By Brynne Gilmore
When your disease burden is high, resources are low and the migration of your skilled workforce is of constant concern, how is a country to scale-up service initiatives to provide better healthcare for its citizens? On 9 June, the Sudanese Medical Association (UK & Ireland) hosted a conference in Galway entitled the Migration of Sudanese Doctors: Dynamics and Opportunities to discuss this matter.
The objective of the conference was to highlight the significance and impact of Sudanese doctors’ migration, and several novel ideas were introduced to aid in increasing the capacity of Sudan’s health sector.
As highlighted by the Federal Minister of Health for Sudan, Bahar Abugarda, many encouraging improvements have been made in tuberculosis and malaria infection rates, maternal and child health, and government expenditure for health services. However, Mr. Abugarda also highlighted an increase in non-communicable and chronic disease, and human resources for health shortages with inequitable distribution across specialities and geographic locations.
The World Health Organisation (WHO) recommends a minimum of 2.5 health workers for every 1000 people. In 2008, Sudan had less than half the recommended amount of doctors, nurses and midwives with approximately 1.1/1000 individuals, according to a WHO and UNICEF 2012 report. As a way forward, Mr. Abugarda suggested the creation of unique opportunities by “encourage[ing] and welcome[ing] collaboration between Sudanese and Irish institutions for mutual benefit.”
One such unique opportunity was discussed by Eric O’Flynn, assistant programme director of the RCSI/COSECSA collaboration programme. The programme saw the College of Surgeons of East, Central and Southern Africa (COSECSA) and the Royal College of Surgeons in Ireland (RCSI) jointly develop and administer a unique, African-centric, e-learning platform to train surgeons in East, Central and Southern Africa. The severe shortage of qualified surgeons in most African countries coupled with limited training opportunities means that essential medical procedures are often not performed, something the programme aimed to address. The collaboration, which began in 2007, currently works in nine countries and is believed to be scalable and cost effective across large distances. Trainees complete online courses and exams, often in one of the 19 provided IT labs, before being certified by COSECSA.
Electronic sources such as the use of mobile phones and tele-medicine for diagnostics assistance in service delivery was also suggested by the working group discussing innovative and sustainable health service delivery, education and research initiatives for Sudan. E-learning offers solutions to the challenges posed by a lack of trainers and geography in order to increase, not only the number of health professionals, but also skill levels. As Mr. O’Flynn stated, “The time of being sceptical about e-learning has passed; now it is the time to put it into action.”
The Sudan Health Library, discussed by co-founder of the SMA and deputy president Dr. Abobakr Shadad, is another innovative idea to improve education training and practice. The online library is accessible to medical students and trainees in Sudan as well as nurses, allied health professionals and researchers. Its objectives are to provide educational resources and to have students in Sudan share experiences with peers and instructors from around the world.
Although increasing the number of skilled professionals is pertinent in the efforts to improve Sudan’s health situation, initiatives such as the Sudan Health Library and the Sudan Medical Council (SMA) also recognise the importance of increasing skill levels and capacity of both currently training and trained professionals. For example, the SMA, with Prof. Zein Karrar as President, has succeeded in implementing a national exam for all graduating doctors and regularly holds evaluations and workshops for medical schools.
Changes need to be made in Sudan’s health performance, but there is hope that progress will continue due to innovative efforts such as e-learning, cross-country collaboration and improved in-country standards for teaching. These initiatives must be given support by both the international community and the ministries within Sudan.
As stated by Dr. Shadad “knowledge is the only thing that underlies change.”
1 World Health Organization & UNICEF 2012. Building a Future for Women and Children. The 2012 Report.
I appreciated this article. But My dear what do you want the health workers in Africa to do? When infrastructure is broken down, and health systems are not in place, even the most passionate comapassionate soul finds it diffifcult to thrive.
Nevertheless, alot of work has been done in health systems strengthening in limited resouce settings in Uganda. Maybe some models of care are transferable.