Women and children in Darfur suffer from poverty, disease, and malnutrition, and often die preventable deaths due to poor access to routine health services. Children under the age of 5 are the most vulnerable to disease, stress, and poor growth when food and potable water are scarce for families displaced and ravaged by the ongoing civil conflict. The violence also causes severe problems for expectant and nursing mothers. The leading cause of death among Darfuri women is complications during pregnancy. Malnourished women experience a dual impact - on their own health, and being unable to nurse their newborns.
Since 2005, Relief International (RI) has partnered with local village health providers to establish the Safe Motherhood and Childhood Project in North Darfur. This project expands access and creates a high-standard of quality routine health services for women and children, thus saving lives and creating healthy, strong families.
The Safe Motherhood and Childhood Project supports pregnant and nursing women with pre- and post- natal care at clinics, health posts, and via home visits. RI-trained Community Health Workers, midwives, and traditional birthing attendants work with local doctors to connect with women and children in need, be they in camps, villages, or remote regions. RI has rehabilitated local health facilities and established emergency referral systems to help women with obstetric emergencies arrive at local hospitals without delay. With nutritional support, growth monitoring, immunizations for children under 5, and home visits, local health staff can provide routine care to prevent malnutrition and disease for the youngest in Darfur. The project also ensures that village health centers are equipped with the space and supplies required for the highest standard of primary, maternal, and child health care. RI is providing health services to nearly 100,000 women and children in IDP camps. By training local health personnel to deliver an improved level of care, RI is ensuring that the well-being of mothers and children is an achievable goal in years to come.
RI’s Current Health Activities in North Darfur:
• Facilities: RI operates 2 primary health care (PHC) clinics, supports 8 health posts, and 2 mobile clinics.
• Services & Training: RI bolsters the village health network with expert support for establishment of preventive and curative services, including maternal and child health, an expanded program of immunization, sexual and reproductive health, treatment and care for sexual and gender-based violence (SGBV) and HIV/AIDS, community health education, and distribution of relief commodities (e.g. clean birthing kits).
• Additional Capacity Building: RI provides support to the Ministry of Health and local medical staff to increase skills, standardization and quality of case management. RI has guided the ministry on the establishment of a Health Information System and increased its readiness for participation in region-wide immunization and emergency outbreak response in coordination with WHO and UNICEF.
• Zam Zam Clinic: Modeled on the successful RI Tawilla clinic—which serves 40,000—RI’s newest health intervention in Darfur is the re-establishment of a 24-hour static clinic for Zam Zam Camp. In spring 2006, with the imminent closure of health facilities in this second largest camp in North Darfur, RI planned for the immediate construction of a primary health care center to ensure the continuation of basic medical services needed by 35,000 internally displaced people. Without RI’s action, there would have been a gap in services for 1250-1600 patients per week. The opening of the clinic in August was timely: violence southward drove residents into Zam Zam, resulting in a rapid increase of 6,000 in the camp population and a jump in consultations from 400 to 2,900 within the first month of operation. Today, the clinic averages 800 patients per week. The clinic site includes a safe motherhood center and nutritional and therapeutic feeding centers. The clinic site also serves as a community center for health education and protection activities.
Highlights & Statistics from Last Quarter Health Activities (October 1st to December 31st, 2006):
During the last quarter, a total of 25,878 consultations were provided at clinics in Zam Zam Camp, Sarafaya, Mellit, and at the Kunjara health post. Children under 5 years constituted 43.6% of all patients (11,307 consultations) compared to 34% during the previous quarter. Children over 5 years constituted 26.4% of all patients (6,851 consultations). While visits for safe motherhood accounted for 13.4% of the total (3,196 consultations), vaccination visits accounted for 9.3% (2,431).
The leading cause of morbidity was acute respiratory tract infections (ARI), which accounted for more than 23% of all diseases. This is followed by diarrhea (bloody and other), at roughly 15% of all diseases and malaria, at 6.4%. These three diseases account for more than 43% of the total morbidity.
There was a significant drop in malaria cases due in part to: the quarter marked the end of the rainy season and there was a massive distribution of treated mosquito bed-nets in the project area. UNICEF provided mosquito nets to INGOs, including RI, for distribution to pregnant women and children. RI distributed 4,000 nets through its primary health clinics. Additionally, health education and awareness raising programs were conducted by the RI-trained community health workers (CHWs) network at the clinic, community, and household level. CHWs delivered messages on malaria prevention and control. RI designed the training materials as part of its larger program activities.
Expanded Program on Immunization (EPI) Activities: During the quarter, routine vaccinations were provided to children under 5. 301 children were vaccinated against tuberculosis (BCG), 509 children were given OPV1 and DPT1, 580 children were vaccinated against OPV2 and DPT2, 366 children were vaccinated against OPV3 and DPT3, 142 were vaccinated against measles, and 493 children completed vaccination. During October, RI supported the National Immunization days for Polio eradication in Tawilla area and the surrounding villages where more than 14,000 children were vaccinated and given Vitamin A supplementation.
Safe Motherhood: A total of 5,388 women visited RI’s safe motherhood health facilities. Of these women, 2,954 (54.8%) were pregnant and attending regular antenatal care. During the reporting period, 355 normal deliveries were assisted by RI’s primary healthcare facilities and from these 189 deliveries were assisted by RI midwives at home. Full examinations were completed for all patients, and women were supplemented with iron and folic acid tablets throughout their pregnancy. Most women attended 2 antenatal check-ups. Postnatal care was low and accounted for only 10.6% of total consultations. As a result, midwives were instructed to conduct regular home visits to follow women after delivery and during the postnatal period. 5 women with high risk pregnancy and 1 woman with postnatal problems (postpartum hemorrhage) were referred to Mellit hospital. 2 women from Zam Zam Camp were referred to El Fasher Maternity Hospital due to prenatal bleeding.
Health Education: Advocacy and health education activities were conducted in Zam Zam Camp with the participation of 25 community leaders and 1,000 adolescents. RI team conducted an Awareness-raising campaign devoted to World AIDS Day in Zam Zam Camp, which focused on encouraging the use of family planning methods and condom promotion.
Training: November 26 – 29, RI, in collaboration with the Sudan Ministry of Health (SMOH) conducted training courses for PHC clinic staff on data collection and statistical reporting. The old RI statistical forms for safe motherhood and EPI were reviewed and SMOH presented a new weekly morbidity format. Training included practical exercises with each statistical form. There were 23 training participants: 4 medical assistants, 2 health visitors, 8 midwives, 4 vaccinators, and 5 nurses.
Monitoring: Statistical clinical monitoring forms developed by MoH are used in PHC clinics. Weekly statistical reports on health activities generated by location are submitted from all PHC clinics and reviewed and analyzed. Medical assistants verify collected information during field visits and report to the Health Coordinator. Health Coordinator conducts weekly monitoring to each location and submits weekly and monthly reports on health activities to the Country Director.