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Family planning in the Sudan: a pilot project success story.


 In 1980, the Department of Community Medicine of the University of Khartoum designed an operations research project to test the possibility of getting village midwives to be involved in the delivery of maternal and child health and family planning (MCH/FP) services. From 1981-1983 the project was implemented by the University of Khartoum in cooperation with the Ministry of Health. The project area covered 100 km. It encompassed a largely agrarian population of 93,000 in 90 villages north of Khartoum along the banks of the Nile. The focus was on training and supervising village midwives. Information was provided on contraceptives for birth spacing, distribution of oral contraceptives, and referral for other methods. Also provided to midwives was information for mothers on oral rehydration therapy for children with diarrhea, and distribution of oral rehydration solution packets. Nutrition education was given midwives with emphasis on breastfeeding and weaning procedures. Information was also supplied about vaccination for children under 5 years of age (in collaboration with the Sudan Expanded Program on Immunization). The project was expensive, particularly regarding incentive payments for supervisors and midwives. The project had a very good start, but when incentive payments were withdrawn, it almost collapsed. At first, what midwives could do to provide maternal and child health services was targeted, but as the project went on, there was more concern for involvement of midwives in broader rural health delivery. The project area was a conservative, Islamic one. An extension area was selected 5 hours travelling time from Khartoum in Shendi District of Nile Province. The project was begun in 60 villages of 75,000 inhabitants. The land stretched for 120 km along both banks of the Nile. In the extension area, a small fee (US$.025) was charged per cycle, half going to the midwives, and half towards the health teams' expenses. 21 health zones were created, and a health team created for each. Registers of women aged 15-49 and children 3 years have been set up for each health zone. There have been very good results in the management of diarrhea.
