The current health system In Sudan

Current Health Status InSudan

Health Care Providers

•Ministry of Health (FMOH,SMOH).

•Health Insurance Fund.

•Private (for Profit) sector

•NGOs (non-profit)

•Army Medical corps

•Police Health force

Health Facilities by Affiliation

Health Cadre Distribution

MOH Functions in a Three-tier system

FEDERAL

STATE

LOCAL/DISTRICT

Formulation ofNational policies, plansand strategies;resource mobilization,overall monitoring andevaluation,coordination,supervision, trainingand external relations.

Formulation ofState’s policies,plans andstrategies,according tofederalguidelines,funding andimplementationof plans

Implementationof national/statepolicies andservice delivery,based on theprimary healthcare approach

Pathway to Care

Five year strategy 2007 – 2012, FMOH

Population/1 HF

Types of functioning facilities

Percentage of Localities having full functionalorganizational structure according to the standards,Mapping survey 2008

The current health facility population ratios of one ruralhospital for every 100,000 population and one healthcentre for every 34,000 of the population;Sudanhouseholds survey 2011. The international standard is tohave (one PHC per 5,000 population).

PHC

•Total Number of PHC facilities: 5265

•Total Number of functioning PHC facilities: 4533

•Primary Health Care has been adopted as the keystrategy for health care provision in Sudan in 1978 andre-emphasized in the National Comprehensive Strategyfor Health in 1992-2002 and in the 25-Year StrategicHealth Plan 2003-2027.

•The Interim Constitution of the Republic of the Sudan,article 46, states the commitment of the Government toprovide universal and free of charge basic health servicesbut the fact is there is no free health service provisionsince 1992.

•The health system is markedly skewed towardshospital and tertiary care services. There has beenincreased focus on establishing hospitals duringthe past years (their number increased from 253 in1995 to 351 in 2004). The hospital/population ratiois 1/100,000.

•Furthermore, there is an urgent need to upgradethe existing lower health facilities (dressingstations and PHCU) to basic health units capable ofconveying sustainable and adequate package ofservice as shown in the following table.

Reasons for non-functionality

Coverage of minimum package bytype of health facilitiesThe minimum package includes: 1) Treatment of common diseases 2) System fordrug disbursement 3) Immunization 4) Reproductive Health 5) Nutrition and growthmonitoring.

Coverage of comprehensivepackage by type of health facilities

The comprehensive package includes: 1) Treatment of common diseases 2) System for drugdisbursement 3) Immunization 4) Reproductive Health 5) Nutrition and growth monitoring 6)Laboratory services 7) X – Ray services 8) Basic Emergency Obstetric Care and 9)Comprehensive Emergency Obstetric Care.

Coverage by individual services

Health Cadre & Workforce

•The global average of health workers per 1000 pop. Is 4.0.

• World Bank reports maintained that: (public health andminimum essential clinical interventions require about 1.0physicians per 1000 population and between 2 and 4 graduatenurses per physician).

•A workforce density (counting physicians, nurses and midwives)of less than 2.3 health workers per 1000 population is found tobe associated with failure to achieve 80% coverage of measlesimmunization and births attended by skilled health personnel

•Based on this and on further research, the WHO suggests thata minimum of 2.5 health workers per 1000 people is requiredto attain adequate coverage of essential health interventionsand core MDG-related health services (WHO, 2006).

•MOH claims that Sudan is above the criticalshortage zone with a 2.7 health worker per 1000pop.

•But looking at their calculation disprove this:

–The density of physicians, nurses and midwives(whom are the essential health cadre) is (1.23 per1000)

–House officers should not be included in suchcalculations since they are trainees who don't havethe legal capacity to conduct a curative interventionon their own.

–The Administrative and support staff whom actuallyplayed the major bulk in creating this ratio should aswell not to be included since they are not health cadre

The following table explains it all:

•Moreover, almost 70% of that cadre haven'thad professional training nor even a universitydegree.

•70% of the total cadre is based in Khartoumserving about 15% of the country population.

MCH Indicators

•Maternal mortality ratio: 216/100,000 LB

•Under-5 mortality rate: 78/1000 LB

•Infant mortality rate: 57/1000 LB

•Neonatal mortality rate 33/1000 LB (42%)

Source: SHHS 2010

Yearly, 106,000 Sudanese children die beforereaching their fifth birthday

290/ day

12/hour

MCH Indicators Cont.

•Total fertility rate: 5.6

•Adolescent birth rate/1000 women: 102

•Contraceptive prevalence: 9%

•Unmet need for family planning: 28.9%

•Births attended by qualified attendant: 72.5%

•Institutional deliveries: 20.5%

•Antenatal care. 4visits, 1 visit:47.1%,74.3%

Source: SHHS, 2010

Health Insurance Fund

•Public health insurance was introduced in Sudan in 1994 withthe inception of the National Health Insurance Fund (NHIF).

• Health insurance mainly covers public sector employees andthe NHIF has established some health facilities of its own indifferent states.

•Health staff working in health insurance services ispredominantly seconded from the ministry of health.However, the NHIF also employs some staff exclusively, inparticular management and support staff.

•As well the fund uses health professionals working ingovernmental health facilities in rewards for dealing with theinsured patients.

•The NHIF was originally created under the FMOH but has beenrecently moved to be affiliated to the Ministry of Social Affairs