Private Healthcare in Sudan

Dr Yagoub M A Magid, FRCOGConsultant, Assisted Reproduction

Nile Fertility CentreKhartoum Sudan

Whom does private healthcare serve?

Everybody including foreign community & patients from

neighbouring countries.

Introduction:

Private Healthcare is relatively new in Sudan

It started with the deterioration of MOH services

It is responsible for delivering of 25% health services

Objective of Private Healthcare:

To deliver comprehensive modern healthcare services.

Requirements for Healthcare service :

A) qualified staff

I- medical staff

ii- nursing staff & Paramedics

iii- others ( administrative, catering staff ..etc )

B) Suitable premises Purpose built hospitals / centres

C) Provision of appropriate equipment

Lab, OT, USS, CT, MRI ..etc

•

Number of Private Hospitals/Centres – Khartoum State 2011

Private Room (N)Centres/

Polyclinic (N) Hospitals (N) Area

325 31 22 UMD

235 21 20 KRT N

408 57 46 KRT

968 109 88 Total

Type of Private Hospitals, Khartoum State 2011

Diabetes(N)

Dermatology(N)

Breast(N)

ENT(N)

Paed(N)

Eye(N)

Maternity(N)

General(N)

Hospitals(N) Area

01 03 04 0 10 22 UMD

01 01 02 05 11 20 KRT N

01 01 01 01 02 06 36 46 KRT

01 02 01 01 05 08 11 57 88 Total

Major Private Hospitals in Khartoum State 2012

DialysisUnit

CardiacCatheterlab

P.T. OT NICU LW ICU MRI CT X-ray US Lab A&E No ofBeds

UnitHospital

√ √ √ √ √ √ √ √ √ √ 59 Albaraha

√ √ √ √ √ √ √ √ 30 Aldwoli

√ √ √ √ √ √ √ 40 Alfaisal

√ √ √ √ √ √ √ 28 Alnil Alazrq

√ √ √ √ √ √ √ √ √ √ √ √ √ 48 Alzeitona

√ √ √ √ √ √ √ √ √ √ 63 Asia

√ √ √ √ √ √ √ √ 50 Bestcare

√ √ √ √ √ √ √ √ √ √ 32 Doctors

√ √ √ √ √ √ √ √ √ √ √ 103 Fedail

√ √ √ √ √ √ √ √ √ √ 70 Imperial

√ √ √ √ √ √ √ √ √ √ √ √ √ 50 Royal care573 Total

Number of case visited private hospitals Khartoum state 2011

Insured (%) All cases Area

40% - 60%

73791 UMD

55191 KRT N

55846 KRT

184828 ? Total

?Only 3% of no. of cases visited MOH Hospitals/CentresReason:

Inaccurate recordingDoes not include cases seen at Private Rooms ( 1500000 ) = 27.5%

Number of cases visited government hospitals/ centres, Khartoum state, 2011

insured Total / Area

713398 2431231 UMD

517984 1648049 KRT N

393134 2054515 KRT

162451626.5%

6133795 Total (3 areas)

What has been achieved so far?

i. Provision of acceptable service for patients

Via i. Medical insurance

ii. Employer

iii. Self Funding

ii. Improvement in quality of Nursing

Foreign nursing staff

What has been achieved so far?

iii. Introduction of modern: Laboratory service

imaging technology , USS, CT, MRI Key hole techniques

Fedail Hospital G/E Endoscopy Diploma Training Programme, Totally Free)) Endoscopy ) Training programme, IVF/ Laparoscopy & Embryology 12 yrs ( Fertility treatment

Dental Centres physiotherapy Service Purpose built hospitals

What has been achieved so far?

IV. Employment and Training of Junior medical and other staff

V. Helping the poor ( PHC Help Group )

VI. Introduction of Private Healthcare Charter

VII. Attraction of Medical Insurers

International: e.g. BUPA, AXA, I G, GMC, Vanbreda

Local: e.g. Prime Health, Shaikan!!

Pictures;

Problems:

I. Concessions & Subsidies

. Customs

Red tape, Inconsistency, increasing charges

.Taxation

Sales tax, income tax

.Local Council Rates

Local tax, Garbage money, sewage money, Fire service charge

.Electricity and Water Bill

Huge prepaid at commercial rate

II. Limitation on Medical Equipment / Consumables Imports

- Problems with Foreign currency ( availability and exchange rate)

- Refurbished / Ex Demo equipment (X)

- Imports office:

wrong place ( pharmacy directorate )

red Tape, endless procedure, Junior staff

no coordination with standards office

-AMERICAN SANCTIONS

Getting worse

Round about way

Can any one help?

III. Competition with Providers delivering PHC service within MOH

premises

e.g. South Block, Sharg al nil, Private wings ( UMH, KNH, ..etc )

Advanced Medical centre, Jordanian Laboratories ..etc

IV. Sending patients abroad for treatment

Bank of Sudan, Foreign Ministry, NEC, Agric Bank, Sudatel ..etc

V. Health Insurance

Corporate ) ) - Limited to companies and government departments

i.e. no individual cover policies

- limited level ( ceiling ) of cover

- small premium = no adequate(

- Delayed or no payment ( Shaikan}

VI. Pharmaceutical Companies:

-Problems with foreign currency .i.e. LC .etc

-Drug registration Procedure = Red Tape

Scarcity of drugs

Encourages Black market and import by Street Traders!!

VII. Competition with Foreign Investors:

-Ultra Lab

-Al Mukhtabar Al Burj Lab -

-Jordanian Lab

-Others

owned and supported by influential people

VIII. Media: Papers , Radio ..etc

Papers: Harassment & Negative Publicity

All against doctors and PHC

Radio :

Nutrition Weekly programme

Rx Pumpkin Seed

Honey Remedy for all, Weekly programme

Rx Bee Sting

IX. Doctors’ Problems

-work long hours to earn enough

no pension scheme, life/ income insurance or protection against

litigations

- limited opportunity for training, CME ( conferences, workshops ..etc )

Doctors Problems:

–Licensing to practice by SMC

a- easy for visiting foreign doctors

Advertising, Papers, TV

Operate ( preop assessment ? & postop F U ? )

b- difficult for Sudanese doctors working abroad

Doctors’ Problems:

-Role of Sudan Doctors Union towards patients & members

Hardly any role at all

Way Forward:A long way to go:

Provision of sophisticated modern PHC is unattainable in Sudan at present. Most of the Public live below the poverty line and health insurance provides cover for less 10% of those who need it at the moment. However, a reasonably good level of care can be achieved.

What needed is:

-More understanding and support from the government

Special consideration:

plot of land, Customs, Taxation, council rates, electricity & water bill ,

Fire service ..etc

Way Forward:

-Implementation of a comprehensive health insurance programme to

to cater for all with positive contribution from the government &

employer

-Doctors union must play a positive role towards patients its members

-Formulation of a positive charter for both government & private Healthcare

Thank You