Sudans National Health Policy Outlines 2017 2030 Dr

Sudan’s National Health Policy Outlines 2017 -2030 Dr. Abdalla Sid Ahmed Director of the Public Health Institute

Background �Previous Sudan National Health policy developed in 2007. �National Health policy review conducted by a team of experts � Revealed some major gaps, issues and challenges �Recommendations to policy process developed

Background �A number of policy themes identified � Extensive work in each of following themes: 1. Family health policy document 2. Health Finance policy document 3. Policy system document 4. Hi. AP road map document 5. Global health strategy

Document �Previous policy review and current situation �Major issues situation analysis �New orientation and its justification �Vision �Principles �Objectives �Policy directions and priorities �Implementation arrangement �Policy development process �M&E

Vision of the Policy �Sudan is a healthy nation with highest attainable level of health and health equity for everyone regardless of socioeconomic status through strengthening multisectoral approach to health and adopting peoplecentered health systems thereby achieving SDG and universal health coverage and contributing to the overall social and economic development of the country.

Values of the Policy �Right to health �Equity �Universality �Solidarity �Sustainability �Transparency �Accountability �Efficiency �Participatory

Guiding Principles of the Policy �Comprehensive approach �Shared responsibility �Partnership �Strengthening Decentralization �Policy coherence �Evidence based approach �System thinking

Conceptual Framework of the Policy Directions Comprehensivene ss Coordination Decentralization PHC, people centered Addressing SDH Prepaid services Community oriented education Policy Commitment s HS Building Blocks Social Determinants of Health Policy Objectives -Cover all Sudanese by ESHP -Avail people centered Family health approach -Decrease burden of CDs &NCDs -Reduce Inequities -Raise life expectancy Policy Goals Attaining the highest possible standard of health in a responsive manner Ensure healthy lives and promote wellbeing for all at all ages

Key transformational Policy Shifts �From narrow policy TO comprehensive policy �From Ministry of health policy TO health policy �From multiple policy foci TO coordinated and unified health policy making system �From HS skewed to curative TO HS based on PHC �From Disease oriented focus TO health prevention and promotion based on SDH � Primary Care: From a selective Care TO comprehensive care that has continuity with higher levels, �From case based TO people-centred holistic approach

Key transformational Policy Shifts �Secondary and Tertiary Care: From an input oriented, budget line financing TO an output based (strategic purchasing). �From out of pocket financed health system TO prepaid financed health system. �From narrow medical education TO comprehensive community and family oriented education �From skill mix towards curative TO skill mix towards PHC cadre

NHP Goal “Attaining the highest possible standard of health in a responsive manner” OR “Ensure healthy lives and promote wellbeing for all at all ages”

Objectives of the Policy 1. To cover all Sudanese by essential health package through prepayment arrangements to be financially protected 2. To avail people centered family health services to all the population across all states and localities. 3. Reduce inequities in health 4. Decrease the burden of Communicable and non- communicable diseases 5. Raise life expectancy 6. Decrease mortality and morbidity

Policy Commitments �We will address Social and environmental determinants of health and develop health in all policies �We commit to support health living through out life course in a comprehensive way giving priority to promotion and prevention �We want to reduce health inequities �We commit to strengthening people-centred health systems and PHC, public health capacity and heath security, emergency preparedness, surveillance and response �We will adopt a comprehensive approach to address the burden of communicable and non communicable diseases

Policy Commitments contd. �We will strengthen governance of health along the agreed frame �We will strengthen governance for health to promote a whole of government and whole of society approach �We want to develop resilient systems and communities �We commit to strengthening the health decentralized system �We want to establish a unified integrated, comprehensive , accurate national health information system that based on modern technologies and facilitates evidence based decision-making at all levels. �We commit to strengthen the functions of health financing system to enable and facilitate the move towards universal health coverage (UHC)

Policy Commitments contd. �We will build an comprehensive, effective human resource development system to enable advancement in universal health coverage and improving health status of all population. �We want to ensure availability, accessibility and affordability to essential medical products and technologies of good quality, safety and efficacy.

The SDH Approach �SDH & risk factors identified follow the frame: 1 - Contextual factors (including Global context): Labour market; Educational system, Political Institutions, other cultural and societal values, Promote redistributive policies 2 - Intermediary determinants of health: Material circumstances; Psychosocial circumstances; Behavioral and/or Biological factors; and the health system itself as a social determinant.

Socio-economic positioning Socio-economic and political context Social Determinants of Health Framework (Adapted from WHO) Social determinant of health inequalities (structural determinants) Including Health System Social determinant of health (Intermedia ry factors) Impact on equity in health and wellbeing

Health promotion is to address SDH through �Policies �Legislations �Individual behavior �Mechanisms intersectoral and coordinating mechanisms(Further develop NHCC at Fed state and local) �Settings : health schools, cities, villages �Development of expertise & competencies �All levels �Structures and Processes like HIAs �Monitoring development and use of indicators to measure the determinants and the disease outcomes and systems to measure such indicators

Health in All Policies �All Ministries and Gov. levels at all levels are to establish formal structures and processes for intersectoral actions �MOH to lead convincing other sectors that preventive and promotive health care approaches are their own challenge �Health should be considered in all strategic plans of sectors, states and localities. �Accountability is done through intersectoral mechanisms and the comprehensive report as indicated in the road map.

Health in All Policies �The intersectoral at federal level and state level is to address the contextual policy level like redistributive policies, poverty reduction strategy �Hi. AP to address nutrition, environmental health, social policies �Health promotion and prevention programs e. g school health

Health in All Policies �Health in all policy approach to be implemented through the Road map Hia. P �The Road map Hia. P selected the following ( in each element of the frame ) as priority actions �The role of the health sector would be to undertake evidence based advocacy and exercise leadership and coordination

Equity �For sustainability Link economic social and environmental development to equity To foster fairness and peace ( high level policy) �Address intergenerational and transmission of equity through child health development �Focus on Pregnancy and early child hood Address systematically to prevent poverty through generation �Address operational inequity

Governance �Strengthen policy system �Develop patient charter (Right to Health, information, complain…) �New leadership role of MOH at federal, state and locality levels � Initiating intersectoral approaches for health and acting as health advocates �Develop leadership through out society �Improving Accountability �Develop Public private partnership based on shared vision and win- win situation �Clarify Roles and responsibilities �Decentralization arrangements �Policy for empowering people, citizen, consumer and patient �Develop resilient Health and community systems �Strengthen partnerships

Governance frame �Define the vision for health and strategic policy framework to achieve better health( policy system recommendations; what policy to go paliment at central and state �Ensure guidence and tools for implementation, Allow incentive, sanctions to inforce implementation ( finance, reports…), role of NHC in enforcing implementation, the idea of binding document finance against performance �Block grants and earmarked �Coordinate, build partnership and exert influence across all sectors for better health; ( stuctures and TORs, identify differential status of partnership ? partnership policy

Governance frame contd. �Providing oversight and accountability (define major accountability lines, structure, processes, define role of community in accountability), quality , equity , authorize policy level to influence equity, address intergeneration inequity. . ); �make available and leverage legal and regulatory instruments; � generate, compile, disseminate and apply intelligence ( IT strategy). �Strengthen research system �Promote ethics and professionalism

. �Promoting the role of Ministry of Health in leading health sector by building robust policy system and strengthening management, coordination and accountability across the decentralized health system �Improving policy coherence and overcoming fragmentation, strengthen decentralized system and improve accountability at all levels �Define HS Structure, roles and responsibility �Define roles of Levels of HS ; formal levels and community �Federal, state and locality Structure- Role and function, relation

Governance and decentralized health system �State level to be developed as policy level �Strengthen local health system �Define concurrent policy �Define policy, strategy and plan � Federal and state reform (from implementation to policy and guiding implementation, Strategic Monitoring system �Define policy process (policy system agenda setting, formulation, policy dialogue, policy forums)

Human Resources for Health �Redefinition of health workforce to include HR in other sectors �Supporting workforce in other sectors to strengthen intersectoral action �Skill mix skewed towards PHC and more role to paramedics �Regulation of HRH practice and development of robust HRH management system. �Training on new competencies e. g. negotiation, communication �Reform education �Readdress role of CHW

Human Resources for Health �Creating new cadres (FP, community nurse) to deliver health care services �Professionalism and ethics �Develop policy to address “dual practice” �Develop policy to manage migration �Agree on career structure for different cadres

Health Information and Research • Build a unified comprehensive and integrated health information system and harnessing technology • Building institutional capacity in management and conduct of researches

Health Finance �Ensuring sustainable, efficient and equitable Financing �Strengthening functions of health financing system to enable and facilitate the move towards universal health coverage

Medicine and Health Technology �Ensure availability, accessibility and affordability to essential medical products and technologies of good quality, safety and efficacy.

Service delivery �Strengthening people centered health systems �Strengthen service delivery system and improve coordination between its levels to achieving universal access to quality integrated essential package of services for all population. �Adopt family health approach �Strengthen public health capacity and emergency preparedness, surveillance and response close to home �Improve Access, efficiency and equity to hospital services

Service delivery �Addressing unfinished agenda of MDGs and continuing efforts to reach the identified targets with regard to maternal and child health and combating of CDs, addressing the rising challenge of NCDs as one of the agenda of SDGs. �Communicable including neglected disease �Halt Non communicable diseases • Combating communicable diseases especially malaria, HIV/AIDS , tuberculosis, leishmaniasis , schistosomaiasis and other endemic diseases. �Addressing growing burden of NCDs on health system in Sudan

Service delivery: Hospital Reform (efficiency, equity, performance) • Apply system approach �Roles and functions �Planning hospitals to be fit for purpose �Fragmentation �Lack of coordination �Hospital autonomy �Dealing with emergency �Quality and clinical governance �Technology and equipments �Relation with PHC �Medical tourism �Role in surveillance, epidemics �Role in teaching and research �Purchasing and payment modalities �Role in telemedicine

National Health Coordination Council Proposed Process for development of NHP Policy Forum Policy Council Steering committee Selected Technical Representatives Technical Committee (PHI) HFP PHC and FM Hi. AP

Thank You