Saving the Fundaments: Impact of a Military Coup on the Sudan Health System

Military coups are not uncommon occurrences, particularly in developing nations where political systems might be less firmly entrenched or still evolving. Developments of this nature can often have profound implications for the affected nation’s healthcare systems, both in the immediate aftermath and over the longer term. This paper narrates some notable consequences of political instability on the national health system, particularly placing them in the context of the military coup in October 2021 – emphasizing the context behind the political turbulence, its acute and direct consequences, and the possible long-term legacies of political shocks on the already overwhelmed health system. As a descriptive piece, this narrative does not only look at the impact of the military coup on hospitals, but considers the implications for the healthcare system as defined by the WHO, with particular emphasis on the impact of the coup on health funding from multi-laterals, service delivery, human resource availability, and supply chains in Sudan.

Alea Ke Pau or Negotiated Evaluation: A Vital Concept in Pacific Health Promotion

For Pacific peoples, health promotion, community nursing and community development initiative over many years, has often been conducted within a framework of one-sided decision-making. There is always an imbalance between the power relationships of the community being studied and those of the researchers or health practitioners. As a result, there is lack of understanding on the part of the researchers and the health funding agencies of the need to negotiate processes with members of the community being studied or engaging with. All of this are within an overarching lack of understanding of, and respect for, Pacific cultural values, frameworks and Pacific ways of doing things. This paper seeks to explore an alternative concept whereby these values are acknowledged. This concept is metaphorically called “alea ke pau” (or, negotiated evaluation). This approach is forward-looking and one that respects a ‘bottom-up’ view rather than the traditional ‘top-down’ view of health work and funding agencies. However, using two Pacific research methodologies called Talanga and Kakala, to explore the concept of alea ke pau were held with five men’s focus groups operating within Kava Clubs in Auckland, New Zealand, and five focus groups in Tonga. The results from these discussions are presented demonstrating the development and application of the “alea ke pau” or “negotiated evaluation” approach.