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  • 1.
    Aweesha, Huzeifa
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. World Health Organization Sudan Country Office, Sudan.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Pulkki-Brännström, Anni-Maria
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Sudan's health sector partnership: from confined progression to openness and hope to uncertain demise2024In: Development Policy Review, ISSN 0950-6764, E-ISSN 1467-7679, Vol. 42, no 2, article id e12757Article in journal (Refereed)
    Abstract [en]

    Motivation: Despite signature of the 2005 Paris Declaration on Aid Effectiveness and subsequent adoption of the effective development cooperation (EDC) principles for better health cooperation, there is a gap in documenting the challenges to implement these commitments at country level. Sudan represents an interesting case study: the country adopted a local health compact in 2014, but for much of the time since the regime was under sanction. Sudan witnessed a revolution in 2018, followed by a counter-coup in 2021.

    Purpose: We aim to explore the evolution of Sudan health sector partners’ relationships, perspectives, and adherence to EDC principles of ownership, alignment, and harmonization, while accounting for underlying processes and context changes between 2015 and 2022.

    Methods and approach: We collected data through two rounds of interviews, in 2015 (16) and 2022 (8), with stakeholders within the Sudan Health Sector Partnership. We used the framework method for data analysis where responses are coded then sorted into themes.

    Findings: Prior to the 2019 revolution cooperation was progressive but restricted, with civil society marginalized and a dominating government. The principles, especially ownership, were misused and misaligned with national priorities driven by donors’ interests and conditions.

    The transitional (post-revolution) period witnessed partners’ openness and influx, but unstable leadership and subsequent changes in priorities led to wasted opportunities.

    Following the coup, donors adopted a no-contact policy towards the de facto government. Instead, the expectation was that civil society organizations would replace the government as the main implementers. Overall, limited coordination capacity and no sustainability measures were present throughout.

    Policy implications: Much of what was observed was down to the often complicated and difficult context of the governance of Sudan. That said, general issues arose including the government's ability to coordinate policy and implementation; the need for stable, legitimate arrangements; and the need to define the role of civil society and to empower civil society organizations. Within a complex and volatile context, revisiting partners’ commitments through joint compact reviews and transparent EDC progress monitoring is crucial.

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  • 2.
    Nur, Muna Mohamed
    et al.
    Development of Health System Unit, World Health Organisation, Nile Avenue, Othman Digna St., Khartoum, Sudan.
    Aweesha, Huzeifa
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Development of Health System Unit, World Health Organisation, Nile Avenue, Othman Digna St., Khartoum, Sudan.
    Elsharif, Mahmoud
    Development of Health System Unit, World Health Organisation, Nile Avenue, Othman Digna St., Khartoum, Sudan.
    Esawi, Ahmed
    Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Canada.
    Omer, Arwa
    International Health Directorate, Federal Ministry of Health, Nile Avenue, Othman Digna St., Khartoum, Sudan; University of Medical Sciences and Technology, AlRiyad, Africa Street, Khartoum, Sudan.
    Musa, Mohamed
    Development of Health System Unit, World Health Organisation, Nile Avenue, Othman Digna St., Khartoum, Sudan.
    Humanitarian–Development Nexus: strengthening health system preparedness, response and resilience capacities to address COVID-19 in Sudan—case study of repositioning external assistance model and focus2024In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 39, no 3, p. 327-331Article in journal (Refereed)
    Abstract [en]

    The advent of the COVID-19 pandemic and the establishment of a new transitional government in Sudan with rejuvenated relations with the international community paved the way for external assistance to the EU COVID-19 response project, a project with a pioneering design within the region. The project sought to operationalize the humanitarian–development–peace nexus, perceiving the nexus as a continuum rather than sequential due to the protracted nature of emergencies in Sudan and their multiplicity and contextual complexity. It went further into enhancing peace through engaging with conflict and post-conflict-affected states and communities and empowering local actors. Learning from this experience, external assistance models to low- or middle-income countries (LMICs) should apply principles of flexibility and adaptability, while maintaining trust through transparency in exchange, to ensure sustainable and responsive action to domestic needs within changing contexts. Careful selection and diverse project team skills, early and continuous engagement with stakeholders, and robust planning, monitoring and evaluation processes were the project highlights. Yet, the challenges of political turmoil, changing Ministry of Health leadership, competing priorities and inactive coordination mechanisms had to be dealt with. While applying such an approach of a health system lens to health emergencies in LMICs is thought to be a success factor in this case, more robust technical guidance to the nexus implementation is crucial and can be best attained through encouraging further case reports analysing context-specific practices.

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