Could a new law revolutionize Sudan’s health care system? Mar 22, 2016

Could a new law revolutionize Sudan’s health care system?

Located in Northeast Africa, Sudan has a population of 37 million people and a life expectancy at birth of 60 years for males and 64 years for females. The country continues to tackle critical health challenges, including inadequate access to health in rural and peri-urban communities.

With the passage of a new amendment in 2003, universal health coverage (UHC) became a priority area for Sudan, an associate member of the Network.

Earlier this year, in an effort to move closer to achieving UHC, the Sudanese government passed a new law that requires that every Sudanese person have access to health care services without facing financial risk.

In this interview, we speak with Mohammed Yusuf Ahmed, the Director-General of Planning and Research at the National Health Insurance Fund to learn more about the new law and its anticipated impact on Sudan’s health sector landscape.

JLN: What jump started Sudan’s interest in achieving universal coverage?

MYA: The National Health Insurance Fund (NHIF) started in 1995. At that time, the first law mandated for civil servants to be enrolled in health insurance. Then in 2003, a new amendment was passed, which put UHC as a priority issue in Sudan. However, the amendment did not make health coverage compulsory and as a result, many Sudanese are still uncovered. In addition, we have other limitations and constraints that have made it difficult to move quickly towards UHC

In January 2014, we participated in an international conference for UHC [co-hosted by the WHO-Sudan, NHIF Sudan, the European Union, among others] where we started to draw a map for Sudan to explore the central question—what steps should Sudan take to achieve UHC? Fortunately, that conference drew the attention of the government. There is now more political commitment from the government to pass legislation towards expanding health coverage.

JLN: What do you think are some of the strengths and weaknesses of Sudan’s National Hospital Insurance Fund?

MYA: I think there are several strengths of the NHIF. For example, there is a great deal of political will. Since 2014, the government has been very committed to cover the poor populations. Today, more than 1.6 million poor families (65% of the total population of low-income families) are covered by health insurance. Additionally, people can get health services no matter where they are in Sudan because health insurance cards are accessible through mobile phones and we have roaming agreements with some international mobile phone companies. Therefore, service provision is not constrained by limited internet connectivity. Another strength is our equitable benefits packages to all subscribers.

One weakness is NHIF’s own health facilities. At these facilities, we have noticed challenges with allocating tasks equitably and efficiently amongst our workers. Going forward, the NHIF hopes to turn over the operation of all facilities to the Ministry of Health. Another challenge is that the dominant payment mechanism is fee-for-service, which means all the risk is on the NHIF’s shoulders. We would like to move to other types of payment, such as capitation to share risk more evenly between the NHIF, providers and subscribers.

JLN:  What was involved in passing the new law?

MYA: Since South Sudan’s secession, Sudan has faced a great deal of economic challenges as a result of sanctions. As an aftermath of South Sudan’s secession, the Sudanese government passed a wave of reforms, including health reforms, to protect the Sudanese people from catastrophic health shocks and expenditures.

The law was initially proposed by the NHIF. Then it was accepted by the Federal Ministry of Health, the Zakat Chamber, and members of the private sector. We had extensive discussions of the law over the past year. Finally, we took the proposed law and presented it in front of the Federal Ministry of Justice, which approved the passage of the law. 

The new law mandates that every Sudanese person should have health insurance or access to health care services without facing financial risk. Specifically, the new law will ensure that every institution, company, factory, or organization should enroll their employees in health insurance, and all universities should provide coverage to their students.

We believe the new law will provide efficient provision of services and resources.

JLN: Now that law has been passed, how will the law be implemented?

MYA: There is still much left to be done. We need to do more research around the costing of health services to offer affordable prices to our beneficiaries. We’re also thinking about new forms of payment, instead of fee-for-service—with capitation as one alternative payment method.

Through this law, we are collaborating with the FMOH to decide what specific services will be included in health coverage. Another goal of the law is making sure that all private employers provide health coverage to their employees, so we also plan to have conversations with these employers over the next few weeks.

JLN: What types of services will be covered under the new law?

MYA: We have a large benefits packages, which include services provided free at the facility level; doctor and dentist visits; diagnostics services, including laboratories, x-rays, Ultrasound, Dopplar, ECG, EEG, CT-Scan, MRI and endoscopy; hospital in-patient admission, surgery (general surgery, urology, orthopedics, cesarean section); and antenatal care and delivery.

Many other services can be provided with a 25 percent co-payment (we have a list detailing all of these services, including renal failure). Services excluded from NHIF coverage include: Plastic surgery; Teeth rooting; Open heart surgery; Chemotherapy; and Implants and transplantation.

JLN: Why did Sudan decide to join the JLN?

MYA: We discovered the JLN through a health financing course that was arranged by the WHO. We then decided to apply for membership to share knowledge and experiences with other countries who have had similar experiences and challenges.

One thing we want to know is – How can we develop a good Monitoring and Evaluation system to monitor the impact of these new interventions? We would like to know if other JLN members have suggestions from their previous experiences. Also, how have countries used Information Technology to improve their health systems? We want to know if Sudan should adopt any ICT processes towards achieving UHC.

So far, we have received great knowledge through the discussions posted on the JLN Member Portal. We look forward to more interactions with members through participation in in-person workshops and events.

We want to engage, specifically, with Ghana as its experiences have a lot to offer Sudan. We also hope the JLN can organize training courses on financial management (i.e. risk management) and provider payment mechanisms.