The role of the federal ministry of health in Sudan

The health system in Sudan is messed up!

Sudan governing system is federal. This means the provision of health services is the responsibility of each state. This includes dealing with the workforce from medical to supporting staff. Each state should run it according to its health priorities and budget. Health priorities of Khartoum are different from Gadarif. Hence different spending priorities.

The question that we need to answer is what is the role of the federal ministry of health is going to be as federalism is here to stay.

Firstly, the role of the federal health ministry should be limited to a certain aspect of the health system. The FHM role should be the provision of a road map to improve public health in general. The emphasis should be on prevention as it is the most effective and rewarding. However, the states need to run these programs, and the federal ministry should provide technical support and training.

Secondly:

The federal ministry should be responsible for establishing, running, and maintaining surveillance systems that cover all of Sudan for early detection and intervention. Dealing with outbreaks and “Pandemics” should be a federal responsibility. This also should include data collection regarding communicable and non-communicable diseases from the states.

Thirdly:

Curative medicine should be the responsibility of the states. This should include running hospitals, health centres, etc. The role of the FMH should be limited. The FMH should run a few federal hospitals to serve a certain purpose. For e.g. tertiary hospitals where it is more cost-effective to treat by increasing the caseload and the expertise to deal with certain conditions such as Cancer, Cardiac surgery and so on. Not every state needs these centres, but there should be clear criteria and area of coverage for such services. With the provision of such services, there will be a need for federal transport services between the states and these specialized centres.

Fourthly:

Training & Research! The FMH should use the specialized medical centres to train medical and nursing professionals and to conduct research that helps improve the health service in Sudan.

Fifth:

Work Force! Logically, most doctors should be hired by the states rather than the Federal Ministry of Health. So most industrial disputes should be between the local unions and the state ministry of health rather than with the federal ministry of health. Although, the Federal ministry should have its employees and should deal with their representative bodies.

Six:

Finance! Each state should be responsible for its own health budget! The federal government should provide financial assistance to less developed states. State such as Khartoum should not receive any federal funding for curative purposes. However, if Khartoum treats other states residents shouldn't Khartoum get compensation by other states and vice versa? Point for debate because the state health budget should come from local taxes.

Despite federalism is the governing system in Sudan the health system is controlled from the centre. Running a federal health system means increase running cost and fragmentation of services. Having a small but effective federal ministry of health will help reduce the fragmentation and improve coordination between the states and lead to an efficient health system. Federalism is a political choice and not a medical one.