The Demise of the Healthcare System in Sudan: A Narrative of Corruption and Lack of Transparency

The Demise of the Healthcare System in Sudan: A Narrative of Corruption and Lack of Transparency

Sudan Democracy First Group
Sudan Transparency Initiative

Report Launching Press Release: “The Demise of the Healthcare System in Sudan:
A Narrative of Corruption and Lack of Transparency
20th June 2017

The Sudan Democracy First Group (SDFG), is pleased to announce the release of its report on the corruption and demise of the healthcare sector in Sudan. The report is the latest publication of the Sudan Transparency initiative series of researches that focus on exposing the various aspects of corruption and lack of transparency in Sudan.

Lack of transparency and corruption are rampant across Sudan. Many stories were published in different media outlets about the magnitude, scope and penetration of corruption in the public and private sectors in Sudan. However, these stories have failed to mobilize the grassroots to demand accountability; instead they ended up as sensational stories for public consumption and gossip. SDFG launched its ambitious Sudan Transparency Initiative (STI) in March 2015, an initiative dedicated to the study and documentation of corrupt practices and lack of transparency in Sudan, with the objective of raising awareness and mobilizes citizens to demand accountability.

This report emphasises the roots and the enabling factors of corruption that led to the collapse of healthcare sector in Sudan. As well, it documents the magnitude of this destruction in the health system since the militarily coup of 1989. Further, the report discusses  governance challenges that face the health system in Sudan including political favouritism and health sector finance situation. Two of many dimensions of corruption in the healthcare system which the Report highlighted and analyses in depth are the government prioritization of the security sector to launch war  against its own  citizens in Darfur, South Kordofan and Blue Nile,  as well as its active policy of privatizing and selling public assets and services to it’s cronies and supporters.  Illustrative examples of the corruption in the health sector are presented in detail in the report.

In addition to documenting and corruption ininhe health sector, the Report concludes with a set of  recommendations and systematic measures aimed at the addressing the root causes of corruption in the healthcare system. These include:

1.Political measures:

1.1 Stopping all wars and immediately reallocating the excessive military and security expenditures to reinvest them in health may at first seem to rhetorical or irrelevant to the fight against health sector corruption in Sudan. However, Inqaz’s continuing wars have not just led to underfinanced health services; they have also produced corrupt practices which have affected the health sector.
1.2 It is crucial for opposition groups, civil society, citizen/consumer/patient action groups to continue highlighting, exposing and demanding redress of corruption in Sudan’s health sector.  This effort should be consistently maintained and proceed systematically to the level of legal challenge of such practices against the regime’s own existing laws.  Even if the effort does not achieve its goal of stemming corruption, it will at least maintain the pressure on the regime, increase documentation on corruption and serve as a mobilization tool towards regime change.
1.3 One concrete action needed to create the basis for this consistent advocacy effort is the creation of an anti-corruption clearing-house managed by a conglomerate of suitable Sudanese civil society groups, tracking and documenting corruption across many sectors, monitoring and recording the legal and practical responses and counter-measures undertaken, mapping community and civil society’s anti-corruption efforts, providing expert resources, networking and linkages with similar groups in Africa and globally.  The platform should best be secure electronic one to enable broader access.

2.Legislative Measures

2.1 One would be forgiven to think that the extent of corruption practiced in Sudan’s health sector today is indicative of some type of gap in legislation or absence of certain laws to enforce.  However, that is generally not the case.  There are sufficient constitutional, legal and law enforcement tools to criminalize all types of corruption currently being practiced in Sudan’s health sector.  The problem is in the political will to enforce such measures.  It is therefore critical that the Sudanese citizens, civil society groups, activists and opposition bodies actively pursue litigation measures against corrupt practices and to follow them through their entire course of appeals and enforcement.

2.2 The few areas where a new or strengthened legislative framework is needed to combat corruption are in the empowerment of citizen action to hold the government accountable at local and national level.  Thus, there is a need for legalizing the actions of groups such as the Sudanese Consumer Protection Association, a need to legally empower civil society groups to represent communities and the public interest in front of the law when litigating corruption incidents at the local neighborhood, local government, state and federal levels.

2.3  Review and develop new or strengthen existing legislative frameworks and laws relevant to health while prioritizing those regulating food supply, medical commodity importation and manufacturing standards, medical practice, environmental hygiene & sanitation, communicable disease control and patient rights;

3.Policy-level Measures

3.1 Establish a national participatory multi-disciplinarily council to oversee development of policies, planning and setting the overall objectives of health system.

3.2 Develop mechanisms to effectively and transparently regulate and monitor the quality and standards of delivery in the private sector, with strong accountability parameters to the state, the professional bodies, the patient and the community; consider establishing reasonable costing parameters and guidelines which enable the private sector to profit while maintaining the affordability of access by the population. Empower such bodies by law and assist in enforcing their work to hold service providers accountable for the quality and extent of health service delivery coverage;

3.3 Dramatically increase the proportion of governmental budget spent on the health and social protection sectors, including reforming the current national health insurance to ensure it increases its coverage and it meets the social protection needs of the most vulnerable Sudanese citizens; while ensuring sufficient investments in women, youth, adolescent, child, disability support and support to victims of Sudan’s wars.

4.Institutional and Management-level Measures

4.1 Establish regular (preferably annual) public multi-disciplinary, multi-sectorial and multi-stakeholder joint health sector review events which must include elected officials, other ministries, national and local officials, professional unions, Sudanese civil society groups as well as key UN and donor partners;
4.2 Create corruption tracking metrics within the formal health sector’s health information management systems by adapting experiences such as Uganda’s Data Tracking System.

5.Local and Health Service-level Measures:

5.1 Establish local accountability at service delivery points, municipal, state and at national-level FMOH to comprise elected health worker unions, patient/consumer group representatives, parliamentary/formal legislative branch and service providers.
5.2 Develop a mechanism to assure the formal accountability of health service delivery institutions (both preventative such as environmental health, water/sanitation, vaccination, etc; as well as health care curative services) to local communities and to seek its active participation;
5.3 Develop & implement performance-based funding by the FMOH towards sub-national elements of the health system, usinag models implemented successfully in Rwanda, Ethiopia and elsewhere; including features that enable local health facilities to benefit from tax and other revenue raised by the local government in which they are located.
SDFG would like to point out that “The Demise of the Healthcare System in Sudan: A Narrative of Corruption and Lack of Transparency report is by no means inclusive of all issues surrounding the healthcare services in the Sudan, however it is an attempt to draw broad outlines of the problem and lay the foundation for future targeted studies.

Arabic translation and hard prints of this report will follow shortly. For reading the full report and recommendations, please follow the following link:

Sudan Democracy First Group

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