ABSTRACT
An analysis of Sudan's health system revealed a lack of sound leadership for village-level providers. The district-based peripheral health system was failing to meet an increased demand for leadership and management support. Some of the principal factors explaining this state of affairs were population growth, increased numbers of health units, long distances and transport difficulties. With a view to solving these problems, the country was divided into smaller health areas around rural hospitals and similar physician-led facilities. A decentralized system based on the principles of primary care was established in these areas under health area management teams. Setbacks encountered in giving effect to the policy have led to proposals for a new implementation strategy.
PIP: Despite Sudan's commitment to primary health care, considerable health system weaknesses still existed in the late 1980s. For example, the health system was still operating under the organizational structure established by the former colonists and most of the allocated funds supported hospitals and salaries. The communities did not participate in primary health care activities and instead depended on official and outside funding. Lack of leadership and management support for health workers in the villages were perhaps the leading factors explaining the weaknesses. Its district-based system collapsed in the late 1970s due to population growth, transport problems in these large districts, creation of urban and rural councils to conduct administrative and decision making functions, separation of preventive and curative services (preventive services under local governments and curative services under the Ministry of Health [MOH]), decline in the national economy and in political commitment to health, increased numbers of physician specialists, and reduced numbers of physicians willing to go to rural areas. The MOH joined with Gezira University in Wad Medani, Sudan to develop a new health care policy. The National Council for Health adopted the new policy in December 1987. It decentralized the health system into 175 health areas around rural hospitals or health centers. Each area had a health area management team. The new policy was based on primary health care, community participation, and sound managerial processes. Since there was no clear national implementation plan, the regional health authorities tried to implement the new policy. Few regions did so successfully. Thus Sudan suggested that each region first implement the policy in 2-3 areas. Health workers would learn some lessons from this phase which they can apply to expand the system.
