combating hiv.aids, malaria and tuberculosis in the arab world

Report
The London Conference for better health services
in Southern Sudan
Lecture Theatre 1, Sir Alexander Fleming Building.
The Imperial College, South Kensington Campus. London.
July 14th & 15th 2005
&
The London International Conference
To Start the Process for a Health Development Plan for Dar Fur, Sudan
1st – 3rd March 2010
Brunei Gallery Lecture Theatre
School of Oriental & African Studies (SOAS)
----------------------------------------------------------------------Prof. Mohamed Elfatih Baraka
Presented to SDU meeting 17.6.2012
British & American Friends of Southern Sudan
(BAFOSS)
The London Conference for better health services
in Southern Sudan
Lecture Theatre 1, Sir Alexander Fleming Building.
The Imperial College, South Kensington Campus. London.
July 14th & 15th 2005
Dr. John Garang said:
“It is up to the North to make unity
attractive to people in the south.”
And
that is what I have tried to do
It does not look nice at all…..
Dr Zachariah Bol-Deng
Represented: The 1st Vice President of the
Sudan Dr John Garang De Mabior
Dr J.G. De Mabior vision when he addressed the people upon his return
to Khartoum in 2005:
 Access to clean water and food for all
 Mother and child care, including vaccines available to all.
 Providing methods of preventing and treatment of major diseases
like malaria, diarrhoeal diseases, TB, H.I.V/aids, leishmaniasis,
schistosomiasis, trypanasomiasis and other major killers in one
country.
 Encouraging health education, not only in schools but for all adults
especially women.

BAFOS London Conference for better health services
in Southern Sudan (July 14-15, 2005)
Dr. Omer Sulieman M. Omer
Consultant WHO advisor
Community –based comprehensive
health strategy for
Southern Sudan.
HEALTH SYSTEM & HEALTH CARE IN FUTURE
SUDAN:
CASE STUDY OF SOUTHERN SUDAN
Dr. Mustafa Khogali
July, 2005
LONDON
Objectives




To address key health challenges and barriers.
To provide a useful framework based on MDGs and
its indicators.
To provide and explore options on the basis of new
goals for Health System (in NS and SS)
To outline priority areas.
Recommendations

H. Secretariat of SS:
1.
Should not promise to deliver more than it can
2.
Review priorities of the Basic health Service
Package to be provided comprehensivley through
a team.
3.
Develop a schedule for phasing its components
4.
Outline clear policy guideline for combating the
communicable diseases specially Malaria, TB &
HIV/AIDS
5. Enhance Community Participation at all
level.
6. Review carefully the place of specialized
vertical programs.
7. Establish a functional HIS.
8. Develop a research agenda.
Health Services in
Southern Sudan
Where to start &
which way
forward?
Prof Hassan Bella
College of Medicine
King Faisal University
Saudi Arabia
The Wish
Carol Bellamy
Director General, UNICEF
“The day will come when nations will be judged
Not by their military or economic strength;
Nor by the splendour of their capital cities & buildings,
But by the well being of their people,
By their levels of health, nutrition & education,
By their opportunities to earn a fair reward for their labours,
By their ability to participate in the decisions that affect their lives,
By the respect that is shown for their civil & political liberties,
By the provision that is made for those who are vulnerable &
disadvantaged, &
By the protection that is afforded to the growing minds & bodies of
their children.”
Health in Post Conflict Southern
Sudan
Reasons for Hope _ _ _ _ _ _ _
Mamoun Homeida,
Academy of Medical Sciences and Technology.
The London International Conference on the Establishment of Better
Health Services in Southern Sudan.
London 14-15 July 2005
Humanitarian Impact of the
War in Sudan

2 million people killed

4 million displaced

¼
million
child soldiers

½
million
street children

War traumatized victims (phys / Psych.)

Dramatic increase in women – headed
households
Trachoma
Trypanosomiasis
750,000 patients
Where are the tsetse flies in Sudan?
Distribution of tsetse flies
Onchocerciasis
The Way Forward




Many meetings, conferences, held on behalf of the
Sudanese. In Michigan, Nairobi, London (RCP –
December 2004), London July 2005 Efforts to be coordinated by the National Ministry of
Health, OR Ministry of Health in SS. (Khartoum –
Rumbuk – Juba)
Preliminary strategic plan for health should be laid
down based on the scattered data on
prevalence/morbidity/mortality of diseases.
Partnership with NGDOs, UN agencies private
sector should be created to cater for different
sectors of the region or diseases but avoid vertical
approach for control of diseases.



All activities should be lead/spear-headed by the
National Ministry of Health / in full Ministry of Health
GOSS.
Full utilization of National resources in the country
especially in relation to human resources
Community participation and empowerment to
maintain a sustainable health care delivery. Disease
control programmes should be a response to
problems perceived by the communities and they
must be carried out in a way which is acceptable to
the community members.
(We have an excellent example in CDTI (onchocontrol)
BAFOSS conference on establishment of
better health services in Southern Sudan
July 14 and 15 2005
A call to target infectious
and parasitic diseases
A. Fenwick, D. Molyneux and P. Hotez
Presented by
Professor Alan Fenwick
Department of Infectious Disease Epidemiology
Imperial College
London
Imperial College London
24
The Neglected Tropical Diseases
There are 13 Tropical Infections to be considered.
They ….
 afflict the poor and powerless
 are in rural areas of low-income countries
 cause immense suffering and life-long disabilities
 impair childhood growth and development
 promote poverty and impair education and
economic development
 do not receive appropriate attention and funding
(unlike HIV/AIDS, TB, Malaria)
 do not support commercial markets for drugs or
vaccines
25
Imperial College London
Onchocerciasis
Lymphatic Filariasis
Guinea Worm
Schistosomiasis
Trachoma
4.2 billion people in 142 countries
27
Imperial College London
Addressing the Poverty Agenda
The Millennium Development Goals
MDG 1:
MDG 4:
MDG 5:
MDG 6:
MDG 8:
Eliminate extreme poverty and
hunger
Reduce child mortality
Reduce maternal mortality
Combat HIV/AIDS,TB and
Malaria and other diseases
Develop a global partnership
for development
In line with recommendations from
the Commission for Africa


Donors should ensure that there is adequate
funding for the treatment and prevention of
parasitic diseases and micronutrient
deficiency.
Governments and global health partnerships
should ensure that this is integrated into
public health campaigns by 2006.
*Priority Health Care Package
For Post-war South Sudan*
Presented by:CONSTANTINE JERVASE YAK
Associate Professor
Department of Surgery
Faculty of Medicine
The Academy of Medical Sciences &
Technology
Khartoum - Sudan
RESOLUTIONS


That the Government Of South Sudan
(GOSS):Must first demonstrate the political will
necessary to develop an effective health
care system, at affordable costs, and with
accessible services distributed equitably
within its community.
On Health Care System:
That the only working health care system in
South Sudan is the Primary Health Care,
having been earlier launched successfully
during the peaceful times. Its proper
implementation should be able to ensure
the presence of a health facility (PHCU) in
every village, with a strong community
involvement and a proper ladder-pattern
referral system.
On Preventive Medicine:
That Health promotion and disease
prevention should form the basis for
medical services as they relate to wider
local and national communities. If we
are to contribute effectively to the
urgent needs of our beleaguered
people, we cannot merely transfer and
apply
elaborate
curative
medical
technology. This would be inappropriate
because it distracts from their basic
public health needs.
On Health Training Institutions:
Relocation of the high institutes
of education, now stationed in
North Sudan, back to South
Sudan, and the creation of much
more needed health training
facilities of other categories.
HEALTH FACILITIES
AND HEALTH MANPOWER
IN THE SUDAN:
PROBLEMS AND PROSPECTS
The London International Conference on the
Establishment of Better health services in
Southern Sudan: July 14-15, 2005
Professor Ahmed Bayoumi:
DPH, MD, FFPHM, FACTM
Professor of Health Care Epidemiology
Medical and Research Centre (MRC)
Table 2: Health facilities by region
Region
1. Northern
2. Eastern
3. Central
4. Khartoum
5. Kordofan
6. Darfur
7. SS
Total
SH GH RH HC
RD
Total
%
2
5
48
194
225
474
18.8
5
8
38
98
158
307
12.2
10
13
54
250
474
801
31.8
19
13
7
131
161
331
13.2
2
5
24
94
177
302
12.0
1
6
22
44
130
203
8.1
0
16
1
40
40
97
3.9
39
66
194
851
1365
2515
100.0
The Burden of Trachoma in
Southern Sudan
Photo by: J.Ngondi
15th July 2005, London
By: Dr. Jeremiah Ngondi
Onchocerciasis
Control in South
Sudan
Dr Adrian D. Hopkins M.R.C.Ophth., D.O., D.T.M&H.
Dr Sansom Baba M.D., M,P.H.
Mr Fasil Chane. Ad Dipl: Env. Sc.
VISION 2020
A plan for blindness
prevention in South Sudan
Dr Adrian D. Hopkins M.R.C.Ophth., D.O., D.T.M&H.
Ms Marcia Zondervan R.N., D.T.M&H., D.C.E.H., M.B.A.
Dr Sansom Baba M.D., M,P.H.
BAFOSS International Conference- London 14/7-15/7/2005
Post-conflict Response to HIV/AIDS
Epidemic in Southern Sudan





Isam M A Salam
Elwathig Bellah Ali Mohamed
Siham Gaber
Mohamed Sidahmed
Constantine Jervase Yac
Tribal Teeth Extraction
A Custom Prevalent
Amongst the The Dinka &
Neur Tribes
By Dr Lena Baraka BDS
15.07.05
London
BAFOSS
41
Why attention to reproductive
health is vital to the future of
Sudan?
Dr. Nahid Toubia
President & CEO
RAINBO
Health and Rights for African Women
www.RAINBO.org
A REALISTIC STRATEGIES FOR SHAPING
HEALTHIER FUTURE OF SOUTHERN
SUDAN: “CHALLENGE TO THE MEDICAL
SCHOOLS OF THE SOUTH”.
PROFESSOR ELBAGIR ALI A. ELFAKI
MBBS.FRCS.FRCSI.FACS.
Faculty of Medicine & Medical Sciences
UMM-Al-qura University , Makkah, Saudi Arabia.
A Floating Laboratory
Along the White Nile
A recommendation from The BFOSS conference for the
development of better health services in Southern Sudan.
Held in London July 2005.
Background
Welcome
Floating
Laboratory
Suggested
Routes
1. Malakal-Juba
2. Malakal Nasir
John Angul, Minister of
Health
And the personal envoy of Omar AlBashir,
to the conference:
Announced that he will fund the project
!!!
Conference recommendations:
The recommendations are grouped according to
the five areas of key challenges:

Health system and Health Service Delivery:
–
–
–
–
–
–
–
–
–
Review priorities of the basic health service package to be provided
comprehensively through a team.
Preliminary strategic plan for health should be laid down based on the scattered
data on prevalence/ morbidity/ mortality of diseases.
Establish a functional Health Information System.
All activities should be lead/spear-headed by the National Ministry of Health/ in full
Ministry of Health GOSS.
Enhance community participation and empowerment to maintain a sustainable
health care delivery.
Partnership with NGOs, UN agencies private sector should be created to cater for
different sectors of the region or diseases. It is sensible to avoid “vertical” approach
for disease control, but eradication of polio and Guinea worm disease require
special prioritization and urgency.
PHC to be addressed and improved in a wider framework of integrated rural
development strategy with intersectoral collaboration.
Stakeholders should prepare to cope with expected demanded services.
Establish/strengthen partnerships within Health authorities/ community, health
related sectors and NGOs.
– Early involvement of health authorities, other sectors &
the community.
– We should think of regulatory bodies from day one.
– Improvement of the poor coordination of the hospitals in
SS for a better service delivery.
– Simple structures can be defined and must be defined to
ensure that patients receive the best possible medical care
with available resources.
– Consider Reproductive health as an essential health care
component.
– Develop a research agenda.
– Build research capacity for control of tropical diseases in
the south of Sudan.
– Develop or create research institutions in SS.
2. Infections and Endemic Diseases

Epidemiological baseline data is needed across SS for all diseases so that treatment
programmes and drug delivery can be planned.
– Maps of endemic diseases, STIs and HIV/AIDs should be constructed.
– Review carefully the place of specialized vertical programs
– Outline clear policy guidelines for combating communicable diseases especially
Malaria, TB & HIV/AIDs.
– The development of appropriate strategies for targeted disease control integrated
into the developing PHC structure.
– Support the VISION 2020 approach to prevention of avoidable blindness and
encourage the development of the SS programme through VISION 2020 goals and
coordination with the VISION 2020 plan already prepared by GOS. Development of
VISION 2020 Links Programme for support in training.
– Partnerships be fostered to include all stakeholders in technical and financial
support of the VISION 2020 programme.
– Strengthen the mapping of trachoma in Southern Sudan and apply SAFE strategy in
all endemic areas through the Primary Care component of PHC.
– Onchoceriasis: Continued development of the 5 APOC projects and integration as
soon as possible of the former programmes in GOS/SPLA areas of SS.
– HIV/AIDs is potentially explosive as the displaced and possibly infected
persons return to SS. Surveillance is essential and ARVs are urgently
needed.
– Scaling up activities in Juba to prevent the spread of HIV/AIDs by
implementing behavior and attitude changes in the general population.
– Onchoceriasis: Continued development of the 5 APOC projects and
integration as soon as possible of the former programmes in GOS/SPLA
areas of SS.
– HIV/AIDs is potentially explosive as the displaced and possibly infected
persons return to SS. Surveillance is essential and ARVs are urgently
needed.
– Scaling up activities in Juba to prevent the spread of HIV/AIDs by
implementing behavior and attitude changes in the general population.
– Advocate increased collaboration between human and veterinary medical
programs in addressing 200 NCD e.g TB, Trypanosomiasis and
Brucellosis.
– The fight against HIV/AIDs should be started in other towns in the
Southern Sudan.
– Collaboration with Uganda should be mandatory to benefit from their
experience in keeping the epidemic at controllable level.
– Coordination of four drug distribution initiatives and combine them to
reduce costs and prices of drugs.
– Purchase of CD4 cells counter and antiretroviral drugs should be availed
as this will encourage voluntary testing & control thereafter.
– Concerted efforts are needed to identify and contain sources of Guinea
Worm infection and polio so this scourge can be eradicated quickly.
– Encouragement and establishment of the laboratories as basis of
diagnosis.
– Standardization and development of Floating Laboratories & clinics
– Critical need for more and safe blood in all areas of Sudan.
– The Southern Sudanese government must acknowledge and work
tirelessly to halt any HIV/AIDs epidemic.
– Create a research environment for control of tropical diseases.
– R & D essential for evidence based policy for control of tropical diseases
should be included in long term health plans for SS.
– We have tools to improve health by treating parasitic infections. We
should use them without delay.
3. Health Expenditure
– Financial support should be shared
between the government of SS,
international donors and NGOs.
– Engage private enterprise, with
corporate social responsibility to
participate in effective health care
delivery.
– Let’s budget for each
recommendation.
4. Human Resources
– Full utilization of National resources in the country especially in relation to
human resources.
– Capacity building to be supported by experts in Sudan and international
institutions.
– Move the medical schools of Juba, Upper Nile and Bahr El Ghazal
universities to the south as soon as possible.
– Strengthening and supporting the capacity of the 3 universities in SS to
train medical personnel to assist in the improvement of health services in
the area and oversee the training of other health cadre.
– Medical Schools should have strong community based curriculum.
– Coordination body/board to formulate curricular priorities of all health
schools and medical and coordination and facilitate the team work with
early clinical and community work.
– Primary health care approach should be the only approach to start with
based on multidisciplinary, interdisciplinary and multi-sectoral.
– Field training for students should have a high priority (strong emphasis)
– Curriculum of all health schools (Medical and Health allied)
– Twin-ship with medical schools in northern Sudan.
5. Disparity
– Health delivery will be very much
facilitated if the returnees were
gathered in groups such as villages
instead of unplanned return.
– Try to distribute health care
equitable between rural and urban
and between the regions of Sudan.
Priorities:










Establishment of realistic goals & objectives.
Careful, evidence-based prioritization of activities.
Development and implementation of a comprehensive approach, as
well as management at all levels through team work.
Development of efficient information system to allow monitoring at
all levels.
Active Community Participation/Empowerment
Establishment of Public Health Schools. They are critical and
essential to the development of knowledge about health of
populations and for training and capacity building.
Reallocation of the 3 medical schools back to Southern Sudan.
Establishment of laboratory services in SS will be of great importance
in protecting public health.
Collaboration of the government, the NGOs, universities of SS private
sector and the international donors are needed to provide better
health services.
Strong emphasis on operational and applied research.
BMJ 2005;331:179
NEWS ROUNDUP:
Peter Moszynski
Conference plans
rebuilding of Southern
Sudan's health services
[Full text]
Rapid Responses published:
Establishment of better health services in Southern
Sudan after the signing of the peace agreement
Mohamad Baraka, Mustafa Khogali and Alan Fenwick (15
August 2005)
Rapid Responses: Submit a response to this article
The London International Conference
To Start the Process for a Health Development Plan for Dar Fur, Sudan
1st – 3rd March 2010
Brunei Gallery Lecture Theatre
School of Oriental & African Studies (SOAS)
Together for Sudan
Special thanks to Dr Lillian Craig Harris
OBE, Director of the UK-registered
Sudanese NGO ‘TfS’, and her husband
Mr Alan Goulty, (formerly British
Ambassador in Sudan) for their valuable
assistance in securing the prestigious
venue (SOAS) for the conference.
The Darfur conference, March 2010
BFOS, Alahfad University, SOAS and DAN
Health Services for
Population in/after
Crisis
By: Dr. Omer Elhag Sulieman
(tape)
The impact of internal
displacement (I.D) on mental
health in Alginaina camps in
Darfur. Sudan
Dr. Ibtisam .A.Ali, D.Manal M Hisain, D.Yosif. A. Alwahab

JASMAR Human Security Organization
www.jasmar.net
By : Dr. Hussein Elobeid
[email protected]
[email protected]
The Federal Ministry of Health
and
Darfur Health Care:
Interventions, Challenges and Prospects
presented by
Dr.Elsheikh Badr
The London International Conference on Health
Services in Darfur
London SOAS, March 2010
Reproductive and Sexual Health in
Sudan
The Darfur Region
Professor Hamid Rushwan
International Federation of Gynecology and
Obstetrics (FIGO)
Obstetric Fistula Prevention
and Treatment Services in
Darfur
Sudan
Dr. Adam Salih
Associated professor of obstetric & gynecology
Director Fistula Centre North Darfur
Dr. John Kelly Fistula Surgeon (UK)
Dr. Ezizgeldi Hellenov
UNFPA -Sudan
66
66
Patricia Parker, MBE

2 goats for every village
Sustainable development
at grass
root level transforms
village life in
Dar Fur
Patricia Parker, MBE,
Kids for
Kids, UK
2 midwifes for every village
Towards Better Health Service
and Healthier Future for Darfur.
Professor Elbagir Ali A. Elfaki
MBBS.FRCSI.FRCS.FACS.
UMST. ALZAYTOUNA SPECIALIST HOSPITAL
KHARTOUM, SUDAN.
The London International Conference
to Start the Process for a Health Development Plan for Darfur, Sudan
1- 3 March 2010
Some remarks concerning
an adequate health and nutritional
policy in Sudan
Zygmunt L. OSTROWSKI and Marie-Christine JOSSE
2 Panel discussion sessions
Panel
Discussion 1
How to avail resources to support
implementation of conference
recommendations
Panel
Discussion 2
Health as entry point for peace in Dar
Fur
The
recommendations
meeting
The conference recommendations




Ensure that human resource imbalances in selected priority
programmatic areas are addressed in an effective and
comprehensive manner
Develop effective prioritization system with special focus on areas
related to mother and child health; as a start priority areas identified
in this meeting including
– Enhancing, supporting, and expanding midwifery and nursing
training program in Darfur. Institutionalization of the midwives in
the local health system
– Support the integration of mental health programs at PHC
services
Institute an effective health delivery system which suits population in
post conflict situation in partnership with communities and other
stakeholders addressing social health determinants and basic
development needs as a pre-requisite to health in three selected
districts as a field demonstration in Darfur
Introduction of the concept of health as a human right in general ,
health and medical education curricula



Establish Partnership between MoH, DAN, BFOS
,AHFAD university and the health cluster which is
lead by WHO and other NGOs to support the above
recommendations and possibility of inclusion of
these recommendations in their strategic plans
Advocate for increased share for health sector from
national budgetary allocation to reach Aboja
recommendation in 2005 (15%) with special
emphasis on Darfur
Call on all those concerned to pay immediate
attention to the health problems arising from
draught
The recommendations could be
achieved through:



The development of a clear implementation and follow up
mechanism
Adopt an integrated stratified approach towards addressing
priority issues and ensure that this process is inclusive of all
health partners
the Sudanese in diaspora to work together to support the
availability of adequate resources to support the
implementation of the above recommendations
BMJ
Conference plans reconstruction of Darfur’s health services in wake
of ceasefire. Peter Moszynski.
BMJ 2010;340:c1150




Darfur's main rebel group signed a truce with Sudan's government this week, paving the
way for a negotiated end to a conflict that has displaced millions of people and
devastated the region. This “potential breakthrough” makes next week's London
conference on rebuilding Darfur's shattered health services “exceptionally timely,”
according to its organiser, Mohamed Baraka.
Being held at London University's School of Oriental and African Studies from March 1-3,
the conference is organised by the charity British Friends of Sudan, in collaboration with
Sudanese community-based development agency Development Action Now, Sudan's
Ahfad University for Women and the London Middle East Institute.
Professor Baraka told the BMJ: “We welcome this latest agreement and hope it will
develop into a lasting peace. The people of Darfur have suffered greatly for a long time.
They need immediate and sustainable help, particularly in health care. Now is the time to
begin to develop a health reconstruction plan for Darfur and we hope that this
conference will assist in communicating to the outside world exactly what is required.”
He said that “the key determinants of health are for the most part lacking in Darfur.”
Basic minimum needs include: “primary health care, basic education, food security,
water, healthy environment, adequate income, housing and safety as well as the
rehabilitation and reconstruction of the infrastructure.”

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