1 Sudans Health Sector Reform addressing the SDGs

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

ar W tou hi m te N Ka ile ss a G la ad Bl ar ue if R Nile ed N Sea or R thre iv er n N il W Ge e es zi t D ra ar fu r S Ea in n s a C en t D r tra arf u So l D r ut arf W h D ur es a So t K rfur ut urd h K fan N urd o N rth. D fan or th arf Ku ur rd fa n Kh 5 100% 80% 60% 40% 20% Health information system % of health facilities with complete reports 2017 120% 100% 83% 80% 73% 69%68% 52% 48% 45% 34%32% 23% 18% 11% 8% 7% 4% 3% 0%

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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, , 4824 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 120% 100%100% 92% 90% 89% 100% 88% 100% 90% 100% 94% 88% 87% 80% 60% 36% 40% 20% al W a h or ite th N i So Ko le r d ut uf h Ko an W es rdu t K fan Ea ord uf st Ko an rd N or ufa n th D ar W fu es t. D r So a ut rfu r h C en Dar tra fu l. D r ar fu r G ad ar i R ed f Se Kh a ar to um G ez ira Su da n ile ss N N Ka nn ar ue Bl Si r. N iv e R N or th re n ile 0% 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 peoplecentered 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 Financing Resources creation and mobilization Governance and management Services Delivery HR level Communities and individuals level

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

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

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

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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 FMo. H 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

Before Implementation so far 25 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 After target) Training of 12, 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)

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 , 1416 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 FMo. H institution culture Development of strategic plan to change FMo. H 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 (DHIS 2) 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 2017 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