Title:
Political Economy Analysis of the Expansion of the National Health Insurance Fund in Sudan.Analyzing the Resistance to Implementing Health Financing Reforms That Support Expanding the Role of the NHIF
Authors:
Abdalrahman, Ramy Abdalrahman Mohamed Osman
Place:
Amsterdam, The Netherlands
Publisher:
KIT (Royal Tropical Institute)
Year:
2024
PAGE:
59
Language:
En
Subject:
Health and Poverty
Keywords:
Political economy analysis, Health policy, Politics, Sudan
Abstract:
Background: Sudan’s health system faces significant fragmentation, with multiple public financing schemes, such as the NHIF, Free Care Program, and Zakat Fund, operating in parallel. Despite NHIF’s mandate as the main insurance provider, independent purchasing and the implementation of reforms persist. Weak governance, political instability, conflicting stakeholder interests, and policy incoherence slow progress toward Universal Health Coverage. Objective: This study examines the political economy dynamics that hinder the integration of major public funding pools into the NHIF and limit the implementation of health financing reforms. It aims to provide actionable recommendations to reduce fragmentation, expand risk protection through Sudan’s primary health insurance mechanism, and address a gap in the existing literature. Methodology: The study employed a mixed method, including a literature review, analysis of policy documents, and key informant interviews. The analysis was guided by Campos and Reich’s political economy framework. Findings: The main findings show that top and mid-level managers and medical doctors linked to the free care committee are key sources of resistance to the NHIF expansion. Although political leadership across different regimes has expressed a willingness to pursue reforms, they have lacked the strong commitment necessary for effective implementation. As a result, the system remains fragmented, with insufficient public funding and high out-ofpocket expenses, hindering progress towards Universal Health Coverage (UHC). Conclusion and Recommendations: Health financing fragmentation in Sudan is shaped by complex political economy factors. To address these, the study recommends engaging political leadership, building strategic alliances to support NHIF expansion, and strengthening beneficiary engagement through targeted communication and education.
Organization:
KIT (Royal Tropical Institute)/ Vrije Universiteit Amsterdam
Institute:
KIT (Royal Tropical Institute)
Country:
Sudan
Region:
Northeast Africa
Training:
Master of Science in Public Health 2024
Category:
research
Right:
© 2024 Abdelrahman
Document type:
Thesis/dissertation
File:
YjGBAN4JYa_20251211115234115.pdf