Sudan’s Health Sector Reform; addressing the SDGs

1. Sudan’s Health Sector Reform; addressing the SDGs Dr. Isameldin M. 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 Ministers’ 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

6. Public financing of health sources Health finance

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 (9,200 midwives, 1,513 medical assistances, 3,591 community health workers) and in-service training of HRH (45,816 in 2016) • Distribution/ retention of 1,058 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) • Building of 174 health centers and 463 dispensaries in addition to scaling-up of HRH production allowed for increase geographical coverage to 95% (2016) Number of inhabitants served by a health facility by State, Sudan, 2011

9. Medicines and health technology Availability of tracer medicines, Sudan, 2013

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 systemsthus 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. Basic documents for health reform • National health policy • Health finance policy and strategic plan • Family approach policy

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

14. The Reform levels • Financing • Resources creation and mobilization • Governance and management • Services Delivery • Health System level • Facilities level • HR level • Communities and individuals level

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

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

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

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

19. 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)

20. Implementation so far • National plan for health sector reform was developed and endorsed in February 2016 by the council of states ministers • Out of the 138 activities (the total number of the activities); no implementation started for 54 activities, implementation started but not finished for 59 activities , implementation finished for25 activities by the end of 2016 • Only 5 stated has developed their own reform plans

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

22. Reform success prerequisites • Shared responsibility: Whole government & whole society • Enhanced partnership and coordination • Policy coherence - HiAPs • Evidence based tactics • System thinking; Ability to move from out of pocket financed system to prepaid financed health system; and from an input, budget line financing to an output based &strategic purchasing • Emphasis on decentralization with more clear roles

23. Thank you