1. Sudan’s Health Sector Reform; addressing the SDGs
Dr. Isameldin M. Abdalla
Undersecretary, Sudan Federal Ministry of Health

2. Introduction
Health sector reform is part of the overall movement towards reforming the national institutions
People centered
Broad scope
Long term
Comprehensive approach, with coordinated actions
Adopted by the Ministers’ Council

3. Why reforming? Sudan faces multiple challenges
Peace building
National reconciliation
Development struggles
Diverse social determinants of health in the Sudanese societies beyond the influence of health care services
The global changes and the SDGs as a context adaptable approach

4. Governance and stewardship
Sudan has an up-to-date and fully costed Health Strategy
State wise, 16 of the 17 states also have an up-to-date annual operational plan
only 65 localities out of a total of 178 had some kind of operational plan
Utilization of allocated budget by state, Sudan, 2013

5. Health information system

6. Public financing of health sources
Health finance
Public financing of health sources

7. Human resources for health
HRH density for Sudan (doctors, midwives and nurses) is 0.17/1,000 population
PHC expansion program started in 2012 allowed for scaling-up production of HRH (9,200 midwives, 1,513 medical assistances, 3,591 community health workers) and in-service training of HRH (45,816 in 2016)
Distribution/ retention of 1,058 medical specialists to different states
Density of doctors, nurses and midwives per 10,000 population, Sudan, 2011

8. Service delivery
14% of the population have no geographical access to PHC services (2012)
Building of 174 health centers and 463 dispensaries in addition to scaling-up of HRH production allowed for increase geographical coverage to 95% (2016)
Number of inhabitants served by a health facility by State, Sudan, 2011

9. Medicines and health technology
Availability of tracer medicines, Sudan, 2013

10. Sudan health Vision
Sudan is a healthy nation with highest attainable level of health and health equity for everyone, regardless of their socioeconomic status, through strengthening multi-sectoral approach to health and adopting people-centered health systems thus achieving SDG & universal health coverage and contributing to the overall social and economic development of the country.

11. Reform values Right to health Universality Equity Solidarity
Participatory
Sustainability
Transparency and Accountability

12. Basic documents for health reform
National health policy
Health finance policy and strategic plan
Family approach policy

13. The reform levels Health System level Facilities level HR level
Communities and individuals level

14. The Reform levels Health System level Facilities level HR level
Financing
Resources creation and mobilization
Governance and management
Services Delivery
Health System level
Facilities level
HR level
Communities and individuals level

15. The Reform levels Health System level Facilities level HR level
Communities and individuals level
Structures
Institutions culture
Supporting systems

16. The Reform levels Health System level Facilities level HR level
Communities and individuals level
Professionalism
Dual practice (public and the private)
Training

17. The Reform levels Health System level Facilities level HR level
Communities & individuals level
Strengthen CSOs and patients’ groups
Communities lead health facilities
Media involvement

18. The contents of reform
Health insurance as the main source for financing health
Increasing fund to health (government, other sources)
Restructuring health insurance fund
Increasing geographical and financial coverage of health services
Improving quality of health care services

19. The contents of reform
Improving and strengthening of monitoring frameworks
Restructuring coordination mechanisms
strengthening and computerization of supportive systems (supervision system, HRH management system, financial tracking system)
Shifting of orientation of health system (SDH, continuity of care, family health approach, HiAP, client-centered approach)

20. Implementation so far
National plan for health sector reform was developed and endorsed in February 2016 by the council of states ministers
Out of the 138 activities (the total number of the activities); no implementation started for 54 activities, implementation started but not finished for 59 activities , implementation finished for 25 activities by the end of 2016
Only 5 stated has developed their own reform plans

21. Follow-up on implementation
At national level mechanisms for follow-up on implementation include: National health sector coordination council, cabinet of ministries, minister of health council & undersecretary council
At state level it includes: State health sector coordination council, state cabinet of ministers, state minister of health council & state director general council

22. Reform success prerequisites
Shared responsibility: Whole government & whole society
Enhanced partnership and coordination
Policy coherence - HiAPs
Evidence based tactics
System thinking; Ability to move from out of pocket financed system to prepaid financed health system; and from an input, budget line financing to an output based & strategic purchasing
Emphasis on decentralization with more clear roles

23. Thank you