Decentralization Fails Women in Sudan: International Development Research Centre

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IDRC's Women, Rights and Citizenship program

2008-11

When Asha Elkarib and her colleagues at the Gender Centre for Research and Training were studying decentralization and women in Sudan, they encountered a stark example of the impact on health care.

Two women in the locality of Halaib died in labour, unable to afford the medical services that might have saved them and their babies.

In Sudan, particularly in Darfur and other southern states, women who have problems during labour and delivery often die, says Elkarib, director of the Gender Centre. Almost half of all Sudanese women (48 percent) deliver with no health attendant present.

According to the World Health Organization, in the North, there are on average 504 maternal deaths per 100 000 live births. But in the South, Elkarib puts the figure at 800/100 000, and the UN Population Fund last year cited the figure as 2 030 per 100 000 – one of the highest rates in the world.

Decentralization – a form of governance required by many donor organizations – is intended to disperse power and resources from the central government to each of Sudan’s 26 states, for the benefit of all Sudanese.

In Sudan, decentralization is a process that has occurred over time and is still evolving. In 1991, a Local Government Act divided Sudan into nine states with 69 provinces and 219 local councils, or localities. In 1993, Sudan was divided into 26 states, 188 provinces, and 531 localities. Various reorganizations continued, and in 2003 Sudan consisted of 26 states, 127 provinces (renamed localities) and 134 administrative units. The responsibility for delivering basic services, such as education, health, and water was decentralized to local levels, but as Elkarib’s research indicates, budget management remains centralized. Most states lack the necessary resources or revenues to provide effective services, she says.

Power and budgets are still tightly controlled from the capital, Khartoum. Unfortunately, health and education services for women have worsened under the decentralization model that Sudan’s constitution and a 2005 Comprehensive Peace Agreement dictate, says Elkarib.

The Gender Centre’s two-year project, funded by Canada’s International Development Research Centre, is the first research conducted in Sudan about the impact of governance on women, she says.

“There has never been any fiscal decentralization. The government is very reluctant to let go,” remarked Elkarib, a rural economist by training, during a visit to IDRC’s Ottawa office last fall.

The result is that most states receive few fiscal transfers; any that are forthcoming arrive in an ad hoc fashion from the central government, “regardless of the needs of the state or the size of the state,” says Elkarib.

To bridge the fiscal gap, each state imposes its own taxes and user fees, which mainly affect health and education, Elkarib says. Local communities do the same. In the larger urban centres, the result is a two-tier health system with hospitals and the availability of doctors improving in the private sector, but worsening in the public sector, she says.

Access to health is restricted by cost, uneven distribution of health facilities, and by transportation barriers, says Elkarib. Although health care facilities were already unevenly distributed before decentralization, the process has worsened the situation because the unequal resource base of states results in the inequitable availability, efficiency, and quality of facilities and services that each can provide, her research indicates.

In northern Sudan, some women travel three days to reach the nearest hospital. In the southern states, getting to hospital can mean a woman must spend two days on the back of a camel, while she is in labour. “That’s why they prefer to stay at home,” Elkarib says.

Access to doctors is also a barrier; in eastern Sudan, there is not a single female gynecologist, and women are not allowed to consult male gynecologists, says Elkarib.

Infrastructure and institutional capacity among states and local communities has also strengthened the inequalities that people face, because decentralization has been an uneven process, fragmented over time.

Education is also severely affected. Under decentralization, the federal Ministry of Education is in charge of planning, training, curriculum, evaluation, and foreign relations. The federal government has withdrawn from financing pre-school education. That poses a serious barrier to access by many poor families, according to Elkarib’s research. Because state and local governments now control that program and other powers related to education, there is widespread variation in enrolment and literacy among the different states. Many local institutions have paid little attention to local planning, and those states with fewer resources have a hard time recruiting and retaining teachers and maintaining facilities. In eastern Sudan, for example, local authorities are responsible for teachers’ salaries, maintaining schools, and supplying textbooks. The result is that local governments impose user fees or other taxes to try and fund education.

“So they go straight to the people,” says Elkarib. Although both the constitution and the Comprehensive Peace Accord stipulate that basic education is free, “in real life, it is not.”

The cost has directly affected girls, particularly in rural families. The families choose to send boys to school. Girls stay at home to work in the fields, carry water and tend to children.

Overall, illiteracy in Sudan is about 50 percent. That figure rises to 84 percent among women. Literacy also varies widely among the states, with the gender gap almost negligible in Khartoum state, at 50 percent for men and 57 percent for women. Illiteracy is highest in southern Darfur, where literacy drops to 24 percent overall. In eastern Sudan, 80 percent of girls drop out of school after Grade 4, as do 60 percent of boys.

Part of the problem with implementing decentralization in Sudan has been the lack of democratic elections, says Elkarib. Although decentralization of power generally opens the door for women’s increased participation in political systems, in Sudan decentralization occurred under a military government that was not democratic. Most people working in the federal and state parliaments are appointed by the ruling party, which is following its own interests, according to Elkarib’s research. Thus, few women hold political positions, or reach senior levels in the civil service, says Elkarib. For example, in the federal Ministry of Health, women are represented only at the administrative level.

“People assume that decentralizing systems are beneficial because they guarantee responsibility and accountability” closer to people’s daily lives, Elkarib says.

Elkarib’s research concludes that the experience of decentralization has been uneven in Sudan. In many states, women and girls are in worse situations than before decentralization, in large part because states and local communities have responsibilities without adequate resources or revenue tools to implement the programs.

Despite these difficulties, Elkarib’s statistics have helped to influence change, she says. The Ministries of Education, Health, and Labour and Agriculture recently came together to talk about women’s issues. The Gender Centre is now a consultant for girls’ education, involved in shaping a national girls’ education strategy. And the Bank of Sudan is considering hiring one of the Centre’s research staff as an advisor to design a strategy on microcredit and finance issues for women.

Elkarib believes the democratic elections scheduled in late 2008 or early 2009 could improve conditions for women.

“I’ve never given up hope,” says Elkarib, who counts herself a feminist since her membership in 1971, at age 18, in the now-defunct Sudanese Women’s Union. “Sometimes when you feel disappointed at the political level … then you go and work with women’s organizations at the grassroots level and you do something that makes a difference.”

Decentralization Fails Women in Sudan

Photo: Arne Hoel/World Bank

2008-11

Photo: Arne Hoel/World Bank