Bulletin of the World Health Organization

Strengthening human resources for health through information, coordination and accountability mechanisms: the case of the Sudan

Elsheikh Badr, Nazar A Mohamed, Muhammad Mahmood Afzal & Khalif Mohamud Bile

Volume 91, Number 11, November 2013, 868-873

Table 1. Status of human resources for health, Sudan, 2005 and 2012

Challenge 2005a 2012b
Data collection and use – Deficient HRH information – A comprehensive electronic HRH database built
– Weak capacity for data analysis and use – Improved capacity for data analysis and knowledge translation
– Lack of studies on HRH – HRH operational research on key workforce issues commissioned – several studies accomplished
Partnerships – No mechanism to bring HRH stakeholders together – Stakeholder forum established and operational
– Poorly coordinated HRH actions – leading to duplication and conflicts – HRH analysis, decisions and actions are coordinated, coherent and jointly conducted
Policy and planning – Lack of documented and coherent HRH policies – Institution of an inclusive policy process in the domains of pre-service education, the scaling up of CPD and health-worker deployment and distribution
– Absence of a national strategic plan for HRH – Development of a costed national HRH strategic plan for 2012–2016
Institutional strengthening and leadership development – Modest capacity for HRH leadership and advocacy – Emergence of HRH champions – leading to the strategic positioning of HRH issues in higher government forums and, subsequently, supportive deliberations by the Federal Cabinet
– Lack of a critical mass of HRH technical staff at the Federal MOH and inadequate HRH-focused training – Number of HRH technical staff at the Federal MOH raised from 20 to 115
– Limited capacity of training institutions for mid-level and community health workers – More than 340 individuals in MOH exposed to HRH training opportunities
– More training institutions for mid-level and community health workers at national and state level – and greater enrolment at older institutions
Coverage and skill mix to revitalize PHC services – Critical shortage of health workers and a distorted skill mix – Number of training institutions for nurses and midwives increased from 18 to 55
– More than 5500 nurses and midwives produced in a year, with majority enrolled in the rural health network
– More than 3400 individuals enrolled in a new programme for the training of community health workers
– Number of medical schools increased from 27 to 33, with 3000 doctors produced per year
– Mechanisms introduced for predicting future HRH needs and levels
CPD coverage – Lack of CPD institutional structures and norms – Establishment of a national CPD programme and a CPD centre – with 15 state-level branches
– Sporadic in-service training covering only 24% of the workforce – Mobilization of additional resources and extension of coordinated and harmonized CPD activities to 67% of the health workforce
Geographical distribution of health workforce – Seventy per cent of health workers serving 30% of the population – Over 10 000 new employment positions sanctioned, many of them in rural and other provincial areas
– Limited job creation at state and rural level and poor workforce retention – Improved bonding schemes to strengthen the implementation of training policies
– Introduction of a major “discrete choice experiment” to help in the design of an appropriate and effective incentive package for rural retention
– Improved staff retention through decentralized education and improved enrolment of students from rural areas
Emigration of health workers – Few data on emigration of health workers – Establishment of migration database – leading to several studies on health-worker migration
– Lack of policy attention despite increasing levels of emigration – Establishment of national Migration Studies Centre
– Emigration issues raised in the political agenda – the problem being discussed by the Federal Cabinet to support a national policy on the subject
– Movement to sign bilateral agreements with three destination countries – Ireland, Libya and Saudi Arabia – initiated

CPD, continuing professional development; HRH, human resources for health; MOH, Ministry of Health; PHC, primary health care.

a The situation in 2005 applies to the Sudan before the secession of what is now South Sudan.

b Six years after the establishment of a national observatory and the introduction of the country coordination and facilitation process in the Sudan.