The Republic of Sudan is situated in the northeast of Africa and is considered to be a low-middle-income country. It is the third largest African country in terms of geographical coverage after Algeria and the Democratic Republic of the Congo. The nation has a well-established healthcare system with many drawbacks, mostly due to economic and administrative factors followed by prolonged political turmoil and sanctions.
Public health expenditure (percent of GDP) stayed at about 1% and, at best, was closer to 2% in 1995-2013. In 2007-2010, substantial progress was made at a rate of 2.22%, suggesting an improvement in the production of infrastructure dependent on oil (Mahjoub Ebaidalla & Mohammed Elhaj). Sudan is awarded on natural and human capital, but economic and social growth has been below expectations. Similarly, statistics on health funding and spending are inadequate and incomplete. It makes it difficult for decision-makers to prepare, allocate and clearly see the deficient region. The available information has shown that overall government expenditure on health is very low and that the health sector is underfunded. As overall government expenditure increased largely due to oil revenue growth, the total allocation to the health sector also increased in absolute terms until 2011. The National Health Insurance System comprises about 8% of the population, most of whom are government workers (75%), the rest are poor families (6%), families of martyrs (3%) and students (2%). External assistance to the health sector has not been substantial in the last decade, although some foreign organizations have been committed to working with the government to improve and expand health programs, including those funded by the World Bank.
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In 1976, Sudan introduced primary health care as the main health care policy and, in its future plans and policies, focus was focused on primary health care. Policies and plans in Sudan are drawn up at three levels that include federal, state and district (also known as locality). The federal government is responsible for the implementation of national health policies, programs, initiatives, overall monitoring and assessment, planning, training and international relations. The state level is concerned with state policies, initiatives, and on the basis of federal requirements for the funding and execution of programs. Districts or localities nearest to residents mainly provide primary health services, promote wellness and facilitate community involvement in the services of their health and the environment. They are also responsible for water and sanitation facilities. This well-established district framework is a key component of the decentralization strategy followed in Sudan, which in effect provides a wider space for local government, administration and enables the control and monitoring efforts of higher authorities to be overcome.
There are some weaknesses in the health system of Sudan which include the following:
- There are no consistent processes for enforcing, tracking and reviewing the process for the policies and plans in the program.
- Poor data consistency, storage and dissemination of information across all aspects of the health system.
- Fragmented health information network.
- Unclear management structures for collaboration and instruction between the federal and state departments of education, the military, police, universities, private sector and civil society.
- Not enough postgraduate training.
- Weak HR works at a decentralized level and low regional distribution with urban segregation.
- No ongoing program of professional development for health care.
- Deterioration of civil services due to out-of-datedness.
- Logistic supply (equipment, disposables, medicines, etc.)
- Out-of-pocket payments.
- Impaired access and use of health services.
- Inequitable distribution of health care facilities.
- Lack of preventive and pro-active health care (primary prevention).
- Inadequate referral network.
There are many opportunities for improvement of health care system in Sudan which include recent international commitments, decentralization leading to better decisions and actions, external financing incentives (WHO), partnerships with foreign institutions and universities, improved efficiency in the economy, initiative for reforming the health system.
Various steps can be considered to improve the current health care system in Sudan. First, the establishment of law enforcement divisions in districts, state health ministries, and federal health ministries would significantly improve compliance with existing policies. In addition, the establishment of a contact channel between all levels of policy making would allow efficient and timely decisions to continue, amend or even put an end to these policies. Secondly, it is recommended not only to track the progress of ongoing initiatives and programs, but also to pay special attention to the evaluation of the outcome. It is also recommended to further promote the use of the health information system, improve data quality and enhance the value of dissemination of results. Third, creating incentives for medical practitioners, delivering appropriate facilities and rising the doctor-to-physicist ratio to reach the norm would potentially reduce the high skilled attrition rate. Finally, it is proposed to upgrade primary health care facilities and create new units to meet existing needs and population growth, as well as to follow a bottom-up approach focused on community empowerment, disease prevention and health promotion.
Sudan's health care network has a robust array of long-term or short-term action plans and policies. The implementation and management of the fragile health data system is weak. The main external factors undermining the system are the global economic instability that led to reductions in the health budget. Sudan is not a liberal country, and long-standing economic sanctions have also significantly affected the country's ability to operate a viable, sustainable healthcare system, along with the gradual erosion of the number of healthcare professionals. Sudan needs to further reflect on the strengths it has and explore the tools available to develop basic health indicators.
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