI UNICEF, UNFPA, WHO, RI

1

1

SMoH SMoH 1 3 12

16

Total 14 122 147 15 298

In addition to SMoH and the community, 29 health partners operate in North Darfur. Twelve of whom are

based in El Fasher locality, followed by El Seraif locality with eight. Other localities have between 1 and 8 as

shown in the table above.

Ayadi Elrahma, Um Elrahma, Anhar, SAEKER, CDO, BVO and Elshaheed organization, Al Massar, HAD, KPHP

and Zulfa (ZDPO) are NNGOs in North Darfur

2.3.1 NGO health partners

The number of HFs managed by NGOs in North Darfur decreased from 83 in the previous quarter to 82 in

Q1 – 2017. The decreases were mainly noted in the facilities run by NNGOs. RI continuous to manage the

most number of HFs 20 (6 PHCCs, 6 BHUs and 8 Mobile Clinics), of any NGO in the state.as compared with

the last quarter. In addition, RI took over the management of one more PHCC. Likewise, the number of HFs


managed by GOAL 16 same as in previous quarter (12 PHCCs and 4 BHUs) currently, the second highest of

any NGO in the state.

The number of HFs managed by NNGOs still same as previous quarter in the state, Anhar managed seven

HFs currently , BVO managed one. In addition, the number of HFs managed by HAD dropped from Four in

the previous quarter to three currently. Likewise the number of HFs managed by Al Massar same as

previous Quarter , no change .

Figure 11: Health partners managing HFs North Darfur and facility types

2.4 Health Personnel in North Darfur

Health personnel are categorized as HF based staff (health staff working at the HF) and community based

staff (the community staff working in the community in the catchment area of the HF (i.e. village/camp)).

As with the decreased of HFs in North Darfur, the total number of medical personnel also further decreased

from 3,717 in Q4 - 2016 to 3,561 currently. Of these, 1,929 (54%) are facility based while 1,632 (46%) are

community based.

This decrease however is more on the number of community based staff compared to the number of

facility based staff members. For example, the number of VVs in El Fashier decreased from 178 personnel in

the previous quarter to 163 currently.

Despite a decrease from 1,077 in the previous quarter to 1,028 currently, Elfasher locality still has the most

number of medical personnel in the state. Meanwhile, with 27 medical personnel, El Tina locality has the

least number of medical personnel.

1 3

22

4 1

3 5

2 5

2

8

3 5

1

3

6

12

3 1

3 2

1

6

1 1

3

1 1 0

5

10

15

20

25BHU Mob_clinic PHCC


Table 5: Distribution of the health personnel by locality and staff category

State Locality

Facility based community based

MO MA Nurse PHO MW Vacc Nut Staff

Lab Personnel

CHW VV CHP TBA VTMW Total

No

rth

Dar

fur

Ailliet 4 23 22 2 49 13 12 3 16 2 6 3 3 158

Alwaha 2 6 3 2 24 3 4 2 15 0 3 5 9 78

Dar el Salam 3 9 11 0 19 8 6 3 8 37 7 0 3 114

El Fasher 26 112 112 15 200 58 46 27 51 178 89 34 80 1028

El Kuma 1 6 3 1 13 3 0 1 5 1 0 0 0 34

El Malha 2 14 24 1 30 11 8 2 6 0 0 0 0 98

El Taweisha 2 16 15 1 22 4 4 2 12 5 9 3 4 99

El Tina 1 2 4 0 6 3 2 1 3 0 0 4 1 27

ElSeraif 6 8 17 1 13 4 6 1 1 0 35 0 6 98

Kalemando 1 11 4 0 47 14 15 1 10 145 0 0 4 252

Kebkabiya 8 27 50 4 23 16 16 12 9 15 36 4 2 222

Kornoi 1 4 4 0 5 2 1 1 2 0 9 0 0 29

Kutum 2 35 50 1 22 33 16 4 9 39 3 180 24 418

Mellit 2 30 68 2 65 11 6 7 23 239 8 33 37 531

Saraf Omra 3 8 6 1 10 2 1 1 0 0 0 0 0 32

Tawilla 4 12 12 1 12 18 4 3 7 48 52 0 3 176

Um Buru 3 6 10 0 9 4 1 3 5 0 7 0 3 51

Umm Keddada

4 10 28 2 29 5 4 2 20 0 6 0 6 116

Total 75 339 443 34 598 212 152 76 202 709 270 266 185 3561

Figure 12: Distribution of Medical Officers, Medical Assistant, and Nurse by locality

0

50

100

150

200

250

300 MO MA Nurse


Figure 13: Distribution of Midwife, Village Trained Midwife, and Traditional Birth Attendant by locality

2.3.1 Health Personnel Gap Analysis

Below is the analysis of the gaps in health staff availability against the national staff standards for RHs, PHCC and BHUs. There are no standards for mobile clinics; this will not be analyzed in this section. Based on the HeRAMS data, gaps in health staff has been analyzed against the local Health System standards at RH, PHCC and BHU levels. 2.4.1.1 Rural Hospitals

In Rural hospitals, the minimum standard set is at least one Medical Officer, one Medical Assistant, three Nurses, one Midwife, one Vaccinator, one Nutrition staff, one Public Health Office and one Laboratory personnel. This is the bare minimum, more is recommended. Minimum Standard: MO+ MA+ 3 nurses or more + MW+ Vaccinator+ Nutrition staff + PHO + Lab. Personnel

According to the latest information collected from the field, Kabkabeya, Kutum Hospital, Saraf Umra and

Umm Keddada RHs are the only facilities which fully meet the required standard set by MoH. As previously

noted in the last quarter report, Um Sayalla meet all requirement but have only one nurse as opposed to

the three according to the standard.

The most notable specialist across all is the absence of PHOs and Vaccinators. The below bullets show the

facilities with missing key personnel according to the set standards.

Gabir RH lacks a nurse and Um Sayalla lack two nurses

PHOs are absent in Dar Salam, El Lait, Gabir, Malha , Krnoi and Tina RHs.

Vaccinators Gap in El Lait, Elserif, Eltwisha and Mallit RHs.

Lab. Personnel in absent in Elserif RH.

0

50

100

150

200

250

300

350

MW TBA VTMW


2.4.1.2 Primary Health Care Centre


one Midwife, one Vaccinator, one Nutrition staff and one Laboratory personnel. This is the bare minimum,

more is recommended.

Minimum Standard: MA, 2 Nurse or more, PHO, MW, Vaccinator, Nutrition staff, Lab. Personnel

Information collected indicates that only four PHCCs, El Lait, Korma, NHI Clinic and Tawila PHCCs meet the

required staffing levels stated by MoH. The rest fell short of the standard as shown in the Figure 14 below.

Figure 14: Gap of Health Personnel at PHCC Level in North Darfur

The percentages are calculated out of the total PHCCs (122) in North Darfur

In most facilities core staff are missing, for example 89% don’t have a PHO, 68%, don’t have any laboratory

technician, 67% don’t have a nutritionist, 36% lack at least two nurses while 11% lack a Medical Assistant.

Midwife is available in most RHS, lacking in only 5% of all facilities.

2.4.1.3 Basic Health Unit

The minimum standard set for a BHU is at least one Medical Assistant, one Nurses, one Midwife, one


Minimum Standard: MA, Nurse, MW, VTMW, Nutrition staff and Vaccinator.

Information collected indicates that El Sireaf, Galab, Zam Zam B and Zam Zam C are the only out of the 147

BHUs which meet the standard.

The remaining HFs lack at least one or a combination of staffs, including 84% of the BHUs lack VTMW, 77%

lack a nurse, 71% lack a vaccination staff, 77% lack a nurse, 58% lack a MA and 20% lack a MW as shown in

Figure 15 below.

11%

36%

89%

5%

35%

67% 68%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MA Nurse PHO MW Vacc Nut Staff Lab


Figure 15: Gap of Health Personnel at BHU Level in North Darfur

The percentages are calculated out of the total BHUs (147) in North Darfur

2.5 EWARS reporting HFs in North Darfur EWARS is an essential service for detection of unusual diseases and outbreaks of communicable diseases. In Darfur however, only a few facilities are designated sites due to the existence of the equipment and necessary training for the EWARS staff. The table below shows summary of the number of functioning HFs designated under EWARS

Table 6: Showing localities with designated EWARS HFs

State Locality EWARS Designated Site Total HFs in the locality % EWARS in Locality

No

rth

Dar

fur

Ailliet 3 29 10%

Alwaha 3 14 21%

Dar el Salam 5 10 50%

El Fasher 12 70 17%

El Kuma 0 7 0%

El Malha 0 16 0%

El Taweisha 2 16 13%

El Tina 0 2 0%

ElSeraif 2 4 50%

Kalemando 1 16 6%

Kebkabiya 6 17 35%

Kornoi 0 3 0%

Kutum 11 23 48%

Mellit 6 30 20%

Saraf Omra 1 2 50%

Tawilla 4 10 40%

Um Buru 4 7 57%

Umm Keddada 0 22 0%

Total 60 298 20%

Of the 298 health facilities in North Darfur, 60 (20%) of them are designated EWARS HFs (mostly PHCCs &

BHUs). Um Buru locality has the highest number of designated HFs at 57%, conversely, Kalemando has the

lowest number of designated HFs at 6%.

El Kuma, El Malha, El Tina, Kornoi and Umm Keddada localities don’t have any designated EWARS facility.

58%

77%

20%

71%

81% 84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

MA Nurse MW Vacc Nut Staff VTMW


2.6 Provision of Minimum Basic Health Package in North Darfur

The minimum set of services that should be basically provided by any HF, are: -

Outpatient services





Figure 16: Provision of HFs offering MBHP by locality

The Percentage of facilities is out of the 298 functioning HFs in North Darfur

17% 14%

60%

47%

14% 13%

31%

50% 50% 56%

94%

33%

52% 57%

50%

30%

57%

27%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


3. South Darfur


Primary Health Care facilities are classified into different standard categories based on the provision of services, staff pattern and population coverage; they are

rural hospitals, health centers, basic health units, and mobile clinics. The following table provides the distribution of the existing health facilities (static and

mobile); in terms of number and percentage of the functional facilities out of total. See acronyms for details.

Table 7: Distribution of HFs in South Darfur by locality and facility type

Locality

RH PHCC BHU Total

State Func Total % Func Func Total % Func Func Total % Func Func Total % Func

Sou

th D

arfu

r

Alwehda 1 1 100% 0 0 0% 1 4 25% 2 5 40%

Bielel 0 0 0% 13 14 93% 6 15 40% 19 29 66%

Buram 1 1 100% 0 0 0% 10 15 67% 11 16 69%

Dimsu 0 0 0% 2 2 100% 3 8 38% 5 10 50%

Ed el Fursan 1 1 100% 5 5 100% 19 28 68% 25 34 74%

El Radoom 1 1 100% 1 1 100% 19 28 68% 21 30 70%

El Salam 1 1 100% 9 9 100% 9 11 82% 19 21 90%

Gerida 1 1 100% 5 5 100% 8 11 73% 14 17 82%

Kass 1 1 100% 2 3 67% 9 17 53% 12 21 57%

Katayla 2 2 100% 3 3 100% 9 9 100% 14 14 100%

Kubum 2 2 100% 1 1 100% 10 10 100% 13 13 100%

Marshang 0 0 0% 5 5 100% 2 10 20% 7 15 47%

Niteaga 1 1 100% 3 3 100% 4 4 100% 8 8 100%

Nyala 2 2 100% 11 12 92% 0 2 0% 13 16 81%

Rahad el Berdi 1 1 100% 1 1 100% 14 17 82% 16 19 84%

Sharq Jabel Marra 0 0 0% 0 2 0% 5 9 56% 5 11 45%

Shattai 0 0 0% 1 1 100% 0 3 0% 1 4 25%

Sunta 0 0 0% 2 2 100% 17 18 94% 19 20 95%

Tullus 1 1 100% 0 1 0% 3 5 60% 4 7 57%

Um Dafug 1 1 100% 1 1 100% 4 5 80% 6 7 86%

Total 17 17 100% 65 71 92% 152 229 66% 234 317 74%


The number of HFs in South Darfur in Q1 2017 is 317 following a little increase from 316 in Q4 2016. Two

changes were noted in the Management of HFs after KPHF Takeover one clinic in Otash Camp and NIDO

NNGOs handed over Sheikh Musa clinic to SMoH. In total, 234 of the 317 HFs in South Darfur are

functional, broken down as 17 RHs (all function), 71 PHCCs (91.5% or 65 function), 229 BHUs (66.3% or 152

function).

Katayla (14 HFs), Kubum (13 HFs) and Niteaga (8 HFs) localities have all the HFs in those localities

functioning while only one Health Facility out of three in Shattai function.

Note: The 3 State Hospitals in Nyala locality are all functioning, they are, Teaching Hospital, Military

Hospital and Police Hospital. However, they are not analyzed amongst the health service delivery due to

the restriction in public usage.


Management of health facilities means the primary focal entity who takes charge of admission and

providing services to the patients. The below graph shows the respective entities that manage the health

facilities.

Figure 17: Distribution of HFs by management - South Darfur

*Figures in bars show the number of HFs in each category Figure 18: Percentage of HFs by management - South Darfur

Trends above indicate no change in management by Government and NGOs.

146

25 16

187 6

40 1

47

0

50

100

150

200

250

BHU PHCC RH Total

SMOH NGOs

78% 80% 79%

22% 20% 21%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Q1/Q2 2016 Q3/Q4 2016 Q1 2017

Govt

NGOs


There has been a slight change in the management of facilities by both NGOs and the government. The only

change was the handover of three PHCCs from World Vision to the SMoH.

3.3 Health Partners in South Darfur

Several health partners operate in South Darfur. The table below shows health partners managing and

supporting different health facilities.

Table 9: Distribution of Functioning HFs in South Darfur by managing and supporting Partners

Health Partners Health Facilities

Locality Management Support RH PHCC BHU Total

Alwehda SMoH SMoH 1 1

SMOH, WHO 1 1

Bielel

ARC ARC 2 2

CIS CIS 1 1

IMC IMC 4 4

IOM ECHO 1 1

NCA NCA 1 1

SMoH SMoH 4 5 9

WVI WVI, WHO, DFATD

1 1

Buram SMoH SMoH 10 10

SMoH, WHO 1 1

Dimsu ARC ARC 2 2

SMoH SMoH 3 3

Ed el Fursan SMoH SMoH 5 19 24

SMoH, WHO 1 1

El Radoom SMoH SMoH 1 1 18 20

WHO 1 1

El Salam

ARC ARC 6 6

SMoH SMoH 3 9 12

WV WV 1 1

Gerida

ARC ARC 5 5

SMoH SMoH 8 8

SMoH, WHO 1 1

Kass

CIS CIS 2 5 7

SMoH SMoH 4 4

SMoH, WHO 1 1

Katayla

Mubadiroon SMoH, WHO 1 1

SMoH

SMoH 1 9 10

SMoH, WHO 1 1 2

SMOH, WHO 1 1

Kubum SMoH

SMoH 10 10

SMoH, WHO 1 1

SMoH, WHO 1 1

WVI WVI, DFATD 1 1


Marshang

SMoH SMoH 2 2

WVI

WVI 1 1

WVI, WHO, DFATD

1 1

WVI, WHO, OFDA 3 3

Niteaga

SMoH SMoH 1 2 4 7

WVI WVI, WHO, DFATD

1 1

Nyala

KPHF KPHF 1 2 3

Muslim aid.UK

Muslim aid.UK 1 1

RHF RHF 1 1

SMoH SMoH 1 5 5

WVI

WVI, WHO, OFDA 1 1

WVI, WHO, DFATD

1 1

Rahad el Berdi SMoH SMoH 1 14 15

SMoH, WHO 1 1

Sharq Jabel Marra

SMoH SMoH 5 5

Shattai SMoH SMoH 1 1

Sunta SMoH SMoH 17 17

WHO 2 2

Tullus SMoH SMoH 3 3

SMoH, WHO 1 1

Um Dafug SMoH SMoH 1 4 5

RHF RHF 1 1

Total 17 65 152 234

In addition to SMoH, 14 other partners manage or support HFs in South Darfur. As shown in the table

above, Nyala locality has the highest presence of partners with 8 working in the locality. Alwehda, Buaram,

Shattai and Sharq Jabel Marra localities have only SMoH working there although still receiving support from

WHO.

UNICEF and UNFPA provide regular support (drugs and medical supplies), either directly to the NGOs

managing the HFs or through the SMoH while WHO provides drugs, kits and equipment for PHCC and RHs

to fill any identified gaps and also respond to emergencies.


Of the 234 functioning HFs in South Darfur, 47 HFs in South Darfur are managed by NGOs. ARC manages 15

(all PHCCs), the most of any NGO in the state. Followed by WVI with 10 (all PHCCs) then CIS with 8 (3 PHCCs

and 5 BHUs). The rest as shown in the graph below manage less than 5 HFs each.


Figure 19: Health partners managing HFs and facility types

3.4 Health Personnel in South Darfur

Health personnel are categorized as HF based staff (health staff working inside the HF) and community

based staff (the community staff working in the community in the same catchment area of the HF (i.e.

village/camp)).

Table 10: Distribution of the health personnel per locality and staff category

State

Locality

Facility based Community based

MO MA Nurse

PHO

MW

Vacc

Nut. Staff

Lab Personnel CHW VV

CHP TBA

VTMW Total

Sou

th D

arfu

r

Alwehda 2 3 5 2 6 1 0 0 0 0 1 0 1 21

Bielel 8 23 39 4 32 16 37 6 10 83 21 168 3 450

Buram 4 5 54 0 2 15 12 3 9 0 10 0 0 114

Dimsu 0 4 2 0 4 3 12 0 3 38 4 0 11 73

Ed el Fursan 2 18 18 3 19 11 6 1 10 1 15 35 6 145

El Radoom 1 4 21 1 8 3 0 0 17 0 20 0 0 75

El Salam 2 12 17 1 30 11 45 2 8 108 18 12 51 317

Gerida 1 11 14 0 23 8 22 2 18 70 14 0 86 269

Kass 2 14 17 2 26 11 3 3 3 61 64 0 0 206

Katayla 2 16 22 2 21 7 2 3 7 20 14 0 1 117

Kubum 2 9 9 4 9 10 9 3 2 0 8 0 1 66

Marshang 3 6 8 2 7 6 3 3 4 1 31 6 4 83

Niteaga 0 5 6 4 8 2 3 1 8 1 7 0 1 46

Nyala 11 19 36 10 19 16 15 15 4 34 35 18 4 236

Rahad el Berdi 1 7 16 4 5 3 4 1 7 0 13 0 0 61

Sharq Jabel Marra 0 0 0 0 3 0 0 0 5 0 5 0 0 13

Shattai 0 0 0 0 0 0 0 0 0 0 1 0 0 1

Sunta 0 2 2 0 10 4 0 0 20 0 37 0 19 94

Tullus 1 5 9 1 5 0 2 2 1 0 2 0 3 31

Um Dafug 2 5 9 3 18 3 1 2 2 11 4 0 2 62

Total 44 168 304 43 255 130 168 47 138 428 324 239 193 2480

15

3 4 1

2 1 1

2

10

5

1

0

2

4

6

8

10

12

14

16PHCC BHU


The number of medical personnel in this quarter indicates increase by 8% from 2,279 in Q4/– 2016 to 2,480

in Q1- 2017. Of these 1,159 (47%) are facility based while 1,321(53%) are community based staff.

As it was reported in the previous quarter, Shattai locality has only one HFs which operates with only One

CHP. On the other hand, Bielel Locality has 450 personnel.

Figure 21: Distribution of Medical Officers, Medical Assistant and Nurse by locality

0

10

20

30

40

50

60

70

80 MO MA Nurse


Figure 22: Distribution of Midwife, Village Trained Midwife, and Traditional Birth Attendant by locality

3.4.1 Health Personnel Gap Analysis in South Darfur

Based on the HeRAMS data, gaps in health staffing has been analyzed against the local Health System standards set by the Sudan’s Ministry of Health. 3.4.1.1 Rural Hospitals

In Rural hospitals, the minimum standard set is at least one Medical Officer, one Medical Assistant, at least

three Nurses, one Midwife, one Vaccinator, one Nutrition staff, one Public Health Office and one

Laboratory personnel. This is the bare minimum, more is recommended.

Minimum Standard: MO+ MA+ 3 nurses or more + MW+ Vaccinator+ Nutrition staff + PHO + Lab. Personnel

The general human resources availability in South Darfur Rural Hospitals has remained the same as in the

previous report, exactly as below.

Only two RHs Rehaid Elberdi Hospital and Um Dafug RH of the 17 functioning RHs in South Darfur meet the

requirement of a RH. The facility has all the necessary personnel and in most cases, more than the required

number. The rest however, have some staff missing in some fields. Hay Elwahda lacks a laboratory

technician and Nutrition Staff to fulfill the standard requirements of a RH. El Radoom, Katayla,Niteaga and

Um Labasa lack a nutritionist , Buram,Tulus,Katayla,Elradoum and Gerida RHs lack a PHO, Tulus RH,Niteaga

and Katayla lack a Vaccination staff.

0

50

100

150

200

250 MW TBA VTMW


3.4.1.2 Primary Health Care Centre





Only Sakali and Sheikh Musa PHCC have all the staff according to the established standard. All the other

facilities in South Darfur lack at least a staff in one or many of the categories. As shown below, 12% of the

facilities lack Midwives, 77% lack a PHO, 60% lack Laboratory Technician, 49% lack Nurses, 37% lack

Nutritionist, 17% lack a Vaccinator while 8% lack Medical Assistants.

Figure 23: Gap of Health Personnel at PHCC Level in South Darfur

The percentages are calculated out of the total PHCCs (65) in South Darfur

3.4.1.3 Basic Health Units



8%

49%

77%

12% 17%

37%

60%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

MA Nurse PHO MW Vacc Nut Staff Lab Personnel


Minimum Standard: MA, Nurse, MW, VTMW, Nutrition staff and Vaccinator

Like in the PHCCs, no changes were recorded in the number of medical personnel working in BHUs in South

Darfur.

Only Gereida BHU has the required staff composition of a BHU. The rest lack one or most of the staff. Most

facilities, 97% lack a VTMW, 96% lack nutritionist, while 89% lack vaccinators, 81% lack Midwifes, 78% lack

nurses while 68% lack medical assistants.

Figure 24: Gap of Health Personnel at BHU Level in North Darfur

The percentages are calculated out of the total BHUs (152) in South Darfur

3.5 EWARS reporting HFs in South Darfur EWARS is an essential service for detection of unusual diseases and outbreaks of communicable diseases. In Darfur however, only a few facilities are designated sites due to the existence of the equipment and necessary training for the EWARS staff. The table below shows summary of the number of functioning HFs designated under EWARS

Table 11: Distribution of functioning HFs reporting under EWARS

Locality EWARS designated sites Total HFs in the Locatiy % EWARS designated sites

Alwehda 1 2 50%

Bielel 12 19 63%

Dimsu 2 5 40%

Ed el Fursan 6 25 24%

El Salam 9 19 47%

Gerida 7 14 50%

Kass 8 12 67%

Katayla 5 14 36%

Kubum 1 13 8%

Marshang 5 7 71%

Niteaga 1 8 13%

Nyala 11 13 85%

Sunta 1 19 5%

Um Dafug 2 6 33%

Total 71 176 40%

68%

78% 81% 89%

96% 97%

0%

20%

40%

60%

80%

100%

120%



Of the 234 health facilities in South Darfur, 71 (30%) of them are designated EWARS HFs (mostly PHCCs &

BHUs). In addition, only 40% of HFs of the localities that have EWARS designated sites, as shown above.

Nyala locality has the highest number of designated HFs at 85%. Conversely, Sunta has the lowest number

of designated HFs at 5%.

Buram, El Radoom, Rahad el Berdi, Sharq Jebel Marra, Shattai and Tullus localities don’t have any

designated EWARS reporting units.

3.6 Provision of Minimum Basic Health Package in South Darfur The minimum set of services that should be basically provided by any HF, are:

Outpatient services






The Percentage of facilities is out of the 234 functioning HFs in South Darfur

26%

60% 56%

42% 50%

33%

50%

69%

14% 12% 8%

89%

67%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


4. East Darfur

4.1 Distribution of Primary Health Care facilities:

Health Facilities are classified into different standard categories based on the provision of services, staffing and population coverage; they are

Rural Hospitals (RH), Primary Health Care Centers (PHCC), Basic Health Units (BHU), and Mobile Clinics. The following table provides the

distribution of the existing health facilities (static and mobile); showing the number and percentage of the functional facilities out of total. See

acronyms for the initials used.

Table 12: Distribution of HFs in East Darfur by locality and type

State Locality



East

Dar

fur

Abu Jabra 1 1 100% 2 2 100% 7 9 78% 6 8 75% 16 20 80%

Abu Karinka 0 0 0% 5 5 100% 1 2 50% 0 0 0% 6 7 86%

Adila 1 1 100% 3 3 100% 5 8 63% 1 2 50% 10 14 71%

Assalaya 0 0 0% 3 4 75% 7 8 88% 1 1 100% 11 13 85%

Bahr El Arab 1 1 100% 5 8 63% 5 6 83% 0 0 0% 11 15 73%

Ed Daein 0 0 0% 5 5 100% 4 5 80% 0 0 0% 9 10 90%

El Ferdous 1 1 100% 1 1 100% 8 16 50% 1 1 100% 11 19 58%

Sheiria 1 1 100% 3 3 100% 1 2 50% 0 0 0% 5 6 83%

Yassin 1 1 100% 4 5 80% 3 7 43% 0 0 0% 8 13 62%

Total 6 6 100% 31 36 86% 41 63 65% 9 12 75% 87 117 74%

The number of HFs Static in East Darfur are a little increase from 116 in Q4 2016 to 117 in Q1 2017 after SMoH opening One Mobile clinic in area

of Elnimer supported by ARC and WHO . As well, for functional HFs no change still in 74% currently functioning. In a nutshell, there are 6 RHs, 36

PHCCs, 63 BHUs and 12 mobile clinics. All the 6 RHs are functional, 31 of the 36 PHCCs, 41 of the 63 BHUs and 9 of the 12 mobile clinics are

operational.





facilities.

Figure 26: Distribution of HFs by management - East Darfur

*Figures in bars show the number of HFs Figure 27: Percentage of HFs by management - East Darfur

In East Darfur, the govenernment through the SMoH and National Health Insurance is managing more HFs,

more than 90% of all the facilities are managed by the government.

7 1 1

5

16

39

8 1

8

1

0

5

10

15

20

25

30

35

40

45

RH PHC BHU Mob Clinic

NGOs SMoH NHI

85% 91% 90%

15% 9% 10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Q1/Q2 2016 Q3/Q4 2016 Q1- 2017

Govt NGOs


4.3 Health Partners in East Darfur Table 13: Distribution of Functioning HFs in different localities in East Darfur State by managing and supporting Partners

State Locality


Management Support RH PHCC BHU Mob Clinic Total

East

Dar

fur

Abu Jabra

NHI NHI

1

1

SMoH

SMoH

7 6 13

SMoH, WHO 1

1

SMoH, WHO

1

1

Abu Karinka

NHI NHI

1

1

SMoH SMoH

4 1

5

Adila

ARC ARC

1 1 1 3

NHI NHI

1

1

SMoH

SMoH

1 4

5

SMoH, WHO 1

1

Assalaya

NHI NHI

1 1

2

SMoH

SMoH

1 6

7

SMoH, ARC

1

1 2

Bahr El Arab

Mobadiroon SMoH, WHO, UNFPA

1

1

NHI SMoH, WHO, UNFPA

1

1

NIDO WHO 1 1

SMoH SMoH 1 2 5

8

Ed Daein

ARC ARC, WHO

1

1

SMoH

Mobadiroon, WHO

2

2

SMoH

2 4

6

El Ferdous

ARC ARC,WHO,UNICEF

1

1

NHI NHI 1

1

SMoH SMoH

8 1 9

Sheiria

NHI NHI

2

2

SMoH

SMoH

1

1

SMoH, WHO 1 1

2

Yassin

ARC ARC

2

2

NHI SMoH

1

1

SMoH

SMoH

1 3

4

SMoH, WHO 1

1

Total 6 31 41 9 87

In addition to SMoH, 7 health partners work in East Darfur. Ed Daein locality has the highest presence with

6 partners, the rest of the localities have between one and three partners as shown in Table 13 above.


The total number of HFs managed by NGOs increased from 8 in the previous quarter to 9 currently.

ARC still managed the most number of facilities, 7 in total including 5 PHCCs, 1 BHU and 1 Mobile clinic.

Mobadiroon and NIDO on the other hand only manage one PHCC.



4.4 Health Personnel in East Darfur Health personnel are categorized as HF based staff (health staff working inside the HF) and community based staff

(the community staff working in the community in the same catchment area of the HF (i.e. village/camp)).


State

Locality


MO MA Nurse PHO MW Vacc Nut Staff

Lab Person CHW VV CHP TBA VTMW Total

East

Dar

fur

Abu Jabra 4 4 8 3 8 6 1 5 36 13 17 3 10 118

Abu Karinka 1 4 3 5 9 4 1 1 1 5 3 0 4 41

Adila 2 8 9 11 18 7 14 4 14 13 5 43 2 150

Assalaya 1 7 2 10 15 8 0 0 5 24 10 12 11 105

Bahr El Arab 3 9 6 2 14 16 10 11 9 30 9 4 6 129

Ed Daein 13 13 41 6 25 11 19 8 1 12 11 112 8 280

El Ferdous 0 11 12 3 11 7 6 3 11 30 8 10 19 131

Sheiria 2 2 8 0 16 3 4 2 7 0 4 3 9 60

Yassin 1 9 6 1 18 8 14 2 29 1 4 1 8 102

Total 27 67 95 41 134 70 69 36 113 128 71 188 77 1,116

Following an increase from 1,015 in Q4 2016 to 1,116 in Q1 2017, of these, 539 (48%) are facility based,

while the remaining 577 (52%) are community based.

As it was in the last quarter, Ed Daein has the highest number of medical personnel at 280 followed by

Adila with 150. Conversely, Abu Karinka has the lowest number of health workers at 41 personnel. As

shown in the Table 14 above.

5

1 1

1

1

0

1

2

3

4

5

6

7

8

PHC BHU Mob clinic

ARC NIDO Mobadiroon


Figure 27: Distribution of Medical Officers, Medical Assistants and Nurses by locality

Figure 28: Distribution of Midwives, Village Trained Midwives, and Traditional Birth Attendants by locality

4.4.1 Health Personnel Gap Analysis in East Darfur


In Rural hospitals, the minimum standard set is at least one Medical Officer, one Medical Assistant, at least three nurses, one Midwife, one Vaccinator, one Nutrition staff, one Public Health Officer and one Laboratory personnel. This is the bare minimum, more is recommended.

4 1 2 1 3 13

0 2 1

4 4

8 7 9

13

11 2

9

8

3

9

2

7

41

12

8

6

0

10

20

30

40

50

60

70

80

Abu Jabra AbuKarinka

Adila Assalaya Bahr ElArab

Ed Daein El Ferdous Sheiria Yassin

MO MA Nurse

8 9 18 15 14

25 11 16 18 3 0

43

12 4

112

10 3 1 10 4

2

10

6

8

19 9 8

0

20

40

60

80

100

120

140

160

Abu Jabra Abu Karinka Adila Assalaya Bahr ElArab

Ed Daein El Ferdous Sheiria Yassin

MW TBA VTMW


Minimum Standard: MO+ MA+ 3 nurses or more + MW+ Vaccinator+ Nutrition staff + PHO + Lab. Personnel

All the six RHs in East Darfur start improving for the minimum standards set by the MoH. Abu Jabra meet all

except they lack a nutritionist, Assalaya and Sheiria meet all but lack a PHO for Sheiria and lack of

nutritionist and Lab Personnel for Assalaya . still Ferdous RH they don’t have MO same as previous report.

Mohajrea and Abu Matarig face the worst challenge in medical personnel. Mohajrea lack a MO, the

required three nurses and a PHO. Meanwhile Abumatarig lack a MA, the required three Nurses and a PHO.

4.4.1.2 Primary Health Care Centres





Like RHs, the 31 PHCCs in East Darfur have various personnel gaps, the biggest of which is the limited

number of Laboratory personnel, nurses, PHOs and nutritionist.

Abu Matarig, Abu Matarig NHI, Abugabra, Alferdous, Hay Almatar and Saleah PHCCs have all the

recommended medical personnel for running such a facility. The rest have at least one or more staff

missing in one or all the standard categories.

As shown in Figure 29 below, 52% of PHCCs in East Darfur lack a PHO, the same percentage lack a

nutritionist, 19% required one or more additional nurses while 58% lack a laboratory technician. 29% lack

vaccinators and 16% lack a MA. As compared to last quarter reports, this indicates a little improve in

situation but still worse.

Figure 29: Gap of Health Personnel at PHCC Level in East Darfur

The percentages are calculated out of the total functioning PHCCs (31) in East Darfur




16% 19%

52%

13%

29%

52%

58%

0%

10%

20%

30%

40%

50%

60%

70%

MA Nurse PHO MW Vacc NutStaff Lab Person


Minimum Standard: MA, Nurse, MW, VTMW, Nutrition staff and Vaccinator

All the 41 BHUs in East Darfur fall short of the minimum staffing requirement in one or more field of

speciality. Of these, 20 BHUs (Abu Sendeirra, Abuood, Al Jugan, Allet, Elderiga, Elhuda, Fara Elhabeel,

Funga, Habella Altaror, Ruhel Boro, Ruhel Kalam, Ruhel Samaha, EL rayaan, Altaalba, Elmadkok Hammad,

Gazala gawazt, Kelekil Abusalam, Um Irg and Umelkhairat) don’t have any of the required medical

personnel for a BHU.

Four BHUs, Altaalba, Gazala Gawzat, Kelekit and Ruhel Senoon operate with the support of only one

VTMW. Likewise, Four BHUS (Abu Saeeda, Sunta Rumada, Um Waragat and Wester Route (Nomadic)

operate with the assistance of one MW each.

Figure 30: Gap of Health Personnel at BHU Level in East Darfur

The percentages are calculated out of the total functioning BHUs (41) in East Darfur

As presented in figure 30 above, at 93% each, Nurses and Nutritionists are the skills missing in a majority of

the BHUs. Vaccinators follow at 80%, VTMW at 78%, MAs at 68% and lastly MW at 51%.

4.5 EWARS reporting HFs in East Darfur

EWARS is an essential service for detection of any unusual disease trends and outbreaks of communicable

diseases in Darfur. The table below shows summary of the number of functioning HFs designated under

EWARS per locality.


Locality EWARS Designated Sites Total HFs % EWARS Designated Site

Abu Jabra 3 17 18%

Abu Karinka 0 6 0%

Adila 3 10 30%

Assalaya 1 10 10%

Bahr El Arab 3 11 27%

Ed Daein 4 9 44%

El Ferdous 3 11 27%

Sheiria 3 5 60%

Yassin 3 8 38%

Total 25 87 29%

68%

93%

51%

80%

93%

78%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



All the localities in East Darfur have at least one EWARS facility except Abu Karinka locality. However, only 25 (29%) of the 87 HFs are designated EWARS sites. Ed Daein locality has the highest number of HFs at 44%.

4.6 Provision of Minimum Basic Health package in East Darfur

The minimum set of services that should be basically provided by any HF, are:

Outpatient services






Percentage represents the percentage of HFs providing the MBHP out of the total functioning HFs

19% 17%

40%

27% 27%

55%

27%

20%

62%

0%

10%

20%

30%

40%

50%

60%

70%

Abu Jabra Abu Karinka Adila Assalaya Bahr El Arab Ed Daein El Ferdous Sheiria Yassin


5. West Darfur


HFs are classified into different standard categories based on the provision of services, staffing and population coverage; there are Rural

Hospitals (RH), Primary Health Care Centers (PHCC), Basic Health Units (BHU), and Mobile Clinics. The following table provides the distribution of

the existing health facilities (static and mobile); showing the number and percentage of the functional facilities out of total. See acronyms for the

initials used.

Table 16: Distribution of HFs in West Darfur by locality and facility type

The number of health facilities in West Darfur increased by 14 from 144 in the previous quarter to 158 currently after Seven BHU facilities

Constructed (Not yet handed over to WD SMoH) by Darfur Regional Authority (DRA), located in:

Two in Foro Baranga, One in Jeble Moon, One in Sirba , One in El Geneina , One in Beida and One in Kereink , the number of functional HFs

increased from 97 to 100 currently. The breakdown of the facilities (both functional and non-functional) includes 5 RHs, 54 PHCCs, 88 BHUs and

11 Mobile Clinics. All the RHs in West Darfur are functional, 80% of the PHCCs, 57% of the BHUs and 9% of the mobile clinics are functional.

Compared with the last quarter, increased were noted in the number of functional PHCCs and BHUs in Kereinik locality, no changes were noted

in the other localities. In Kerinik locality , the number of functioning PHCCs & BHUs increased by One PHC and Two BHUs .

State Locality

Rural Hospital PHCC BHU Mobile Clinic Total


We

st D

arfu

r

Beida 0 0 0% 5 9 56% 1 3 33% 0 2 0% 6 14 43%

El Geneina 0 0 0% 19 20 95% 10 12 83% 0 2 0% 29 34 85%

Foro Baranga 1 1 100% 2 5 40% 1 6 17% 0 0 0% 4 12 33%

Habila 1 1 100% 3 3 100% 3 8 37% 0 0 0% 7 12 58%

Jebel Moon 0 0 0% 1 1 100% 4 11 36% 0 2 0% 5 13 36%

Kereinik 2 2 100% 8 10 80% 16 25 64% 1 4 25% 27 41 66%

Kulbus 1 1 100% 1 2 50% 8 13 62% 0 0 0% 10 16 63%

Sirba 0 0 0% 4 4 100% 8 11 73% 0 1 0% 12 16 75%

Total 5 5 100% 43 54 80% 51 88 57% 1 11 9% 100 158 63%





facilities.

Of the 100 functioning HFs in West Darfur, 50 are managed by the government, 10 by NHI and 40 by NGOs.

The governments through SMoH manage all RHs in West Darfur and 16 PHCCs, 28 BHUs and only 1 Mobile

Clinic. NHI, a government agency on the other hand manage 8 PHCCs and 2 BHUs.

Figure 32: Distribution of HFs by management - West Darfur

Figure 33: Percentage of HFs by management - West Darfur

Government (SMoH and NHI) and NGOs continue to manage health facilities

As depicted in figure 33 above, the number of facilities managed by government and NGOs changed

marginally.

5

16

28

1

50

8 2

10

19

21

40

0

10

20

30

40

50

60

70

80

90

100

RH PHC BHU Mobile Clinic Total

SMoH NHI NGOs

63 69

59

37 31

41

0

10

20

30

40

50

60

70

80

Q1/Q2 2016 Q3/Q4 2016 Q1 2017

Govt(SMoH and NHI) NGOs


5.3 Health Partners in West Darfur Table 17: Distribution of Functioning HFs in different localities in West Darfur State by managing and supporting Partners

State Locality

Health Partners Health facilities

Management Support RH PHCC BHU Mob Clinic Total

We

st D

arfu

r

Beida

IMC IMC, WHO, UNICEF, UNFPA

4

4

SMoH

SMoH, UNICEF, WHO, UNFPA

1

1

WHO, UNICEF, UNFPA

1

1

El Geneina

IMC

IMC, WHO, UNFPA

1

1

IMC, WHO, UNICEF, UNFPA

1 2

3

NHI

NHI

5

5

SMoH, NHI, WHO, UNICEF, UNFPA

1

1

PORD

HRF, WHO, UNICEF, UNFPA

1

1


1

1

SMoH

NIDAA, SMoH, WHO

1

1

SMoH, UNICEF, WHO

1

1

SMOH, WHO

2 1

3

SMoH, WHO, UNICEF

1

1

SMoH, UNFPA, WHO, UNICEF

4 1

5


1

1

WHO, UNICEF, UNFPA

1 3

4

WR WR, SMoH, WHO, UNFPA

1

1

Foro Baranga

NHI NHI

1

1

SMoH

SMoH, SC, WHO, UNICEF, UNFPA 1

1

SMoH, SC, WHO, UNICEF, UNFPA

1 1

2

Habila

NHI NHI

1

1

SC SC, UNICEF, UNFPA, WHO

1

1

SMoH

SMoH

2

2

SMoH, WHO, UNFPA 1

1

SMoH, SC, WHO, UNICEF, UNFPA

1

1

WHO, UNICEF, UNFPA

1

1

Jebel Moon

CONCERN CONCERN, UNICEF, UNFPA

1 3

4

SMoH SMoH, WHO, UNFPA

1

1

Kereinik


4

4

ISRA ISRA, WHO, UNFPA

1

1

NHI NHI

1

1

SC SC, UNICEF, UNFPA and WHO

2

2

SMoH

CONCERN, WHO, UNICEF, UNFPA

1

1

SMoH

1 1

2

SMoH, UNICEF, UNFPA

4

4

SMoH, WHO

1 1 1

SMoH,MSF Swiss

1 1

2

SMoH, WHO, UNFPA

1

1

SMoH, WHO, UNFPA, SC 2

2

SMoH. WHO

1

1

WHO, UNICEF, UNFPA

1

1

WR WR, SMoH, WHO, UNFPA

1 3

4

Kulbus

SMoH

COSV, WHO, UNICEF, UNFPA

7

7

SMoH, WHO, SMoH

1

1

SMoH, WHO, UNFPA 1

1


1

1

Sirba


1 2

3

NHI NHI

1

1

SMoH

SMoH, UNICEF, UNFPA

1

1

SMoH, WHO

1 1

2

SMoH, UNFPA, WHO, UNICEF

1 1

2

WHO, UNICEF, UNFPA

1

1

WR

WR, SMoH, WHO, UNFPA

1

1

WR, WHO, UNICEF, UNFPA

1

1

Total 5 43 51 1 100


In addition to SMoH, 14 health partners work in West Darfur. Both El Geneina and Kereinik localities have

the highest presence with 9 partners each as shown in Table 17 above.


A total of 40 out of the 100 HFs in West Darfur are managed by NGOs. At 15 HFs, IMC (7 PHCCs and 8 BHUs)

manages the majority of HFs in the state. NNGOs ISRA and PORD manage one and two PHCCs respectively.

The other facilities manage between one and thirteen. The Figure 34 below shows the disaggregation of

the HFs managed by the NGOs.


5.4 Health Personnel in West Darfur

Health personnel are categorized as HF based staff (health staff working inside the HF) and community

based staff (the community staff working in the community in the same catchment area of the HF (i.e.

village/camp)).



State Locality MO MA

Nurse

PHO

MW

Vacc

Nut Staff

Lab Person

CHW VV

CHP TBA

VTMW Total

We

st D

arfu

r

Beida 1 9 17 2 30 8 18 2 6 24 6 89 132 344

El Geneina 17 42 58 9 59 36 26 16 28 36 29 120 84 560

Foro Baranga 5 7 18 2 8 7 10 3 4 2 4 3 9 82

Habila 5 7 25 4 17 7 9 3 7 1 7 0 8 100

Jebel Moon 0 4 5 4 14 5 4 1 5 4 5 1 1 53

Kereinik 7 23 52 5 81 37 24 6 27 27 23 78 108 498

Kulbus 1 12 11 9 5 12 10 2 10 19 10 5 14 120

Sirba 2 14 12 0 15 13 6 1 11 14 11 85 41 225

Total 38 118 198 35 229 125 107 34 98 127 95 381 397 1,982

The number of medical personnel working in West Darfur was increased from 1,495 in Q4/ 2016 to 1,982

currently Of these, 8,84 (45%) are facility based, while the remaining 1,098 (55%) are community based.

3

8 5

1

7

1 2 3

2

0

2

4

6

8

10

12

14

16

Concern IMC ISRA PORD SC WR

BHU Mob clinic PHCC


Kereinik has the highest number of health personnel at 498 followed by El Geneina with 560. While Jebel

Moon locality has the lowest number of staff 53.

As it was in the last quarter, the net 487 increase in medical personnel due to proper data collection done

during Q1-2017, The number of MOs increased by 4, MAs by One, nurses by 5, MWs by 63, Vaccinators by

1, Nutritionist by 19 and lab personnel by one, CHW by 10, VVs by 6, CHPs decreased by 214, TBAs by 344

and VTMW by 251, resulting to a net increase of 487.



5.4.1 Health Personnel Gap Analysis in West Darfur

Based on the HeRAMS data, gaps in health staffing has been analyzed against the local Health System Standards set by the Sudan’s Ministry of Health.

0

20

40

60

80

100

120

140

Beida El Geneina Foro Baranga Habila Jebel Moon Kereinik Kulbus Sirba

MO MA Nurse

0

50

100

150

200

250

300

Beida El Geneina ForoBaranga

Habila Jebel Moon Kereinik Kulbus Sirba

MW TBA VTMW


5.4.1.1 Rural Hospitals

In a RHs, the minimum standard set is at least one Medical Officer, one Medical Assistant, at least three nurses, one Midwife, one Vaccinator, one Nutrition staff, one Public Health Office and one Laboratory personnel. This is the bare minimum, more is recommended. Minimum Standard: MO+ MA+ 3 nurses or more + MW+ Vaccinator+ Nutrition staff + PHO + Lab. Personnel

The situation in all RHs in West Darfur remains the same as reported in the previous quarter. Of the five

HFs in West Darfur, two RHs (Kereinik and Morni) fall short of the minimum requirement. The gaps are in a

MO for Kerreinik RH and a MW for Morni RH. On the other hand, Forabaranga Town RH is best staffed,

surpassing the set minimum standards.






PHCCs in West Darfur have various personnel gaps, the biggest of which is the absence of PHO and

laboratory staff. Of the 43 functioning HFs, 72% and 58% don’t have a PHO and laboratory personnel

respectively. In addition, the number of nurses is below the standard (79% of HFs below the standard) but

all the facilities have at least one nurse.

The same facilities five PHCCs (Al Maglis, Ardamta HI, Kereinik, Mornei, Beida and Um Dowain HI) reported

in the last quarter meet the set standard for PHCCs. The rest are functioning with skeleton staff, the worst

of which is Kongi PHCC with only 2 nurse, one vaccinator , Ganderni PHCC with 2 Nurse , one vaccinator and

one Nutrition staff and Um Dalbaa with only two nurses and one vaccinator.

Figure 37: Gap of Health Personnel at PHCC Level-West Darfur

The percentages are calculated out of the total functioning PHCCs (43) in West Darfur


9%

79%

72%

12%

5%

23%

58%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

MA Nurse PHO MW Vacc Nut Staff LabPersonnel




Minimum Standard: MA, Nurse, MW, VTMW, Nutrition staff, Vaccinator

Of the 51 functioning BHUs in West Darfur, 12 meet the minimum to operate as a BHU, they are:- Azerni,

Condebi, Durti, Gokar, Hajar Assal, Rijil Kubri, Zeinah, Door Shari, Kongay, Adawie, and Muli BHUs. The rest

have gaps in one or more of the personnel category.

The biggest gap in BHUs is the absence of nutritional personnel. Twenty-eight (29) or 57% of the 51 BHUs

don’t have a nutritionist. Other gaps were identified in VTMWs, MWs, Nurses and Mas as illustrated in

Figure 38 below.

Furthermore, there gaps are in Abu Zer BHU and Sawani BHU which has only one vaccinator and one

VTMW for both of them . While Buri, and Masmagei BHU are managed by one nurse and one PHO .

Figure 38: Gap of Health Personnel at BHU level - West Darfur

The percentages are calculated out of the total functioning BHUs (51) in West Darfur

5.5 EWARS reporting HFs in West Darfur

EWARS is an essential service for detection of any unusual disease trends and outbreaks of communicable

diseases in Darfur. The table below shows summary of the number of functioning HFs designated under

EWARS per locality.


State Locality EWARS Designated sites Total HFs in the locality % EWARS

We

st D

arfu

r

Beida 3 6 50%

El Geneina 7 29 24%

Foro Baranga 3 4 75%

Habila 2 7 29%

Jebel Moon 0 5 0%

Kereinik 10 24 42%

Kulbus 1 10 10%

Sirba 4 12 33%

Total 30 97 31%

16% 18%

21%

12%

57%

31%

0%

10%

20%

30%

40%

50%

60%



All localities in West Darfur except Jabel Moon have EWARS designated sites, however, only 31% of the

facilities are EWARS designated sites. Foro Baranga locality has the greatest number of facilities, 75% with

EWARS designated sites.

5.6 Provision of Minimum Basic Health package in West Darfur

The minimum set of services that should be basically provided by any HF, are:

Outpatient services

EPI : routine immunization against all national target diseases and adequate cold chain in place




Figure 39: Provision of Minimum Basic Health package per locality

The graph above shows the percentage of facilities offering minimum basic health care services in each locality.

83% 83%

75% 71%

20%

70%

60%

83%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Beida El Geneina ForoBaranga

Habila Jebel Moon Kereinik Kulbus Sirba


6. Central Darfur

6.1 Distribution of Health facilities

Health Facilities are classified into different standard categories based on the provision of services, staffing and population coverage; they are Rural Hospitals (RH),

Primary Health Care Centers (PHCC), Basic Health Units (BHU), and Mobile Clinics. The following table provides the distribution of the functioning health facilities

(static and mobile); showing the number and percentage of the functional facilities out of total. See acronyms for the initials used.

Table 22: Distribution of HFs in Central Darfur by locality and type

Rural Hospitals PHCC BHU Mobile Clinic Grand Total

State Locality Func Total % Func Func Total % Func Func Total % Func Func Total % Func Func Total % Func

Ce

ntr

al D

arfu

r

Azum 0 0 0% 2 2 100% 5 6 83% 1 1 100% 8 9 89%

Bindisi 0 0 0% 3 3 100% 1 1 100% 0 0 0% 4 4 100%

Mukjar 1 1 100% 3 4 75% 0 0 0% 1 10 10% 5 15 33%

Nertiti 1 1 100% 14 14 100% 11 20 55% 6 6 100% 32 41 78%

Rokoro 1 1 100% 0 0 0% 5 22 23% 0 0 0% 6 23 26%

Umm Dukhun 0 0 0% 2 2 100% 2 4 50% 6 6 100% 10 12 83%

Wadi Salih 1 1 100% 8 8 100% 9 9 100% 0 0 0% 18 18 100%

Zalingei 1 1 100% 16 18 89% 3 6 50% 0 0 0% 20 25 80%

Total 5 5 100% 48 51 94% 36 68 53% 14 23 61% 103 147 72%

The number of health facilities in Central Darfur has increased from 142 in the previous quarter to 147 currently. Changes were recorded in the number of BHU which

increased from 66 to 68 and Mobile clinic from 10 to 14, driven by the creation of 2 BHU in Nertiti , at the same time Azum PHCCs decreased from 3 to 2 and adding a

Mobile clinic . An increase was recorded in the total number of mobile clinics from 19 to 23 as 4(Four) new mobile clinics became operational.

The 147 health facilities in central Darfur are distributed as 5 RHs, 51 PHCCs, 68 BHUs and 23 mobile clinics. Of the total 147 facilities, 103 or 72% are functioning a

slight increase from the 68% functioning in the previous quarter. All the five RH function while, 94% or 48 of the 51 PHCCs, 53% or 36 of the 68 BHUs and 61% or 14

of the 23 mobile clinics are functional.



Management of health facilities means the primary focal entity who takes charge of admission and providing

services to the patients. The below graph shows the respective entities that manage the health facilities.

Figure 40: Distribution of HFs by type and management - Central Darfur

Of the functional 103 HFs in Central Darfur, 43 are management by SMoH, 49 by NGOs and 11 by the NHI

shown figure 40 above. As compared to the previous quarter, changes in management only occurred in HFs

managed by NGOs. the PHCCs managed by NGOs are 29 same as the previous Quarter . In BHUs, the number

of HFs managed by NGOs increased from 3 (three) to 7 (seven) as compared to the last quarter. In Mobile

clinics, the number increased from 9 to 13, mainly in Nertiti locality where WR started operating 3 (Three)

mobile clinics.

Figure 41: Percentage of HFs by management - Central Darfur

5

12

25

1

43

7

4

11

29

7

13

49

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

RH PHC BHU Mob clinic Total

SMoH NHI NGOs

23%

42%

49%

77%

58% 51%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Q1/Q2 2016 Q3/Q4 2016 Q1 2017

NGOs Govt(SMoH and NHI)


After successive decreasesin the last three quarters, NGOs incerased the number of HFs they operate in

Central Darfur from 42% in the last quarter to 49% currently. This effectively reduces the facilities mangemed

by the government from 58% to 51% as indicated in Figure 41 above.

6.3 Health Partners in Central Darfur All HFs in Central Darfur are supported by SMoH, UN Agencies or both irrespective of the management the

facility. Conversely, National Health Insurance (NHI), a government entity only supports the HFs it manages.

Table 23: Distribution of Functioning HFs in different localities in Central Darfur State by managing and supporting Partners


State Locality Management Support RH PHCC BHU Mob Clinic Total

Ce

ntr

al D

arfu

r

Azum

HI HI 1 1

SC SC,WHO, UNICEF, UNHCR, UNFPA 1 1

SMoH SMOH, WHO 1 3 3

WR WHO OFDA 1 1

WR ,WHO OFDA 1 1

Bindisi

HI SMoH 1 1

IMC IMC, WHO, UNICEF 1 1

SMoH SMoH, WHO 1 1

SMoH, WHO, UNFPA, UNICEF 1 1

Mukjar

HI HI 1 1

IMC IMC, WHO, UNICEF, OFDA, SHF 1 1

SMoH SMOH, WHO, UNFPA 1 1 2

SRCs SRCs, SMoH, UNHCR 1 1

Nertiti

HI HI 1 1

IMC IMC, WHO, UNICEF 1 1

IRW

CHF 2 2

ECHO 4 4

IR Canada 2 1 3

SDC 3 3

SHF 1 2 3

NCA NCA,WHO, UNICEF, UNFPA 1 1

SMoH SMoH 5 5

SMOH, WHO, UNFPA 1 1

WHO, SMoH 2 2

WR WR ,WHO OFDA 3 3 6

Rokoro SMoH

SMoH 3 3

SMoH, UNICEF 1 1

SMOH, WHO, UNFPA 1 1

WHO, SMoH 1 1

Umm Dukhun

HI HI 1 1

IMC IMC, SMoH, WHO, UNICEF 2 5 7

SMoH SMOH, WHO, UNFPA 1 1

WHO, UNICEF, UNFPA 1 1

Wadi Salih

HI HI 2 1 3

IMC IMC, WHO, UNICEF 1 2 3

SMoH

NCA, WHO, UNICEF, UNFPA 1 1

SMoH 1 1

SMOH, WHO, UNFPA 1 2 3

SMoH, WHO, UNICEF 1 1

SMoH, WHO, UNICEF, UNFPA 1 1

WHO, UNICEF, UNFPA 2 2

WHO, UNICEF,UNFPA 3 3


Zalingei

Al Massar WHO, SMoH 1 1

HI HI 3 3

IMC IMC, WHO, UNICEF, SHF 5 5

NCA NCA, WHO, UNICEF, UNFPA 3 3

SC SC, WHO, SMoH 1 1

SMoH

SMoH 1 1 2

SMoH, UNICEF, UNFPA, WHO 2 2

SMOH, WHO, UNFPA 1 1 2

WHO, SMoH 1 1

Total 5 48 36 14 103


Of the 103 functioning HFs in Central Darfur, 49 are managed by NGOs (47 by INGOs and 2 by NNGOs). IMC

manages 18 HFs (11PHCCs, 2 BHUs, and 5 Mob Clinic) followed by IRW managing 15 HFs (12 PHCCs and 3

Mob Clinics) and NCA manages 4 PHCCs while SC manages 1 PHCC and 1 BHU. NNGOs Al Massar manage 1

PHCC and SRCS manage 1 Mob Clinic respectively, refer to figure 42 below.

Figure 42: Health partners managing HFs and types

6.4 Health Personnel in Central Darfur

Health personnel are categorized as HF based staff (health staff working in the HF) and community based

staff (the community staff working in the community in the same catchment area of the HF (i.e.,

village/camp)).

The number of medical personnel working in Central Darfur increased from 2,461 in the last quarter to 2,776

currently. Of these, 1,733 or 62% are community based while 1043 (38%) are based at the health facilities.

The biggest increase was recorded in Umm Dukhun locality where the number of health workers increased

from 161 in the previous quarter to 274 currently.

1

11 12

4 1

2

1

5

3

1 0

4

8

12

16

20

Al Massar IMC IRW NCA SC SRCs

PHCC BHU Mob Clinic




State Locality MO MA Nurse PHO MW

Vacc

Nut Staff

Lab Person

CHW VV

CHP

TBA

VTMW Total

Ce

ntr

al D

arfu

r

Azum 1 9 14 2 15 10 5 2 6 14 32 21 13 144

Bindisi 0 5 14 1 6 17 4 4 12 36 3 33 3 138

Mukjar 2 8 12 3 7 15 18 3 1 65 28 42 10 214

Nertiti 4 33 48 3 43 31 33 18 21 26 228 187 110 785

Rokoro 1 7 11 0 10 7 0 1 9 12 0 0 5 63

Umm Dukhun 1 9 22 1 29 14 61 1 4 2 8 120 4 276

Wadi Salih 3 17 70 4 48 24 28 7 20 34 132 63 22 472

Zalingei 12 35 105 3 45 26 38 13 78 42 71 177 39 684

Total 24 123 296 17 203 144 187 49 151 231 502 643 206 2,776

Nertiti locality has the highest while Rokoro locality has the lowest number of staff members in all categories

as depicted in Table 23 above.



0

20

40

60

80

100

120

140

160

Azum Bindisi Mukjar Nertiti Rokoro UmmDukhun

Wadi Salih Zalingei

MO MA Nurse

0

50

100

150

200

250

300

350

400


Wadi Salih Zalingei

MW TBA VTMW


6.4.1 Health Personnel Gap Analysis in Central Darfur


In a Rural hospital, the minimum standard set is at least one Medical Officer, one Medical Assistant, at least three nurses, one Midwife, one Vaccinator, one Nutrition staff, one Public Health Office and one Laboratory personnel. This is the bare minimum, more is recommended. Minimum Standard: MO+ MA+ 3 nurses or more + MW+ Vaccinator+ Nutrition staff + PHO + Lab. Personnel

Based on HeRAMS data, four (4) of the 5 RHs in Central Darfur meet this minimum standards. Zalingei RH

performs better that all RHs in the state because it has at least five folds (12 MOs, 35 MAs, 105 Nurses, 45

MWs, 26 Vaccinators, 3 PHOs, 38 Nutrition Staff and 13 laboratory personnel) more than the minimum

standard.

Golo RH is the only facility which doesn’t meet the bare standard; the facility lacks a PHO and a nutrition

staff.


The minimum standard set for a PHCC is at least one Medical Officer, one Medical Assistant, two Nurses, one

Midwife, one Vaccinator, one Nutrition staff and one Laboratory personnel. This is the bare minimum, more

is recommended.


PHCCs in Central Darfur have various personnel gaps, the biggest of which is the absence of a PHO and

laboratory personnel. Only sex of the facilities has a PHO and 24 have Laboratory personnel.

Of the 48 functioning PHCCs, Only Deleig, PHCC have the required number of staff meeting the minimum

standard above.

Medical Assistants are available in all the PHCCs except Kabar and Moradaf PHCCs. Mukjar has four MAs.

Figure 45: Gap of Health Personnel at PHCC Level – Central Darfur

The percentages are calculated out of the total functioning PHCCs (48) in Central Darfur

4%

44%

87%

2% 4% 10%

48%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

MA Nurse PHO MW Vacc Nut Staff LabPersonnel



The minimum standard set for a BHU is at least one Medical Assistant, one Nurses, one Midwife, one VTMW,

one Nutrition staff and one vaccinator. This is the bare minimum, more is recommended.

Minimum Standard: MA, Nurse, MW, VTMW, Nutrition staff, Vaccinator

As it was in the previous quarter, the biggest gap in BHUs still remains the absence of nutritional personnel.

Only 9 of the 33 functioning BHUs have a nutritionist. Furthermore, the absence of VTMW has come up this

quarter, only 10 BHUs have one VTMW.

Of the 36 functioning BHUs, Al Salam, Abdowi, Noor El salaam, Mali, Nertiti Center8, Jabal Ahmer and Ordi

meet the minimum requirement for a BHU.

The table below shows the gap in each speciality in BHUs.

Figure 46: Gap of Health Personnel at BHU level - Central Darfur

The percentages are calculated out of the total functioning BHUs (36) in Central Darfur

6.5 EWARS reporting HFs in Central Darfur

EWARS is an essential service for detection of any outbreaks of communicable diseases. The table below

shows summary of the number of functioning HFs designated under EWARS in Central Darfur per locality.


State Locality EWARS % EWARS Total HFs

Cen

tral

Dar

fur

Azum 2 25% 8

Bindisi 2 50% 4

Mukjar 1 20% 5

Nertiti 2 6% 32

Rokoro 0 0% 6

Umm Dukhun 0 0% 10

Wadi Salih 6 33% 18

Zalingei 11 55% 20

Total 24 23% 103

8% 6%

14%

8%

64%

28%

0%

10%

20%

30%

40%

50%

60%

70%



Generally, out of a total 103 HFs in Central Darfur, 24 have functioning designated EWARS facilities (mostly

PHCCs & BHUs). The relative percentage by locality indicates that Zalingei has the highest coverage with 11

out of 20 (55%) HFs are EWARS sentinel sites. Followed by Bindisi with 2 out of the 4 (50%) HFs are EWARS

sentinel sites. The other localities have less than 50% of facilities as EWARS sentinel sites.

Rokoro and Umm Dukhun locality have no EWARS facilities.

6.6 Provision of Minimum Basic Health package in Central Darfur

These are a set of minimum services that should be provided by all HFs, they are:-

Outpatient services

EPI : routine immunization against all national target diseases and adequate cold chain in place

Antenatal care: assess pregnancy, birth and emergency plan, respond to problems (observed and/or

reported), advise/counsel on nutrition & breastfeeding, self-care and family planning, preventive

treatment(s) as appropriate.

Figure 47: Provision of Minimum Basic Health package per locality - Center Darfur

*% represents the percentage of HFs providing the MBHP out of the total functioning HFs.

Of all the HFs in Umm Dukhun and Zalingie 80% offer the minimum basic health care package. Conversely, only 17% of

the health facilities in Rokoro provide this package.

50% 50%

40%

62%

17%

80%

67%

80%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%


Wadi Salih Zalingei


Annex - : List of Health Partners working in Darfur per State

State Partner Initials Partner Name C

ENTR

AL

DA

RFU

R

NHI National Health Insurance

IMC International Medical Corps

IRW Islamic Relief Worldwide

NCA Norwegian Church Aid

SCS Save the Children Sweden


SOHA SOHA

SRCS Sudanese Red Crescent

EAST

DA

RFU

R NHI National Health Insurance

ARC American Refugee Committee international


NO

RTH

DA

RFU

R

Al Massar Al Massar

Anhar Anhar

Ayadi Elrahma Ayadi Elrahma

BVO Bagiyat Voluntary Organization (BVO)

CDO Community Development Organization (CDO)

GOAL GOAL

HAD Humanitarian Aid and Development


MSF-E Medicines Sans Frontiers – Spain

KPHF Kuwaiti Peoples’ Helping Fund

RI Relief International

SAKAR Sakar


Um Elrahma Um Elrahma

ZULFA (ZDPO) ZULFA Development and Peace Organization (ZULFA)


SOU

TH D

AR

FUR

ARC American Refugee Committee international

CIS Care International Switzerland


IOM International Office for Migration

KPHF Kuwaiti Patient’s Helping Fund

Muslim aid.UK Muslim aid.UK

NCA Norwegian Church Aid

NIDO NIDO

RHF Rufaida Health Foundation


SRCS Sudanese Red Crescent

WVI World Vision International

WES

T D

AR

FUR

CONCERN CONCERN


PORD Peace, Relief and Development Organization


ISRA Islamic Relief Agency

SCS Save the Children Sweden


WR World Relief

Note: 1. UN Agencies, UNAIDS, UNHCR, UNICEF, UNFPA provide technical and logistical assistance in all the

states and localities.

2. The list above only includes organization who manage health facilities

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