Current Health Status In Sudan

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 of National policies, plans and strategies; resource mobilization, overall monitoring and evaluation, coordination, supervision, training and external relations. Formulation of State’s policies, plans and strategies, according to federal guidelines, funding and implementation of plans Implementation of national/state policies and service delivery, based on the primary health care approach

Pathway to Care

Primary health care units (PHCU) community health workers (CHWs) Level Facility Cadre/ Capacity Financed Primary health care Primary health care units (PHCU) community health workers (CHWs) Localities Dressing stations (DS) nurse and/or a medical assistant Dispensaries medical assistant Health centres physician (medical officer/GP) SMOH Secondary care level Rural (district) hospitals 40 to 100 beds tertiary-level Teaching, specialized, and general hospitals 21 tertiary-level hospitals and specialized centres FMOH Five year strategy 2007 – 2012, FMOH

Population/1 HF

Types of functioning facilities

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

The current health facility population ratios of one rural hospital for every 100,000 population and one health centre for every 34,000 of the population;Sudan households survey 2011. The international standard is to have (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 key strategy for health care provision in Sudan in 1978 and re-emphasized in the National Comprehensive Strategy for Health in 1992-2002 and in the 25-Year Strategic Health Plan 2003-2027. The Interim Constitution of the Republic of the Sudan, article 46, states the commitment of the Government to provide universal and free of charge basic health services but the fact is there is no free health service provision since 1992.

The health system is markedly skewed towards hospital and tertiary care services. There has been increased focus on establishing hospitals during the past years (their number increased from 253 in 1995 to 351 in 2004). The hospital/population ratio is 1/100,000. Furthermore, there is an urgent need to upgrade the existing lower health facilities (dressing stations and PHCU) to basic health units capable of conveying sustainable and adequate package of service as shown in the following table.

Reasons for non-functionality

Coverage of minimum package by type of health facilities The minimum package includes: 1) Treatment of common diseases 2) System for drug disbursement 3) Immunization 4) Reproductive Health 5) Nutrition and growth monitoring.

Coverage of comprehensive package by type of health facilities The comprehensive package includes: 1) Treatment of common diseases 2) System for drug disbursement 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 and minimum essential clinical interventions require about 1.0 physicians per 1000 population and between 2 and 4 graduate nurses per physician). A workforce density (counting physicians, nurses and midwives) of less than 2.3 health workers per 1000 population is found to be associated with failure to achieve 80% coverage of measles immunization and births attended by skilled health personnel Based on this and on further research, the WHO suggests that a minimum of 2.5 health workers per 1000 people is required to attain adequate coverage of essential health interventions and core MDG-related health services (WHO, 2006).

But looking at their calculation disprove this: MOH claims that Sudan is above the critical shortage zone with a 2.7 health worker per 1000 pop. But looking at their calculation disprove this: The density of physicians, nurses and midwives (whom are the essential health cadre) is (1.23 per 1000) House officers should not be included in such calculations since they are trainees who don't have the legal capacity to conduct a curative intervention on their own. The Administrative and support staff whom actually played the major bulk in creating this ratio should as well not to be included since they are not health cadre The following table explains it all:

Moreover, almost 70% of that cadre haven't had professional training nor even a university degree.

70% of the total cadre is based in Khartoum serving 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 before reaching their fifth birthday 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 with the inception of the National Health Insurance Fund (NHIF). Health insurance mainly covers public sector employees and the NHIF has established some health facilities of its own in different states. Health staff working in health insurance services is predominantly seconded from the ministry of health. However, the NHIF also employs some staff exclusively, in particular management and support staff. As well the fund uses health professionals working in governmental health facilities in rewards for dealing with the insured patients. The NHIF was originally created under the FMOH but has been recently moved to be affiliated to the Ministry of Social Affairs

Source of Funding Ministry of finance 87.6% Zakat 6.5% Government employers fund 0.4% Private employers fund 0.5% Household funds 0.7% Other private funds 4.3%

Conclusions Health indicators in Sudan are still lagging behind Service delivery is described as inequitably distributed, low quality, poorly planned and ineffectively managed

THANK YOU