Health Services Availability and Readiness Assessment in Sudan: A Comprehensive Evaluation of Health Facilities and System Preparedness in Four States

Health Services Availability and Readiness Assessment in Sudan: A Comprehensive Evaluation of Health Facilities and System Preparedness in Four States | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Health Services Availability and Readiness Assessment in Sudan: A Comprehensive Evaluation of Health Facilities and System Preparedness in Four States Geoffrey Babughirana, Gerald Nuwagira, Andrew Tumuhameho, Ali Hado, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7818252/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Sudan’s primary health care system has been degraded by conflict in Darfur, South Kordofan, Blue Nile, and other regions. Before 2023, 70% of Sudanese lived within 30 minutes of a facility, about half of visits were with unskilled providers, and fewer than 30% of children with diarrhea received appropriate treatment. The 2023 war closed about 70% of facilities in the hardest hit states. Methods: This study assessed service availability and readiness in four states. We conducted a cross-sectional SARA assessment of 99 primary health units in Blue Nile, East Darfur, South Darfur, and South Kordofan. Trained teams observed five domains: human resources, infrastructure, basic equipment, essential medicines, and key services including immunization, antenatal care, nutrition, and community health. Domain scores were the proportion of required tracer items or staff present. Results: A facility functionality score summarized adherence to national PHU standards, with state means computed from facility scores. Ethical approval and informed consent were obtained. Readiness was low across all states. Mean functionality was 8% in South Kordofan, 25% in East Darfur, 37% in Blue Nile, and 61% in South Darfur. More than 85% of facilities scored below 50%, and none met minimum standards. Infrastructure was weak: waiting shelters achieved 20 to 29% of norms, and most sites lacked reliable water or electricity. Staffing met 38% of norms in South Kordofan with midwives at 4%; South Darfur was under 72%. Diagnostics were scarce: laboratory capacity was under 1% in South Kordofan, 18% in East Darfur, and about 52% in South Darfur. Essential medicines averaged 5%, 23%, and 45% in South Kordofan, East Darfur, and Blue Nile. Cold chain was rarely present. Immunization readiness ranged from 3% to 62%. Nutrition and outreach services were under 40%. Conclusions: Primary health units are severely underprepared. Immediate priorities are mobile services and emergency supplies. Recovery requires sustained investment in workforce, facility rehabilitation, diagnostics, and reliable supply chains. Study Registration : Not applicable Health service availability health readiness Sudan health systems facility assessment health equity Full Text Additional Declarations No competing interests reported. Supplementary Files CleanIssues.zip Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 18 Dec, 2025 Reviewers agreed at journal 14 Dec, 2025 Reviewers agreed at journal 22 Nov, 2025 Reviewers invited by journal 16 Nov, 2025 Editor assigned by journal 11 Nov, 2025 Submission checks completed at journal 11 Nov, 2025 First submitted to journal 09 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7818252","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":549675222,"identity":"26581028-68e4-4454-932c-f21eb92bbe87","order_by":0,"name":"Geoffrey 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Before 2023, 70% of Sudanese lived within 30 minutes of a facility, about half of visits were with unskilled providers, and fewer than 30% of children with diarrhea received appropriate treatment. The 2023 war closed about 70% of facilities in the hardest hit states.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study assessed service availability and readiness in four states. We conducted a cross-sectional SARA assessment of 99 primary health units in Blue Nile, East Darfur, South Darfur, and South Kordofan. Trained teams observed five domains: human resources, infrastructure, basic equipment, essential medicines, and key services including immunization, antenatal care, nutrition, and community health. Domain scores were the proportion of required tracer items or staff present.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A facility functionality score summarized adherence to national PHU standards, with state means computed from facility scores. Ethical approval and informed consent were obtained. Readiness was low across all states. Mean functionality was 8% in South Kordofan, 25% in East Darfur, 37% in Blue Nile, and 61% in South Darfur. More than 85% of facilities scored below 50%, and none met minimum standards. Infrastructure was weak: waiting shelters achieved 20 to 29% of norms, and most sites lacked reliable water or electricity. Staffing met 38% of norms in South Kordofan with midwives at 4%; South Darfur was under 72%. Diagnostics were scarce: laboratory capacity was under 1% in South Kordofan, 18% in East Darfur, and about 52% in South Darfur. Essential medicines averaged 5%, 23%, and 45% in South Kordofan, East Darfur, and Blue Nile. 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