1. National Health Policy
Role of NHIF in National health policy and implementation challenges
February, 2018
الصورة يتم تغييرها لتتناسب مع الموضوع

2. Contents
Introduction
Policy components
Achievements
Challenges

3. Introduction
Health plays a key role in the national and international development framework.
The constitution states: “The State shall promote public health and guarantee equal access and free primary health care to all citizens” .
The Universal Health coverage(UHC) declaration 2017 also reaffirms that health is a human right, that the Government of Sudan is responsible to assure the health of its people
Equity in health is an expression of social justice .

4. Current situation of health financing
There is a significant increase in government health expenditure from 6% in 2012 to 9%. However, this is less than the Abuja target of 15%.
Public expenditure as a percentage of total health spending is 22%[6]
54% of the population (21.8 million) is covered by NHIF, most of which are poor people.
74% of the poor are covered through subsidies from ZAKAT and the MOF.

5. Current situation of health financing
Health financing is inefficient due to presence of fragmented pools
Lack of split between purchaser and provider created inefficiency in management and compromised quality of services
Fee for service is the predominant payment mechanism used by NHIF which increase the cost of health services
Health financing is skewed towards hospitals (>80%) instead of primary care level

6. Key Policy transformational Shifts
From Health services and skill mix skewed towards curative TO comprehensive integrated and responsive health care based on PHC with a functional referral system
From out of pocket financed health care TO prepaid financed health system with protection of marginalized and vulnerable population.

7. Vision
Vision: To become the pioneers in insuring all the citizens and to guarantee provision of excellent medical services that lead to the social security.
Mission: The National Health Insurance Fund is a consolidative Institution that offers excellent equitable and sustainable medical services that meet our clients delight.
Objective : The National Health Insurance Fund is a consolidative Institution that offers excellent equitable and sustainable medical services that meet our clients delight.

8. Key objectives of health financing
component
Objectives
Governance
Align implementation with Policy
Collection
Sufficient and sustainable revenues
Polling
Equitable management of revenues
Effective utilization of revenues
Purchasing

9. Key objectives of health financing
component
Objectives
Governance
Align implementation with Policy
Collection
Enforcing health financing policy will ensure financial risk protection
Sufficient and sustainable revenues
Polling
Equitable management of revenues
Purchasing
Effective utilization of revenues

10. Key policy components (1) Governance
Exercise the role of NHCC as the main and supreme governing body
Develop technical committee to guide implementation of health financing policy among stakeholders
Split health service provision from purchasing and define roles and responsibilities among different partners
Establish national independent body for accreditation 0f health facilities
Strengthen the health information system to respond to the needs of partners

11. Achievements
NHIF Act was approved earlier in 2016, and the General regulation issued in 2017
One National board of directors with representatives from all States meeting quarterly
Characterized by centralized planning at H.Q and decentralized implementation at state level with unified structure and policies.
There is technical committee headed by H.E Undersecretary of health to execute the financing policy
Joint plan with MoH developed and phased out until the end of 2020 guiding NHIF to be the health service purchaser

12. Challenges regarding governance
Activation of health coordination councils and technical committees at state level
Formulation and endorsement of joint plans at state level with the aim to achieve UHC
Develop an integrated health information system among partners
Strengthening monitoring and evaluation systems

13. Key policy components Increase public finance for health
(2) Collection
Increase public finance for health
Improve public expenditure for NHIF at the state level through earmarking
Increase state contribution for health with the aim to achieve financial protection through NHIF
Adjust premiums according to actuarial studies and improve collection mechanisms

14. Achievements
Public spending for health increased from 6% in 2012 to 9% in 2017
Increased government coverage of poor families from 750,000 family in 2015 to 2.9 million poor family in 2018
State contribution to cover poor families:
Enrollment of (55,000 family in Gadarif, 20,000 family in Northen state and 12,000 in River Nile state)
Earmark taxation for NHIF in west Darfur state (10,000 family)
Issuance of decree in 10 states that link marginal enterprises with health insurance card acquisition

15. Achievements Coverage of poor families by international organization:
Coverage of 15,000 family by Islamic Aid organization
Coverage of 100,000 orphan by Qatar Eid organization (the startup is by 17,500 orphan)
Premiums increased for both informal and social security support sectors in 2017
Partnership with UNHCR to cover 10,000 refugees from Syria and Yemen

16. Challenges of collection
To continue government financing for health to attain UHC
Increase contribution of states to cover informal sector through earmarking policy introduction
Increase premiums to balance with costly health services and infliation

17. Key policy components
(3) poolling
Overcome fragmentation in healthcare financing and guide shifting to pool different fragmented initiative into a single large pool
Improve pooling mechanisms within NHIF through central collection of premiums, and improve resource allocation to states
Align and direct international funds towards UHC and policy priorities

18. Achievements
Development of a plan to guide shifting of free care funds of under five to NHIF in 6 states
Partial shifting of resources from Zakat chamber to NHIF to cover 200,000 new poor family reaching to 655,000 poor family in total
Central pooling of NHIF premiums

19. Challenges of pooling
Integration with private fragmented initiatives into a single pool
Development of a system to efficiently allocate centrally pooled resources to states
Direction of international funds into the single pool to attain UHC

20. Key policy components
(4) Health service purchasing
Define medical benefit package (Basic, Comprehensive)
Study cost of health services
Shift from input-based purchasing to strategic purchasing of health services and reform provider payment mechanisms
Assessment and accreditation of health facilities are prerequisites for contracting with NHIF

21. Achievements Agreement on basic and comprehensive benefit package
Bulk purchasing of medicines and medical consumables from NMSF since 2012
International technical assistance to support design and cost benefit package
First draft developed for strategic purchasing and payment mechanism to health service providers
Piloting capitation as alternative payment mechanism in north Kurdofan State

22. Challenges of health service purchasing
Ensure that the biggest share of resources is shifted towards PHC
Develop a unified fee schedule for medical services cross different states