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Letter to the Editor
Iran J Public Health, Vol. 44, No.1, Jan 2015, pp.145-146
Prospects for Delivering and Managing Curative Health Services
in North Darfur State, Sudan
*Abdallah IA YAGUB 1, Khondlo MTSHALI 2
1. Dept. of Policy and Development Studies, School of Social Sciences, University of KwaZulu-Natal, South Africa
2. Dept. of International and Public Affairs, School of Social Sciences, University of KwaZulu-Natal, South Africa
*Corresponding Author: Email: [email protected]
(Received 11 Oct 2014; accepted 20 Oct 2014)
Dear Editor- in-Chief
The conflict in North Darfur State, western Sudan,
started in 2003. With the country’s limited resources, the conflict led to difficulties in the delivery of curative health services. This conflict affected 1.6 million people, 81% of the population
of North Darfur State, with 37% classified as Internally Displaced Persons (IDPs) (1). Eighty percent of the people in rural areas and 47% in urban
areas have to live on less than US$1 per day. The
number of outbreaks of disease among the people
is very high (2). Because the capacity of government in North Darfur State is limited, the NGOs
provide 52.9% of the health budget and nearly
60% of health personnel. In this study, a total 60
interviewees participated; 15 of the participants
were expatriates working for international NGOs
and 45 were health professionals and administrations working in the health sector. The result
shows that the government has become increasingly dependent on the services of NGOs, which
provide 70% of curative health services, yet the
government is suspicious of NGO’s motives (3).
More recently, the independence of South Sudan
in July 2011 has led to continuing border issues
and disputes over oil revenue. This has resulted in
the further weakening of the public health system;
thus making the communities even more reliant
on services provided by NGOs.
The public health sector in North Darfur State
falls short of the government of Sudan’s and international norms and standards. For example, the
Central Bureau of Statistics reports that in North
Darfur State there are 73 Basic Health Care Units,
61 primary health care centres and 79 dispensaries,
to serve 2 113 626 people in the State (2, 4). A
Basic Health Unit serves 28 953 people, a Primary
Health Care Centre serves 34 649 people and a
dispensary serves 26 754 people (2, 4). According
to the norms of Sudan Health Service Standard (5),
a Basic Health Unit should serves 5 000 people, a
Primary Health Care Centre should serve 20 000
people and a dispensary should serve 25 000 people. North Darfur State fails to meet these standards, especially in relation to Primary Health Care
Centers, and even more so for Basic Health Care
Units. North Darfur State has a relatively low
number of hospitals beds, 0.2 beds for every 10
000 people, while in Africa 10 per 10 000 is regarded as a norm (6). In addition, there is a lack of
health staff in the State. For example, one deputy
specialist, two specialists and five general practitioners serve 100 000 people. In Sudan, the ratio
of specialists to service a population of 100 000 is
3.3. The ratio of general practitioners in Sudan is
20 per 100 000 population (7). According to Logie
et al. (8), WHO suggests that a minimum of 10
doctors serve 100 000 people. Therefore, the proAvailable at:
Ia Yagub and Mtshali: Prospects for Delivering and Managing Curative Health …
vision of specialists and doctors in North Darfur
State is below average for Sudan and below that
suggested by WHO. In additions, 1.4 technicians,
2.1 medical assistants, 2.8 nurses and 0.16 public
health inspectors serve 10 000 people. If one consider the ratio of nurses for every 10 000 people,
the statistic of 2.8 in 2010 in North Darfur State is
dramatically lower than that of Sudan, which was
4.9 in 2006 (7), and far below the norm of 9 recommended by the World Bank (9) and that of 12
suggested by WHO (10).
The recent independence of South Sudan has two
main consequences for curative health services in
North Darfur State. Firstly, the independence of
South Sudan reduces public revenue available to
Sudan. Secondly, the government of Sudan continues to divert effort and resources into dealing
with internal conflict and disputes along its borders. In these circumstances, it is probable that
public revenue for health in Sudan, and for health
services in North Darfur State, will decline. In this
study, health facilities, equipment and technical
services, as well as general infrastructure, were areas of concentration. A second was the continuing
the role of NGOs. The capacity of government, at
all levels, to provide curative health services in
North Darfur State is limited and need urgent assistant from NGOs. The third focused on recent
political developments in Sudan and how they affect curative health service delivery in North Darfur State. The study concluded the analysis by putting all the findings into perspective.
The authors declare that there is no conflict of
Available at:
1. United Nations (2011). Sudan Work Plan 2011.
Available from:
2. State Ministry of Health Survey Report (2010).
The Final Health Facilities and Human Resources Survey Report in the State and Distracts, Dismember 2010, El Fasher, North
Darfur State.
3. State Ministry of Finance and Economy Report
(2009). The Final Report of Ministry of Finance and Economy, El Fasher, North Darfur
4. Central Bureau of Statistics, Fifth Sudan Population and Housing Census (2008). Khartoum,
Sudan. Available from:
5. Sudan Health Service Standard (2004). Series
Documents the Restructuring of the Health
Sector, Document Describe Health Units and
Functional Connectivity, Federal Ministry of
Health, Khartoum, Sudan.
6. World Health Organization (2009). World Health
Statistics 2009, Health Workforce, Infrastructure, Essential Medicines, Table 6.
7. World Health Organization (2006). Health Systems Profile- Sudan, Regional Health Systems
Observatory, Egypt. Available from:
8. Logie, D, Rowson, M, Ndagije, F (2008). Innovations in Rwanda’s Health System: Looking to
the Future. Lancet, 372(9634):256-61.
9. World Bank (2010). People, World Development
Indictors. Available from:
10. Bateman, C (2007). Slim Pickings As 2008 Health
Staff Crisis Looms. S Afr Med J, 97(11): 10201034.