Rebuilding Community Maternal and Child Health in Sudan
Summary
In collaboration with MASS Design, Nubia Health commits to building a cutting-edge maternal and child health center in Wadi Halfa, Sudan an ancient drought-stricken city lacking essential health services. The project will bring essential primary care services to the rural underserved community, provide basic maternal and child healthcare, a community developed communal space with access to locally grown food, and workforce development through the training of a cadre of community health workers
Approach
In this US-Sudan collaboration, Nubia Health commits to opening a maternal and child health center in Wadi Halfa, Sudan. The aims of this project are to (i) build a health center to serve communities in the Northern State of Sudan (ii) provide basic maternal and child health care and community-based health education (iii) train a cadre of community health workers. Led by MASS Design, we will construct a community health worker training center, communal space and garden for providing health and nutrition education (including growing foods at home) , center with a small inpatient unit, and health worker accommodation. The Nubia Health Center will bring best practice in community health to rural Sudan and undertake the following activities: 1. Proactive search: Working with Muso Health, a pioneering organization building community health programs in Africa, Community Health Workers (CHWs) and community members will be trained to search for patients through door-to-door home visits, to connect them with care early. 2. Doorstep care: CHWs will provide a package of evidence-based life-saving health care services in the home. These include family planning, newborn screening, and treatment for children with malaria, diarrhea, and malnutrition. 3. Rapid-access clinic: The Nubia Health Centre will provide rapid-access, nurse-led clinics to see patients referred by CHWs. 4. Inpatient care: For those patients that require overnight care for interventions such as fluid replacement, intravenous antibiotic therapy, or observation and inpatient unit managed by nurses and doctors will oversee care. 5. Research: The Nubia Health Center will train fellows from across Sudan on building community health programs and develop the center’s research capabilities to generate evidence on delivering healthcare in rural settings. Nubia Health aims to build a care model and facility that combines the best practices in community health with cutting edge maternal and pediatric medical care.
Action Plan
Construction of the Nubia Health Center be completed by 31 December 2023 according to budget and launch of healthcare operations: Led by MASS Design, we will construct a community health worker training center, communal space and garden for providing health and nutrition education (including growing foods at home) , center with a small inpatient unit, and health worker accommodation. To this end, the following key milestones will be met. 1. Completion of the design by September 30, 2022. 2. Beginning of construction of the center by December 31, 2022. 3. Completion of the construction of the center by December 31, 2023. 4. Launch of the pediatric outpatient clinic by June 1, 2023 (i.e. following completion of the outpatient clinic being built) 5. Completion of construction of the health worker accommodation by March 31, 2024. Launch of the Community Health Worker (CHW) program: By March 31, 2023, Nubia Health will recruit and train 50 CHWs to serve 50,000 people in 2023 to cumulative 150 CHWs by March 31, 2024, to serve a population of 150,000. Muso Health will be providing technical support to develop the CHW program. We are working closely with the Ministry of Health, Northern State, Sudan who are seconding staff to the health center to work and train. Our aim is to build a center embedded in the public health system. Within 3 years, Nubia Health aims to have the following health impacts: 1. Reduce the prevalence of febrile illness among children age children under-five from 40% at baseline to 20%. 2. Reduce the prevalence of under-five stunting from 29% to below 5%. 3. Reduce under-five mortality rate from 30/1000 to 7/1000.
4. Enrolment in antenatal care with a skilled provider in the first trimester from 49% to 90%.
Background
Following decades of neglect, Nubia Health aims to develop a new model for rural health so that historically neglected areas of Sudan can access basic health services. Nubia Health is starting with this effort in Wadi Halfa, in the Nubia region of Sudan. Once home to the Nubian Kingdom, this region has a rich culture and history, with an ancient language that is still spoken today. Contemporary Wadi Halfa sits at the edge of Lake Nubia, a vast reservoir created by the Aswan Dam following the Nile Water Agreement in 1959. When the dam was completed, floodwaters submerged ancient temples and settlements, displacing communities who had lived on the banks of the Nile for thousands of years. Old Wadi Halfa was destroyed, and most inhabitants were forced to migrate. Today, as Sudan emerges into a new era, communities are returning to Wadi Halfa and rebuilding the region. However, as people are being drawn back to the banks of the Nile, a dearth of community-based healthcare means that those living in and around Wadi Halfa, especially children, remain vulnerable to high rates of preventable diseases and poor health outcomes. Isolation of communities in regions such as Wadi Halfa in the peripheries of Sudan has exacerbated inequalities leading to long travel times for the most basic health needs. In the Wadi Halfa region, 80% of children are anemic and 29% of children are stunted due to malnutrition. Wadi Halfa’s existing healthcare facility is no longer functional with basic amenities such as running water unavailable. Wadi Halfa’s lack of health education, primary care, and adequate facilities are compounded by low numbers of trained health workers in the Nubia region. For doctors in Wadi Halfa, poor facilities and housing increase the challenges of retention.
Progress Update
Nubia Health’s Commitment to Action was announced in 2022. A few months later, in April 2023, a civil war began in Sudan, displacing 8.5 million people and causing over half a million to cross the border into Egypt from Wadi Halfa, where Nubia Health is based.
Despite the challenges posed by the ongoing conflict, Nubia Health remained active, pivoting its work to support the growing humanitarian crisis as Wadi Halfa became a place of refuge for thousands of displaced people.
As outlined in its original commitment, Nubia Health initially planned to construct a new health center but repurposed an existing building (formerly an old hospital) to serve as the new Nubia Health Center in collaboration with MASS Design. This facility now functions as a CHW training center, communal space, and outpatient unit. The Community Health Worker (CHW) program is being launched, targeting a CHW:population ratio of 1:1000 to cover a catchment area of 900,000 people displaced by the war and now settled in Wadi Halfa. This initiative includes collaboration with Muso Health, with staff from the Muso team joining Nubia Health in Sudan to aid in the program’s implementation. Nubia Health also received medical supply donations from various organizations, including Emergency (Italian NGO) , Aswan Heart Center, Salam Heart Centre, and Butterfly, and is working with Edesia to secure therapeutic foods.
After focusing on immediate humanitarian support, Nubia Health is now pivoting back to its original commitment of building an enduring community health program and center. This center aims to act as a beacon of excellence for the region as it continues to grapple with a growing humanitarian crisis.
Partnership Opportunities
Through this Commitment to Action, Nubia Health seeks financial resources and implementing partners to realize this effort to transform community maternal and child health in Sudan. Nubia Health is also looking to partner with organizations developing novel low-cost diagnostics and other technologies to support treatment of diseases prevalent in rural Africa.,As part of this Commitment to Action, Nubia Health is open to collaborating with other partners with an interest in improving community maternal and child health from across disciplines. Nubia Health can provide partners with support in developing their community health programs, especially in rural African settings. This support includes guidance on building health centers in drought-prone areas, launching clinics, community health worker programs, and evaluations.