Insurance Services in Sudan
The health system in Sudan is organised into three tiers: primary care, secondary and tertiary care. Most primary health care services are delivered through public hospitals. Secondary and tertiary care is equally divided between the public and private sectors. A large portion of out-of-pocket health care expenditures is paid by the low-income population.
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There are a variety of insurance schemes in Sudan. These include Social Health Insurance and Private Health Insurance. Although these insurance systems have been in operation for some time, their sustainability is questioned. Nevertheless, the presence of both types of insurance is increasing. In addition, the country hosts a large number of refugees from neighbouring countries. This provides opportunities for South-South collaboration.
The main challenges of Social Health Insurance are ensuring its sustainability and the recruitment of the informal sector. Moreover, the FMOH lacks national strategies and protocols for cancer screening and management. It is therefore important for the health sector to improve its capacity to provide comprehensive care to its insured clients.
Health Insurance Services in Sudan
Among the challenges facing the FMOH are rapid turnover of administrative personnel, lack of effective relationships with research institutions and academia, and insufficient coordination of cancer management efforts. In addition, the government’s spending on healthcare is relatively low. This results in inequitable access and poor outcomes. Consequently, the FMOH needs to strengthen its relationship with international health agencies.
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Private Health Insurance is growing in importance in Sudan. The NHIF is one of the largest health insurance providers in the country. However, little research has been conducted on the impact of this type of insurance. Hence, the current study aims to evaluate the effectiveness of the NHIF in terms of access, quality, efficiency, and equity. Based on these, it is possible to suggest some policy recommendations for improving the NHIF.
The study also examined the magnitude of voluntary out-of-network physician visit utilization in Sudan. In Al Jazirah state, insured clients of the NHIF reported a high percentage of out-of-network physician visit utilization. As a result, it is important to understand how this phenomenon is influenced by socio-economic factors, including age, education, and family income. Further, it is important to explore the causes of out-of-network utilization in order to develop evidence-based interventions.
The study was conducted in January and February 2017. Participants were selected from four Social Health Insurance institutions in the country. They were interviewed using a pre-coded structured interview questionnaire. This questionnaire collected data on the socio-economic characteristics, the frequency of visits to the NHIF clinics, and the utilization behavior of NHIF clients.
Overall, the participants viewed the quality of SHI services provided by the NHIF as good. However, the waiting time at NHIF clinics was perceived by out-of-network users to be very long. Furthermore, out-of-network use was more prevalent among the participants who perceived the quality of care in Egyptian HIO clinics to be poor. Finally, the study highlighted the need to reduce the patient leakage to out-of-network services. Moreover, the study encouraged the policy makers and other stakeholders in the health sector to collaborate in order to identify and address these issues.