Providing remote rural communities with access to health care has been one of the principal achievements of Presbyterian Disaster Assistance supported ACT/Caritas health care program in south Darfur.

Waiting patiently outside the clinic. Photo by Charlotte Brudenell, ACT/Caritas

It’s Sunday, market day in Hassaballa. People have come to trade their wares, but they have also come to visit the mobile health clinic that was set up by Presbyterian Disaster Assistance partner in the Darfur crisis, ACT/Caritas.

The mobile clinic visits Hassaballa twice a week, providing medical services to a total population of over 18,000 people in the area. "On average we see some 50 to 80 patients each time," says Ibrahim Suliman Hajar, the mobile clinic’s Sudanese Supervisor.

Near the market, under a large acacia tree, a group of men, women and children are gathered, listening intently to Ibrahim.

“In the morning I give sessions to the community to educate them about health matters and hygiene, and in the afternoon, we offer medical consultations, mother and child health care and give out the appropriate medicines to treat ailments.” Ibrahim explains.

"This clinic is so important for the area. It is so great that people can come here and get treatment. The nearest clinic is more than a four hour journey away," says one local sheikh, Ahmed Fadil Omer, who is also head of the health committee for the clinic.

"The health education sessions are also important. Some diseases such as diarrhea, malaria and tropical diseases like bilharzia (parasitic worms) are communicable, and health education can prevent these diseases from spreading. We have already noticed that they have decreased in our villages," says Ahmed.

The health education sessions target the five most common conditions reported in the monthly mortality and morbidity data.

"The mobile clinic has done a good job; it is able to offer basic primary health care and disseminate health education" says Dr. Mutisya. "However, maintenance of such a service is not cost-effective."

The cost of vehicle maintenance, fuel, and paying drivers is high and is only sustainable in the short term. The challenge now is how to ensure this service continues when ACT/Caritas is no longer there.

The State Ministry of Health simply doesn’t have the human resources to staff even the current clinics, let alone new ones. So, ACT/Caritas is working with the local community on a range of solutions.

The first step has been to set up a health committee with representatives from the whole community: women, sheikhs, young people, local authorities and traditional community health workers.

The committee is then given training to understand their role, leadership skills and health promotion and is provided with guidance on the management of the clinic, as well as fundraising aspects.

The health committee has been responsible for mobilizing the community to build shelters in which the consultations take place and encouraging people to attend the educational sessions.

The committee is now organizing the construction of permanent buildings. They have arranged to charge patients (not including the very ill, children under five years old or pregnant mothers) a small fee for attending the clinic, in order to raise money to pay for materials. In Sudan, it is government policy to charge patients a fee for the provision of health care.

"If there is a permanent structure, the community will be encouraged to continue health service provision by themselves, and they can even perhaps begin to negotiate with the Ministry of Health for assistance," says Dr Mutisya.

In the meantime, the major emphasis for ACT/Caritas is to develop the skills and knowledge of the health workers in the community — traditional healers and birth attendants. Through training and mentoring to build their capacity, it is hoped that the community workers will be able to continue to offer an effective basic health service when ACT/Caritas stops the mobile service.

The community midwifery workers have also been given equipment to enable them to support clean delivery and monitor and supply prenatal care.

In addition, efforts are being made to empower health promoters within the community with the knowledge and skills they need to be able to continue to disseminate health messages beyond ACT/Caritas’s project.

It costs approximately $64.00 to train a health worker. 284 health workers and civilians were trained during 2006.

Presbyterian Disaster Assistance is participating in the Darfur response as a member of an international alliance of Catholic, Protestant and Orthodox aid organizations from the United States, Europe and Sudan — ACT/Caritas.