Transcript The current health system In Sudan

Current Health Status In
Sudan
Health Care Providers
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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
Level
Facility
Primary health care units (PHCU)
Primary health
care
Dressing stations (DS)
Cadre/ Capacity
Financed
community health
workers (CHWs)
nurse and/or a medical
Localities
assistant
Dispensaries
medical assistant
Health centres
physician (medical
officer/GP)
SMOH
Secondary care
level
Rural (district) hospitals
40 to 100 beds
SMOH
tertiary-level
Teaching, specialized, and general
hospitals
21 tertiary-level hospitals and
specialized centres
Five year strategy 2007 – 2012, FMOH
SMOH
FMOH
Population/1 HF
Types of functioning facilities
Percentage of Localities having full functional
organizational structure according to the standards,
75
Mapping survey 2008
57
9
0
0
0
0
0
0
0
11
14
14
15
17
13
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).
• 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
290/ day
12/hour
MCH Indicators Cont.
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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
Zakat
Government employers fund
Private employers fund
Household funds
Other private funds
87.6%
6.5%
0.4%
0.5%
0.7%
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