by Malene Haakansson, ACT/Caritas information officer
It is not unusual to find a rural hospital in Darfur without doctors, or a health unit without medicine. General poverty, lack of infrastructure and a two-year long civil war has left Sudan's western region with a broken down health system.
One of the biggest challenges so far has been the recruitment of qualified staff. The 20 temporary clinics provide primary health care to more than 20,000 displaced people and affected host communities.
"The number of qualified and trained health personnel is inadequate, and the ones who are available are not motivated to go to the rural areas in Darfur where conditions are poor," explains Ann Okiya, primary health care co-ordinator of the ACT/Caritas operation.
Dr. Mohammed Ali Sharif, from the Ministry of Health backs this up saying that, of more than 150 doctors working in south Darfur, only 20-30 are stationed in the rural areas. The rest all work at the hospitals in Nyala, which is the capital of south Darfur.
"The doctors are not available for the people who are in need," says Dr.Sharif, citing the example of the El Fursan area where only two doctors serve 700,000 people.
Motivation is key
In order to make positions with the Ministry of Health more attractive, ACT/Caritas offers financial incentives to health personnel in the clinics - otherwise the few qualified people will work for a private organisation with higher pay than the salary from the Ministry of Health.
Another way of encouraging people to work in the rural areas is to create an attractive working environment with new medical instruments and enough medical supplies.
Dr Walid Mohammed Mustafa has been employed by ACT/Caritas in West Darfur for eight months, and admits living conditions are difficult. In Garsilla where he worked in the camps, he shared a dilapidated house with local hospital personnel. The ceiling was hanging down and there were big cracks in the wall.
"I can live like this but it is too basic to bring down family from Khartoum," he says. When asked about why he decided to go to Darfur, he answers: "This is my country. If educated people are not willing to make a sacrifice, Sudan will never develop."
He also explains that there are many unemployed doctors in Khartoum, while there are hospitals in the rural areas of Sudan, such as Darfur, with no doctors. Gaining experience from working with an NGO, is also a plus.
"I get jealous when I see how the international organisations work. They are very strong. Why do we not have something such as 'Doctors Without Borders' in Sudan? We have good doctors and nurses but they are just spread out in the country."
Hope for continuous support
Dr Walid says the civil war in Darfur has only worsened Sudan's already poor health system. "The distance to get health services has increased because people have been displaced."
In Djugma, a town next to the Chadian border, the ACT/Caritas clinic received 3,000 patients in the first few months. Some internally displaced persons (IDPs) who had originally fled to Chad, had walked for two days to reach the clinic.
The Ministry of Health official believes the ACT/Caritas health programme is the best contribution in south Darfur, saying that it has revitalised the rural health system.
Dr Mohammed Ali Sharif comments: "ACT/Caritas is providing services in areas where we did not have anything. They are rehabilitating dispensaries and are providing good management. Our health system was almost collapsing. No-one goes out to reassess services in rural areas and staff have not been trained for many years."
Ann Okiya is aware of the big impact her programme has on Darfur's health services, but also knows how difficult it will be for the Ministry of Health to continue the work when ACT/Caritas is not there anymore.
"It is our hope that the Ministry will be able to finance the clinics one day. We are here to build up their capacity, but the responsibility is that of the Ministry of Health," says Okiya.
Community participation is essential for a continuation of the NGOs' work and payment for treatment will most properly be a solution. However, where possible, services should be free to people displaced by the conflict
Building healthcare capacity
- By the end of 2005, ACT/Caritas will have constructed or rehabilitated 23 primary health clinics and two rural hospitals in South and West Darfur.
- The facilities are staffed and equipped with drugs, medical supplies, materials and furniture
- Local staff are trained in order to improve the health services
- Ideally, each clinic should have a medical assistant, two nurses and onemidwife
- At the moment one clinic and one hospital is not operational because of alack of trained staff