Mindful insights, including possible solutions and innovative ideas, are being offered here by a field engaged Sudanese General Medical Practitioner regarding the challenges and obstacles hindering an equitable access to health in Sudan

By Hanan Abdel Aziz Marhoum

Insights on Access to Health in Sudan

Being a General Medical Practitioner who worked for non-profit organizations from 2005 till 2017 in remote areas like Darfur Region, I do believe that I have compiled some insights and points of view regarding challenges and obstacles hindering access to health in Sudan. Though some of these insights might be very obvious and common knowledge to everyone whether inside or outside the medical field, yet I believe that we can still discuss it and give it a fresh look if we approach it from a different perspective.

Ultimately we can foresee and anticipate why and what factors are hindering our progress and innovation and hence hopefully we can alter and change and mould our innovative suggestions and solutions and be open to new ways of execution if we want to reach our goal which is provision of access to health to ALL.

FACTORS AFFECTING ACCESS TO HEALTH IN SUDAN

Factors affecting access to health differ depending on whether the area targeted is rural or urban.

In Urban Areas main factors are:

Brain-Drain of medical staff: Many doctors and nurses migrate from the country just a few years following graduation leading to big human resource – HR gaps especially at the big hospitals and casualties which ultimately led to a decrease in the quality of care given to patients and in some incidents due to lack of qualified staff and/or experience resulting in professional medical mistakes and loss of lives.
Lack of motivation of staff: Due to the low salaries and incentives, staff can hardly afford their living let alone affording purchase of medical references or regular participation in advanced medical conferences/workshops/forums etc. as all these have to be done on the staff own expenses and desire without any financial support from the Ministry of Health except for post-graduates who are being given scholarships from the Ministry.
Lack of appropriate Infra-structure and appropriate medical staff: Most of the well-equipped and well-built hospitals in Khartoum are actually belonging to the private sector and very few are belonging to the Ministry of Health and this logically results in provision of quality care and services to the patients who can afford the high expenses and fees of the private sector hospitals, while those who cannot afford it will for sure head towards less equipped hospitals or health centers or even go to traditional healers and herbal medicines practitioners. Actually in the recent 10 years the herbal medicine practitioners evolved and flourished as more of the public approached them for treatment for various diseases including even cancer. They even requested from the government a legislation of their activities and even were on the verge of making their own pharmacies. They even had regular advertisements in the national media claiming they can treat all types of serious diseases and gained many believers among the general public!!
Inadequate allocated national budget: It is no secret that the budget allocated for health is about 1% of the national budget!!!!!! Of course Sudan being torn with conflicts and wars, the government allocated more funds to meet the needs and expenses of those conflicts. So what can the Ministry of Health do with such a small allocated budget? While affecting the National Strategic Planning for Health Services and Care, this also affected the mapping and distribution of health services; and since adequate funds were not available, there was inadequacy and failure to execute those plans e.g. the return back of Malaria as a disease in Sudan, after it was almost completely eliminated following the withdrawal of Global Fund from financing malaria and TB programs.
The sanctions put by the USA on Sudan and its impact on the economic status of the country: It also led to a severe shortage in meeting the demands of pharmaceutical companies importing medical drugs as the Central Bank could not secure enough currency for them to be able to import adequate amounts of drugs. This resulted in a big crisis and shortage of life-saving drugs.
Alleviation of the financial support of medical drugs given by the Ministry of Health: this directly impacted the medicines related to chronic diseases such as renal failure, diabetes, and psychiatric diseases. Those who could not afford the purchase of their chronic regular medications had to stop taking them or to become irregular in taking those medications or to decrease their doses against and without medical advice or to seek alternative medicine drugs like honey, garlic etc.!!!!
Political Factors: The economic status and the continuous drop in the value of the Sudanese Pound against the US Dollar impacted negatively the public and, with the added shortage in life-saving drugs and the increased fees of medical care, people started to aggregate in protests against the previous regime. Finally they ended it in April 2019 and currently the new government is trying its best with the support of the International Community to recover and support improvements in all fields.

As for the Rural Areas I will not go into much details as they are very obvious and known: so poverty, lack of qualified Human Resources and medical centers, marginalization, centralization of medical care at Khartoum level only and the main cities, influence of traditional healers, lack of education and ignorance, lack of adequate and appropriate means of transportation, lack of electricity and other essential services etc.

CONCLUSION

If we look at all the above mentioned factors we find that they are all having a common denominator which is that they resulted from more than 30 years of being under Sanctions a country put on hold for that long and this impacted its economy, led to brain-drain and progressive continuous decline in all aspects of life not just Access to Health.

So how can we innovate?

Well first we should include everybody in the brain-storming and in the discussion, we as Sudanese we should focus on altering and shifting Sudan from being a poor country to a strong and better place.

Solutions and innovative ideas related to access to health in Sudan should be unique to us, adapted to our perspective and identity in order to be achievable and successful. It should include the reality of our ethnicity being both African and Arab, it should evolve knowing that Sudan with its different regions and states and many local languages resembles a continent with many different countries so what we can execute in one country might not be the ideal or suitable solution for the other country.

We should also include the opinions of the local staff and people and approach this issue from their perspective and adapt our innovative ideas accordingly especially as we still have some gender issues and Taboos as well as we still in some regions suffer from the harmful traditional practices.

Another aspect of access to health is the umbrella of the National Health Insurance which has under it all the employees but does not include those who have no jobs except some special categories. So, how can we include those deprived from it to ensure that access to health is for all?

Finally, Access to Health is a very broad topic and unique to each country in its execution and perspective as well as in approach. Innovative suggestions will be dependent on the local understanding and approach to the topic and without the participation of the local people nothing would be accomplished. Any innovation from abroad needs to be adapted to the local culture and has to include in it the political and economic as well as the understanding of the context for it to be realistic and acceptable by the targeted community.