Turning the tide on female genital mutilation in a high prevalence country: a programmatic data analysis for Sudan’s comprehensive health sector response, 2016–2018

Abstract

Sudan has about 87% of females aged 15–49 years living with female genital mutilation (FGM), mostly performed by midwives (64%). In 2016, the Federal Ministry of Health (FMoH) adopted the WHO’s global strategy to stop healthcare providers from performing FGM. Our review of activity reports from 2016 to 2018 found the format of activities (N=95) was mainly meetings (58%) and trainings (31%) with median costs of US$10 645 and US$14 964, respectively. The FMoH (57%) and student/professional associations (25%) implemented activities at national (36%) and state (62%) level. The costs of activities were highest for FMoH compared with student/professional associations and academia, respectively.Sudan addressed WHO’s global strategy pillars through FGM-related policies and plans (pillar 1), trainings (pillar 2) and monitoring, evaluation and accountability materials (pillar 3) targeting mainly community midwives (N=16 183) as well as creating supportive legislative and regulatory environment (pillar 4). Governmental funding on training was comparable to donor’s resulting into 31% of community midwives trained on FGM complications management. Further, 31% of community midwives signed declarations or petitions to end FGM practice, while 19% were sensitised on punitive administrative measures for conducting FGM.Although Sudan implemented a laudable health sector response to address FGM, there is a need to evaluate the quality and effectiveness of past and ongoing interventions. Particular attention to costs and quality assurance data is essential to identify cost efficient implementation approaches to reach the remaining sizeable number of health professionals to stop their involvement in FGM.

Evaluating the long-term impact of large-scale trainings: an exposure based cross-sectional study on female genital mutilation-related knowledge, attitudes and practices among Sudanese midwives in Khartoum State

“…Studies have shown that monitoring and evaluation (M&E) is an effective strategy in improving health workers’ practice in low-income settings 15 16. A study which assessed Sudan’s health programmatic interventions found no FGM-related data at facility level,6 suggesting limited tracking for M&E and low accountability for health workers on the quality of care and FGM medicalisation.…”

National and international programmatic perspective on facilitators and barriers for Sudan’s health sector response on female genital mutilation (2016–2018): a qualitative study

“…Finally, because the events occurred 3–5 years prior to the study, there may have been recall bias. Our strategy to mitigate this through sharing questions in advance and recommending review of their programme reports seemed to reduce this as the activities discussed by respondents matched the activities we found in previous programmatic data review 15…”

“…The health interventions funded by the SFFGC programme were guided by WHO’s four pillars of action: strengthen governance and funding (pillar 1); increase health workers’ knowledge and skills (pillar 2); improve monitoring and evaluation (M&E) and accountability (pillar 3); and create a supportive environment (pillar 4) 6. Between 2016 and 2018, Sudan had significant achievements in the health component of SFFGC programme,5 prompting further in-depth study to understand how and why this occurred. The present study contributes to a much-needed programmatic evidence base on complex health interventions in low-income FGM prevalent settings, in contrast to the current body of evidence, which has addressed singular health interventions or factors affecting FGM-related health interventions in high-income settings 7–15…”

“…Between 2016 and 2018, Sudan had significant achievements in the health component of SFFGC programme,5 prompting further in-depth study to understand how and why this occurred. The present study contributes to a much-needed programmatic evidence base on complex health interventions in low-income FGM prevalent settings, in contrast to the current body of evidence, which has addressed singular health interventions or factors affecting FGM-related health interventions in high-income settings 7–15…”

Lessons learnt in scaling up evidence-based comprehensive health sector responses addressing female genital mutilation in highly prevalent settings

“…This could explained partly because the foundational activities were not rolled out to scale together with the absence of FGM related monitoring and evaluation systems. 16 Strengthening monitoring and evaluation of foundational activity processes would need to go hand in hand during implementation and continued thereafter.…”