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

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