INVESTING IN MIDWIVES

Susan Dokolo

JUBA

13^th May 09

Maternal mortality has become a serious global problem threatening mothers of developing countries such as the Sub-Saharan Africa, Latin America and Southern Asia.

In Sudan, household survey indicates that Southern Sudan has the highest maternal mortality rate in the world.

Dr Dragudi Buwa, Head of UNFPA Office Juba confirms in his speech;

"You might be pretty aware that the maternal health indictors for South Sudan are actually the poorest in the world and that for every 100,000 Live births in Southern Sudan 2054 of the mothers die".

To help reduce this high rate, on May 14^th this year, the United Nations Population Fund (UNFPA) together with the International Confederation of Midwives (ICM) with support from the government of Southern Sudan launched a program in Juba called; "investing in midwives and others with midwifery skills to accelerate progress towards millennium Development Goal number four, five and six."

Millennium Development Goal five aims to reduce maternal mortality by 75 per cent.

Addressing the crowd during the occasion, the vice President of the government of Southern Sudan, Dr Riak Machar Teny urged the citizens to stop harmful traditional practices that prevent women from safe delivery.

Dr Machar said the government has the challenge to develop the profession of Midwifery and promised the government support to the ministry of health. 

"There is also a misunderstanding; even the midwives are having problems how to communicate with the society....... So these are challenges. She wants to improve on how to reduce the maternal death rates, but when she gets confronted, she can't communicate...... so the aspect of advocacy is very important .We should talk about it until our people can reduce maternal death rate, child death rate by improving or by training midwives." advised Dr Riak.

An adviser from the international confederation of Midwives (ICM) explained that her organization's vision is that every child bearing woman should have a midwife access to herself and her new born baby.

In a press conference prior to the occasion, Dr Jamima Dennis said that midwife is a key to reducing maternal mortality and infant mortality in a country.

Dr Jamima a PHD holder in midwifery profession said that there is a need to educate midwifes and set regulations to support the work of midwives and advocate to the government to set up necessary structures.

‘We believe that the midwife is a very critical skill birth attendant that every country in sub-Saharan Africa, Asia and Latin America should promote, and develop the position to be able to contribute towards making this change in our societies. We believe that a woman should not die because she wants to bring another life into being.' expressed Dr Jamima.

Low morale

Midwives play key roles when it comes to caring for pregnant women, and therefore needs to be encouraged to do the work.

Kolorinda Laku is a midwife working in Juba; she is amongst many other midwives who have worked in the profession for long without any promotion.

Madam Kolorinda said she has worked for eleven (11) years now but has not yet been upgraded. However, she still believes she has an important duty to perform.

"We are working for a mother and her child. We don't take it so serious and put money ahead. We want the two to be successful in our hands even if we have problems."

The Minister of health in the government of Southern Sudan, Dr Joseph Monytueil said that to invest in Midwives is investing in the future generation.

He pledged his ministry will increase the number of nurses and midwives. He also emphasized the importance of putting healthy foundation for a health system.

Optimism

Meanwhile, the head of the United Nation Population Fund (UNFPA) Dr Dragudi Buwa expressed hope that the launch of the program "investing in midwives", will remind the international agencies and government of Southern Sudan on what to do for the women in the region.

The UNFPA is one of the international organizations that have focused its program on improving the reproductive health.

Last year the organization in partnership with the ministry of health trained a total of thirty six (36) community midwives.

According to UNFPA in order to reduce the maternal mortality rate there is need to have access to comprehensive primary health care including family planning and safe abortion, skill care for pregnant women and access for emergency intervention when complications arise.

The launch was attended by top officials from the government of Southern Sudan, international organizations and a cross section of the community.

Africans countries the International confederation is working include: Benin, Burundi, Congo, Ghana, Sudan, Uganda and Zambia.

"We need to make sure that the salaries are going to go, the money is going to flow from the central, you know, to the state authorities; or, if the ministry has the budget, then from the ministry to the line ministries in the states."

Ameerah Haq

In an exclusive interview with Miraya FM, UN Humanitarian Coordinator in Sudan, Ms Ameerah Haq, warned of the possibility of deterioration in the humanitarian situation on the ground in Darfur two months from now.

Ms Haq said that the joint UN-Sudanese Government assessment report on the humanitarian situation in Darfur shows that there is no immediate crisis now.

But she added that more measures need to be put in place so as to avert the possibility of the emergence of a crisis in the future.

following is the transcript of the interview  

Miraya: You have just finalized the report of the joint UN-Sudanese government assessment team to Darfur. What are your conclusions?

Ameerah Haq: Yes, we concluded the assessment last week between the government and the UN and we looked at the issues related to four life-saving sectors: that was food, health and nutrition, water and sanitation, and then emergency shelter.

And in each of these areas, but particularly in food, we did not see an immediate crisis because WFP had provided a two-months distribution of food in a sort of an ad hoc, one-time distribution with local food committees. And, likewise, we also saw that because the government, through the ministry of health, WHO and UNICEF, had taken certain stop-gap measures, with respect to health and water; that people, you know, did have water,  although not in the same quantities that they had before, and that

health clinics were running, but not with the full range of services.

So, when we heard about the expulsion on the fourth of March, there was, you know, anticipation that everything might have come to a screeching halt. It did not happen, and particularly the important element is that food distributed.

People got food for two months by WFP. But that's not to say, you know, that the situation is fine, because these are only

stoop-gap measures.

These are just emergency measures for a very short time and the critical message is that we have a situation that is arising before us that if certain measures are not put into place then we are going to a serious crisis in the provision of food, in water, in health and in nutrition.

And even in some of these areas right now there are gaps. For example, in the therapeutic feeding for children, pregnant and lactating mothers, one third of WFP's centers that fed these are not getting the therapeutic feeding.

In the issue of health, as you know, we have said that 650,000 people, apparently, are not getting the full range of services. So, you know, some clinics are working. But, on the other hand, they cannot provide the full range of services.

So, I think, in a nutshell, what I would say is that a crisis did not occur and, when the mission was there, we did not see people starving, or, you know, that there was no water. We didn't see that. And that was because of the responses that were taken.

Those responses were just, as I said, a one-off response. But what we need to make sure now is that within the next two weeks, between the next two weeks, till the end of April, a lot of measures need to be in place if we are going to avert a crisis in these four critical area

Miraya: What are your specific concerns regarding the situation on the ground? And what are the  necessary actions to address these concerns?

The specific concerns I will tell you, in food distribution WFP lost its NGO partners who together planned and fmanaged the implementation of food going to 1.1 million people. This includes the shipment of food. And, you know, this food comes into Port Sudan.

The food then moves from the port to various, you know, sort of concentration points. From there, it goes to distribution centers. From there, it goes to, you know, where the beneficiaries actually get the food.

This involves surveys to determine who needs the food. It involves surveys to determine who are most vulnerable.

You know, there is a whole process of planning, programming, management, operations that goes into that process before someone actually takes a sack of food and puts the sorghum into someone else's, you know, who is receiving it.

We have lost that capacity; that entire planning and management capacity. That is very difficult to replace quickly. WFP needs to find partners who are going to be able to do that within the next two weeks if they are going to be able to provide the distribution to 1.1 million people. That's the danger. The government with the ministry of health with the World Health Organization are trying to address the sectors, I mean all the clinics where people were provided health.

But, for example, in health, because of the technical capacity that the NGOs had, we have missed the surveillance capacity. In other words, it has been quiet on the surveillance side. In other words, we have not been able to pick up information of, you know, where there might be disease outbreak in order that you can go and mitigate in that area.

In the water, as I said, water is running, but in many places, you know, some of the pumps and other things are broken.

But the sanitation is absolutely critical. There has been no, you know, de-sludging, you know, the maintenance of, you know, groundwater monitoring, etc. Now, from 2006 there has been no outbreak of acute watery diarrhea in any of the camps in Darfur.

Now, with this complete stoppage in sanitation services, we run the risk, you know, unless we make some really quick adjustments with people, with equipment, with supplies and everything else to restore the sanitation services, of real, you know, real gaps in hygiene and outbreak of diseases such as acute watery diarrhea or cholera.

So what we have seen is the same thing in non-food items, that, you know, some of the assets were taken by the government.

Those assets need to be returned so that people can get the plastic sheeting for their tents and other things before the rainy season.

So, we have the hunger gap approaching with respect to the food distribution. We have the rainy season approaching with respect to the distribution of non-food items. You know, we have got again the rainy season where the prevalence of disease is higher.

So, all of it leads to two things: timeliness, you know, that response has to come very quickly in terms of these significant events in terms of the rainy season and the hunger gap become in front of us; and also that a whole lot of, you know, contracting, operations, capacity replacement, technical agreements with NGOs who may be here. So, a whole lot of administrative procedures also that need to be taken into place.

So those are all our concerns. Those are the concerns that how is this going to happen in a timely manner so as to avert a crisis in any of these areas. The government has said that they will provide salary in terms of health and water.

So, we need to make sure that the salaries are going to go, the money is going to flow from the central, you know, to the state authorities; or, if the ministry has the budget, then from the ministry to the line ministries in the states.

You know, there are many steps. These are not easy. And once you had a system that was set up, and that system just suddenly collapses overnight, it's very difficult, you know, to rebuild that system in such a short period of time.

Miraya FM: Do you have any assurances from the Sudanese government that they will be able to sustain the provision of humanitarian aid to Darfur after May?

Yes, we did. What is, I think, very noteworthy in this is that this has been signed by the government, and has been signed by the United Nations. So, it's a joint assessment. Now, the government has committed to provide the staff, the salaries, and the finances that are required for equipment and supplies to all the health clinics up to the end of 2009, and equally to provide the budget that is required to keep the water running. Those are the commitments that the government had made. Now, one of the areas that we have agreed on is strong monitoring.

So, we will be monitoring very carefully to see that the clinics, and particularly in rural areas and other areas, are receiving the budget that the government has committed to do. The government has also given us assurance that they are going to be fast-tracking the administrative and the bureaucratic procedures; for example, the technical agreements of NGOs so that they can get the stay permits and the visas and the permits to travel.

The government has committed for access for humanitarian workers because during the time of the mission, the mission was able to go to all the areas that they wanted to visit, and the government has committed that they will provide that level of access as the humanitarians go on. So the government has given us many assurances on budget, on finance, on personnel, on administrative procedures, on, you know, lifting the bureaucratic impediments, and, as I said, we will be monitoring to see that all these are in place so that it helps to speed and fast-track what the international humanitarian community along with the government and the line ministries there need to do to avert a crisis.

Miraya FM: Lastly, thanks so much Ms Ameerah Haq, the UN Humanitarian Coordinator in Sudan, for giving us this chance to interview you.

Ms Haq: Thank you very much.

The government does not respect itself and returning to the point of the beginning is its own responsibility, Minawi says.

Interviewed by: Abdulhamid Awad

Several months ago Minni, chief assistants of the President, leader of SLM left his office in the presidential palace. Such absence put question marks among the community and on political level in Khartoum, Darfur and internationally. In particular with those who are interested with Darfur crisis? However, the most important signal given by Minawi, who preferred to stay somewhere in Darfur among his forces, is that he fixed the final wedge in the coffin of Abuja agreement signed less than two years back.

Some leaders of his faction described his absence as normal, and that is does not necessarily means desertion of peace process. In order to look into Obscurities of political vacuum in the political scene created by Minawi, particularly in Khartoum, Miraya FM contacted Minawi and carried out the following dialogue:

Miraya: First, Mr. Minawi yesterday the Sudan Armed Forces (SAF) accused your forces of attacking their convoy among which there were civilian vehicles, where at least four (4) people were killed, what is your comments?

Minawi: No, No. From the beginning the accusation should be directed to the SAF or rather to the government troops called the Central Reserve Forces (CRF) which represent the other face of Janjaweed. These forces started to kill innocent people, and violate Abuja agreement continuously along with attacking our areas. During the last few months they have killed 27 persons of our forces. We tribute the Armed Forces, but forces used by the government now, represents the other face of the Janjaweed and named the Central Reserve Forces. Actually, they are a group of people gathered by authorities and mobilized without training. These people attacked our area at Abu Hamra, which is well known as our own site for six years. Till now we did not accuse the Army while we accuse the (CRF).

Miraya: But the Army itself accused you yesterday of attacking their convoy as I asked you before, which means that you are now actually accused?

Minawi: This is false, and a trial to cover a bad deed carried out by the (CRF) before two days, but we will not stay just watching if they try again.

We respected seize fire but will not keep silent from now on in case of any violations.

Miraya: Could you explain how will you respond; because we spoke to the spokesperson of your army who confirmed that the SLM had military and political means to face such attacks, do you agree with him?

Minawi: Certainly, SLM will not keep silent towards violations all the time, as violations continued since signature of seize fire agreement in N'Djamena.

Even after signature of Abuja Agfreement, all agreements are being violated every day by governmental groups (while we kept silent) to respect seize fire, but such silence will not continue.

Miraya: Does this mean death of mechanisms specified by Abuja to deal with such violations? And is this a return to war?

Minawi: Well, this depends upon the government itself, as it is an essential part of Abuja and committed itself before the international community to follow it. So, if the government respects Abuja it will never die, but if it keeps ignoring it and the international community does not oversee concerned parties commitments, then Abuja will not exist. I reiterate if the government and the international community respect Abuja it will be a holy book, otherwise it would be mere an ink on paper.

Miraya: If Abuja is cancelled along with its mechanisms, does this mean to you a return to war square with the government, as all indications refer now?

Minawi: The question now; did Abuja die? Up to this moment will the government continue to nullify Abuja? Upon answering this question I shall clarify our position.

Actually, I was ready to see President Bashir in Darfur, but I was not invited.

Miraya: But your absence from Khartoum office in the Presidential Palace and your presence among your own forces could be an indication to beginning of war, according to observers, in the light of mutual accusations?

Minawi: My presence among my forces is not considered as violation of any agreement, because these are our own areas. Moreover, I'm in charge of Darfur and I can discharge my task from anywhere. The transitional authority in Darfur has no a specific place, so presence of the chairman of the authority among his forces does mean the war. But, government continuous violations and cheating the agreement along with international community silence towards such attitude could indicate returning to the first square, which we do not wish to happen.

Miraya: Yes, you are the chairman of Darfur transitional authority, and chief assistants of the President, but during the President's visit to Darfur itself you were not there?

Minawi: Actually, I was not invited for the visit, this is clear that the government particularly the National Congress Party (NCP) intend to marginalize the transitional authority, and cancel Abuja agreement to return to the war to kill and run away. I was ready to see the President, but not invited. Even I had no information about the visit until I heard the President addressing people in Al-Fasher city at north Darfur.

Miraya: But Mr. Minawi the President invited you in front of the masses?

Minawi: Which type of invitation?

Miraya: The President spoke to the mass meeting and said "I invite Minawi to return back to his office in the Presidential Palace, as I remember?

Minawi: This is not an invitation? If the government is ready to follow Abuja, the president should revive available mechanisms, because speaking before masses is not official. Our demands are: Seize fire, stopping violations and evaluation of Abuja.

Miraya: You are talking about non implementation of Abuja, revival of Abuja Agreement mechanisms between you and the government; do you have any other demands?

Minawi: Actually, necessary demands begin with seize fire, particularly violations by government groups. Then we could discuss Abuja Agreement in order to evaluate the same along with evaluation of Darfur peace. Also the government should enter into dialogue with non signatories of Abuja.

Miraya: You seem to be confronting the government, but some leaders in Khartoum, for instance vice president of Sudan Liberation Movement (SLM) Dr. Al-Rayah Mahmood said in a press statement that movement institutions absolutely reject presence of Minawi in Darfur, and that this is your own decision. Moreover, there are news about dismissing you from the position of movement's leadership, according to press resources?

Minawi: We are following all these rumors, which are engineered by NCP and the government. In case the said group takes any decision on dismissing me, then the government and NCP should take the responsibility of such action. From my part I don't need any body's permission to go to Darfur, headquarter of my activity as SLM also headquarter of my work as chairman of the transitional movement. Accordingly, if Al-Rayah Mahmood and his companions take any action it would mean their end in the movement, and end of Abuja for the Sudanese government.

The vice president of the SLM and its general secretary are the reason behind aborting Abuja, we consider them members in the NCP hiding themselves inside the movement.

Miraya: Did you consult the vice president of the movement or the general secretary on this decision, or even did you meet with the movement's institutions?

Minawi: First, the movement has different mechanisms for the agreement. Again I assure that we consider the vice president of the SLM and its general secretary as members in the CNP hiding inside SLM. If they leave the movement they will quit alone and shall be the worst people among the NCP.

As to negotiations, the movement has its own mechanisms and rules before Al-Rayah joins the movement.

Miraya: To the last point, Mr. Minawi with regard to the International Criminal Court's repercussions, your vision is not clear on the General Prosecutor's request? What is the real stand of SLM from recommendation of the General Prosecutor on indictment of President Bashir?

Minawi: We will give our opinion in due course.

Miraya: When?

Minawi: In due course as I said.

Miraya: Final word to the government.

Minawi: The government does not learn from lessons, if it respected Abuja neither Ocampo would accuse Bashir nor Omdurman would have been attacked. Even many things wouldn't happen.

Another thing, the government looks forward is to weaken its dissidents through quitting of some people from the movement, which we consider as a good guide towards unity of the movement. Therefore, the government should respect itself and should follow mechanisms specified in Abuja agreement.

Miraya: And your message to members of SLM?

Minawi: We honor their steadfastness and their solid stands.

 Miraya: Thanks Minawi.

Minawi: Thanks.

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