126. The estimated prevalence rate of HIV/AIDS in (North) Sudan was 0.

67
percent (0.5 for males and 1.24 for females) among the population 15-49 years
old in 2009. Sudan launched its national policy in 2004 and the Government has
shown strong commitment to the effort. The main focus of the national
HIV/AIDS control program (SNAP) has been on advocacy, involvement of all
sectors in the national response, testing, prevention, treatment and control
services for sexually transmitted diseases, and monitoring and evaluation. HIV
treatment and care services have been introduced in all the states, with 32 Anti-
retroviral sites in the country in 2009. The HIV/AIDS efforts have received
assistance from the Global Fund, UN agencies, and the private sector.

127. Health Facilities: Overall coverage with basic health facilities is poor. In
2009, there were 365 hospitals and over 4,800 primary health care facilities in
North Sudan. This works out to one hospital to 90,000 people primary health
care facility to 7,000 people. The health system employed a total of 97,303
health workers in all Sudan comprising over 20 different professions. However,
according to the WHO criteria Sudan falls within the critical shortage zone
considering the density of physicians, nurses and midwives of 1.23 per 1,000
people)°. There are substantial regional variations in the availability of health
services. For instance, Khartoum state has 65.5 general practitioners per
100,000 people, compared to 12.1 in Kassala, 7.7 in North Kordofan and 3.6 in
West Darfur state. Together, Khartoum and El-Gezira states account for more
than 50 percent of the public hospitals and private clinics, the practicing
physicians and medical technicians.

128. Health Expenditures: Total health expenditure amounted to 6.2 percent of

the GDP and US$122 per-capita for the year 2008, with 66.8 percent of total
expenditure on health out-of-pocket, exposing many to catastrophic health
expenditures. This compares with an average of 41 percent in sub-Saharan
Africa and 47 percent in the low-income group!°. Also, health spending is
skewed towards curative and hospitals care, and most of the allocation is for
salaries. As a consequence, primary and first-referral care, particularly in the
poorer states, suffers from lack of resources.

129. The states have become dominant in health expenditures, with he states
accounting for 63 percent of all federal and state expenditures. Not surprisingly,
there are significant variations between states in the levels of spending (total
and per capita). States that receive high per capita levels of federal transfers
(Blue Nile) or mobilize significant amounts of own revenues (Khartoum, Red
Sea) tend to spend more per capita on health services. The recent public
expenditure tracking survey (PETS) of the health sector found that some states
generate revenue from the sector in the form of various facility level fees. It
found significant disparities among the studied regarding the retention or
transfer of fees to state and local governments. The PETS study noted that there
was scope to allocate more resources to service delivery levels in several states.
It made a number of recommendations towards improving service delivery in
health facilities, including the harmonization of systems of allocation of
resources across states at all levels and types of facilities,i
i
9 Human Resources for Health (HRH), Strategic Work Plan for Sudan, (2008-2012)
10 http://healthsystems2020.healthsystemsdatabase.org accessed on 13 September,
2009
11 National Health Account preliminary report, 2010
12 World Bank (2011): Sudan, Public Expenditure Tracking Survey of the Health
Sector. The study is the first of its kind in Sudan, looking at the operations and
management of resources at primary care facilities in Sudan.