‫ﺑﺴﻢ اﷲ اﻟﺮﺣﻤﻦ اﻟﺮﺣﻴﻢ‬

Sudan
Government of
National Unity

Federal Ministry of
Health

National Health
Policy, 2007

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TABLE OF CONTENTS:
FOREWORD BY H.E. THE MINISTER OF HEALTH ............................................................. 3

1. INTRODUCTION ................................................................................................. 4

2. THE NATIONAL HEALTH POLICY ................................................................ 4

3. VISION .................................................................................................................... 5

4. MISSION STATEMENT ..................................................................................... 5

5. GUIDING PRINCIPLES ..................................................................................... 5

6. VALUES OF THE NATIONAL HEALTH POLICY ....................................... 6

6.1 Social determinants of health ...................................................... 6

6.2 Gender mainstreaming and equal opportunities ................... 6

6.3 Quality of health care and clinical governance ...................... 7

6.4 Partnership and collaboration for health .................................. 7

6.5 Consumer satisfaction and patients’ rights .............................. 8

7. POLICY IMPLEMENTATION AND MONITORING .................................... 8

7.1 Policy implementation .................................................................... 8

7.2 Monitoring and evaluation ............................................................ 8

8. THE POLICY STATEMENTS ........................................................................... 9

8.1 Structural issues .............................................................................. 9

8.2 Health care delivery .....................................................................15

ACKNOWLEDGMENTS ................................................................................................................18

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FOREWORD BY H.E. THE MINISTER OF HEALTH
As Sudan enters a new era of national reconciliation,
stability and long-awaited peace, the most significant
post-conflict peace dividend is the process of
sustainable development that the country is now
embarking upon to ensure that Sudan will become a
better country for all its citizens.
The health system in Sudan faces many complex
challenges, ranging from the high burden of
communicable and noncommunicable diseases to economic constraints,
poverty and regional disparities. Climatic factors resulting in natural disasters,
such as floods and drought, pose further challenges to the system. To combat
these challenges, the Government of Sudan is committed to exerting
maximum efforts to rehabilitate and develop the health sector, as reform of the
health sector has been identified as one of the main long-term priorities on the
national agenda for post-conflict recovery.
The historic signing of the Comprehensive Peace Agreement (CPA) and the
establishment of the Government of National Unity have paved the way for all
partners to work together in a coherent strategy toward a more equitable and
effective health care system which is responsive to the needs and
expectations of the Sudanese people. It is also anticipated that recent
economic growth will have a positive impact on health and development
nationwide.
In order to structure and make our efforts coherent and comprehensive, I have
the pleasure of introducing a National Health Policy for the country which
outlines the key strategic directions for the development of the health sector.
With the introduction of this instrument, it is expected that all health-related
programmes and initiatives will be consistent with the guiding principles
outlined in this policy paper. In addition, the local and international initiatives
to which Sudan is signatory, are valid, including the Convention on the Rights
of the Child (1990), the Millennium Summit Declaration and Millennium
Development Goals (MDGs), and the development of the primary health care
approach.
On behalf of the Government of Sudan, I would like to thank all those who
participated in the development of this policy paper. I, also, on behalf of the
Federal Ministry of Health, wish to express our commitment to proactively
facilitating all the necessary steps and actions and coordinating with national
and international partners and stakeholders to move forward in a spirit of
openness, ownership and national unity, to make this policy a reality for one
Sudan, one people and one future.
Dr Tabita Shokai, PhD
Federal Minister of Health
Sudan

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1. INTRODUCTION

The interim Constitution of Sudan ensures the promotion of public health and
guarantees equal access and free primary health care to all its citizens. With
this spirit hereby, the National Health Policy is promulgated.
The National Health Policy has been developed following a vision and with a
mission to accomplish. The constituent tenets draw from and build on existing
policies to develop a Sudanese health system based on a comprehensive
primary health care approach, including referral support. The proposed
interventions fall into two categories: structural issues and health care delivery
issues.
The policy statements are underpinned by overarching principles and values
while the need to define the implementation arrangements and document the
achievements of the National Health Policy is highlighted. It is emphasized
that policy directions should not be treated as vertical programmes, but rather
should be developed in an integrated manner for a sustainable, effective
march towards a healthy nation.
While, in developing this document in partnership with stakeholders, an
explicit effort was made to address the main health issues, it cannot be
exhaustive. This document is in the public domain, however, and comments
are welcome, and may be directed to the Health Policy Unit, Directorate
General, Health Planning and Development, Federal Ministry of Health. The
constituent tenets of the policy will be constantly reviewed and evaluated with
regard to maintaining, replacing or terminating them.

2. THE NATIONAL HEALTH POLICY

The National Health Policy has been formulated within the context of a
comprehensive peace agreement which puts an end to the many years of
conflict that have disrupted the country’s social service institutions, including
its health institutions and services. The policy also recognizes the
opportunities created as a result of economic growth in the country.
This policy is framed within the remits of the relevant provisions of the interim
Constitution of Sudan, 2005, the Local Government Act, 2003, and the
resolute state laws and decrees which have introduced and institutionalized
decentralized federalism in the country.
Furthermore, this policy draws from and builds on the 25-year health strategy
and existing policies relating to reproductive health, child health, HIV/AIDS,
the national drugs policy, the essential primary health care package and the
10-year human resources strategy. It also reiterates national and international
commitments, such as the Alma-Ata Declaration and the Health-for-All
Strategy, the Millennium Summit Declaration and other global strategies, such
as Roll Back Malaria (RBM), Stop TB and the Global Strategy for the

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Prevention and Control of Sexually Transmitted Infections, including
HIV/AIDS.

3. VISION

The National Health Policy envisages the building of a healthy nation, thereby
contributing to the achievement of the targets of the Millennium Development
Goals (MDGs) and the overall social and economic development of the
country.

4. MISSION STATEMENT

The mission of the National Health Policy is to ensure the provision of health
care to all citizens of Sudan, with emphasis on the health needs of the poor
and the underserved, disadvantaged and vulnerable in order that they are
able to lead socially and economically productive lives.

5. GUIDING PRINCIPLES

The National Health Policy is committed to: achieving equity and poverty
reduction; ensuring investment in health; reaching the targets of the MDGs;
maintaining and securing human rights and dignity; preserving the rights of
women and children; and fighting disease and ignorance.
Within the remits of the provisions of the Constitution and national and
international commitments, the following guiding principles form the
framework of the policy:
• Health, being central to the process of human development, is a social
right of all citizens of Sudan, irrespective of their regional, religious,
racial, cultural or ethnic affiliation.
• Health will be used to enhance peace-building and rehabilitation and to
encourage economic development. Support will be given in ways that
facilitate a return to a normal situation and promote sustainable
development.
• The health system will be reformed to ensure the strengthening of the
local and national health system based on the principles of primary
health care. The planning for this reform will be based on solid policies,
scientific evidence and a critical analysis of the situation.
• Capacity in local health management, planning and policy will be built at
all levels of governance, including federal, state and local levels. This is
to create an enabling environment for decentralized units within the
health system.
• An equitable and sustainable health care delivery system, especially for
the poor, disadvantaged and vulnerable, including those in underserved
and conflict-affected areas, will be ensured.

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6. VALUES OF THE NATIONAL HEALTH POLICY

The National Health Policy envisages building the health system on a

comprehensive concept of health which ensures equity, quality and
accountability and which promotes professionalism. The aim is that the health
system satisfies both the needs of users and providers, and is based on the
principles of citizenship, pluralism, solidarity and universality.
In order to achieve this aim, while designing strategies and operational plans,
particular emphasis will be given to the following cross-cutting issues.

6.1 Social determinants of health

Health, as a multifaceted issue, requires the involvement of many other

sectors and institutions to play a critical role in the provision, promotion and
maintenance of health. This concept is enshrined in the Alma-Ata Declaration
of 1978 for comprehensive primary health care. Intersectoral collaboration has
received renewed commitment as a result of the emphasis on social
determinants of health in the Ottawa Charter for Health Promotion, 1986, and
subsequent WHO global conferences, which have provided guidance and
directions on the actions to be taken in order to achieve the target of health for
all.
Also, the Bangkok Charter for Health Promotion in a globalized world in 2005,
confirmed the need to focus on the use of health promotion to address the
social determinants of health and to identify required actions. The focus in this
exercise has to be on communities and civil society.
The FMoH will, therefore, advocate and ensure allocation of adequate
resources for health and establish and sustain institutions for social security.
Furthermore, the FMoH, working through appropriate authorities in
Government, will advocate and ensure, for example by becoming members of
appropriate bodies, that the policies of other sectors are health-friendly.
Emphasis, in this regard, will be on healthy residential conditions,
occupational environment, social support and the promotion of health.

6.2 Gender mainstreaming and equal opportunities

Sudan, as a multi-ethnic, multi-cultural country encompassing hundreds of

ethnic and tribal divisions and languages, has since its independence faced
conflicts that have had implications for the country’s social service institutions,
including health.
National health policies should, therefore, create appropriate conditions and
institutions for people irrespective of gender or their regional, religious, racial,
cultural or ethnic affiliation in order that they are provided with the opportunity
and ability to make decisions about their health and lives. This could be
achieved through the creation of mechanisms whereby these groups become

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involved in the institutions assigned to undertake policy analysis at various
levels and due consideration is given to their input.
The FMoH will ensure provision of gender-friendly health care at all levels of
health care delivery and will also consider gender analysis as an element in
the development of strategic and operational plans at all levels of government.

6.3 Quality of health care and clinical governance

Good quality health care is a prerequisite for the utilization of health care
services by consumers. The FMoH, in collaboration with the SMoH, will
develop national standards for all levels of care—primary, secondary and
tertiary—and for specialized medical, surgical, paramedical, nursing care, etc.
Standard operating procedures, clinical practice guidelines and protocols,
including for health management, will be developed. The FMoH, in
collaboration with the SMoH, will develop mechanisms to measure
performance against pre-established standards, and will devise measures for
selected indicators and scores to be assigned to a league table for the
reference of health care providers.
Clinical governance, as a comprehensive approach for assuring quality and
accountability, will be introduced. This initiative will assist in measuring the
quality of health care in terms of the efficiency of resource usage,
patient/client satisfaction, post-intervention risk management and professional
performance review or the assessment of technical quality.

6.4 Partnership and collaboration for health

The Government will create an environment that is conducive to partnership-

building between different levels and different actors to allow an exchange of
experience and of resources and to increase the commitment of all partners to
achieve the realization of shared goals. It is, therefore, essential to build
strong, professional partnerships with different concerned partners in health to
achieve the stated objectives.
This policy affirms building partnerships with all stakeholders, including
universities, UN agencies, nongovernmental organizations, countries and
regional and international banks and donors. Also, it encourages collaboration
and coordination with neighbouring countries in health research and health
services provision. The health sector will develop its capacity in order to be
prepared for the process of the globalization of health.
Furthermore, as the attainment of good health is dependent on the
involvement of not only the health sector but other sectors also, the policy
affirms collaboration with related sectors in promoting the provision of a safe
water supply, the promotion of a healthy environment and the prevention of all

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kinds of pollution. The policy also acknowledges the role of health in
promoting and building the peace process.

6.5 Consumer satisfaction and patients’ rights

The health system has a responsibility not only to improve people’s health,
but also to protect them against the financial cost of illness and to treat people
with dignity. Accordingly, the Government will ensure that all subsystems are
performing to achieve the overall goals and to protect the interests of
consumers in their utilization of health services from exploitation and abuse.
The Government will also mediate between the conflicting interests of different
parties.
The health system will be fair and will be responsive to consumers' needs,
providing them with credible and effective mechanisms to address their
concerns and to take an active role in improving and maintaining their health.
The FMoH will develop a Patients’ Bill of Rights that will provide, inter-alia,
information on people’s rights in relation to information disclosure; choice of
providers and treatment plans; access to emergency services; participation in
treatment decisions; respect and non-discrimination; confidentiality of health
information; complaints and appeals. Also, appropriate measures will be taken
to create a strong accreditation and registration system and to institute
mechanisms such as financing and the development of new fiscal policies.

7. POLICY IMPLEMENTATION AND MONITORING

7.1 Policy implementation

The policy, however robust, is useful only if implemented in its true spirit.
Therefore, the FMoH will create mechanisms, such as establishing a health
coordination committee/council at national level to oversee the
implementation of the policies agreed by all levels and framed under the
authority of the concurrent powers conferred through the relevant provisions
in the interim Constitution of Sudan.
Furthermore, the Government will take appropriate and adequate measures,
including conducting advocacy and harnessing political commitment to ensure
that the vision of the National Health Policy is translated into strategic and
operational plans. This will involve making available resources commensurate
to the stated targets and creating conditions conducive to the achievement of
the vision and mission.

7.2 Monitoring and evaluation

The objectives of the National Health Policy, enshrined as policy statements,

will be systematically monitored. This is particularly important for Sudan where

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states and localities or counties are responsible for the delivery of care and
services as laid out in the policy. Therefore, the FMoH will take appropriate
measures, including the provision of adequate resources to institutionalize the
monitoring of the achievements towards policy objectives.
Verifiable indicators and measurement tools are needed to monitor progress
at all levels. The FMoH, with the SMoH, will select appropriate indicators and
will install mechanisms to measure and monitor the achievement of the
objectives of the policy. Furthermore, the FMoH will draw up a consolidated
periodic health report for all levels of care which outlines developments in
public health.
The aforementioned report will also serve as a document for reporting and
reviewing the achievements in order to assist in a decision regarding whether
any policy should be maintained, replaced or terminated. There may also be
other evidence for assessing the outcome of a particular policy. A health policy
unit in the FMoH will be the focal point coordinating the activities for the
formulation, implementation, monitoring and evaluation of policies.

8. THE POLICY STATEMENTS

In order to realize the vision and mission of the National Health Policy, guided
by the principles as specified, policy statements are hereby set forth for the
priority areas and are divided into the two subsets of structural issues and
health care delivery issues. Each area will be subject to separate and
extensive documentation and greater operational details in the form of 5-year
strategic and 1-year operational plans.
Furthermore, it is imperative that these areas are not emphasized or treated
as vertical programmes, but are developed in an integrated manner as part of
the comprehensive system of health services in order to achieve the vision
and mission of the National Health Policy.

8.1 Structural issues

Policy statements on structural issues will essentially require action at the

systemic level but may also overlap with statements concerning issues related
to health care delivery, and vice versa.

8.1.1 Governance and stakeholder involvement

The Government will endeavour to develop and strengthen a national health
system within the framework of the interim Constitution, and for the assurance
of good governance, the involvement of all stakeholders, and particularly
communities, is an important parameter. All elements of the organization of
the health system should act transparently and innovatively, ensuring
adherence to values and ethics and promoting gender mainstreaming and
teamwork in the discharge of their functions.

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For this purpose, at all levels of the health system, health councils with
adequate representation of all partners will be constituted to oversee the
development of health policies and strategies, essentially based on scientific
evidence and critical analysis of situations, and will monitor their
implementation.
Federal level will be responsible for: the formulation of national policies, plans
and strategies; national quality standards; health information and surveillance
systems; mitigation of major or interstate disasters and epidemics; medicines
policy and regulations; in addition to overall monitoring and evaluation,
coordination, supervision, training and external relations.
At federal level, the FMoH will be the sole government body responsible for
establishing the National Health Policy in consultation with all related bodies.
Public sector institutions involved in providing health care, including
universities, military and police health services and the National Health
Insurance Fund will comply with the provisions of the National Health Policy.
States and regions will be responsible for the formulation of local policies,
plans and strategies, according to federal guidelines. They are also
responsible for the funding and implementation of plans. The locality or county
is mainly concerned with the implementation of national/state policies and
service delivery, based on the primary health care approach.

8.1.2 Organization and management of health system

The Government will continue to strengthen the devolved, decentralized
health system, especially at local/district/municipal levels. At the heart of this
policy statement is the assurance that everyone in need will have access to
good quality health care. This objective will be achieved through the
establishment and institutionalization of a sustainable local or district health
system.
The FMoH, for this purpose, will steer and lead the reform process and
reorganize the existing health care delivery network based on: the priority of
preventive care over curative care; a desire to serve underserved and conflict-
affected areas; consideration of the treatment of common childhood diseases
and emergency obsetric/gynaecological care; concern for remote and rural
areas or urban areas; an emphasis on outpatient over inpatient services; and
decentralization of health services with the aim of making the regional and
local health services self-sufficient and responsible for a given population.

8.1.3 Health care financing

Currently, only a small proportion of the Sudanese population are covered by
health insurance schemes. The FMoH and the SMoH will advocate for a
revision of the current situation and will identify factors creating barriers to
access and will evaluate the possibilities for the expansion of coverage.

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However, as in the foreseeable future, health financing will continue through
public revenue, the Government will continue to fulfil its commitments made in
2006 at the Abuja Conference, Nigeria, “Financing for Development: The
Abuja Commitment to Action”, to raise domestic public expenditure on the
health sector to 15% of the total government expenditure.
Furthermore, the FMoH will institutionalize national health accounts in order to
document the flow of funds in the health sector. Also, the FMoH and the
SMoH will take adequate measures to build the capacity of its staff in health
economics and to improve the functions of health financing in the health
system.

8.1.4 Private sector in health

The private sector, including both the profit and non-profit sectors, plays a
major role in the provision of health services; and it will be encouraged to
continue to do so, albeit within defined boundaries. The FMoH, in
collaboration with the SMoH, will take appropriate measures to institute
mechanisms for the regulation of health services delivery, both in the public
and private sector, inter-alia, through the monitoring of minimum standards of
care. One important intervention would be to strengthen the health information
system in order to include the private sector and make it responsible for
reporting within defined parameters.
The primary role of the public sector in service delivery is to provide primary
and secondary health care services. The public sector will engage in the
provision of tertiary care services for the purposes of educational training,
protecting the poor, price moderation and filling gaps in service provision. The
private sector will be encouraged to become involved in the provision of
health services, although it will be required to observe certain standards, such
as employing full-time staff.
For underserved and conflict-affected areas, as a short-term measure, the
private sector, particularly the non-profit sector, will be contracted to provide a
defined package of health services. However, in parallel, the FMoH and the
SMoH, will ensure that work on system development, financing and the
building of capacity within the public sector is undertaken. The intervention
will, inter-alia, include defining standard operating procedures and clinical
practice guidelines.
Traditional healing, as an established practice, has relatively widespread
accessibility and acceptability; consumers have the right to choose it as an
option for health care. However, measures will be taken to ensure its
regulation, to eliminate harmful practices and to promote dialogue and mutual
education between the practitioners of traditional and allopathic systems.

8.1.5 Human resources for health

The primary concern in terms of human resources for health is to match the
needs of the country’s health system as it is being rehabilitated, reconstructed

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and reformed. The declaration of the Government to upgrade nursing and
allied health personnel training to post-secondary diplomas and Masters
programmes will continue to be pursued by authorities at relevant levels to
match these needs.
The same is true for the 10-year strategic plan for human resources which
aims to increase the availability of human resources for health to meet health
needs, revitalize primary health care and reduce inequity in the distribution
and imbalance of the composition of health teams. This policy calls for the
institutionalization of a coordinating mechanism between partners involved in
human resources for health to satisfy the needs of the country and with the
FMoH/SMoH as a major employer. In this regard, while a system for the
accreditation and standardization of medical and paramedical training will be
institutionalized in collaboration with health academies in states, the role of
community health workers and family doctors will be considered in health care
reform in Sudan.
Furthermore, as the capacity of the existing workforce in health is weak,
particularly in health planning and management, and given the increasing
demand as a result of federalism, decentralization and the ongoing efforts of
reviving and improving the health system, continuing in-service training
programmes will be instituted at all levels of government. Also, as a result of
the lack of attention paid to the existence of conflicting curricula for different
disciplines, the FMoH will work with the appropriate authorities to update
curricula and incorporate new developments to ensure that curricula is
community-orientated, promotes professional values and ethics and
emphasizes continuous professional and leadership development.

8.1.6 Health statistics and the information system

A typical well-functioning health information system ideally comprises of data
on: disease surveillance; household surveys; registration of vital events;
patient and service records; and programme-specific monitoring and
evaluation. In Sudan, due to the absence of a robust health information
system, surveys are only conducted periodically. These are often purpose-
specific and are rarely comprehensive.
As statistics play an important role in measuring and monitoring the progress
of a country on the road to development, including its achievement toward
reaching the targets of the MDGs, the National Health Policy envisages
designing and implementing a comprehensive health information system;
revamping the existing disease surveillance system; conducting household
surveys; performing registration of vital events; maintaining patient and
service records; and conducting programme-specific monitoring and
evaluation. Such a tool, which will also bring the private sector into the
system, will promote evidence-based decision-making and enhance the
capacity of managers to effectively analyse and utilize statistics.

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This policy requires government at all levels, as part of the health information
system, to arrange the compilation and evaluation of data for publication at
regular intervals, making such information useful not only for managers,
planners and policy-makers, but also for researchers, academics, students
and institutions. The training of relevant staff for capacity building in the
monitoring and evaluation functions of all three levels of government will also
be ensured.

8.17 National medicines policy

The National Health Policy upholds the current medicines policy and essential
medicines list for different levels of care as a way to ensure that all people are
treated with the necessary medicines and biologicals, including vaccines for
protection and cure from diseases. But, it emphasizes the promotion of
rational prescription, employing an increased use of therapeutic protocols and
clinical practice guidelines and ensuring the avoidance of self-medication.
The Government will enact legislation, regulations and institutional measures
for the effective management and control of the manufacture, importation,
handling and pricing of medicines and biologicals and will assure the safety,
efficacy and quality of medicines and cosmetics.
The Government will promote the appropriate use of herbal medicines and
promulgate regulations for their registration and therapeutic use. It will
encourage research to explore and make use of the wide range of medicinal
plants of therapeutic value in the country.
This policy emphasizes rigorous evaluation based on the best evidence of
their safety, efficacy, effectiveness, ethics, impact on the quality of life and
cost–effectiveness and aims to inform policy-making before introducing new
drugs or biotechnology into health care. Accordingly, the FMoH will work to
introduce a system of health technology assessment and management.

8.1.8 Health technology assessment

Health technology encompasses a wide array of materials, appliances,
procedures and associated knowledge used in health care. While assessing
the suitability of a technology, decisions by the concerned authorities for its
introduction should provide satisfactory answers to the following questions:
Which patients will benefit the most? What is the balance between benefit and
harm? What value for money do the technologies offer? How affordable are
these technologies? Is it appropriate for these technologies to be provided by
a particular health system?
The FMoH, in coordination with the SMoH, will institutionalize health
technology assessment to ensure appropriate technologies are introduced
into the country’s health system. Also, measures will be taken to ensure
effective health technology management, including the establishment of
courses in biomedical technology.

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8.1.9 Disaster preparedness and humanitarian action
Sudan has just emerged from a protracted period of conflict that has brought
disaster on its people, directly and indirectly. While some areas have
witnessed war, others have suffered from the strain of hosting displaced
populations, and yet others have been affected as a result of the diversion of
resources meant for development. In addition, the country is prone to natural
disasters, such as floods and droughts, and as a result of its geopolitical
location, shares borders with nine other countries. It is also exposed to the
outcomes of strife in neighbouring countries.
While currently a host of international organizations are working in Sudan to
provide humanitarian assistance, the National Health Policy envisages
building on the existing structure, strengthening the internal capacity of the
country’s health system and enabling it to respond to any emergency situation
or situation which threatens the health of its people. This intervention will be
made at federal, state, local and facility level to institutionalize emergency and
humanitarian action for health as a regular programme for disaster-risk
management issues, including preparedness, response, mitigation and
recovery.

8.1.10 Health systems and biomedical research

The National Health Research Council (NHRC) is the sole body responsible
for setting the national policy and guidelines concerning health research. It
has two arms comprising ethical and technical committees which are
responsible for approving health research involving international collaborators
or biomedical research involving human subjects. The SMoH and health
research institutes in Sudan will be encouraged to form their own ethical and
technical committees under the direct supervision of the respective
subcommittee of the NHRC.
The National Health Policy, while endorsing these policies, emphasizes the
use of health systems and the results of policy research to inform decision-
making; policies grounded in research have a greater chance of improving
health and ensuring effective utilization of resources. In this regard, while it is
important to maintain a balance between applied, basic and clinical research,
the FMoH and the SMoH will update national and regional health research
priorities and will make available the funds required for research.
In an era of globalization, the FMoH will endeavour to acquire new research
tools and cutting-edge technologies in public health which are deemed as
critical and essential to meet the expectations of consumers and the demands
of an increasingly competitive market. Particular emphasis in this regard will
be paid to harnessing the opportunity for conducting research during the
current rehabilitation and reform of the health system in order to document the
process and learn lessons from the experience.

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8.2 Health care delivery

Health care delivery is an important component of the health system and the
National Health Policy envisages a number of statements with the overall
objective of ensuring the provision of health services which are accessible,
affordable, appropriate, efficient and effective.

8.2.1 Health care package

The interim Constitution of Sudan states that the “State shall promote public
health, establish, rehabilitate and develop basic medical and diagnostic
institutions and provide free primary health care and emergency services for
all citizens”. One inference from this Article is that while the State is obliged to
provide free primary health care and emergency services for all citizens, the
private sector also has a role, with the Government creating and instituting
mechanisms for its effective regulation.
The content of the primary health care package includes as a minimum: the
promotion of child health (immunization against vaccine-preventable
diseases, nutrition counselling and growth-monitoring and implementation of
the Integrated Management of Childhood Illness package); the promotion of
school health; the promotion of reproductive health (safe motherhood,
including safe pregnancy and family planning); the control of endemic
diseases (malaria, tuberculosis, HIV/AIDS, schistosomiasis, etc); the
protection and promotion of environmental health and sanitation; and
treatment of simple diseases and injuries and mental health.
In addition, the FMoH with the SMoH, will design and develop health
packages for secondary and different specialized services through the use of
health technology assessment. This exercise may also involve the
development of standard operating procedures and clinical practice
guidelines.

8.2.2 Health care infrastructure

The protracted period of conflict has disrupted the health system, including
much of the health infrastructure which has either been destroyed or is in
need of maintenance and repair. Results from a recently concluded health
system study indicate that many health facilities are not functional as a result
of the use of dilapidated buildings and a lack of necessary equipment. This
situation extends also to various programmes.
The interim Constitution requires the establishment of relevant levels of
government, the promotion of public health and the establishment,
rehabilitation and development of basic medical and diagnostic institutions.
The National Health Policy, therefore, calls for rebuilding/repairing and
refurbishing the health infrastructure, including the provision of necessary
equipment. While this intervention should start at the level of hospitals and

15
health centres, for lower level primary health care facilities, it will be based on
the following standards for health facilities.
• The basic health unit, headed by a medical assistant, will be the smallest
health facility to deliver primary health care. Dressing stations staffed by a
nurse, and primary health care units staffed by community health workers,
will be replaced gradually with basic health units. The training of
community health workers and village midwives will continue on a limited
scale to meet the needs of nomadic groups and other similar communities.
• Rural health centres and urban health centres (headed by a doctor) are
the first level of contact or the first referral level for the basic health units in
rural and urban localities respectively. The rural health centre will serve
20 000 people in rural areas, and urban health centres will serve up to
50 000 people in urban areas.
• The rural hospital is the referral level for lower level health facilities and
serves 100 000–250 000 people in the locality. A walking distance of a
maximum of 5 km has to be considered while assessing coverage of
health facilities, particularly in rural and underserved areas.

8.2.3 Occupational and environmental health

The National Health Policy envisages strengthening environmental health
services of which occupational health is a component. The FMoH, in
collaboration with the SMoH, will identify potential risks to human health. In
order to avert or mitigate these risks, which are mostly beyond the domain of
the ministries of health, an interdisciplinary committee on environmental
health will be established at all levels of government to define comprehensive
measures to protect and promote a healthy environment, including health at
the workplace.
The policy advocates for the coverage of all workers, including those working
in the informal sector, in small and medium-sized enterprises and in
agriculture by essential interventions and the prevention of basic occupational
health services for primary prevention of occupational and work-related
diseases and injuries. Accordingly, it urges health authorities at all levels to
take measures to establish and strengthen core institutional capacities and
human resource capabilities to deal with the special health needs of working
populations.

8.2.4 Child welfare and survival

Child health will be addressed through a well-coordinated and integrated
evidence-based basic primary health care package both at facility level and
community level, including routine immunization, the promotion of
breastfeeding, the provision of vitamin A supplements, newborn care, and the
prevention and treatment of potentially fatal childhood diseases, such as
diarrhoea, malaria and pneumonia. Delivery of the package will be the
responsibility of the Government, health professionals, civil society,

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communities and families. Attention will be given to emergency areas and
psychological and supportive services for children with special needs.
The Government will enhance the development of laws and/or legislation that
protect and promote the rights of the child and their welfare. The Government
is committed to removing barriers to access and to providing health care
services free-of-charge to children, particularly to children under 5. Neonatal
mortality is also a significant problem. Evidence-based interventions
integrated with maternal and child health programmes are an important step
towards improving neonatal survival and health.

8.2.5 Reproductive and maternal health

Reproductive and maternal health, as a vital social and economic investment,
is an important component of the National Health Policy. It envisages
addressing reproductive health issues across the life-cycle with priority to safe
motherhood, ensuring women’s right to survive pregnancy and childbirth and
to enjoy family life.
Accordingly, the Ministries of Health at all levels of Government will ensure
provision in health facilities, whether in the public or private sector,
reproductive health services, including antenatal care, intrapartum care,
routine and emergency obstetric and postpartum care, counselling and
provision of modern family planning services.

8.2.6 Control of communicable diseases

Communicable diseases constitute a major cause of morbidity and mortality in
Sudan. While the National Health Policy endorses the hitherto policies,
including international regulation promulgated for a variety of communicable
diseases, it emphasizes formulation and adoption of an integrated approach,
particularly the setting up of a comprehensive surveillance system for the
early detection and containment of epidemics and disasters.
The Government will take appropriate measures to eradicate polio myelitis
and dracunculiasis, eliminate measles, neonatal tetanus, lymphatic filariasis
and leprosy and control diphtheria, pertussis, congenital rubella and hepatitis
B. This policy affirms the Government’s commitment to achieving the target of
MDG 6 in relation to the control of malaria, tuberculosis, HIV/AIDS,
leishmaniasis, schistosomiasis, sleeping sickness, onchocerciasis and other
communicable diseases.
This policy also demonstrates the Government’s resolve in the enforcement
and fulfilment of the country's commitment towards implementation of
international health regulations for transborder control of communicable
diseases.

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8.2.7 Noncommunicable diseases
A well-integrated and community-based approach will be adopted to control
noncommunicable diseases through addressing common and preventable
biological and behavioural risk factors. Health education, advocacy,
surveillance of risk factors, research and control of advertising are essential
elements of the control strategy.
This policy emphasizes the promotion of healthy lifestyles for all citizens of
Sudan including advocating healthy diets, promoting personal hygiene and
enhanced physical activity, oral health, injury prevention and avoiding
alcoholic drinks, narcotics and tobacco use. Also, this policy prohibits the
media from advertising unhealthy habits and practices.

8.2.8 Mental health

The people of Sudan have been through a painful period of conflict and
resultant suffering which has left not only physical scars but also mental scars.
Such a situation calls on governments, both at federal and state level to take
adequate and appropriate measures to ensure that mental health services are
integrated into the health package.
In Sudan, spiritual healing is an established practice and while consumers
have the right to choose, the Government will take measures to eliminate
harmful practices. In this regard, a mental health institute will be designated to
guide and promote dialogue with practitioners of spiritual healing.

ACKNOWLEDGMENTS
The road to developing the National Health Policy has been long, and at
times, difficult. The process began in 2001 and has passed through many
phases, essentially iterative, of assessing the situation, reviewing a host of
background documents, and at times, collecting empirical data. The Federal
Ministry of Health would like to take the opportunity of acknowledging the
direct and indirect contribution of the authors of these documents. Also, the
full benefit of international experience was taken and corroborative evidence
was used in the development of this policy document.
The General Directorate of Health Planning and Development took the lead in
drafting this document, supported by a drafting committee (Annex 1)
comprised of national consultants, representatives of UN agencies (WHO and
UNICEF), representatives of the General Directorates in the Federal Ministry
of Health and many other individuals who assisted in the work to accomplish
this daunting task.
Gratitude and thanks are extended to Professor Elsheikh Mahgoub for his
support and guidance as Chairperson and to the members of the august
Committee which was established to develop the National Health Policy for
their invaluable contribution. Also, thanks and felicitation go to all those who

18
participated in the consensus-building workshop, held from 12 to 13 May
2007, in Khartoum who enriched this document.
The FMoH appreciates the efforts of Dr Ehsanullah Tarin in editing, structuring
and the considerable contribution he made in finalizing and bringing the
document into its current shape.
The FMoH appreciates the contribution of the office of the Editorial Services,
WHO Regional Office for the Eastern Mediterranean for revising the
document.
Finally, development of this National Health Policy would not have been
possible without H.E. the Minister for Health, Government of National Unity,
and Dr Abdullah Sid Ahmed, Undersecretary, FMoH, as they have provided
unswerving support.
As mentioned in the Introduction, this is a working document which is
amenable to change to reflect new realities and adaptable to emerging
situations. The aim is to create improved health in a manner most dignified to
the people of Sudan in order that they can lead socially and economically
productive lives.

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Annex 1
List of committee members
Professor Elsheikh Magoub (National Consultant/Chairperson)
Dr Mustafa Salih Mustafa (Planning Directorate/Reporter)
Professor Bashir Hamad (National Consultant)
Dr Mustafa Khogali, (Ahfad University)
Dr Nazaar Khalid (Private sector)
Dr Mustafa Nimeiri (International Africa University)
Professor Awatif Mohamed Osman (Nursing Collage, Science and Technology
University)
Dr Abd Alhalim Al Tahir (UNICEF)
Dr Sarra Hassan Mustafa (Planning Directorate)
Dr Zahir Ajab Al Sideeg (Planning Directorate)
Dr Gada Omer Shouna (Pharmacy Directorate)
Dr Mohamed Ali Yahya (Primary Health Care Directorate)
Dr Igbal Ahmed Al Bashir (Reproductive Health Department)
Dr Talal Alfadil (Khartoum State Ministry of Health)

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