[allAfrica.com] [The_Leon_H._Sullivan_Summit_Dinner] USAID Program Aims to Save Families in War-Ravaged Sudan United States Department of State (Washington, DC) NEWS June 2, 2004 Posted to the web June 3, 2004 By Charles W. Corey Washington, DC Improving the health and saving the lives of the children, mothers and families living in war-ravaged southern Sudan is the goal of the Sudan Health Transformation Program, which was recently announced by U.S. Agency for International Development (USAID) Assistant Administrator for Global Health E. Anne Peterson when she toured selected parts of the region. The $34 million, five-year program, according to Dr. Peterson, seeks to transform U.S. humanitarian health assistance to southern Sudan from simply providing emergency-based treatment for medical maladies to improving the long- term sustainable health of the southern Sudanese people, whose health status is among the poorest globally. The program's focus will be Eastern and Western Equatoria, Upper Nile, Southern Blue Nile, Bahr el Ghazal and the Nuba Mountains. Extremely poor nutrition due to the country's decades-long civil war has exacerbated disease epidemics, including malaria, diarrhea and respiratory infections, resulting in high child-mortality rates. "By no means has there been a concerted, overarching health system" operating in southern Sudan, Peterson told the Washington File in a recent interview after returning from the region. "There aren't any drugs, there aren't any roads, there are barely any intact clinics," she said. "We saw two hospitals that barely are [functioning] and ... diseases are getting worse. We know that malaria and TB [tuberculosis] are getting worse, the diarrheal diseases -- they had an Ebola outbreak last week. ... On every health care indicator we have been concerned about they have gotten worse, not as bad as if the NGOs [nongovernmental organizations] had not been there, but we need to transform their entire health system. ... Some kind of government entity needs to actually implement services and policies and then link in the NGOs and private providers that are in there," she said. Peterson, a medical doctor with a specialty in public health and preventative medicine, identified southern Sudan's number one health goal as building access to health care, followed by enhancing the capacity of the health care system. She said she came away from the region with measured optimism about what can be accomplished there. "I was very impressed with the southern Sudanese health sector leadership. They understand Sudan's health problems. They understand what is not working, what is broken and what they don't have. They understand what they need to have to put together a health system. ... They know what they want -- like every child immunized -- but they don't necessarily know what it takes to put a system together -- the staffing that you need, the policies and the structures. "These guys [the health care leaders] were very impressive and understanding of what it will take to put a system together and asked the right and hard questions about what the donors could be bringing in to help them put that system together," she said. "If we want to make the most difference very quickly," Peterson stressed, basic health care is needed throughout the region, starting with safe water, improved sanitation and a focus on HIV/AIDS education programs. "As Sudan, hopefully, moves into a peace process, one of the big issues" of concern, she said, "is the large number of Sudanese who are outside of southern Sudan and are expected to be crossing borders from high-prevalence AIDS areas back into Sudan -- bringing AIDS with them." With lots of people and commerce coming in, she warned, there is the tendency to spread diseases. The peace process to which Peterson referred includes the May 26 signing of three protocols by the government of Sudan and the Sudan People's Liberation Movement. Taken together, these protocols, with the agreements reached previously, resolve the outstanding substantive issues that were at the heart of Sudan's civil war. Peterson said Sudanese health officials have told her they see HIV/AIDS as the country's second war. "They want to address it now before it spreads in southern Sudan. That was very, very heartening to hear that kind of political leadership that can be so transforming for HIV/AIDS," she said. Peterson said the biggest and most immediate health care issue she saw in southern Sudan was malaria, which is "probably the largest killer," followed by a lack of clinics. "There are no clinics. The hospitals don't have running water, there are no people to staff them and there is nothing inside them." Asked how this program for southern Sudan compares to other USAID medical programs, Peterson said: "The problems are going to be similar, the prevention strategies are going to be similar. We are going to need to get clean drinking water and immunization in there and malaria bed nets and treatment. "What is different [in Sudan] is that you are starting with nothing essentially. Normally, we have some amount of an existing public sector with a government with central policies and a ministry of health and district hospitals and clinics and trained nurses ... but here you have almost nothing. ... "We just have little spots of NGOs working -- doing great work in different areas in very adverse circumstances -- that are only able to cover small amounts [of territory]. ... There are no roads. You can't get from one place to another ... so all of those things make things much more difficult." In southern Sudan, she said, the health care infrastructure must be put together from nothing, "so deciding how centralized and decentralized" must take place, as well as determining how many clinics in each province, staffing levels, etc. "They are starting with all that, essentially, as a blank slate ... and that is unusual." One of the few other places where somewhat the same conditions existed was in Afghanistan, she explained. Peterson said she had just traveled to Afghanistan before going to Sudan. "There are some real similarities there," she noted -- "two crisis countries that had been decimated and did not have anything that were putting together their whole health care system from scratch [nothing]. ... "What was very heartening, going from one to the other, was seeing two years out how much progress has been made, at least in certain parts of Afghanistan," she said. "They [the Afghans] had strong leadership and they are implementing the kinds of programs that we are going to be doing in Sudan. "We have been doing a lot of health systems work with the Ministry of Health in Afghanistan and already at two years, when I went and talked to the people in the villages and the leaders, they said: 'Now there are clinics, now our children are getting services. Our mothers are doing better when they are pregnant and our babies are not dying anymore.' "That is part of the message that I could bring when I went to Sudan ... that this is a little bit like putting back together Afghanistan. ... I have just seen where Afghanistan is two years down the road and it is good. ... It is hopeful. It is not perfect, it is still building, but Sudan can go in this direction, and you have the right leadership to guide you that way." (The Washington File is a product of the Bureau of International Information Programs, U.S. Department of State. 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