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CHALLENGES OF HEALTH SYSTEM IN SUDAN: BALANCE PRIVATE/PUBLIC: THE WAY AHEAD

CHALLENGES OF HEALTH SYSTEM IN SUDAN: BALANCE PRIVATE/PUBLIC: THE WAY AHEAD. MUSTAFA KHOGALI JUNE 2012. OUTLINE. Role of Health Systems Health Status /Republic of Sudan (RS) Status of Private Medical Sector since 1990 4 . Major Health Challenges:

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CHALLENGES OF HEALTH SYSTEM IN SUDAN: BALANCE PRIVATE/PUBLIC: THE WAY AHEAD

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  1. CHALLENGES OF HEALTH SYSTEM IN SUDAN:BALANCE PRIVATE/PUBLIC:THE WAY AHEAD MUSTAFA KHOGALI JUNE 2012

  2. OUTLINE • Role of Health Systems • Health Status /Republic of Sudan (RS) • Status of Private Medical Sector since 1990 4. Major Health Challenges: Public / Private Overlap (Dual Practice) 5.The Way Ahead 6. Conclusion

  3. ARAB COUNTRIES(Map)

  4. POLITICAL MAP OF REPUBLIC OF SUDAN

  5. 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.

  6. 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

  7. 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.

  8. 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

  9. HEALTH CARE SERVICES Services depend on Health Care Workers Community Satisfaction

  10. 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 )

  11. HISTORY OF HEALTH CARE IN SUDAN • 1951 Local Government Act. • 1960 Province Administrative Act. • 1971 Popular Governance Rule. • 1979 Authorities' of M of H (Provinces). • 1980 Local Govt. Act (5 reg.ex KH) • 1991 Adoption of Federal System.

  12. Population by Region/Hospitals/Beds(CBS 2011) Region Pop000 % P/Hos Beds % Khart. 5274 17 46 6546 26 Cen(G/WN) 5306 17 87 3856 15 North(RN/N) 1819 06 29 2095 08 E(RS/K/G) 4534 15 57 3353 13 SE(Sen/BN) 2117 07 50 3491 14 SW(NK/Sk) 4327 14 44 3133 13 Darf(N/S/W) 7516 24 32 2529 10

  13. 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 $

  14. Current Numbers of Doctors In RS 2010 * Others Refer to categories registered in other than ministry e.g. private facilities source (FMOH, 2010)

  15. PRIVATEHEALTH 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

  16. PRIVATE HEALTH CARE SYSTEM / MEDICAL EDUCATION Medical Schools: 32 Khartoum: 19 (Private 14 and Governmental 5) All other States: 13

  17. LIST OF MEDICAL SCHOOLS (KH. STATE) Private • Ahfad 8. ALWatania • Karari 9. ALRibat • AfAlAlamia 10. Sud. I. U. • U. Tech. 11. ALNeel 5. UMST 12. ALMogtarbeen 6. K M S 13. ALYarmouk 7. ALRazi 14.Om ALAhia

  18. LIST OF MEDICAL SCHOOLS (KH. STATE) Governmental • Khartoum • AlzeemAlAzhary • Omdurman Islamia • AlNeeleen • Bahri

  19. STATEMEDICAL SCHOOLS • ALGazera 1979 • Kassala 1991 • Kordofan 1991 • AlFasher 1991 • Shandi 1994 • ALImamALHadi 1995 • BakhatALRuda 1997 • ELGedaref 1997

  20. STATE MEDICAL SCHOOLS 9. Dongola 1997 10.Sennar 1997 11. WadiALNeel 1998 12. West Kordofan 2007 13. Red Sea 2007

  21. HISTORICAL PROSPECTIVE OF PRIVATE PRACTICE SINCE 1990 • 1991 Users Fees for P H Facilities. • 1992 Macroeconomic Reforms ↓ Govt. expenditure. • 1994 Adoption of 26 States. • 1994 Social Health Insurance • 1998 Local Governmental Act (633 localities) and its impact on H Services.

  22. 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

  23. 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

  24. 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

  25. IMPACT OF DUAL PRACTICE • Predatory Behaviour: e.g. C S rates (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

  26. POSSIBLE INTERVENTIONS • 1. Total Banning of DP • 2.DP with restrictions. • 3.DP without restrictions

  27. 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.

  28. 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.

  29. CONCLUSION The tremendous variety of approaches to various aspects of DP throughout the World provides an opportunity for each nation to identify ALTERNATIVESsuitable for its prevailing condition & current operations. Each country should take ADVANTAGE of knowledge derived from already existing experiences in other countries. HOPEFULLY SO ?!

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