Improving the Effectiveness of the Curative Health Services in North Darfur 8.1 Introduction
8.3 Curative health services provision
168
169 Also the interviewee said:
Priority needs to be given to geographical areas where no health services exist and where the population live in underserved areas. The health facilities and their equipment must be regularly maintained so as to minimize the negative impact on the cost of renovation and repair and delivery of health services. Due to long distances and bad roads between the district headquarters and El Fasher, we need one ambulance in each district headquarter.
The government needs to provide guidelines and procedures regarding the routine maintenance of plant and equipment. Donors and NGOs need to assist the government to do so.
According to an interviewee (2-4, 25 December 2010, El Fasher) in El Fasher Teaching Hospital:
The existing health facilities and infrastructure are extremely inadequate and need to be developed. In my view to do this the State Ministry of Health should undertake a mapping exercise and make an accurate assessment of the physical structures of the existing health facilities in rural areas. About 85% of them require major renovation, 15%
require minor renovation and we definitely require new facilities according to the population size and the distances that have to be walked.
To do this the interviewee said:
The government needs to benefit from existing NGOs resources and mobilize them to renovate and build new health facilities, because if the NGOs go the government does not have financial resources to do that and the situation of the health infrastructure will become even worse. Other health infrastructure issues which are need to be considered are the existing health facilities which include inadequate or a complete lack of medical equipment, communication equipment, clean water and energy supplies, and transport issues, all of which the government and its partners are required to address for health infrastructure to be fully functional. To do so the government and its partners need to hold an international conference for financial assistance from developed countries and donors and NGOs and UN agencies to support them to rebuild health infrastructure.
170
The inadequacy of the public health facilities is very evident. Both the statistical data already presented, together with the views from a range of informants in government and in hospitals, indicate this. Here, too, they suggest that the problem is not only with the facilities themselves but with the infrastructure in general, for instance, water, and electricity supply, which are essential for health services. The solution, the interviewees say, is for government to rely on international donors and to further partnerships with foreign agencies and NGOs.
8.3.1.2 Equipment and technical services
In Chapter Four, the necessity to supply the health fac ilities with enough proper medical equipment, appliances, drugs and technical services was identified. Beyond El Fasher little is available (see Table 4.10). Vehicles and ambulances are also needed to transport patients and supplies. How can these shortages be addressed?
According to an interviewee (1-2, 13 January 2011, El Fasher) in the State Ministry of Health:
Public health facilities in North Darfur State especially in the rural areas are in need of materials and equipment. To provide modern and adequate health materials, including hospital beds and equipment for laboratories, as well as free drugs for poor people, the government should make an agreement with international NGOs which are working in the State. In my view there is a need for strong and active agreement between the State Ministry of Health and the hospital‟s administration and NGOs so that NGOs supply public health facilities with modern technical services such as diagnostic equipment, X- ray units and dialysis. The government should take the opportunity of the existence of international NGOs for support. If the government loses this chance and the international NGOs leave the country the shortages of health materials and equipment will still exist and poor people will suffer.
According to an interviewee (1-3, 2 January 2011, El Fasher) in El Fasher Teaching Hospital:
The issue of facilities and equipment in the public sector has become a major source of concern for government and various stakeholders. Therefore the government and its partners should provide modern laboratories, equipment, X-ray and other diagnostic equipment and services in public hospitals which are only available in private clinics
171
which are owned by individuals. In my view the government and its partners should address the position of poor infrastructure of health facilities and equipment through massive renovation of these facilities and replace outdated equipment. Also, they should supply public health facilities in remote areas which are underserved with secondary health care facilities as well as hospital beds according to the WHO norms.
The interviewee also mentioned that:
The issue of power generation and constant power supply should be promptly looked into to make equipment functional. Also broken down equipment should be repaired or replaced promptly. There should be adequate motivation and incentives for all categories of medical assistance staff who are charged with the responsibility for maintaining these facilities and equipment. Also the issues of funding should be addressed to replace the old equipment with new when they appear on the market.
Medical practitioners and health officials are in agreement. They all identify the need to supply, maintain and replace technical equipment for diagnosis and treatment. Without this quality curative health services cannot be provided. The answer, they suggest, is to search for financial and technical support from donors in the developed countries and from international agencies and NGOs. Thus far, the private sector has not been mentioned as a source of assistance.
8.3.2 The role of the private sector
In North Darfur State the private sector plays a limited role in in-patient care, but it is most important for pharmaceutical sales, outpatient care, and informal health services. The private health sector‟s role is limited because relatively few people can a fford to pay for such services and because many are unable to gain access to them since they are mainly located in El Fasher (see Table 4.7). According to the State Ministry of Health Survey Report (2010) 80% of the State‟s population is not able to access private health facilities. Private health facilities have increased in number since 2003, but mainly in El Fasher.
172
According to an interviewee (1-4, 23 December 2010, El Fasher) at El Fasher Teaching Hospital who has his own private clinic:
Private health facilities are available and their numbers have grown since the conflict started in the State in 2003. They have been providing curative health services but only for rich people because these services are very expensive for poor people and concentrated only in El Fasher. To access private health services and get medication a patient needs to pay 90 Sudanese pounds (US$ 30) which is not affordable for the most people. Due to the expensive treatment in private health facilities and the unavailability of treatment in public health facilities, 90% of poor people access the NGOs‟ health facilities. The private health facilities in a poor state such as North Darfur State do not play any role in providing curative health services to the poor people and do not fill the gap of public health facilities. Therefore, the government should not count on private health facilities, because they are not accessible for people.
Although the private sector is not seen as a solution to meeting the need for curative health services, it was noted earlier that most practitioners who offer private health care are already employed by the public sector (see Table 5.7).
8.3.3 The role of NGOs
NGOs have made an important contribution to curative health service delivery in North Darfur State. They provide 70% of curative health services to the IDPs, to the poor and vulnerable people of the State, and have established 24 health centres (SMoH Surve y Report, 2010). Also, as reported previously, they have provided 52.9% of funds for health care (State Ministry of Health Financial 2009), and 1390 health cadres (WHO, 2010:12). NGOs offer certain advantages in working in curative health service delivery in the State. They have motivated staff, community based structures, they are willing to work in remote areas, they are efficient and they are able to collaborate with government. But due to the conflict and difficult political circumstances, NGOs do not make information about their activities available to the public, which makes it hard to evaluate their activities or to build on their experiences.
173
According to an interviewee (2-5, 04 January 2011, El Fasher) in the State Ministry of Health:
NGOs in North Darfur State have been making a good effort in curative health service delivery to the poor and conflict-affected people. But the government should remove the obstacles that it puts in front of the NGOs to access the remote areas, and try to benefit from their resources and experiences to build its capacity of the health system. Without the NGOs‟ assistance the government is not able to deliver curative health services to its population. The challenge that is facing the government in the near future is the sustainability of curative health services delivery after the NGOs leave the country.
Therefore, the government should consider now the sustainability of health service delivery issues and try to get help from donors and existing international NGOs to build and improve the capacity of health facilities and infrastructure so as to at least minimize the gap that will happen when the NGOs leave the country. 2
This study has documented the extensive role that NGOs have played in providing curative health services during the period of civil conflict, especially to the remote areas, where government services have not reached communities, and the IDP camps. The main concern is what will happen if and when the international NGOs leave. The interviewees are well aware of this issue and mainly suggest that the government seek to maintain partnerships with the international community.