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UNDP/ GFATM 2012 ANNUAL REPORT

Table of Contents

Acronyms .................................................................................................................................................. 4

EXECUTIVE SUMMARY............................................................................................................................ 6

Sudan Map ................................................................................................................................................ 8

BACKGROUND AND INTRODUCTION .................................................................................................... 9

Table 1: Overview of GFATM grants in Sudan since 2005. .............................................. 12

Table 2: Overview of the total approved, received funds and expenditures until December 31st 2012 ............................................................................................................................ 13

UNDP/GFATM PROJECTS............................................................................................... 13

1.1 OVERALL GOALS, OBJECTIVES AND ACHIEVEMENTS ......................................................... 13

1.1.1 Scaling up Malaria Interventions in Sudan .......................................................... 13

1.1.2 Scaling up the National Response for prevention and treatment of HIV/AIDS (Round 5) .......................................................................................................................... 15

1.1.3 Intensify the HIV/AIDS national response in Sudan (Round 10) ......................... 15

1.1.4 Single Stream Funding (SSF) – TB and Health Systems Strengthening Programme (SSF-TB/HSS) ............................................................................................... 16

1.1.5 Single Steam of Funding (SSF): Health System Strengthening .......................... 17

1.2 PROJECT MANAGEMENT ........................................................................................................... 19

1.3 PROCUREMENT........................................................................................................................... 20

1.3.1 Details of the construction activities under all grants ............................................................. 20

1.3.2 HIV/AIDS Grant- Construction and rehabilitation of health facilities ...................................... 20

1.3.3 Ensuring and improving drug storage conditions ................................................................... 20

1.3.4 SSF-TB/HSS ................................................................................................................................. 21

1.3.5 SSF-TB/HSS- rehabilitation / construction of the academies of health sciences ................. 22

Table 3: Summary of construction activities for all grants in 2012 .................................... 22

Table 4: Key pharmaceutical and non-pharmaceutical products procured- 2012 ............. 23

1.4 SUPPLY CHAIN MANAGEMENT ................................................................................................. 25

1.4.1 Logistics Management Information System (LMIS) ................................................................. 25

1.4.2 PSM Technical Assistance ......................................................................................................... 25

1.4.3 Central Medical Store .................................................................................................................. 25

1.5 MONITORING AND EVALUATION .............................................................................................. 26

1.6 CHALLENGES, LESSONS LEARNED AND RECOMMENDATIONS ......................................... 28

1.7 FOCUS AREAS FOR 2013 ........................................................................................................... 29

Annex I: Indicators ................................................................................................................................ 32

Annex I.1: Malaria Round 7 Indicators Update- 2012 ........................................................ 32

Annex I.2: Malaria Round 10 Indicators Update- 2012 ...................................................... 33

Annex I.3: HIV/AIDS Round 5 Indicators Update- 2012 .................................................... 34

Annex I.4 HIV Round10 Indicators Update- 2012 ............................................................. 35

Annex I.5 SSF TB/HSS Indicators Update- 2012 .............................................................. 36


Annex II: Implementing Partners: ......................................................................................................... 38

Annex II.1: Organizations involved in the Malaria Round 7 grant implementation ............ 38

Annex II.2: Organizations involved in the Malaria Round 7 grant implementation ............ 39

Annex II.3: Organizations involved in the HIV/AIDS Round 5 grant implementation ......... 40

Annex II.4: Organizations involved in the TB/HSS SSF grant implementation .................. 41

Annex II.5: Organizations involved in the TB/HSS SSF grant implementation .................. 42


Acronyms

AIDS

ACSM

Acquired Immunodeficiency Syndrome

Advocacy Communication & Social Mobilization

ART Anti Retroviral Therapy

BCC Behavioural Change Communication

CBO Community‐Based Organization

CBS Central Bureau of Statistics

CMS Central Medical Store

CCM Country Coordination Mechanism

CSM Condom Social Marketing

CSOs

DOTs

Civil Society Organizations

Direct Observatory Treatment

FSWs Female Sex Workers

GFATM/GF The Global Fund to fight AIDS, Tuberculosis and Malaria/Global Fund

HBV Hepatitis B Virus

HCP Health Care Provider

HCV Hepatitis C Virus

HIV

HSS

Human Immunodeficiency Virus HSS Health Systems Strengthening

Health System Strengthening

IDPs Internally Displaced Persons

IMAI Integrated Management of Adolescent and Adult Illness

LFA Local Fund Agency

LLIN Long Lasting Insecticidal Nets

MARPs Most At Risk Populations

M&E

MDR

Monitoring and Evaluation

Multiple Drug Resistance

NMCP National Malaria Control Programme

NGO Non Governmental Organization

NTP National Tuberculosis Control Programme

OI Opportunistic Infections

PITC Provider‐Initiated HIV Testing and Counselling

PLHIV People Living with HIV

PMTCT Prevention of Mother To Child Transmission

PR Principal Recipient


PSM Procurement and Supply System

RH Reproductive Health

SFPA Sudan Family Planning Association

SGP Safe Guard Policy

SGS Second Generation Surveillance

SNAP Sudan National AIDS Control Programme

SOP Standard Operations procedures

SR Sub‐Recipient

SRCS Sudanese Red Crescent Society

SSF Single Stream Fund

STIs Sexually Transmitted Infections

TBMUs Tuberculosis Management Units

UNDP United Nations Development Programme

UNFPA United Nations Population Fund

UNICEF United Nations Children’s Fund

VCCT Voluntary Confidential Counselling and Testing

VNRBDs Voluntary Non‐Remunerated Blood Donors

WHO World Health Organization


EXECUTIVE SUMMARY

This Report provides an overview of Global Fund financed activities implemented in 2012 in Sudan in

collaboration with partners and The Principal Recipient, UNDP. The Report will highlight the general

objectives of all active Grants throughout 2012, the main achievements; as well as the main

challenges faced. The report will also outline both short and longer term interventions that will be

implemented in 2013 and beyond.

Some of the major achievements in 2012 that are highlighted in this report are the following:

During the year, malaria project activities have enabled 2,894,862 cases of uncomplicated and severe

malaria cases to receive anti‐malarial treatment according to National standards and guidelines.

Through the malaria grant, a total of 3,106,115 bed nets were distributed protecting an

approximately 6.2 million people from getting malaria. 2,229 dispensaries in rural and hard‐to‐reach

parts of the country were fully supported to continue providing free Rapid Diagnostic Test for

malaria; while the project has continued supporting the provision of free anti malarial drugs for 4,330

health facilities throughout Sudan.

Through Behaviour Change Communication (BCC) interventions; HIV/AIDs grants reached over

168,000 people, almost 137,335 members of Most‐At‐Risk & vulnerable population (youth in IDPs) as

well as 4,000 young people from out‐of‐school settings. The HIV/AIDS grant reached 4,487 MARPs

(MSM&FSW) through a peer education approach. Counselling and testing services were also provided

to 60,036 people including pregnant women and MARPs.

More than 85,000 people have received HIV testing and counseling services; reaching 5,500 people

with advanced HIV infection to receive ARV combination therapy. During the year, 2,574 people were

retained on ARV treatment. A total of 2,032 TB patients have begun ARV treatment during or at the

end of their TB treatment. 79 pregnant women have also received ARV treatment as part of the

overall intervention to reduce the risk of mother to child transmission of HIV. In 2012, sseveral

capacity development interventions were held to PLHIV associations, other CSOs and SNAP. About

151 health care providers were trained on syndromic management of STIs according to the national

guideline, while 59 health care providers received training on Infection prevention in health care

settings.

With regard to Tuberculosis project, the grant has enabled the detection of 6,518 new smear positive

TB cases; with 70.6% of new smear positive cases being successfully treated. In 2012, a concerted

effort was made that enabled the detection and treatment of 254 MDR TB cases. As part of TB/HIV

collaborative activity a total of 190,589 condoms were distributed to TB patients. A total of 2, 827

people were trained on TB management, contact tracing and management, PPM, DOTS links and


health communication skills in 2012. In an effort to expand TB services in Darfur states, 27 TBMUs &

54 DOTs were newly established during the year.

As part of the cross‐cutting health system strengthening effort, site assessment and design work for

rehabilitation of the Academies of health Sciences was finalized and rehabilitation and construction

initiated. 14 Academies of Health Sciences in 14 states were provided with minibuses to facilitate

their daily work and commute students to and from their practice health facilities and the Academies.

Equipment to upgrade 5 rural hospitals, 25 health centers, 15 laboratories & 5 Academies were

procured & handed over to MOH. A total of 293 health management personnel from 114 localities

were trained in decision‐making, teamwork, effective meetings, and health planning and district

health management. The capacity of Locality Health Management Teams is enhanced by the

provision of vehicles, office equipments and computers. 25 personnel from States and Federal level

were trained on M&E of the health system. 42 health managers from states and localities were also

trained in health economics/financing. 5 fellowships in health economics & health care management

were awarded in collaboration with the National Health Insurance Fund & the University of

Chulalongkorn, Bangkok, Thailand. 20 health managers from states & localities were enrolled in

health economics/financing in‐country for a medium term course.

At the end of the report, main challenges and future plans are listed. Several annexes are also

provided showing details of performances for specific indicators related to the respective projects. AS

can be seen from this report, it is clear that within the various challenges faced, the UNDP/ GFATM

projects did manage to reach and achieve the majority of the targets it had set from the beginning

and will continue to deliver more with a aim of saving lives, enhancing better health and

strengthening the health system to sustainably mitigate the impacts of the three diseases.


Sudan Map

Health Service Provision points supported by UNDP/ GFATM for the three diseases throughout the

country: (Needed here)

UNDP Sudan: Global Fund Projects, 2012 Annual Report

BACKGROUND AND INTRODUCTION

With an annual growth rate of 2.8%, the total population of Sudan as projected from 2008 census is equal to

34.1 million for 2012, 88% are settled, including 32.7% in urban areas, while 8% are nomads. Almost 6.9% of

the population is internally displaced. There has been increasing urbanization, with natural disasters, civil

conflicts and poor conditions in rural areas, contributing to this.

Sudan comprises 17 States each divided into localities, which in total are 1841 but varies with time due to

redrawing of the boundaries of the existing ones.

The epidemiological profile of Sudan is typical of other Sub‐Saharan African Countries, dominated by

malnutrition and communicable diseases, frequently aggravated by natural disasters (floods, heavy rains and

droughts) as well as sustained internal conflicts. The main causes of morbidity and mortality are infectious

and parasitic diseases, particularly malaria, tuberculosis, schistosomiasis, diarrheal diseases, acute respiratory

infections and protein‐energy malnutrition.

With changes in socio‐economic and lifestyle conditions, non communicable diseases (NCDs) are now

emerging as a public health problem in Sudan. Hypertension, diabetes, heart disease, cancer, asthma,

cataract and mental disorders are the major ones prioritized in the 2011‐2016 National Health Sector

Strategy.

Sudan made progresses towards the Millennium Development Goals (MDGs) with a reduction in child

mortality by a third between 1990 and 2010, and reduction in the maternal mortality rate by 60%. However

recent trends suggest that Sudan is unlikely to reach the MDG targets for child and maternal health by 2015.

Another feature is the marked disparity between states in health status, for example, the infant mortality rate

is 60 overall but ranges from 39 per 1,000 in Gezira state to 85 per 1,000 in Red Sea state2. The range is even

wider for maternal mortality rates, ranging from 106 per 100,000 in Northern to 335 per 100,000 in South

Darfur. These indicators demonstrate considerable inequity in health status across the country.

The health service delivery system in Sudan includes a range of public providers and both not for profit and

for profit private sector providers. The National (Federal) Ministry of Health (FMOH) has a leading role in

policy and stewardship while responsibility for delivery of public services is largely led by states and their

localities and by other agencies including police and army health services and the National Health Insurance

Fund (NHIF). In areas affected by conflict, Non‐Governmental Organization (NGOs) have been playing a

substantial role in service delivery. This has resulted in an uncoordinated patchwork of services, with gaps in

1 FMOH. Mapping of PHC services in Sudan 2010 2 Data from Sudan Household Health Survey 2010 (SHHS).


some states and duplication in others. The high proportion of public funding and qualified health workers

allocated to public hospitals and substantial costs of administration leaves less than 20% of public funds

allocated to primary health care (PHC) services and public health programmes.

PHC services include community level, small family health units, larger family health centres and rural/locality

hospitals, which report to the locality administration. Public health services (environmental, food safety,

campaigns) are managed from the locality level as well. The distribution of PHC facilities is uneven across the

country. The ratio of PHC facilities to population varies from 1:3,000 people in the Northern State to 1:21,000

people in South Darfur, compared to the planned 1:5,000 population. In six states over 20% of the population

lives more than 5 km from a health facility (HF) (five Darfur states and Red Sea). PHC services are variable,

with only 24% of facilities offering services in all the main components of the PHC package (reproductive

health, immunization, nutrition, prevention and treatment of common diseases and essential drugs).

Analysis of health system financing indicates that 65% of funding is from private sources, almost all out of

pocket expenditure. Reliance on out of pocket spending for health care exposes individuals to financial risk

and is likely to reduce access for the poor. Public funding has risen considerably in recent years and reached

9.8% of public expenditure in 2011. The allocation of public funding is very uneven across states once

population is taken into account, ranging from below 10 SDG per person in South Darfur to almost 40 SDG per

person in Red Sea state in 2008. The NHIF and other health insurance schemes (mainly for public sector staff)

fund some 7% of all health spending while coverage of health insurance is around 37% of the population; this

indicates that NHIF is only providing limited cover for the costs of health care. In addition payments are on a

fee for service basis which does not encourage efficiency and cost control.

Health information in Sudan is primarily based on health facility reporting supplemented by surveys. The

MOH hospitals generally report regularly but there are gaps in reporting from PHC facilities in many states

and low coverage of other sectors including private providers. There are multiple systems and forms for data

collection for different programmes. Data quality assurance is limited and systems for data management and

analysis are largely manual. Annual statistical reports are produced at national and state levels but there is

limited use of data at sub‐national levels.

Human Resources for Health (HRH) are a critical component of service delivery. Issues facing Sudan include

the relatively high number of medical doctors relative to nurses, midwives and paramedics, and the tendency

of doctors to emigrate for better conditions or to work in urban areas and referral hospitals, leaving PHC and

rural hospitals understaffed. States have established Academies of Health Sciences to redress this imbalance

in the skill mix and further efforts are required to improve the distribution of health workers and to maintain

their professional development. Community midwives have played an important role in Sudan in reaching


remote populations and more recently programmes have established specialized community workers such as

for malaria.

Basic equipment and services are not available in a significant proportion of health facilities especially in

poorer rural states. Medicines are a major share of the health expenditure by individuals (some 40%) and use

of antibiotics is very high, at over 70% of prescribed medicines, which suggests serious over‐use of these

medicines. There is a single supply agency for the public sector but in practice there are multiple procurement

and supply arrangements, including more than 15 different systems in the Federal MOH linked to different

programmes.

To help the country join the global fight against HIV/AIDS, TB and malaria, UNDP’s role is two‐fold: it manages

all funds allocated by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM) in Sudan; as well

as implementing interventions that address these diseases as they affect development, governance, the

protection of human rights and gender equality.

Since 2005, the Country Coordinating Mechanism (CCM) in Sudan3 nominated UNDP as the Principal Recipient

(PR) for the implementation of the GFATM supported grants4. As the Principal Recipient for 8 grants (2005‐

2016) amounting to more than USD 400 million, UNDP is managing the largest fund portfolio in the Middle

East and North Africa Region. UNDP‘s management role consists of implementing grants, ensuring financial

accountability, and training of a variety of national and international counterparts on programme

management and financial accountability. The established GFATM Programme Management Unit, which falls

within UNDP’s MDG and Poverty Reduction Unit, is responsible for the programmatic and financial

management of the grants, the procurement of HIV/AIDS, malaria and TB‐related commodities and capacity

development of the national partners: Sudan National AIDS Programme (SNAP), National Malaria Control

Programme (NMCP), National TB Programme (NTP), Directorate General of International Health and Planning

(DGIHP) and national NGOs. To ensure the proper management and execution of grants, the Global Fund

Programme Management Unit is organized into eight sections‐ four managing the specific grants, a

Monitoring and Evaluation, Finance, Procurement and Supply Chain Management sections.

3 There were two CCMs overseeing GF grants implementation in North and South Sudan before the cessation of the South.

4 SUD-305-GO4-H, SUD-506-G08-H, SUD-506-G07-T, SUD-202-G03-M, SUD-708-G10-M, SUD-T-UNDP


Table 1: Overview of GFATM grants in Sudan since 2005

Grant Name Project Title Grant Period Budget in USD

Round 2 Malaria Malaria Prevention and Control Apr 1St 2005‐ Sep 30th 2009

33,240,453

Round 3 HIV/AIDS Sudan Proposal for fighting HIV/AIDS Apr 1st 2005‐ Sep 30th 2010

20,682,531

Round 5 Tuberculosis Comprehensiveness and Quality of DOTs in Sudan Jan 1st 2007‐ Dec 31st 2011

11,684,917

Round 5 HIV/AIDS Scaling up the National Response for prevention and treatment of HIV/AIDS in Sudan

Jan 1st 2007‐ Dec 31st 2011

84,976,035

Round 7 Malaria Scaling‐up Malaria Interventions in Northern Sudan Apr 1st 2009‐ Mar 31st 2014

77,156,461

Round 8 Tuberculosis Addressing TB control in war‐affected, post conflict areas and other challenges

Jan 1st 2010‐ Jun 30th 2010

3,171,523

Round 8 HSS Addressing TB control in war‐affected, post conflict areas and other challenges

Jan 1st 2010‐ Jun 30th 2010

714,791

SSF TB/HSS Comprehensiveness and quality of DOTs in Sudan Addressing TB control in war‐affected, post conflict areas and other challenges

Jul 1st 2010‐ Feb 28th 2015 45,267,705

HIV R10 To intensify the HIV/AIDS national response in Sudan Mar 1st 2011‐ Feb 28th 2013

19,180,279

Malaria R10 Scaling up for Universal Coverage with Community Participation

Mar 1st 2011‐ Feb 28th 2013

53,673,711

Total 349,748,406


Table 2: Overview of the total approved, received funds and expenditures until December 31st 2012

Grant Name Approved Received Expenditures Balance

Round 2 Malaria Phase 1 14,237,853 14,237,853 13,156,250

Phase 2 19,002,600 18,840,189 19,206,292 715,500

Round 3 HIV/AIDS Phase 1 7,842,140 7,842,140 7,181,565

Phase 2 12,840,391 12,185,910 11,749,546 1,096,939

Round 5 Tuberculosis

Phase 1&2 11,684,917 11,684,917 11,684,917 0

Round 5 HIV/AIDS Phase 1 29,421,145 29,421,145 18,372,150

Phase 2 55,554,890 44,017,230 49,184,423 5,881,801

Round 7 Malaria Phase 1 28,503,242 35,373,169 25,027,861 10,345,308

Round 7 Malaria Phase 2 48,653,219 26,012,413 21,080,039 15,277,682

Round 8 Tuberculosis Phase 1 7,207,041 3,171,523 3,171,523 0

Round 8 HSS Phase 1 8,292,492 714,791 714,791 0

SSF TB/HSS Phase 1 19,851,519 20,129,456 15,587,385 4,542,071

SSF TB/HSS Phase 2 25,416,186 0 0 0

HIV R10 Phase 1 19,180,279 4,338,391 2,524,573 1,813,818

Malaria R10 Phase 1 53,673,711 27,353,645 19,813,874 9,568,860

Totals 361,361,625 255,322,772 216,426,101 38,896,670

UNDP/GFATM PROJECTS

1.1 OVERALL GOALS, OBJECTIVES AND ACHIEVEMENTS

Malaria

1.1.1 Scaling up Malaria Interventions in

Sudan

The overall goal of the Scaling‐up Malaria Interventions

(SMI) in Northern Sudan Project (Round 7 grant) which

started in April 2009, is to continue and expand disease

management activities implemented under the

previously closed project on Malaria Prevention and

Control (Round 2); which included home based

management of malaria, improvement of clinical and

Figure 1: The Launch of the 8th campaign for Bed Netdistribution. This picture is from Blue Nile State, Damazin locality. The State Governor, State Minister of Health , Undersecretary Federal Ministry of Health, Locality Governor and UNDP Project Officer handing over bed nets to mothers. Project supported by the GF, UNDP and UNICEF


laboratory diagnosis, ensuring availability and rational use of anti‐malarial drugs, establishing a Malaria Early

Warning System (MEWS) to ensure a rapid response to malaria outbreaks.

The other aspects of malaria case management in this project are a gradual shift from clinical, symptomatic ,

treatment to test‐based treatment by introducing the

use of rapid diagnosis test kits, preventing malaria

during pregnancy through the distribution of bed nets

and capacity building of national institutions. Another

objective of this project is to unify and standardize

interventions by all NGOs working in the field of

malaria control in Sudan in line with the national

framework. The Round 10 Malaria, as new grant that

started in March 2012, intends to scale‐up and reach

universal coverage with community participation by

bridging the gaps observed in Round 7 as well as the

introduction of IRS (in‐door Residual Spraying) for

vector control for locations with an in intensive irrigation schemes; mainly Gezira and Sennar states. In

addition, the grant is aimed at strengthening the organizational capacity of national counterpart and provides

support for Malaria Program Review.

Main Achievements in 2012

2, 894, 862 cases of uncomplicated and severe malaria cases received anti‐malarial treatment according

to National guidelines.

3, 106, 115 bed nets were distributed to protect approximately 6,212,890 people from malaria.

4, 330 health facilities were supported to continue the provision of free anti‐malarial drugs throughout

2012.

2, 229 dispensaries in rural and hard‐to‐reach parts of the country were fully supported to continue

providing free Rapid Diagnostic Test for malaria.

Figure 2: Blue Nile State: Children demonstrating bed net use to members of their community – Project supported by GF, UNDP and UNICEF


HIV/AIDS

1.1.2 Scaling up the National Response for prevention and treatment of HIV/AIDS (Round 5)

The overall goal of the Scaling up of the National Response for prevention and treatment of HIV/ AIDs project

(Round 5 grant) is to contribute to reduce HIV transmission and HIV mortality in Sudan. The project aims to

increase awareness of HIV/AIDS and other STDs further enhancing and reducing risk behaviours; and to

ensure availability and utilization of quality VCCT services in all states; increase access to condoms through

free distribution, social marketing and other outlets in target communities. In addition, the project targets

that more than eighty percent of blood transfused in government hospitals is from non‐remunerated

voluntary donors. The project has also a major component for care and support services to PLWHAs.


HIV R5 Main Achievements

The project reached over 168,000 people from the general population through community outreach

Behavior change communication (BCC) interventions.

BCC interventions provided to 137,335 for members of Most at Risk Populations (MARPs) and

vulnerable population (youth in IDPs).

BCC interventions reached more than 4, 000 young people from out‐of‐school settings.

More than 85,000 people have completed HIV testing and counseling process.

About 5,500 people with advanced HIV infection are receiving ARV combination therapy.

2,032 TB patients have begun ART during or at the end of their TB treatment.

1.1.3 Intensify the HIV/AIDS national response in Sudan (Round 10)

The characteristics of the HIV epidemic in Sudan mirror that prevailing in the Middle East and North Africa

(MENA) region. HIV infection is concentrated among high‐risk populations with vulnerable populations being

the bridge of HIV transmission into the general population.

It is with in this context that the Round 10 HIV project, which is launched in 2012, aims to to reduce HIV

transmission and to reduce HIV morbidity and mortality in Sudan.

Objectives

1. To reduce HIV transmission through the provision of services for MARPs.

2. To improve access and utilization of PMTCT services in Northern Sudan.

3. To improve quality and uptake of existing care and treatment services in Northern Sudan.

4. To strengthen HIV prevention in health care settings in Northern Sudan.

5. To improve planning, management and monitoring of the HIV/AIDS response


Cross‐cutting Issues:

‐ TB/HIV is another cross‐cutting issue that is targeted in this project with training voluntary

counselling and testing for TB patients as well as condom distribution.

‐ The project is targeting the 17 states with focus on war affected areas and conflict zones with

activities and capacity building in the form of refurbishment of localities warehouses as well as

upgrading of locality staff capacity in planning and communication.

‐ Income generation activities target Most‐at‐risk populations (MARPs) to empower sex workers with

life skills, information and support needed to make informed decisions on their current and future life

and to abandon sex work or to reduce their risky behaviour. Study conducted in 2008 in Khartoum

state among FSWs showed that, 80.2% were selling sex due to economical reason, and more than

21% do not use condom because their partners refuse.

Round 10 HIV: Main Achievements in 2012

Reached 4,487 MARPs (MSM&FSW) through peer education.

Provided counselling and testing services to 60,036 people including pregnant women and

MARPS.

79 pregnant women received ARVs to reduce the risk of mother to child transmission of HIV.

Trained 151 health care providers on syndromic management of STI according to the national

guideline and 59 health care providers trained on Infection prevention in health care settings.

Retained 2,574 people on ARV treatment.

Tuberculosis and Health System Strengthening

1.1.4 Single Stream Funding (SSF) – TB and Health Systems Strengthening Programme (SSF‐

TB/HSS)

The overall goal of the TB component of this project is to drastically reduce the TB burden in Sudan,

particularly among poor and vulnerable populations in line with the 2015 MDGs and the Stop TB Partnership

targets. The project aims to decrease the burden of TB through reducing mortality, morbidity and

transmission of the disease until the disease no longer poses a threat to public health in Sudan. It also aims to

reduce human suffering and the social and economic burden which families and communities have to bear as

a consequence. The project aims to scale up and strengthen quality DOTs including creating access to war‐

affected and post conflict regions; strengthen partnership including PPM and engagement of health care

providers; prevent and control MDR‐TB, and address TB contact management; as well as raise awareness and

participation of communities and politicians, including the creation of positive perceptions toward TB


prevention, treatment efficacy and adherence, in addition to reducing stigmatizing attitudes the burden of

TB/HIV in Patients and PLWHA.

1.1.5 Single Steam of Funding (SSF): Health System Strengthening

The goal of the Health System Strengthening component of the SSF grant is to contribute to improving the

performance of National health system for a better response to the

three diseases to achieve MDGs, including MDG‐6 for AIDS TB and

Malaria. This cross cutting project aims to improve health services

delivery including laboratory services, assuring quality and equity of

access at all levels of health care; strengthen health management

information system, including surveillance and setting up a M&E

system for measuring the health system’s performance; strengthen the

procurement and management system for drugs, supplies and

equipment, including quality assurance; as well as quantitatively and

qualitatively scale up the availability of Human Resources for Health at

different levels of

health care; and

finally strengthen

health financing

function of health

system for assuring

equity and access to

health service.


Tuberculosis

• TB treatment was provided to 19,831 TB cases.

• The project detected 6, 518 new smear positive TB cases.

• 70.6% of reported new smear positive TB cases were successfully treated.

• 254 TB cases were diagnosed as MDR‐TB cases and placed on treatment.

• 190,589 condoms were distributed to TB patients.

• 2, 827 people were trained on TB management, contact tracing and management, PPM, DOTS links and

health communication skills.

Figure 5: Mini‐buses delivered to Academy of Health Sciences to commute Students to and from hospitals/ Field appernteship to their Academies

Figure 4: Upgrading Rural Hospitals, Primary Health Care centers & Laboratories by equipping & furnishing

Figure 3: Vehicles: to enhance the capacity of Locality Health Management Teams, as part of the overall HSS programme.


• 27 TBMUs were newly established in Darfur states.

• 54 DOTs were newly established in Darfur states.

Health System Strengthening (HSS)

• A health system strengthening project implementation mechanism was created within the Ministry of

Health and the CCM, including establishing a HSS sub‐CCM committee

• Site assessment and design work for rehabilitation of the Academies of health Sciences finalized; and

civil work is on‐going to be realized by June 2013.

• 14 Academies of Health Sciences in 14 states were provided with minibuses to facilitate their daily work

and commute students between health facilities, the academies and communities.

• Equipments to upgrade five rural hospitals, 25 health centers, 15 laboratories & five health academies

were procured & handed over to MOH.

• 293 health management personnel from 114 localities trained in decision‐making, teamwork, effective

meetings, and health planning and district health management

• The capacity of Locality Health Management teams enhanced by the provision of vehicles, office

equipments and computers.

• 25 participants from states and federal level trained on M&E of the health system; out of which 5 staff

was nominated to participate in external advance training on M&E will be conducted in Liverpool

University.

• 42 health managers from states and localities trained in health economics/financing.

• A framework for community based health insurance (CNHI) has been designed.

• Five fellowships in health economics & health care management were awarded in collaboration with the

National Health Insurance Fund & University of Chulalongkorn, Bangkok, Thailand.

• 20 health managers from states & localities were enrolled in health economics/financing 4 week in

country short course in collaboration with the National Health Insurance Fund & University of

Chulalongkorn, Bangkok, Thailand.

• A new implementation strategy was developed in light of the changes in the implementation

arrangement for phase II.


1.2 PROJECT MANAGEMENT

UNDP as Principal Recipient of the GFATM grants has the primary role in ensuring that the implemented

activities, undertaken by sub recipients (SRs), contribute to the national response against HIV, TB and malaria.

At the state and locality level the implementation is carried out by SNAP, NTP and NMCP states’ coordinators.

WHO, UNFPA, UNICEF, UNAIDS and UNHCR are the major Sub‐Recipients responsible for the management

and provision of technical support in areas of treatment, prevention and awareness raising activities for the

various projects, while the UNDP as the Principal Recipient oversees the management and implementation,

including the release of funds and tracking of their use. To ensure the proper management and execution of

grants, the Global Fund Programme Management Unit is divided into eight sections‐ four sections managing

the specific grants (HIV, Malaria, TB and HSS), a Monitoring and Evaluation, Finance, Procurement and Supply

Chain Management sections. The PMU adopted a standard operating procedure for efficient and proper

implementation of all GFATM grants. UNDP’s standard project management framework and internal controls

govern the project execution. The project is also staffed with the relevant programme, Finance, procurement

and other support personnel. In addition, all grants undergo the regular and periodic review and assessment

by the Local Funding Agent (LFA) which is contracted by the Global Fund. UNDP has also annual audits

undertaken by the Office of Audit and Investigations.


1.3 PROCUREMENT

1.3.1 Details of the construction activities under all grants

Delivering adequate health services in Sudan was severely affected by prolonged conflicts and instability in

the country. UNDP, through the Global Fund support and in‐collaboration with local partners, has taken the

lead in health system strengthening initiatives which include rehabilitation and renovation of health

infrastructure; as well as capacity building and

improving the skills of health personnel.

As part of advance procurement planning, a

Request for Proposal for the Provision of Services

for Rehabilitation/Construction Works in Sudan was

launched at the end of 2011 for pre‐qualified

national and International Engineering and

Consulting Firms to engage them under Long Term

Agreement (LTA) for one year to participate in the

civil works as per the 2012 PSM Plans. Accordingly,

a Long Term Agreement was signed with consulting firms in April 2012.

1.3.2 HIV/AIDS Grant‐ Construction and rehabilitation of health facilities

Under the Round 5 HIV/AIDS grant, the Certificates of Final Completion have been issued for 78 constructed

and rehabilitated buildings in 15 States of Sudan. The Sudan National Programmes have taken over these

buildings with the full responsibility of the maintenance.

Construction of two (2) Centres for HIV‐Prevention of Mother to Child Transmission (PMTCT) ‐ is ongoing at a

cost of USD 325,440. The progress as of December 2012 stood at 75% completion. Procurement of one

hundred and eighty six (186) Split Unit Air‐conditioners and Outdoor Pavements and furniture for health

facilities was planned and implemented at the cost of USD 670, 031. This is part of a project to upgrade the

HIV healthcare facility infrastructures throughout the 15 states. The targeted facilities include 80 HIV

healthcare facilities which were constructed between 2010‐2011. The facilities include VCTs, PMTCTs, ART,

Blood banks and offices of PLWHA Associations.

1.3.3 Ensuring and improving drug storage conditions

As part of improving the supply chain of drugs and other health products, UNDP has signed an agreement

with the Central Medical Supplies (CMS) to take the overall responsibility of storage, distribution and

handling of Global Fund funded drugs. UNDP has also constructed warehouse under Round 5 HIV/AIDS. The

Figure 6 Atbara Zonal Lab –Back view, after completion of the Civil Construction works


procurement of Storage Racks, application of Epoxy flooring, installation of Central Air‐Conditioning System,

Construction of internal partitioning, reconstruction of fences, and building of security rooms planned and

initiated at a cost of USD 448,850. Epoxy flooring work for this central warehouse was completed in

December 2012; with the remaining activities to be completed by March of 2013.

In addition, seven (7) Diesel Generators of 80 KVA capacity were procured for States and Regional

Warehouses at a cost of USD 167,996.

Under the Round 7 Malaria grant, three Diesel Generators were procured for Malaria Institutes in Sinar,

Khartoum and Gazeera States at a cost of USD 179,666

As part of refurbishing medical stores in different States, the remaining 4 locality medical stores –out of 107‐

in South Darfur States are supplied with shelving/racking systems. Diesel generators for 4 locality medical

stores in South Kordofan are stored in Central Medical Supplies (CMS) Warehouse in Khartoum due to the

current volatile security situation in the area.

1.3.4 SSF‐TB/HSS

Following a gap analysis done in 2011, refurbishment was planned under the SSF‐TB/HSS grant to

strengthening of Tuberculosis Management Units (TBMUs) in post conflict areas including the rehabilitation

of 18 TBMUs, 45 TBMU Laboratories and 54 DOTs centres, with an estimated budget of USD 519,000.

The improvement of infrastructure of the 18 TBMUs and 54 DOTS centres was achieved as per the approved

plan for phase 1, by supplying and installing basic office furniture with a total cost of USD 32,130. All targeted

facilities were successfully reached apart from 10 locations in Darfur where the supply and installation is

expected to be completed by March 2013

Rehabilitation works for the National Reference Laboratory in Khartoum are completed at the cost of USD

154,522. The certificate of substantial completion was issued on August 2012 and the site was handed over to

the National Programme. In addition, the National Reference Laboratory in Khartoum is supplied with

150KVA Diesel Generator at the cost of USD 33,860.69.

Three (3) Zonal Laboratories are being rehabilitated at the cost of USD 126,627 and will be handed over to

National Programme by mid of March 2013.

To improve quality of TB services and to reduce MDR TB cases, construction of two TB MDR patient wards in

Khartoum is held at the cost of USD 123,907. The construction work commenced in December 2012.


The rehabilitation of another seven (7) Tuberculosis Quality Control laboratories and two (2) Zonal

Laboratories is planned at the cost of USD 311,533; the rehabilitation is expected to commence by March

2013.

As part of upgrading the health facility infrastructures, five (5) Diesel Generators of 20 KVA capacity were

procured for the TB Zonal Laboratories at the cost of USD 92,772.

1.3.5 SSF‐TB/HSS‐ rehabilitation / construction of the academies of health sciences

Following an assessment to verify the rehabilitation requirements for selected academies of health sciences,

the plan for rehabilitation and construction of five (5) Academies of Health Sciences (AHSs) has been

approved by the global fund with an estimated cost of USD720, 000.

Construction/ Rehabilitation of the AHSs is intended to improve the availability of Human Resources for

Health at different levels of health care both quantitatively and qualitatively. Construction/ Rehabilitation of

the five AHSs are being held at the cost of USD 650,000. The construction work has started since December

2012, with a planned completion by June 2013.

Table 3: Summary of construction activities for all grants in 2012

Description of Procurement

Grant/

source of

funding

Value (USD)

Rehabilitation of the National TB Reference

Laboratory TB 154,522

Construction of Two PMTCT Centres and

Rehabilitation of Three (3) Zonal Labs HIV & TB 452,067

Procurement of (186) Split Units for HIV

healthcare facilities in Different States in Sudan HIV 146,125

Procurement of Outdoor Pavements for HIV

healthcare facilities in Different States in Sudan HIV 148,206

Procurement of Diesel Generators for (7) States

Regional Warehouses, National TB Reference lab,

(5) TB States Zonal Laboratories and (3) Malaria

Institutes

TB & Malaria 474,295

Procurement of Storage Racks, application of

Epoxy flooring, installation of Central Air‐

Conditioning System, Construction of internal

Malaria 448,850


partitioning, re constructing the fence, and build

security room

Procurement of 3 stand by Diesel Generators for

Public Health Institute , Blue Nile National

Institute for Communicable Diseases and Algadal

Malaria Training Institute in Sennar

Malaria 160,000

Construction of two TB MDR patient wards in

Khartoum TB 123,907

Construction/ Rehabilitation of (5) Academies Of

Health Sciences HSS 650,000

Rehabilitation Works for 7 Tuberculosis Quality

Control laboratories and 2 Zonal Laboratories in

Different States in Sudan

TB 311,533

Table 4: Key pharmaceutical and non‐pharmaceutical products procured‐ 2012

Grant Name Description of Procurement Value (USD)

SSF‐TB/HSS IT Equipment 41,223

Round 7 Malaria Malaria Health Equipment (Lab) 215,233

Round 10 Malaria Anti Malarial Drugs ( ACTs) ‐Malaria 518,880

Round 7 Malaria Anti Malarial Drugs ( ACTs) ‐Malaria 4,365,492

Round 5 HIV/AIDS HIV/AIDS ARVs 757,638

Round 5 HIV/AIDS HIV/ AIDS drugs 128,673

Round 5 HIV/AIDS HIV/ AIDS Test Kits 121,814.40

Round 5 HIV/AIDS HIV/ AIDS Lab. Equipment 437,551.22

SSF‐TB/HSS Laboratory Equipment 896,792

SSF‐TB/HSS Hospital Equipment 935,714.42

SSF‐TB Second line Drugs 516,412

SSF‐TB First line Drugs 1,343,685

Round 10 Malaria RDT’s 632,520

Round 10 Malaria IRS+ Accessories 3,398,564

Round 10 Malaria Sprayers 395,370

Round 5 HIV/AIDS Furniture 218,661.15

SSF‐HSS Furniture 258,256


SSF‐HSS Skill lab 34,058

HIV/AIDS R5 Vehicles 103,996


1.4 SUPPLY CHAIN MANAGEMENT

During 2011, UNDP/ GFATM, in close collaboration with partners, developed a strategic roadmap to

strengthen the supply chain management system and identified key interventions for establishing a viable

and agile supply chain system in the country. This project supports the national programmes in establishing a

responsive and sustainable supply system capable of delivering appropriate, sufficient quality health

commodities to the right places at the appropriate time and free of charge. Below are the key interventions in

2012.

1.4.1 Logistics Management Information System (LMIS)

UNDP/GFATM is supporting mechanisms aimed at providing reliable logistics data captured through a

functioning LMIS in health facilities and transferred effectively and efficiently along the nationwide supply

chain up to the CMS, national programs and UNDP. The reports to be delivered through the LMIS include

National Physical Inventory reports, Stock Status reports, HIV/AIDS TB and Malaria commodities consumption

reports, Patients per regimen reports and Expiry Risk Analysis reports.

1.4.2 PSM Technical Assistance

UNDP/GFATM contracted Axios Foundation as the PSM technical assistance provider to strengthen the

national supply chains for HIV/AIDS, TB and Malaria programmes in Sudan; as well as assess the current

logistic system. The foundation is to document the system’s strengths and weaknesses, as well as support the

availability of an agile supply chain system.

Axios Foundation had completed the first year work plan as per the agreement. Major deliverables include

the PSM system assessment, PSM system redesign & the support to the national forecasting & quantification

technical working group, manual SCM system development, defined requirements for an electronic LMIS, and

Training of PSM and CMSC staff.

1.4.3 Central Medical Store

UNDP/ GFATM signed a Sub Recipient agreement with the CMS in 2011, with a mandate for the management

of procurement and supply of pharmaceuticals in Sudan. The main objective is the delivery of a wide range of

supply chain interventions to ensure consistent availability of products at all levels and to prevent treatment

disruptions by establishing a sound and reliable logistics system.


1.5 MONITORING AND EVALUATION

Monitoring and evaluation are indispensable learning and management tools for improving current and

future program planning, implementation and decision making. Regular verification of data, and data quality

assurance were among the priority areas for the UNDP/ GFATM M&E section throughout 2012. In order to

avoid creation of an M&E system parallel to the national one, UNDP/ GFATM has exerted efforts into

strengthening the latter. To guarantee collection of data for all indicators using data tools from national

programs which feed the quarterly reports, UNDP/ GFATM, continued working in collaboration with all

partners to review these tools to ensure all important information is captured, and data quality is maintained.

Towards the second half of the year, UNDP‐ GFATM PMU conducted HIV/AIDS Round 5 Outcome Evaluation

Studies focusing on (i) Prevention; and (ii) Care and Treatment components of the program, as an effort to

improve the quality and effectiveness of the national, multi‐sectoral response to HIV/AIDS in Sudan.

The evaluation revealed that program targets were achieved or exceeded except for those related to ART

programme coverage and patient retention, and TB and HIV collaborative activities. Accordingly, the study

recommended investigating the factors contributing to the low patient retention rates at ART centres. This

evidence should then guide a national strategy to improve patient retention and ART adherence monitoring.

The evaluation findings also emphasized the need to strengthen the ability to collect and interpret

information regarding the progression of the HIV epidemic and the influence of the country’s unique socio‐

cultural dynamics on the uptake and utilization of care and treatment services. Such effort would allow

continually monitoring the relevance of the HIV care and treatment programme and adapting it accordingly.

The evaluation studies have underscored that the Round 5 HIV grant made a significant contribution to the

HIV Integrated Bio‐Behavioural Surveillance Survey (IBBS survey project); the findings of which have

established a baseline for the states and served as a means for generating strategic information to design

appropriate interventions for the key populations.

During the fourth quarter of the year UNDP‐GFATM PMU and the LFA conducted On‐Site Data‐Verification

(OSDV) for the TB & HIV grants and Rapid Service Quality Assessment (RSQA) for the HIV grant. The exercise

was intended to verify reported results mainly focusing on treatment and training indicators. The OSDV &

RSQA exercises covered selected health facilities in Khartoum, El Gezira and El Gadarif states.

The OSDV exercise made a number of recommendations including the need to develop standard operating

procedures (SOPs) in order to guide the recording and documentation process at all levels. The need for an

integrated and comprehensive database has also been highlighted through observations of the Global Fund,


the Local Fund Agent (LFA) and various national partners. Observations and recommendations made during

these visits were shared with the UNDP‐ GFATM PMU, CCM and partners.

In order to closely monitor the grant implementation, based on the findings of the shared quarterly reports,

UNDP‐GFATM PMU, SRs and national programmes jointly conducted over 20 field visits to facilities supported

with GF grants (10 field visits to the HIV/AIDS facilities, four visits to TB facilities, five visits to Malaria

facilities, and two visits covering training related activities). Ten out of the seventeen states in Sudan were

covered during those visits. The visits covered the data quality assurance, staff training status; facilities’

supply stock status which includes drugs and test kits; inspection of the warehouses for storage conditions of

the drugs and test kits as well as expired supplies. Reports of the visits with findings and recommendations

were shared timely with the implementing partners.

M&E Related Achievements and Challenges in 2012:

Major achievements:

Contribution to development of National M&E Plans for HIV/AIDS & TB Programs

Initiation of the first National TB Prevalence Survey

Contribution to the implementation of the National Malaria Indicator Survey (MIS)

Successful completion of two evaluation studies on HIV/AIDS prevention, care and treatment

Major challenges:

Limited access in some states for M&E and supervision due to security related restrictions

Lack of National Strategic Framework on M&E

Poorly developed M&E systems & infrastructure especially at the state level

Lack of national policy or strategy on Health Management Information System (HMIS)

Poor progress in finalizing results of HIV/AIDS sero‐behavioural survey

High turnover of trained staff at all levels of the health system, especially at state level


1.6 CHALLENGES, LESSONS LEARNED AND RECOMMENDATIONS

Challenges Related to Security

In 2012, the volatile security situation in certain parts of the country posed constraints on the implementation

and monitoring of project activities. This has been prominent in certain regions of the country, mainly in the

Blue Nile, South Kordofan and several areas of Darfur States. The Darfur states were less accessible for

supervision visits by national health cadres. Consequently, there is also a high turnover of trained state

ministries’ of health staff which negatively impacted the timely reporting from the health facilities to the

state and federal levels. Uneven distribution of health workers in the country, especially the shortage in

security volatile and hard to reach areas has continued to negatively affect access to and quality of services.

Challenges related to programme implementation

Although the unpredictable security situation in many parts of the country posed a continued challenge to the

activities; security challenges are not the only problem facing GFATM projects. At the national level, although

information/ statistics of the prevalence rates of the three diseases is available, there is a lack of information

on the quality and access to health services available throughout the country.

Additionally, the monitoring role of the local administration at the state levels is limited. The sustainability

and ownership of all the programmatic activities at the state levels is crucial to the sustained control of the

three diseases and strengthening the health system in Sudan. However, the changing and limited leadership

role of the local administration continues to be a challenge.

At the national level, there is a substantially high rate of medical staff turnover due to the economic

challenges facing medical staff throughout the country; as well as brain drain. Finally, the limited capacity of

national CSOs when trying to access GFATM funds is problematic. Since the UN and GFATM requirements for

funding are quite strict, this has deterred access of local and national organisations working with the three

diseases. However, by September 2012, the GFATM Board has modified the additional safeguard policy

imposed on Sudan and partially approved the direct access to resources by government entities and CSOs.

This is a major and positive development in terms of creating capacity and reaching most hard to reach

communities in the country. Although in 2012, there were several activities focusing on capacity building of

national NGOs, this remained to be a challenge throughout the year.


1.7 FOCUS AREAS FOR 2013

In line with UNDP’s major intervention and the modified Additional Safeguard Policy, UNDP as a PR will be

engaging several government implementing entities and NGOs to directly implement Global Fund grants as

key Sub‐recipients. This new implementation arrangement will start with TB and HSS grants while other

grants will adopt this arrangement gradually in the years to come. In this context, UNDP will be implementing

several Capacity development activities to national entities and NGO implementing partners, mainly focusing

on Program management and institutional capacity. In this regard, preparations are underway since late 2012

to hold several trainings on grant management, financial management and compliance and Monitoring and

evaluation.

Another major area of engagement for UNDP in 2013 is the alignment of GFATM programs with the recent

reform introduced within the Ministry of Health. Reform created and merged several programs into

respective directorates with significant changes in role and responsibilities. This transition requires a close

follow up and coordination, while ensuring the continuity of service delivery and achievement of the different

targets set for GFATM grants.

With regard to specific grants, UNDP along with the relevant partners will be focusing on the following major

areas of work in 2013:

Round 7 Malaria Grant

To continue delivering the first line drugs for malaria treatment free of charge to more than 4, 630

health facilities with special focus on IDPs, refugees and peripheral communities.

To enhance malaria vector control interventions through the distribution of approximately 1.3 million

long lasting insecticide bed net to targeted communities.

To strengthen the procurement and supply system by refurbishing 4 malaria warehouses in South

Kordofan state.

To continue upgrading the capacity of malaria control staff at the sub national level by conducting

various training courses in the field of malaria.

Completion of Malaria Indicator Survey (MIS) by March, 2013 and dissemination of the report

Round 10 Malaria Grant

Completion of Malaria Programme Review (MPR) to assess where the programme stands and to

update the national strategic plan for malaria control in the country with special focus on the national

M&E plan.


Continue supporting the implementation of M&E e‐database to strengthen the malaria surveillance

for timely reporting as well as timely feedback. This will be done in conjunction with the ongoing

national effort to unify the health management information system (HMIS)

To equip malaria sentinel sites with computers and internet services to monitor the malaria trends to

contain malaria outbreaks.

To distribute more than 2.3 million lasting insecticide treated bed nets to protect approximately 1.5

million people including pregnant women and children under the age of 5.

To continue supporting IRS intervention in Gezira and Sennar states

Round 5 HIV Grant

Ensure the proper and complete closure of the round 5 HIV grant and finalize the implementation of

activities which were part of the grant close plan.

Round 10 HIV Grant

To provide HIV testing and counseling services for at least 400,000 people from the general

population and 2,700 MARPs.

To provide ART for a minimum of 217 HIV positive pregnant women as part of MTCT of HIV

To provide ART services to 5,000 adults and children with advanced HIV infection.

To distribute 2.5 million condoms for free through health facilities and community based out‐ lets.

Tuberculosis (SSF TB)

All procurement for 2013 for Laboratories (equipment & consumables), 1st line and 2nd line drugs

have already been procured with staggered deliveries as per the needs and forecasted delivery dates.

Pharmaceuticals/Health Products, non‐pharmaceuticals and services worth of $2,530,401, $1,725 &

$196,214, respectively will also be provided in 2013 to support the program and improve access and

quality of services.

In 2012 equipment and furniture for TBMUs, DOTS centres & TBMU Labs have been requested. The

furniture for the 18 TBMUs and 54 DOTS is already delivered and installed in the respective facilities

while additional 5 Zonal Labs & 10 QC Labs will be equipped in 2013 once the on‐going physical

renovations of these facilities is completed.

Renovation of all 10 QC labs & 35 TBMU labs, 5 Zonal Labs 2 wards of Abu Anja MDR Hospital will

continue and is planned to be completed in 2013.

Preparation for all three TB surveys is completed during 2012 including the Drug Resistance Survey

(DRS), KAP survey and TB prevalence survey. These surveys will be conducted in 2013 and2014.


The PR through its TB, finance & M&E team will continue to enhance and improve the capacity of the

National counterparts especially the new SRs such as NTP, Epi‐Lab & STPA through on the job

trainings, supportive Supervision, training on Monitoring and Evaluation, reporting, and financial,

accounting and book keeping.

Detailed targets set to be reached in 2013 interims of service delivery; case detection, treatment and

other programmatic indicators are provided in the annex of this report.

Health System Strengthening

The health system strengthening project is a cross cutting project, addressing the mainstream health

care delivery in areas of governance, health care delivery, health information systems, and human

resources for health, pharmaceutical supply management and service delivery. These components of

the project are wrapped around and cross cut the different functions of the health system ensuring

project deliveries. In 2013, the main focus is to enable government counterparts and the Ministry of

Health manage GFATM projects directly by themselves. This entails, In light of the additional safe

guard policy applied by the Global Fund, engaging new SRs, especially the government, requires a lot

of capacity development and risk management interventions. In 2013, organizational leadership,

management, transparent decision‐making and ensuring accountability systems are in place

In addition, the regular HSS interventions in areas of service delivery, HMIS HRH, PSM and Health care

financing will continue. In this regard, additional rural hospitals will be upgraded, referral laboratories

will be equipped and furnished, Primary health care centres will be provided with the necessary

medical equipments and furniture, more focus will be given in training newly recruited CHVs; a total

of 570 in 2013. Additional two AHSs will be renovated and equipped. The IT infrastructure will be

supported to galvanize the government’s effort to streamline and consolidate the HMIS system.

Locality and State Health management teams will be provided both technical and material support.

CONCLUSION

This Annual report is intended to capture the main achievements of the year. However, it is worth underlining

the importance of the huge efforts exerted by all stakeholders involved. The GFATM has gone a long way

since the beginning of activities in 2005. Although there is a lot to be praised; we hope that the coming years

will sustain previous achievements as well as accomplish further successes. All those involved understand

that the road was a difficult one and there is also a lot to look forward to in the coming years head; with the

hope that finally all the people of Sudan will enjoy the benefit of a healthy life.


Annex I: Indicators

Annex I.1: Malaria Round 7 Indicators Update‐ 2012

Indicators Target Results Percentage

Health facilities providing free anti‐malarial drugs (equivalent

number of health facilities will be provided) 4,630 4,330 94%

Communities (villages, nomadic groups, settled IDP camps)

have access to ACTs through HMM programme 290 287 99%

Dispensaries using (free) RDTs for malaria diagnosis 2,406 2,229 93%

Localities with at least 2 malaria control staff trained in

different aspects of malaria control 80 68 85%

Localities with warehouses having adequate storage

conditions 100 103 103%

Localities with standard procurement and supply system in

place 105 105 100%

Health service providers trained in laboratory techniques,

PSM, IVM, epidemic control, HMM, and treatment of cases

(doctors, nurses, lab technicians, medical assistants)

7,383 5,965 81%

Public health officers completing training in medical

entomology and vector control 68 68 100%

Cases of uncomplicated and severe malaria receiving anti‐

malarial treatment according to National guidelines 2,500,000 2,894,862 116%

Number of ITNs distributed 3,412, 905 3,106,115 91%


Annex I.2: Malaria Round 10 Indicators Update‐ 2012


Number of patients with uncomplicated and severe malaria receiving anti‐malarial treatment according to national guidelines

2,500,000 2,894,862 116%

Percentage of locality warehouses reporting no stock out of ACTs for more than one week during the last three months

85% (91/107) 105 115%

Number of ITNs distributed 3,412,905 3,106,115 91%

Number of people trained on malaria treatment, prevention and PSM

737 1,975 268%

Number of HMM volunteers trained on prevention and treatment of Malaria according to national guidelines

100 135 135%

Percentage of service delivery points (health facilities and community service providers) submitting timely and complete reports (to the next reporting level)

80% (50 Community+ 4326 HFs) 3,372 78%


Annex I.3: HIV/AIDS Round 5 Indicators Update‐ 2012


General population reached by GFATM Round 5‐ funded BCC

community outreach activities

54,000 168,450 312 %

People from vulnerable groups reached by BCC community outreach

activities (combined)

120,000 137,335 114 %

Young people exposed to HIV/AIDS education in out of school setting

(Combined)

58,480 4,251 7 %

Young people reached by HIV/AIDS education in school settings

(Combined)

0 0 0 %

People trained to deliver youth education inc trainers, school teachers

and counsellors of drop‐in‐center (Combined)

11,729 8,946 108 %

Schools and drop‐in centers providing life‐based HIV/AIDS education

(Combined)

7,268 9,016 124 %

Service delivery points providing counselling and testing in accordance

with defined minimum standards

128 154 120 %

People completing the testing and counselling process (Combined) 193,600 195,926 101 %

Number of pregnant women completing the counselling and testing

process with GFATM resources

99,885 88,629 89 %

Ccondoms distributed for free with GFATM resources (Combined) 13,860,000 10,862,068 78 %

Blood units transfused in government hospitals that are collected from

voluntary non‐remunerated blood donors (VNRBDs)

80% 48% 60 %

Service delivery points providing ARV combination therapy supported

(Combined)

60 51 85%

People with advanced HIV infection receiving ARV combination therapy

(Combined)

20,736 5,532 27%

People with HIV infection receiving diagnosis and treatment for

opportunistic infections (Combined)

20,736 10,641 51 %

HIV positive TB patients who have begun or are continuing ART during

or at the end of TB treatment

4,000 2,032 51 %

Service points run by PLWHA associations providing care and support

for the chronically ill and families affected by HIV/AIDS

16 15 94 %

People reached by Home based Care including ART adherence support 4,000 4,636 116 %

Number and percentage of treatment sites reporting no stock out of

ARVs and selected diagnostic/treatment

60 (100) 51 100 %


Annex I.4 HIV Round10 Indicators Update‐ 2012


Number of MSM and FSW reached with HIV prevention

package 6,000 4,487 75 %

Number of health care providers trained on syndromic

management of STI according to the national guideline 200 151 76 %

Number of male condoms distributed for free

nationwide. 1,350,000 190,945 14 %

Number of individuals who received testing and

counselling services for HIV and received their results 287,600 60,036 21%

Number of MARPS who received testing and counselling

services for HIV and received their results 1,200 1,367 114 %

Number of HIV positive pregnant women who received

ARV to reduce the risk of MTCT 100 79 79 %

Number of health care providers trained to provide

PMTCT according to national guidelines. 300 86 29 %

Number of adults and children with advanced HIV

infection receiving ART 3,558 2,574 72 %

% of estimated HIV‐positive, TB cases that received

treatment for TB and HIV 15% 2% 10 %

Number of health care providers trained on HIV

infection control 65 59 91 %

Percentage of health facilities (providing VCCT, ART and

PMTCT services) submitting complete and timely

monthly reports to SNAP

70% 76% 109 %


Annex I.5 SSF TB/HSS Indicators Update‐ 2012


Number of new smear positive cases detected. 10,120 6,518 64%

New smear‐positive TB patients successfully treated (cured plus

completed treatment) among the new smear positive TB patients

registered during a specified period (number and percentage).

7,742

(85%)

5,129

(71%) 83%

Number of new smear positive TB cases detected in the newly

established TBMUs/DOTS centres in Darfur and post‐conflict areas. 330 239 72%

New smear‐positive TB patients successfully treated (cured plus

completed treatment) among the new smear positive TB patients

registered during a specified period (number and percentage) ‐ in

the newly established TBMUs/DOTS centres in Darfur and post‐

conflict areas.

187 (85%)201

(69%) 81%

Number of private health facilities, TBMUs and DOTs links from

public health facilities that report to the NTP timely (as defined in

M&E Plan)

690 451 65%

Number of TB patients who receive HIV counselling and testing

(among registered TB patients) ( results from 12 TBMUs with VCT

capability).

2,400 2,791 116%

Number of condoms distributed for TB patients through TBMUs. 320,000 190,589 60%

Number of MDR‐TB cases diagnosed. 350 254 73%

Number of TB patients supported with an income generation

scheme. 150 117 78%

Number of new TBMUs established in Darfur and post‐conflict areas. 18 27 150%

Number of new DOTS centres established in Darfur and post‐conflict

areas. 54 54 100%

Number of TBMU laboratories renovated. 45 0 0.0%

Number of Health management personnel from 114 localities

trained in decision‐making, teamwork, effective meetings, health

planning and district health management

432 293 68%

Number of Rural hospitals, dispensaries and PHC centres equipped

and furnished according to national standards 53 30 57%

Number of Rural and State Hospital laboratories upgraded to provide

referral service, including for the three diseases. 35 19 54%



Number of Discrete Choice Experiment studies on junior doctors

conducted and results disseminated 4 4 100%

Number of staff trained on DOTS, MDR‐TB, and community

volunteers to support DOTs, contact tracing and management, PPM,

DOTS links, or health communication skills and DOTS according to

the national TB guidelines.

2,788 2,827 101%

Number of health managers from states and localities received short

training course (2‐weeks) on health economics/financing. 80 82 103%


Annex II: Implementing Partners:

Annex II.1: Organizations involved in the Malaria Round 7 grant implementation

Type Organization Geographic coverage Area of work

SR

WHO 17 states

(i) Community Mobilization and Promotional Activities

through BBC ‐mass media

(ii) Promotion for campaigns for distribution of LLINs for

targeted communities (localities)

(iii) Training of health care providers

(iv) Treatment through home based management of

malaria

(v) Improving microscopic diagnosis

(vi) Supportive environment by monitoring drug resistance

(vii) Information system and operational research

(viii) Capacity building for National and Sub national Malaria

programme staff

(ix) Monitoring and Evaluation

SR

UNICEF 17 states

(i) In country distribution up to the locality level

(ii) Campaigns for distribution of LLINs for targeted

communities (IDPs)

(iii) Training of medical assistance at health facility level

(IDPs)

SR

UNHCR Two states

(i) Supported health facilities in refugee camps provide

primary health care services (Treatment, Diagnose,

training of health provider and Guidelines).

(ii) LLINs distribution

SR

NMCP All 17 States

(iii) Working as SSR for the main key sub recipient for both

R7&R10 malaria grants and direct SR on

reimbursement basis to conduct some M&E activities

under R10


Annex II.2: Organizations involved in the Malaria Round 7 grant implementation

Type Organization Geographic coverage Area of work SR

WHO 17 states

(x) Community Mobilization and Promotional Activities

through BBC ‐mass media

(xi) Promotion for campaigns for distribution of LLINs for

targeted communities (localities)

(xii) Training of health care providers

(xiii) Treatment through home based management of

malaria

(xiv) Improving microscopic diagnosis

(xv) Supportive environment by monitoring drug resistance

(xvi) Information system and operational research

(xvii) Capacity building for National and Sub national Malaria

programme staff

(xviii) Monitoring and Evaluation

SR

UNICEF 17 states

(iv) In country distribution up to the locality level

(v) Campaigns for distribution of LLINs for targeted

communities (IDPs)

(vi) Training of medical assistance at health facility level

(IDPs)

SR

NMCP All 17 States

(iv) Working as SSR for the main key sub recipient for both

R7&R10 malaria grants and direct SR on

reimbursement basis to conduct some M&E activities

under R10


Annex II.3: Organizations involved in the HIV/AIDS Round 5 grant implementation

Type Organization Geographic coverage Area of work SR

UNFPA

River Nile, El Gazeera,

Kassala, Khartoum

State

(i) Awareness outreach activities an mainstreaming of

HIV/RH services

(ii) Condom promotion and distribution

(iii) Providing health care services

(iv) Capacity building activities of local NGOs

UNICEF All 15 states

(i) Behaviour Change Communication‐Communication

Outreach

(ii) Youth Education

(iii) Provision of VCCT services

(iv) PMTCT and community mobilization

WHO All 15 states

(i) Blood safety

(ii) Provide VCCT services for clients

(iii) Care and support for PLHIV

(iv) Training of health care providers on ART

(v) Provision of OIs diagnosis and treatment

UNAIDS All 15 states (i) Coordination, monitoring and evaluation

(ii) Partnership development


Annex II.4: Organizations involved in the TB/HSS SSF grant implementation


SR WHO

All 15 States

(i) Health workers trainings

(ii) Improvement of cased detection and treatment

(iii) Improvement of reporting

SR NTP Darfur States &

Khartoum State

(i) Identify/develop partnership with NGOs in war‐affected

Darfur States through conducting 2 workshops in each

Darfur state and one central workshop in Khartoum

state

SR EpiLab

All 15 States but

centrally at Khartoum

state level

(i) Build capacity with TB staff on health communication

skills.

(ii) Conduct message pre‐testing for ACSM communication

program

SR STPA All 15 States

(i) Expand existing ACSM networks by engaging health

educators, NGOs and civil society

(ii) Build capacity for TB advocacy with the media

(iii) Empower TB patients and their families through

supportive environments

(iv) Support TB female patient empowerment


Annex II.5: Organizations involved in the TB/HSS SSF grant implementation


SR

WHO National

(v) Improve health services delivery including laboratory

services, assuring quality and equity of access at all

levels of health care;

(vi) Strengthen health management information system,

including surveillance and setting up a M&E system for

measuring the health system’s performance;

(vii) Build capacity of the system for drugs, supplies and

equipment procurement and management, including

quality assurance;

(viii) Scale up, quantitatively and qualitatively, the

availability of HRH at different levels of health care that

matches the basic standards;

(ix) Strengthen health financing function of health system

for assuring equity and access to health service

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