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Technical Report On The Sudan Household Health
Technical Report On The Sudan Household Health
May 2006
Technical report (Draft 2)
Prepared by:
Dr. Ghaiath Mohamed Abas
Federal State SHHS Manager
E-mail: ghaiathh@sud.emro.who.int
Mob: 0912978652
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 1 of 38
DISCLAIMER
THIS REPORT REFLECTS THE OPINIONS AND VISIONS OF THE SMT
IN THE SOUTH DARFUR STATE AND DOES NOT REFLECT ANY
OFFICIAL SITUATION OF THE HIGHER RESPONSIBLE COMMITTEES
MANAGING THE SHHS.
EXECUTIVE SUMMARY
Introduction
SHHS is a national Pan-Sudan survey that covers the whole 25 states of the Sudan. It is
considered as one of the biggest health-related projects that take place after the
signature of the CPA, between GoS and SPLM/A.
In the same context, unfortunately, the crisis in Darfur was described in 2004 as the worst
humanitarian situation in the world. As of July 2005, around 3.3 million people -or 50% of
the total population- have been estimated in need of humanitarian assistance. The
international response, slow at the beginning of the crisis, gained momentum in 2004,
when Darfur started drawing political attention, with increasing ledges of the donor
community, growing numbers of humanitarian workers, and an overall good accessibility
to humanitarian aid. Half of the health requirements were funded midway into 2005.
Despite the ambiguity of Darfur states’ status of security and the constraints faced the
peace negotiations mediated by AU, the three states of Darfur, though classified as
hardship areas, were not excluded from the implementation of the SHHS.
This survey was jointly prepared and conducted by the FMoH and CBS, in partnership
with the relevant UN agencies. Funding was provided by partner UN agencies and the
GoS. The protocol of the study was submitted to an inclusive peer-review.
Regarding the three Darfur states logistic and technical support was offered by SMOH,
UN partners and other NGOs.
The main objective of the survey was to estimate some of the basic health and health-
related indicators in accessible areas. More specifically, the indicators that the survey
aimed to include:
1. Mortality indicators
2. Maternal Health Indicators
3. Indicators on Marital Status
4. Indicators on family planning
5. Child health indicators
6. Indicators on Immunization
7. Indicators on Nutritional Status
8. Indicators on Child Rights
9. Indirect Health Indictors
10. Indicators on Malaria and HIV/AIDS
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 2 of 38
The survey used both retrospective and cross-sectional approaches, based on two-stage
cluster sampling. A separate survey was conducted in each State, each targeting the
selected study populations. The clusters were randomly allocated from EPI frame lists of
villages. The second sampling stage used the standard systemic random cluster
selection methodology. A total of 40 clusters of 25 households each was included in each
state. Data were collected anonymously by teams of interviewers with the supervision of
national staff, using a structured pre-piloted questionnaire in Arabic. Data included
deaths, births, migration in/out during the study period, demographic characteristics and
availability of basic goods and services. Data will be analysed separately for each State
and study population, and jointly for all the other states, after weighting for stratum
population size.
Main Constraints and recommendations
Among other constraints, the issue of security and accessibility to most of the selected
areas remained the main constraint. This led to replacement of about 35% of the selected
areas and extension of the duration allocated to the conduction of the survey from 32
days to 45 days. More details are found in the relevant chapter(s).
Any future planning for conducting a survey in Darfur should have clear vision of the
peculiarities of South Darfur; that represents alone half the surface area of whole Greater
Darfur region (equivalent to half the surface area of France). This should include the
number of teams, having clear commitments of partners and have the financial situation
clear beforehand.
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 3 of 38
LIST OF ACRONYMS
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 5 of 38
Map of Darfur
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 6 of 38
Table of contents
Executive Summary........................................................ 2
List of Acronyms............................................................. 4
Acknowledgements............................................................ 5
Map of Darfur................................................... 6
Table of Contents............................................................... 16
1. Introduction................................................................. 17
3. Discussion.......................................................... 30
4. Conclusions and Recommendations............................... 33
References..................................................................................... 34
Annexes: ………………………………………………………………….. 35
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 7 of 38
1. Introduction
1.1 The SHHS distinguished features
Sudan Household Health Survey (SHHS) is a unified national study that covers the
whole 25 states and134 localities of the Sudan, 40 segments per State and 25 HH per
segment using systematic random selection, a total of 25000 households for the whole
country. Its idea has started in 2004 as 2 separate surveys: PAPFAM (Pan-Arab
Family Survey) in the North and MICS (Multi-Indicator Cluster Survey) in the South.
In Darfur, this survey has further distinguished features. This underdeveloped region of
the Sudan went through recurrent droughts, insufficient investment and spill-over
repercussions from other regional conflicts have exacerbated the already precarious
situation. All these factors have been acknowledged to be at the origin of the recent
phase of the conflict (Polloni 2004, Pantuliano 2004, de Waal 2004 and 2005), which
has been characterized over the last three years by unprecedented levels of violence.
The high level of violence and insecurity has resulted in a huge internal displacement
and in the flight of around 200,000 refugees to the neighbouring Chad. The crisis has
progressively affected nondisplaced communities, whose already stretched resources
and services have suffered from increasing pressures and overall economic
breakdown. As of July 2005, around 3.2 million people, or 50 % of the total population1
in Darfur have been estimated in need of humanitarian assistance.
The number of humanitarian workers has increased from 228 in April 2004 to around
12,500 (national and international) one year later, with 81 NGOs and 13 UN agencies
active in the region (Office of the UN Resident and Humanitarian Coordinator for the
Sudan, July 2005).
1
According to UNFPA & Government estimates of 1999, the pre-conflict Darfur population amounted to
approximately 6.4 million people
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 8 of 38
indicators were based on core international indicators and aimed at monitoring the
MDGs and other international commitments.
The main objective of the survey was to estimate some of the basic health and health-
related indicators in accessible areas. More specifically, the indicators that the survey
aimed to include:
1. Mortality indicators
2. Maternal Health Indicators
3. Indicators on Marital Status
4. Indicators on family planning
5. Child health indicators
6. Indicators on Immunization
7. Indicators on Nutritional Status
8. Indicators on Child Rights
9. Indirect Health Indictors
10. Indicators on Malaria and HIV/AIDS
The Sudan Household Health Survey (SHHS) has five parts: the community
questionnaire, the food security questionnaire, the Household Questionnaire, the
Woman's Questionnaire, and the Under 5 Questionnaire. Each household selected
to participate in the survey will be administered one Household Questionnaire.
Every woman between the ages of 15 and 49 will be administered the Woman's
Questionnaire, and an Under 5 Questionnaire will be completed for each child
under five years of age.
Household Questionnaire
Household Information Panel (HH)
Household Listing Form & Education Module (HL)
Household Income Module (HI)
Water and Sanitation Module (WS)
Household Characteristics Module (HC)
Insecticide-Treated Net Module (TN)
Salt Iodization Module (SI)
Final Household Instructions (FH)
Woman's Questionnaire
Woman’s Information Panel (WM)
Marriage Module (MA)
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 9 of 38
Reproduction and Child Survival Module (RC)
Live Birth History Table (BH)
Maternal and Newborn Health Module (MN)
Tetanus Toxoid Module (TT)
Contraception Module (CP)
HIV/AIDS Module (HA)
Final Woman's Questionnaire Instructions (FW)
Under 5 Questionnaire
Under-Five Child Information Panel (UF)
Birth Registration Module (BR)
Vitamin a Module (VA)
Care of Illness Module (CA)
Malaria Module (ML)
Excreta Disposal Module (EX)
Breastfeeding Module (BF)
Immunization Module (IM)
Anthropometry Module (AN)
Household Questionnaire
One Household Questionnaire will be completed for each household selected to participate in the
survey. The Household Questionnaire may be administered to any adult in the household (anyone in
the household who is 15 years old or older). A brief overview of the contents of each module in the
Household Questionnaire follows.
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 10 of 38
Also included in this module are questions about household items that household members own,
have, or use outside the household.
Woman's Questionnaire
In a household that has been selected for the survey, every woman between the ages of 15 and 49
will be administered the Woman's Questionnaire. A brief overview of the contents of each module in
the Woman’s Questionnaire follows.
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 11 of 38
This module gathers information about the woman’s contraceptive knowledge. Additionally, for those
who have ever been married or in a partnership, information is gathered about the woman’s
contraceptive use.
Under 5 Questionnaire
In a household that has been selected for the survey, an Under 5 Questionnaire will be completed for
every child under the age of five. The mother or caretaker of the child will answer the questionnaire
for the child. A brief overview of the contents of each module in the Under 5 Questionnaire follows.
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 12 of 38
This module includes height and weight measurements for each child, in addition to presence or
absence of edema..
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 13 of 38
Summary of indicators covered by SHHS:
Mortality indicators Maternal Health Indicators
Under-five mortality rate Skilled attendant at delivery
Infant mortality rate Institutional deliveries
Maternal mortality ratio Prevalence and content of antenatal care
Indicators on Marital Status Indicators on family planning
Polygamy Contraceptive prevalence
Young women aged 15-19 years currently Unmet need for family planning
married or in union
Marriage before age of 15 Demand satisfied for family planning
Child health indicators Indicators on Immunization
Care-seeking behaviour for suspected Immunization coverage for Tuberculosis, Polio,
pneumonia diphtheria, pertussis and tetanus (DPT) and Measles
Antibiotic treatment of suspected Neonatal tetanus protection
pneumonia
Timely initiation of breastfeeding Indicators on Nutritional Status
Adequately fed infants Iodized salt consumption
Use of oral rehydration therapy (ORT) Vitamin A supplementation (under-fives)
Home management of diarrhea Vitamin A supplementation (post-partum mothers)
Source of supplies (insecticide-treated Wasting prevalence
mosquito nets, oral rehydration salts, Low-birth weight infants
antibiotics and antimalarials for children)
Underweight prevalence
Indicators on Child Rights Indirect Health Indictors
Child labour Adult literacy rate
Labourer students Pre-school attendance
Birth registration Net primary school attendance rate
Prevalence of female genital Net secondary school attendance rate
mutilation/cutting (FGM/C) Children reaching grade five
Approval for FGM/C Primary completion rate
Use of improved drinking water sources and Water
treatment
Use of improved sanitation facilities
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Implementation and implementation Modalities...............
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2.2. Team Setting
1. As seen in the above diagram, the SMT is composed of three persons: the
statistical officer, the logistic and communication officer and the team leader, the
Federal Supervisor. The SMT members had arranged the team setting to be in the
CBS office in Nyala, before the arrival of the FSSM.
2. It is composed of two offices, each of 3x4 rooms and an additional store of 2x3
meters. All are of good lighting and proper ventilation.
3. There are the following functioning equipments:
i. The statistical officer was responsible for the technical work in terms of recording,
editing, revising, and reporting the questionnaires.
ii. The logistic and communication officer was responsible for the preparations of the
teams' needs utilities, food, water, readability of cars, and the communications to the
addressed locality stakeholders.
5. Almost each step done by any member has its format and checklist agreed upon
and followed by the team. The SMT stays daily from 9.00 am until 6.00 pm,
sometimes as late as 10.00 pm1.
6. Although it was the first time this team works together, there was a real harmony
and smoothness in manipulating the constraints; this was a key factor in the
achievement of our work despite all the constraints SMT faced.
2.2 Advocacy
2.2.1. Advocacy started by the state members before the arrival of the Federal State
Survey Manager.
2.2.2. The levels of advocacy (the target audience) included:
1
Not a single day was made off, or holiday for the last 70 days
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 16 of 38
ix. The local community leaders.
2.2.3. The advocacy was an ongoing process all through the survey conduction.
There was a weekly update made for the U/S of SMOH, and all the NGOs working in
the field of health. This is done in the weekly health coordination meeting held in WHO
office in Nyala.
2.2.4. The update for H/E the Minster of Health was done almost every two weeks.
2.2.5. There were continuous regular visits to the UN partners almost twice a week,
especially to the NGOs that assigned a SHHS focal person.
2.2.6. The outcome of this advocacy policy will be detailed in the needs assessment
section of this report. The overall outcome is considered satisfactory.
2.2.7. The strengths of the advocacy policy were:
i. The communications between the Khartoum offices of the UN agencies were almost always
absent except for the WHO office. This led the SMT to start from the beginning explaining the
survey from A-Z.
ii. This caused the loss of precious time and led also to refusal of WFP office in Nyala to
provide any kind of real help to the survey, unless a "green light" comes from the WFP office in
Khartoum, which never happened till the end of the survey.
iii. There was no emphasis on the local community awareness preparations, e.g. the cars with
loud speakers moving in the streets of the selected village. This is justified by the fact that only
the political parties and the singers' concerts are announced this way; this would have been
misleading.
iv. In addition, the concurrent Polio campaign would have misled the people mixing our work
with that of the campaign using the same media.
There were 40 areas selected, most are rural all over the nine localities of the state. Selection
was population proportional; i.e. the number of clusters in each locality depends on the
population of that locality; this explains that there are nine clusters in Nyala locality, and only one
cluster in Adila, for instance.
In each cluster, all the households are listed, then 25 households are randomly selected. The
total number of covered household is 1000 (25 x 40). This is applicable to all the other states.
Taking the same number of households for all the states despite their widely variable population
densities was raised as a technical question and might be considered as limitation of the study.
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 17 of 38
No. of No. of clusters
Total No. of %
SN Locality cluster replaced
Clusters replacement
covered
1 Nyala 9 6 3 33
2 Kass 3 2 1 33
3 Id Alfirsan 7 6 1 14.3
4 Tulus 2 2 0 0
5 Buram 7 2 5 71.4
6 De'ain 5 4 1 20
7 Rehaid alberdi 1 1 0 0
8 Adila 1 0 1 100
9 Sheriya 5 0 5 100
Total 40 26 14 35
The following table shows the villages that were substituted in each locality highlighted by
light yellow.
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 18 of 38
No. Locality Village/District Adm. Unit
Substitution
Adm. Unit Village/District
21 Shereya Almarwa Bilail Seraif
22 Shereya Hillat umda abdalla Bilail Domaya alkoma
23 Shereya Um hawayim Bilail Domaya Al-um
24 Shereya Nitaiga alum Bilail Gad Alhabob
25 Shereya Jorof Nyala North Shadida
No. Locality Village/District Adm. Unit
26 Tulus Alsadaga
27 Tulus Dimso wasat
No. Locality Village/District Adm. Unit
28 Buram Alwalyim Buram
29 Buram Um marahik Buram Um Labbasa Tayba
30 Buram Tanzania Algoz Um Labbasa Al-Borie
31 Buram Abu hilal Buram Rehaid Al-Berdi October
32 Buram Aradaib Algoghana
33 Buram Sowaina Buram Rehaid Al-Berdi Sheikan
34 Buram Rahd albairid Buram Abu Ajora Sanya Dalaiba
No. Locality Village/District Adm. Unit
35 Rehaid Albardi Hai alnojomi
No. Locality Village/District Adm. Unit
36 De'ain Algobba
37 De'ain Abo sinaidra east
38 De'ain Lihlihaya
39 De'ain Abu matarig
40 De'ain Abu gabra Abu matarig Abu matarig B
The conditions related to the substitution are discussed in further details in the discussion
chapter.
The list of needs that the SMT required from partners included:
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 19 of 38
Item No. Source/Donor Availability Remarks
and function
Cars 3 SMOH Available, all were maintained more than
secured three times each due to their poor
conditions
1 UNFPA Nyala Office We added another 80.000 SD for
paid for car the maintenance of SMOH car to
rental for 3 be with our teams for the rest of
days 60.000 the survey
SD
1 WHO CANCELLED All our selected areas are no-go
areas with one UN car. Thus it is
useless, unless 2 other cars are
made available by other UN
agency(s)
Plane flights 8 UNICEF All secured by UNICEF had to pay for 2 team
UNICEF members who couldn't catch their
team, because of not having their
ID cards. They also managed a
misunderstanding that took place
in the airport.
Communications General Very poorly & The mobile and landlines phones
network hardly are very unstable and were off for
available 7 full days in the first month of
work. The NGOs that offered help
had no field offices in the selected
clusters.
Others UNFPA Available, UNFPA team leader in Nyala was
(stationary, logo secured with a very committed, and helpful.
stickers) cost of about
60.000 SD
Technical UNICEF, They are very helpful and very
assistance WHO, NCA, interested in the methodology and
MSF-H & ARC offered valuable advices about the
technical aspect of the work.
2.5.1. The supervisory visits of the SMT to the field were important for the data quality
control.
2.5.2. Although none was available because of the difficulty of finding a vehicle for any
supervisor, the statistical officer in the SMT managed two supervisory visits to the
teams in Rehaid Albirdi and Id Alfirsan areas. They had a very strong positive effect
on the morale of the teams.
2.5.3. It is important to mention that we have been kindly offered a ride for our
supervisors from NCA & ARC. Unfortunately the areas they offered were not the same
as ours.
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 20 of 38
2.5.4. The SMT had Mr. Abdalbari, the M&E officer from UNICEF, as the Federal
Supervisor who made a very fruitful visit. He helped us re-arranging some points, and
motivated the morale of the team and helped in resolving some pending points. He
also helped in formulating our assessment for the conduction of the survey by the
team in the field.
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 21 of 38
4. Discussion
Limitations in survey design and implementation are the rule, not the exception in field
epidemiology, mainly in complex emergencies. However, a balanced review of how these
limitations have affected the results is key to the interpretation of results and to the choice
of the most appropriate actions.
Several surveys on mortality and nutrition have been conducted, most estimating values
that were widely divergent. Much of this variation was due to the difficulties in estimating
mortality among transient populations and insecure conditions. Denominators are
particularly difficult to establish among rapidly moving populations.
This being said, obtaining data on death, disease or malnutrition rates in conflict
situations is far from simple. First, death rates will differ according to who gets surveyed.
This clearly applies to the different population groups in Darfur. Internally displaced
populations live in appalling conditions and typically have death rates far above any
emergency threshold. Residents who have not had to move, on the other hand, are
usually better off. Moreover, the rate at which refugees die depends on their condition
when they arrive in a given camp. As a result, using rates from a specific group (the most
disadvantaged) to extrapolate deaths for the whole population can seriously distort the
real picture.
Second, estimates will differ according to the timing of surveys. There are months in the
year where deaths are frequent because of temporary escalation of violence, seasonal
disease outbreaks or breakdowns in food supply. If data is collected right after or during
one of these periods, the estimated death toll will be high. Applying this death rate to the
entire region for the entire year will be grossly misleading.
Third, estimations of mortality have to be considered in the light of the counter-factual,
i.e. how many people would have died, if the conflict had not occurred? It is very difficult
to estimate the excess deaths without knowing the baseline mortality, which is the
number of those who would have died anyway without the conflict.
Fourth, stereotypes of conflict-related mortality frequently dominate the debate and
distort clear decision making processes. Outright violence is rarely the main cause
among populations affected by conflict. The IRC mortality study in eastern Democratic
Republic of Congo shows that deaths due to violence represent less than 20% of all
causes (IRC, 2001). Data suggest, however, that there is a correlation between violence
and infectious diseases and malnutrition, which suggests that "people in those areas with
the most violence suffer the most displacement" and therefore have a higher probability
of dying from the latter causes.
The recall period of this survey, more than 6 months, was longer than previous WHO-
EPIET survey and other surveys. In general, the longer the study, the more susceptible to
biases it is, such under-reporting of deaths further back in the past; this could in theory
limit the validity of the comparison with the previous survey. To limit recall bias, a local
calendar of events was used to assist in the definition of precise month of death or birth
as well.
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 22 of 38
In order to collect such a wealth of information in a short period, the survey was
particularly labour intensive, with some 50 people directly involved in the field work. An
effort was made to standardize methods and techniques through an intensive training
and a strong supervision of interviewers, so as to improve reliability of findings; however,
some residual variation cannot be excluded. Additionally, our internal inspection of data
did not reveal any apparent patterns in questionnaire responses (measurement bias)
according either to interviewer team or surveyed population type, a proxy affirmation that
there were no major differences in the data collection process among interviewers and/or
surveyed.
An information bias, such as providing inaccurate death data or information on the size of
the household or on the availability of food or non-food aid, so as to justify more aid,
cannot be completely ruled out. This bias would probably be towards under-reporting
mortality. However, at the beginning of the interview, the respondents were informed that
all the information provided was confidential and that the study was not part of a
registration process for the distribution of aid.
The Darfur crisis has had political connotations from the beginning, and manipulation of
information, like mortality, has been instrumental to opposite political ends. The possibility
of political biases affecting the survey, that is both under and over-reporting mortality for
political purposes in order to minimize or conversely exaggerate the effects of the crisis
has been carefully considered. The following measures were taken to reduce the
influence of this bias: a close supervision of interviewers by a number of national,
politically neutral supervisors and coordinators, discussions with other UN agencies
experts for the validation of preliminary results and internal comparisons of findings.
The literature about previous fieldwork in Darfur, in general and particularly South Darfur
documents very well the major problems of feasibility and accessibility issues. Accessibility
and security were indeed the biggest limitation that faced our work, and should be seriously
taken when manipulating the gathered data. This includes all the stages from data entry to
analysis to the final report.
Other fully supported and well-budgeted surveys like the Crude Mortality Survey, conducted
last year faced similar conditions and they could hardly cover as low as 70% of the areas. If
this is the case with the UN agencies, which have much better chances to access areas that
are not accessible by GOS staff, then we should be expecting even less coverage in terms of
the constraints the work faced at different levels.
For statistical purposes and after deep technical and financial discussions, the steering
committee came out with the conclusion that the clusters from each state should complete 40
clusters to be statistically comparable with the same weight to other states of the country.
More specifically, this survey was conducted in extremely difficult circumstances, within an
uncertain and fragile security situation, need for frequent cross-line movements and
enormous logistic challenges to transport simultaneously an average of 4 teams, each of 6
interviewers and a driver for the state to scattered locations.
The Locality of Sheriya was a big question from the beginning of the survey. It is known that
it is not accessible not only for GOS staff, but also for most of the NGOs staff. UNICEF had
mediated long hard negotiations with the rebel forces, hoping that either one of teams find an
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 23 of 38
access, or to achieve the alterative plan to train people from inside Sheriya to conduct the
survey there. This solution, in case the negotiations succeeded, would have raised very
important questions about the extra-time and budget and above all the quality of the collected
data; knowing that it is even hard to find people who are not illiterate in such a place deprived
from most the basic needs of shelter, food and security.
This had put an additional ethical burden about those people who were deprived from being
studied because they are in inaccessible and insecure areas.
Worse situation was in Buram, where our team could hardly finish two clusters before the
security situation got inflamed. Their personal security was in hazard and their exposure to
direct physical hazard was very possible1. Fortunately, this did not happen, but this indeed
increased the areas to be substituted to complete the 40 clusters in the state.
Despite all the technical and ethical considerations; substitutions seemed to be the most
feasible solution.
1
There is an official document from the National Security and Intelligence Agency that explains the situation. This
document is classified and will not be attached to the report.
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 24 of 38
5. Conclusions and Recommendations
This survey was carried out before the rainy season, when the transmission of malaria
peaks, food and non-food distribution becomes more difficult and the hunger season starts.
As discussed in previous sections of the report, nothing can be said on mortality and other
indicators in areas that could not be included in the survey, because of lack of accessibility,
particularly in the areas of Sheriya and Buram.
The data generated by the study, and in particular mortality data, need to be analysed
together with those produced by the early warning system, with the objective of better
interpreting the survey’s results and validating the coverage and quality of the surveillance
system.
Prospective mortality surveillance is also being advocated, since it enables real-time
monitoring of the crisis and, therefore, a prompter response. On the other hand, the
requirements for sustaining quality surveillance through supervision are high. Additionally,
population movements need to be minimal for a surveillance system to produce good
mortality data. Thirdly, surveillance systems have a limited coverage, usually limited to
camps, and cannot inform about vast areas, as surveys can. In conclusion, as a recent
review points out (Checchi and Roberts, 2005), surveys and surveillance should not be seen
as mutually exclusive, but rather as complementary.
In terms of implementation of the survey at the state level, the overall evaluation is
satisfactory. The SMT was homogenous and well-motivated. It performed in harmony and
consistency. The estimated time for achieving the given clusters was indeed very unrealistic
for South Darfur State conditions.
Better knowledge and more recent assessments of the situations in situ should have been
available before the sampling, or the estimation of time and budget is finally done. The
fragility of the security situation, specially being in coincidence with the peace negotiations,
would indeed make this clear assessment hard to obtain.
The budget lines were not fulfilling all the real needs; this is partially explained by the fact that
planning of the survey at all its levels was at a central federal level. The estimations
depended on the outlines decided by the partners, who would prefer to come with best
results at the least possible cost. In the same aspect, the commitment of the partners in the
field work was variable and far from clarity.
Although this survey is a benefit for everyone, no one seemed to have similar enthusiasm to
get committed. This does not undermine the great help we had from many agencies (please
refer to the acknowledgment section).
Mini- and wide range surveys should be encouraged and conducted by all the NGOs working
in South Darfur; this should be an integral part of any intervention effort.
Finally, as soon as the final report is ready, the findings of this survey need to be circulated
widely among humanitarian actors and donors in order to work for solving the ongoing
humanitarian crises in Darfur, increase humanitarian access and to maintain and enhance
funding for protection and promotion of sustainable health as the health systems in Darfur
recovers from the crises.
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References.....................................................................................
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 26 of 38
Annexes:
MAPS OF DARFUR
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Note: To avoid over sizing of the file, please refer to the following link to get
a copy of the relevant topic:
www.SHHS.i8.com
In this website the following documents in both Arabic and English:
Household Questionnaire
Woman Questionnaire
Under5 Questionnaire
Community Questionnaire
Selected clusters
Sudan Household Health Survey, South Darfur State, Final Technical report Draft 2/Page 38 of 38