CHALLENGES OF HEALTH SYSTEM IN
SUDAN:
BALANCE PRIVATE/PUBLIC:
THE WAY AHEAD
MUSTAFA KHOGALI
JUNE 2012
OUTLINE
1.
Role of Health Systems
2.
Health Status /Republic of Sudan (RS)
3.
Status of Private Medical Sector since 1990
4.
Major Health Challenges:
Public / Private Overlap (Dual Practice)
5.
The Way Ahead
6.
Conclusion
ARAB COUNTRIES
(Map)
POLITICAL MAP OF REPUBLIC OF
SUDAN
HEALTH SYSTEM
Comprising of all organizations, institutions
and resources that are devoted to produce
health actions.
Objectives:
Improving H. of Popn
Responding to people expectations
Providing financial protection against the
cost of ill health.
MAJOR HEALTH CHALLNGES
A
Chronic Diseases
Emerging Diseases
Infectious/Endemic Diseases
B
H. Systems
H. Services Delivery
Human Resources in Health
Public spending on health -DISPARITY
HEALTH SYSTEMS DEVELOPMENT WORLDWIDE
-
1920  Founding of Nat.H. Care Systems
-
1970-80 – Promotion of PHC as a route to achieve universal
coverage. (Success in Developed Countries)
-
1990  More concerned with Demand.
New Universalism. High Quality Delivery of Essential Care.
HUMAN RESOURCE FOR HEALTH (HRH)
HRH policies
---------- > improve HS performance
HRH involved with both resource generation / service provision function
It is crucial
Issues:
 Education of Health Professionals
 Imbalance in workforce
 Migration
 Working conditions
HEALTH CARE SERVICES
Services depend on
Health Care Workers
Community Satisfaction
HISTORY OF HEALTH CARE IN SUDAN
1899 Army
1904 Medical Department of N. Sudan
1905 Central Sanitary Board
1924 S M Services / Kitchener S M.
1924 (HWF: 16 British Doctors, 30
Syrian Doctors and 20 Sudanese Medical
Assistants )
HISTORY OF HEALTH CARE IN SUDAN
1951
1960
1971
1979
1980
1991
Local Government Act.
Province Administrative Act.
Popular Governance Rule.
Authorities' of M of H (Provinces).
Local Govt. Act (5 reg.ex KH)
Adoption of Federal System.
Population by Region/Hospitals/Beds
(CBS 2011)
Region
Pop000
%
Khart.
5274 17
Cen(G/WN) 5306 17
North(RN/N) 1819 06
E(RS/K/G)
4534 15
SE(Sen/BN) 2117 07
SW(NK/Sk)
4327 14
Darf(N/S/W) 7516 24
P/Hos
46
87
29
57
50
44
32
Beds
6546
3856
2095
3353
3491
3133
2529
%
26
15
08
13
14
13
10
SOC/ECON. INDICATORS
Variable
SDG(M)
%
1-G D P
125757
2-Total Exp. H
9203
7.3
3- Govt. Exp. H
2525
2.0
4-Priv. Exp. H
6678
5.3
5-Out /Pocket Exp
6422
96.0
Per cap Exp = 2/Pop =297SDG =60 $
Current Numbers of Doctors In RS 2010
Housemen
General Practitioners
Registrars
Specialist
Ministry
Others*
Ministry
Others*
Ministry
Others*
Ministry
Others*
Total
3653
0
4113
50
1794
0
1586
526
11722
* Others Refer to categories registered in other than ministry e.g. private facilities source (FMOH, 2010)
PRIVATE HEALTH CARE SYSTEM / MEDICAL
EDUCATION
Until 1990 5 Private Hospitals
4 Medical Schools (Khartoum1924,
Gezira 1979, AUW 1990, Omdurman
Islamia 1990).
2011
Private Hospitals and
Diagnostic Centers: 190
Khartoum State:
102
PRIVATE HEALTH CARE SYSTEM / MEDICAL
EDUCATION
Medical Schools: 32
Khartoum:
19
(Private 14 and Governmental 5)
All other States: 13
LIST OF MEDICAL SCHOOLS (KH. STATE)
Private
1. Ahfad
2. Karari
3. Af AlAlamia
4. U. Tech.
5. UMST
6. K M S
7. ALRazi
8. ALWatania
9. ALRibat
10. Sud. I. U.
11. ALNeel
12. ALMogtarbeen
13. ALYarmouk
14.Om ALAhia
LIST OF MEDICAL SCHOOLS (KH. STATE)
Governmental
1. Khartoum
2. Alzeem AlAzhary
3. Omdurman Islamia
4. AlNeeleen
5. Bahri
STATE MEDICAL SCHOOLS
1. ALGazera
1979
2. Kassala
1991
3. Kordofan
1991
4. AlFasher
1991
5. Shandi
1994
6. ALImam ALHadi 1995
7. Bakhat ALRuda 1997
8. ELGedaref
1997
STATE MEDICAL SCHOOLS
9. Dongola
10.Sennar
11. Wadi ALNeel
12. West Kordofan
13. Red Sea
1997
1997
1998
2007
2007
HISTORICAL PROSPECTIVE OF PRIVATE
PRACTICE SINCE 1990
1. 1991 Users Fees for P H Facilities.
2. 1992 Macroeconomic Reforms ↓ Govt.
expenditure.
3. 1994 Adoption of 26 States.
4. 1994 Social Health Insurance
5. 1998 Local Governmental Act (633
localities) and its impact on H Services.
HISTORICAL PROSPECTIVE OF PRIVATE
PRACTICE SINCE 1990
6. 2003 New Local Government Act (134
localities).
7. 2005 Restructuring Health System into
three levels (Federal/ State/ Locality).
8. Comprehensive Peace Agreement
PUBLIC/ PRIVATE OVERLAP
P. Prov. Capture a significant share of H
services delivery.
Dual Practice : Combination of public
sector Clinical work / Private Approach.
(1) Conceptual (2) Descriptive
(3) Impact on H Care System/ H Status.
(4) Qualitative (5) Possible Interventions
PUBLIC/ PRIVATE OVERLAP
Dual Practice: Multiple health – related
practices in the same or different sites.
Public / Public
Public / Private Private / Private
It is worldwide spread
Most Prominent in Developing Countries
IMPACT OF DUAL PRACTICE
1. Predatory Behaviour: e.g. C S rates
2.
3.
4.
5.
(46% Private, 16% Public) and MRI etc.
Conflict of Interest
Internal Brain Drain (Rural → Urban)
Public to Private .
Competition For Time
Corruption in the health Sector /
Outflow of Resources
POSSIBLE INTERVENTIONS
1. Total Banning of DP
2.DP with restrictions.
3.DP without restrictions
WHAT TO DO??
1.Addressing the DP problem openly.
2.Improving working conditions.
3.Incentives.
4.Professional Value System
5.Peer Pressure.
6.Pressure from Users.
7.Recruitment Practice.
8.Regulating Private Practice.
CONDITIONS OF SUCCESS
Strong leadership at both governmental and syndicate levels.
A PC structure at the national level.
A national authority committed to PC:
- Maintains focus on the vision through the organization
- Manages the change process and adapts to the local dynamics
- Creates professional incentives on merit and performance.
- Enforce Regulations equitably
Flexibility from professional associations and health insurance.
CONCLUSION
The tremendous variety of approaches to various
aspects of DP throughout the World provides an
opportunity for each nation to identify ALTERNATIVES
suitable for its prevailing condition & current
operations.
Each country should take ADVANTAGE of knowledge
derived from already existing experiences in other
countries.
HOPEFULLY SO ?!