Actors, policies, programs and activities of Family Planning in Sudan

Actors policies programs and

activities of family planning in Sudan By

Dr Dina Sami Khalifa

Dr Hani Mohamed Ibrahim

Geneva Foundation for Medical Education and Research

GFMER Sudan 2012 Forum No ( 3 )

Name of presenter

Name Position Institution

Waleed Amin Head Community Health Nursing

UMST

Amal Khalil Coordinator RCRU UMST


Dina Sami Khalifa Epidemiologist Ahfad University for Women (AUW)

Hani Mohammed Ibrahim

Medical Director Research Assistant ndashRCRU

Um Bakhita Maternity Hospital

Name of contributors

Objective of presentation

bull Introduction

bull FP objectives in Sudan

bull Policies of FP in Sudan

bull Actors amp Stakeholders of FP in Sudan

bull FP programs amp activities in Sudan

bull Recommendations amp Conclusion

Introduction

FP implies the ability of individuals and

couples to anticipate and attain their

desired number of children by spacing

and timing their births It is achieved

through the use of contraceptive

methods and the treatment of

involuntary infertility

FP guards individual health rights and

improves the quality of life of couples

and their children

Elements of FP Services Suggested by International Organizationssup1

bull Rangechoice of methods

bull Delayed childbirth for adolescents

bull Male responsibility

bull Attention to unmet needincreasing demand

bull Safetyside effects research

bull Sterilization reversal

bull Implant removal

bull Quality services

sup1 Hardee K Yount K From Rhetoric to Reality Delivering Reproductive Health Promises through Integrated Services FHI 360 2012 (Working paper httpwwwfhi360orgenRHPubswspwrkngpapersrhetrealhtm)

Population Demographysup1 bull TFR in Sudan = 55 (2008 census ) (vs 66 in 1993)

bull Crude Death Rate (SHHS 2010) = 96 ( vs 26 in1956)

bull Pop Growth rate 2008 (before separation of South) = 26 (288 in 1956)

bull U 5 Mortality rate = 781000 (vs 2331000 in 1956)

bull U 15 years of age= 45

bull MMR in Sudan ( SHHS 2010) = 216100000 (vs 554100000 in 1989 SHHS)

bull Life expectancy at birth (2010)= 616 (vs 382 in1956)

bull No legal access to abortion services in Sudan

sup1 Statistics from ldquoSudan population policy 2010 ldquo Document

In Sudan context FP should be addressed as

1 Primarily To improve Maternal Health by providing Child Spacing

The most recent survey estimated maternal mortality rate (216100000 LB) at national level (225100000 rural and 194100000 urban ((SHHS 2010)

2 Secondarily To control population growth

Low SES increasing poverty economic instability low resources for developing human capita

Sudan Population Policy (SPP) targets for 2031 sup1

bull Decrease TFR (NO TARGET FOR TFR mentioned in SPP)

bull Decrease population growth (NO TARGET mentioned in SPP)

bull Increase FP use to 39 (currently 7)

bull Decrease crude death rate to 8

bull Decrease under 15 years of age to 37

bull Decrease MMR to 73100000 LB

Importance of FP as a strategy in improving maternal health or stabilizing pop growth is not clearly demarcated in Sudan Population Policy

sup1 Sudan Population Policy 2010 Document (Draft)

Family Planning in the ldquo25 years Strategic Plan for Health Sectorrdquo 2003-2027sup1

bull Family planning is mentioned as one of the strategies to reach the goal (Goal 3) of ldquo Reducing Maternal amp Child Mortalityrdquo through increasing contraceptives prevalence rate among married couple FP is NOT stated as an OBJECTIVE

bull A policy priority mentioned in the plan is ldquoGoods with public health importance will be the responsibility of the government this would include environmental health services prevention of diseases health promotion and quality assurancerdquo access to FP through government sector constitutes gt 70

sup1 Sudan 25 year Strategic Plan for Health Sector 2003- 2027 doc

Family Planning in National RH Policysup1

FP is mentioned in a separate statement in the RH policy

ldquoAt primary health care level the health visitors and medical assistants will provide family planning information and services for child spacing and welfare of women In remote villages and nomadic settings village midwives and community health workers will act as change agent and in addition to providing condoms refer clients to the health facilitiesrdquo

sup1 Sudan RH Policy Document

The policy also requires these services are ldquokept confidential and information about the services provided is divulged after an informed consent of the client Further such services particularly regarding reproductive choices and birth control methods following the principle of voluntarism are administered after an informed consent of the client and will be provided free of chargerdquo

Actors and Stakeholders Family planning services were introduced in the country in

the 1960s with

1 The ldquo Sudan Family Planning Associationrdquo SFPA

An NGO that is pioneer in FP in Sudan till this day UNFPA is a key partner

Objectives sup1

bull Advocacy and Information Education and Communication (IEC) to religious and political leaders and the population

bull Improving the status of women as an indirect contribution to successful family planning programs

bull Providing FP services through its 93 clinics and government structures and non-clinical services through a community based distribution (CBD) project

sup1 wwwippforgenWhereCountry

2 The ldquoMaternal and Child Health and Family Planning projectrdquo MOH amp University of Khartoum

bull Established in 1980s bull Focus VMW training on various MCH issues as well as

community outreach activities eg FP distribution bull It is considered a success storysup1 3 The ldquoSudan Fertility Control Associationrdquo bull Established in 1976 bull Work with Sudan Family Planning Association to provide

family planning services throughout the country 4 National Population Council bull Worked intermittently in Sudan for more then 20 years

through the Middle East Capacity Awards (MEAwards) program

sup1 El Tom AR Farah AA Lauro D Fenn T Community and individual acceptance family planning services in the Sudan Ahfad J 1987 Jun4(1)12-30

5 UN agencies contribution to FP

bull UNFPA sup1

ldquoAdvocacy for integration of reproductive health commodity security including HIVAIDS commodities in the national health commodity systemrdquo

ldquoSupport to integrating management and prevention of sexually transmitted infectionsHIV in reproductive health services outlets including services for young peoplerdquo

ldquoSupport to enhancing capacities of reproductive health care providersrdquo

ldquoCapacity building to implement minimum initial service package in humanitarian settingsrdquo

sup1 Sudan UNDAF document 2013-2016


ldquoSupport to comprehensive condom

programmingrdquo

ldquoStrengthening of the knowledge base on socio-

cultural determinants to guide reproductive health interventions including for HIV preventionrdquo

bull WHOsup1

ldquoSupport MoH to scale up coverage of health services including increasing the number of PHC facilities delivering the integrated basic RH package- Inclusive of FP servicesrdquo

ldquoCapacity development of health cadres to provide quality servicesrdquo


FP activitiesinterventions in Sudan and expected impact

(Most of FP interventionsactivities no Evaluation Research is conducted)

Mostly implemented Capacity building of health personnel on FP (UNFPAWHO NP) MD MA HV VMWs presumed effective if training is tailored phased and based on needs assessment

Community awareness raising advocacy amp education on FP

presumed effective if barrier to FP uptake is low acceptability

Community-based distribution (CBD) of FP a component of community health outreach Started 1996 still weak in Sudan presumed effective if inaccessibility to FP is the problem

Ensuring availability of FP commodities to all communities

presumed effective if low supplyinequity in distribution of FP is the problem

Performance based approach to RH service delivery Incentives to HCP to provide RH services and commodities presumed effective if accessibility to FP is the problem but will not guarantee effectiveness of FP (highly dependent on capacity and skills of HCP)

Integration of FP services with RH services presumed effective if it meets clients needs best utilizes a limited pool of resources and may improve the efficiency and effectiveness of services

Barriers to FP programs implementation

Country level Barriers

Challenges to integration of FP service delivery

Integration can facilitate- - but does not guarantee - implementation of services due to the complexity of RH service packages the existence of established vertical programs and weak administrative capacity sup1


Challenges with expanded RH services infrastructure and referral systems medical support supplies and logistics updated amp evidence based RH service delivery guidelines integrated HIS delegation of activities competence of personnel training for staff and supervisors supervision and evaluation of integrated programssup1

Cost amp Funding the assumption that Sudan contributes two-thirds of the resources for RH and donors contribute the remaining one-third is a challenge under current National Health Expendituresup1


Community level barriers

National researchsup1sup2 has identified inequity in distributionuptake of FP and highlighted barriers to effective FP uptake in the community

Misplaced religious believes

Misplaced believes about side effects of FP

Significant role of husbands mainly husbands with lower educational level

Low educational level of women

sup1 Ali et al Use of family planning methods in Kassala Eastern Sudan BMC Research Notes 2011 443 sup2 Saghayroun AA Khalifa MA Fertility and Islam in the Sudan Sudan J Popul Stud 1984 Jun1(2)1-28

Opportunities for effective FP in Sudan

Positive political commitment Positive donor collaboration Increasing collaboration with Academia to

undergo operationevaluation research Increasing range of stakeholders such as policy-

makers womens advocacy groups grass-roots organizers service providers and client representatives academia among others

Recommendations

bull Addressing FP issues from a Maternal Health perspective not Population Growth Control to gain more religious governmental and community support

bull Targeting religious leaders so as to increase community awareness on importance of FP on the socio economic level and health of mother and child

bull Targeting men as they constitute a large proportion of decision making on use of FP ( 341 of families the male is the sole decision maker on FP use) sup1

bull Targeting women immediately postpartum via counselling and follow-up on FP issues Prime target should be women with lower SES high parity low educational level sup1 Khalifa MA Attitudes of urban Sudanese men toward family planning Stud Fam Plann 1988 Jul Aug19(4)236-43

bull Massive and comprehensive FP promotion campaigns addressing FP types effective use side effects and health benefits Campaigns involving multiple influential stakeholders so as tackle social determinants for the high FP unmet need in Sudan

bull Strengthening policies to support CBD of FP

bull Establishing Operational Evaluation research to examine impact of the various FP interventions in the country to provide evidence for new policy amp interventions

Thank you

Name of presenter


Waleed Amin Head Community Health Nursing

UMST

Amal Khalil Coordinator RCRU UMST


Dina Sami Khalifa Epidemiologist Ahfad University for Women (AUW)

Hani Mohammed Ibrahim

Medical Director Research Assistant ndashRCRU

Um Bakhita Maternity Hospital

Name of contributors


bull Introduction






Introduction










and their children












































the 1960s with



Objectives sup1












bull UNFPA sup1








programmingrdquo



bull WHOsup1

































Recommendations








Thank you


bull Introduction






Introduction










and their children












































the 1960s with



Objectives sup1












bull UNFPA sup1








programmingrdquo



bull WHOsup1

































Recommendations








Thank you

Introduction










and their children












































the 1960s with



Objectives sup1












bull UNFPA sup1








programmingrdquo



bull WHOsup1

































Recommendations








Thank you












































the 1960s with



Objectives sup1












bull UNFPA sup1








programmingrdquo



bull WHOsup1

































Recommendations








Thank you


































the 1960s with



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bull UNFPA sup1








programmingrdquo



bull WHOsup1

































Recommendations








Thank you

























the 1960s with



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bull UNFPA sup1








programmingrdquo



bull WHOsup1

































Recommendations








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the 1960s with



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bull UNFPA sup1








programmingrdquo



bull WHOsup1

































Recommendations








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programmingrdquo



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Recommendations








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bull UNFPA sup1








programmingrdquo



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Recommendations








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bull UNFPA sup1








programmingrdquo



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Recommendations








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the 1960s with



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bull UNFPA sup1








programmingrdquo



bull WHOsup1

































Recommendations








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programmingrdquo



bull WHOsup1

































Recommendations








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bull UNFPA sup1








programmingrdquo



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Recommendations








Thank you



programmingrdquo



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Recommendations








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Thank you






























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Thank you






















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Date post:	10-Nov-2014
Category:	Health & Medicine
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Actors, policies, programs and activities of Family Planning in Sudan

Health & Medicine