1. Sudan’s Health Sector Reform; addressing the SDGs
Dr. Isameldin Mohammed 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 States Ministers of Health 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

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 (12,846 midwives, 2,394 medical assistances, 4,824 community health workers) and in-service training of HRH (45,816 in 2016)
Distribution/ retention of 1,416 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)
Since 2012 Building of 174 health centers and 463 dispensaries in addition to scaling-up of HRH production allowed for increase geographical coverage to 97% (2017)
Number of inhabitants served by a health facility by State, Sudan, 2011

9. Medicines and health technology
Mean Availability in private sector for generic lowest price by States 2017
% of health facilities with NMSF drugs by state 2017

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

13. 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

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

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

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

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

18. 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)

19. Implementation so far
National plan for health sector reform was developed and endorsed in February 2016 by the council of states ministers and by the National Cabinet of Ministers
Only 5 stated has developed their own reform plans

20. Implementation so far
Health finance
Integration of all fund pools into a single fund
Implementation of new payment mechanisms to foster strategic purchasing
Splitting of purchasing role from the provision of health services

22. Implementation so far Health finance
Integration of states’ pools into the national pool and positive signals from police and security forces to join the national fund
Implementation of capitation as a new payment mechanism in NK state
Complete splitting between provider and purchaser in WK state

23. Implementation so far Governance and management
National health services coordination council headed by PM and includes all government sectors at ministerial level (also at state level)
States ministries of health council (headed by Federal Minister of Health and includes all states ministers of health)
Health development forum headed by Minister of Health and includes all development partners and selected federal ministries

24. Implementation so far Governance and management
Revision of FMoH structure and development of standard structures for states ministries of health and local health teams
Management capacity assessment at all levels
Inclusion of leadership and management module as main part in the training curricula of PHI for all health cadre
Crash training program for training of state ministries of health staff and local health teams in leadership and management

25. Implementation so far Service coverage
Before
Implementation so far
Service coverage
Construction of 441 new family health units (59% of the target) and arrangements to complete the target in 2018
Construction of 355 new family health centers (100% of the target)
Training of12,846 community midwives (92% of the target)
Training of 2,394 medical assistants (64% of the target)
Training of 4,824 community health workers (93% of the target)
After

26. Implementation so far Service coverage
Integrated in-service training of 2,550 medical assistants (97% of the target) and 3,092 vaccinators and nutritional assistants (87% of the target)
Training of 600 family medicine specialists (60% of the target)
Expansion of supply chain to cover 4,470 health facilities (88% of the target)
Provision of 111 ambulance cars (20% of the target)
Redistribution and retention of 1,416 medical specialists to cover the services in different states’ hospitals

27. Implementation so far Health system structures
Development of guidelines for description of health facilities and staffing norms
Reorientation of the role of PHC health facilities for family health approach (includes structural changes)

28. Implementation so far Institutions culture
Assessment of FMoH institution culture
Development of strategic plan to change FMoH institution culture
Development of institution culture change plans for some states ministries of health

29. Implementation so far Supporting systems
Health information system reform with computerization (DHIS2)
Development of integrated supervision system
Development of computerized hospital management system (initial phase)
Development and computerization of all health services with clients interface (76)

30. Implementation so far Professionalism
Formulation of national committee for development of national strategic plan for medical ethics and professionalism
Development of scope of practice for different health cadre
Revision of undergraduate curricula for health science schools to include health ethics and professionalism as main stream
In-service training for different health cadre in health ethics and professionalism

31. Implementation so far Training
Development of national strategic plan for CPD
Establishment of a national center for CPD with branches in all states
Development of 25 curricula for CPD for different health professions (some also include curricula for online training)
2,077 in-service training sessions held in different states by end of with 72,919 health cadre trained

32. Implementation so far Communities & individuals level
Strengthening the role of CSOs and patients’ groups in provision of health services but also in development of health policies and advocacy for health
Reorientation of the role of health facilities towards communities in their catchment areas, and strengthening the role of communities in management of health facilities

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

34. Thank you