1. Sudan’s National Health Policy Outlines 2017-2030
Dr. Abdalla Sid Ahmed
Director of the Public Health Institute

2. Background Previous Sudan National Health policy developed in 2007.
National Health policy review conducted by a team of experts
Revealed some major gaps, issues and challenges
Recommendations to policy process developed

3. Background A number of policy themes identified
Extensive work in each of following themes:
1. Family health policy document
2. Health Finance policy document
3. Policy system document
4. HiAP road map document
5. Global health strategy

4. Proposed Structure of the NHP Document
Previous policy review and current situation
Major issues situation analysis
New orientation and its justification
Vision
Principles
Objectives
Policy directions and priorities
Implementation arrangement
Policy development process
M&E

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

6. Values of the Policy Right to health Equity Universality Solidarity
Sustainability
Transparency
Accountability
Efficiency
Participatory

7. Guiding Principles of the Policy
Comprehensive approach
Shared responsibility
Partnership
Strengthening Decentralization
Policy coherence
Evidence based approach
System thinking

8. Conceptual Framework of the Policy
Policy Directions
Policy
Commitments
Policy Objectives
Policy Goals
Comprehensiveness
Coordination
Decentralization
PHC, people centered
Addressing SDH
Prepaid services
Community oriented education
HS Building Blocks
Social Determinants of Health
-Cover all Sudanese by ESHP
-Avail people centered Family health approach
-Decrease burden of CDs &NCDs
-Reduce Inequities
-Raise life expectancy
Attaining the highest possible standard of health in a responsive manner
Ensure healthy lives and promote wellbeing for all at all ages

9. Key transformational Policy Shifts
From narrow policy TO comprehensive policy
From Ministry of health policy TO health policy
From multiple policy foci TO coordinated and unified health policy making system
From HS skewed to curative TO HS based on PHC
From Disease oriented focus TO health prevention and promotion based on SDH
Primary Care: From a selective Care TO comprehensive care that has continuity with higher levels,
From case based TO people-centred holistic approach

10. Key transformational Policy Shifts
Secondary and Tertiary Care: From an input oriented, budget line financing TO an output based (strategic purchasing).
From out of pocket financed health system TO prepaid financed health system.
From narrow medical education TO comprehensive community and family oriented education
From skill mix towards curative TO skill mix towards PHC cadre

11. NHP Goal
“Attaining the highest possible standard of health in a responsive manner” OR “Ensure healthy lives and promote wellbeing for all at all ages”

12. Objectives of the Policy
1. To cover all Sudanese by essential health package through prepayment arrangements to be financially protected 2. To avail people centered family health services to all the population across all states and localities. 3. Reduce inequities in health 4. Decrease the burden of Communicable and non- communicable diseases 5. Raise life expectancy 6. Decrease mortality and morbidity

13. Policy Commitments
We will address Social and environmental determinants of health and develop health in all policies
We commit to support health living through out life course in a comprehensive way giving priority to promotion and prevention
We want to reduce health inequities
We commit to strengthening people-centred health systems and PHC, public health capacity and heath security, emergency preparedness, surveillance and response
We will adopt a comprehensive approach to address the burden of communicable and non communicable diseases

14. Policy Commitments contd.
We will strengthen governance of health along the agreed frame
We will strengthen governance for health to promote a whole of government and whole of society approach
We want to develop resilient systems and communities
We commit to strengthening the health decentralized system
We want to establish a unified integrated, comprehensive , accurate national health information system that based on modern technologies and facilitates evidence based decision-making at all levels.
We commit to strengthen the functions of health financing system to enable and facilitate the move towards universal health coverage (UHC)

15. Policy Commitments contd.
We will build an comprehensive, effective human resource development system to enable advancement in universal health coverage and improving health status of all population.
We want to ensure availability, accessibility and affordability to essential medical products and technologies of good quality, safety and efficacy.

16. The SDH Approach SDH & risk factors identified follow the frame:
1- Contextual factors (including Global context): Labour market; Educational system, Political Institutions, other cultural and societal values, Promote redistributive policies
2- Intermediary determinants of health: Material circumstances; Psychosocial circumstances; Behavioral and/or Biological factors; and the health system itself as a social determinant.

17. Social Determinants of Health Framework (Adapted from WHO)
Impact on equity in health and well-being
Social determinant of health inequalities (structural determinants)
Social determinant of health
(Intermediary factors)
Socio-economic and political context
Socio-economic positioning
Including Health System

18. Health promotion is to address SDH through
Policies
Legislations
Individual behavior
Mechanisms intersectoral and coordinating mechanisms(Further develop NHCC at Fed state and local)  
Settings : health schools, cities, villages
Development of expertise & competencies
All levels
Structures and Processes like HIAs
Monitoring development and use of indicators to measure the determinants and the disease outcomes and systems to measure such indicators

19. Health in All Policies
All Ministries and Gov. levels at all levels are to establish formal structures and processes for intersectoral actions
MOH to lead convincing other sectors that preventive and promotive health care approaches are their own challenge
Health should be considered in all strategic plans of sectors, states and localities.
Accountability is done through intersectoral mechanisms and the comprehensive report as indicated in the road map.

20. Health in All Policies
The intersectoral at federal level and state level is to address the contextual policy level like redistributive policies, poverty reduction strategy
HiAP to address nutrition, environmental health, social policies
Health promotion and prevention programs e.g school health

21. Health in All Policies
Health in all policy approach to be implemented through the Road map HiaP
The Road map HiaP selected the following ( in each element of the frame ) as priority actions
The role of the health sector would be to undertake evidence based advocacy and exercise leadership and coordination

22. Equity
For sustainability Link economic social and environmental development to equity To foster fairness and peace ( high level policy)
Address intergenerational and transmission of equity through child health development
Focus on Pregnancy and early child hood Address systematically to prevent poverty through generation
Address operational inequity

23. Building Blocks Governance
Strengthen policy system
Develop patient charter (Right to Health, information, complain…)
New leadership role of MOH at federal, state and locality levels
Initiating intersectoral approaches for health and acting as health advocates
Develop leadership through out society
Improving Accountability
Develop Public private partnership based on shared vision and win- win situation
Clarify Roles and responsibilities
Decentralization arrangements
Policy for empowering people, citizen, consumer and patient
Develop resilient Health and community systems
Strengthen partnerships

24. Governance frame
Define the vision for health and strategic policy framework to achieve better health( policy system recommendations; what policy to go paliment at central and state
Ensure guidence and tools for implementation, Allow incentive, sanctions to inforce implementation ( finance, reports…), role of NHC in enforcing implementation, the idea of binding document finance against performance
Block grants and earmarked
Coordinate, build partnership and exert influence across all sectors for better health;( stuctures and TORs, identify differential status of partnership ? partnership policy

25. Governance frame contd.
Providing oversight and accountability (define major accountability lines, structure, processes, define role of community in accountability), quality ,equity , authorize policy level to influence equity, address intergeneration inequity..);
make available and leverage legal and regulatory instruments;
generate, compile, disseminate and apply intelligence ( IT strategy).
Strengthen research system
Promote ethics and professionalism

26. Governance and decentralized health system .
Promoting the role of Ministry of Health in leading health sector by building robust policy system and strengthening management, coordination and accountability across the decentralized health system
Improving policy coherence and overcoming fragmentation, strengthen decentralized system and improve accountability at all levels
Define HS Structure, roles and responsibility
Define roles of Levels of HS ; formal levels and community
Federal, state and locality Structure- Role and function, relation

27. Governance and decentralized health system
State level to be developed as policy level
Strengthen local health system
Define concurrent policy
Define policy, strategy and plan
Federal and state reform (from implementation to policy and guiding implementation, Strategic Monitoring system
Define policy process (policy system agenda setting, formulation, policy dialogue, policy forums)

28. Human Resources for Health
Redefinition of health workforce to include HR in other sectors
Supporting workforce in other sectors to strengthen intersectoral action
Skill mix skewed towards PHC and more role to paramedics
Regulation of HRH practice and development of robust HRH management system.
Training on new competencies e.g. negotiation, communication
Reform education
Readdress role of CHW

29. Human Resources for Health
Creating new cadres (FP, community nurse) to deliver health care services
Professionalism and ethics
Develop policy to address “dual practice”
Develop policy to manage migration
Agree on career structure for different cadres

30. Health Information and Research
Build a unified comprehensive and integrated health information system and harnessing technology
Building institutional capacity in management and conduct of researches

31. Health Finance Ensuring sustainable, efficient and equitable Financing
Strengthening functions of health financing system to enable and facilitate the move towards universal health coverage

32. Medicine and Health Technology
Ensure availability, accessibility and affordability to essential medical products and technologies of good quality, safety and efficacy.

33. Service delivery Strengthening people centered health systems
Strengthen service delivery system and improve coordination between its levels to achieving universal access to quality integrated essential package of services for all population.
Adopt family health approach
Strengthen public health capacity and emergency preparedness, surveillance and response close to home
Improve Access, efficiency and equity to hospital services

34. Service delivery
Addressing unfinished agenda of MDGs and continuing efforts to reach the identified targets with regard to maternal and child health and combating of CDs, addressing the rising challenge of NCDs as one of the agenda of SDGs.
Communicable including neglected disease
Halt Non communicable diseases
Combating communicable diseases especially malaria, HIV/AIDS , tuberculosis, leishmaniasis , schistosomaiasis and other endemic diseases.
Addressing growing burden of NCDs on health system in Sudan

35. Service delivery: Hospital Reform (efficiency, equity, performance)
Apply system approach
Roles and functions
Planning hospitals to be fit for purpose
Fragmentation
Lack of coordination
Hospital autonomy
Dealing with emergency
Quality and clinical governance
Technology and equipments
Relation with PHC
Medical tourism
Role in surveillance, epidemics
Role in teaching and research
Purchasing and payment modalities
Role in telemedicine

36. Proposed Process for development of NHP
Selected Technical Representatives
Steering committee
HFP
PHC and FM
HiAP
Technical Committee
(PHI)
Policy Council
National Health Coordination Council
Policy Forum

37. Thank You