Physicians Availability and Associated Factors at Ministries of Health Facilities in Sudan in 2019
[Thesis]
Ahmed, Sali
Gloyd, Stephen
University of Washington
2019
20
M.U.P.
University of Washington
2019
Background: In 2006, Sudan was not considered as a country with a critical shortage of human resources for health (HRH). Nevertheless, 12 years later, with the substantial changes in Sudan socioeconomic environment, the HRH situation looks less promising. Physicians' density was estimated to be 0.314 per 1000 population in Sudan, even though Sudan produces many physicians. By 2009, an average of 2485 medical doctors were graduating annually from medical schools in the country. However, in 2005, it was estimated that over 60% of Sudanese physicians' practice outside the country, and Anecdotal reports suggest that physicians' coverage and distribution is inadequate, but the full extent of the problem has not been determined. Methods: Quantitative and qualitative primary data was collected from a representative sample of 491 health facilities and critical informants from different HRH stakeholders at the federal and state levels in January 2019. Physicians' availability was determined according to minimum standards at each level of health facility set by the Federal Ministry of Health (FMOH). Factors associated with low vs. high physicians' availability were assessed using logistic regression. Results: Of the facilities surveyed, 41% did not have a single physician providing services, and only 15% of the facilities had a number of physicians that met or exceeded FMOH minimum standards. Statistically significant associations were found between low physicians' availability and health facility location outside Khartoum state (OR 7.7, 95% CI 4.9 - 12), facilities in rural areas (OR 4.5, 95% CI 2.9-6.8), secondary level compared to tertiary level facilities (OR 3.2, 95% CI 1.3-8.4) and facilities perceived not fit to provide services compared to facilities perceived fit to provide services (OR 3.9, 95% CI 1.3-8.4). Statistically significant associations were also seen between physicians' availability and the presence of public schools, private schools, and private hospitals in the facility area. Discussion: We found low physicians' availability in government health facilities, especially outside Khartoum, in rural areas, and PHC facilitates. Physicians availability was associated with facilities fitness to provide services and availability of schools and private hospitals in the area. The potential for utilizing expansion of specialization opportunities across Sudan as a means to retain physicians should be explored and generating better data would help design an evidence-based physician retention strategy to guide FMOH retentions efforts.