Making giant strides towards UHC in Sudan What

Making giant strides towards UHC in Sudan. . . . What more can Sudan learn from international experience? Dr. Matthew Jowett - WHO Geneva Sudan NHP Endorsement Meeting 6 -7 February 2018

Looking back 12 months Conference on Universal Health Coverage Khartoum, Sudan 22 -24 January 2017 To progress towards UHC, need good health policies backed up by adequate funding, spent wisely… Universal entitlement to (essential) health services Adequate public funding for health Better use of funds (efficient, equitable)

Impressive developments in Sudan New health financing strategy and NHIF legislation NHIF internal reorganization / management improvements Shift of facility ownership; transfer of free care / U 5 programmes to NHIF Significant increase in potential for greater risk sharing & strategic purchasing

Sudan now focuses resources on priority services & priority population 1. 5 m poor families subsidised under NHIF in 2017. Additional 1 million in 2018.

Good policy often gets stuck at the implementation phase Why are budgets not fully spent in some states? Why do some NHIF members not use services at all, or use very little? Why is higher spending not resulting in better quality services?

Current priority: better understand causes of under-performance

Focus on improving the fundamentals and sequence reforms carefully THAILAND SPEND 10 YEARS BUILDING SERVICE DELIVERY CAPACITY - Mandatory rural service for doctors (early 70’s) - Capital investment in hospitals frozen for 5 years - Extensive expansion of rural facilities in 1980 s PHILIPPINES ran ahead with insurance coverage, despite poor access to services.

No short cuts; solutions lie in Sudan; address the fundamentals Major progress on range of policy issues Continue to strengthen understanding of the constraints to improving performance; M&E Address both supply-side issues (e. g. facilities, human resources, service quality, medicines/supplies), and……. …. demand-side issues: health and treatment-seeking behaviour