PERFORMANCE ANALYSIS OF PURCHASER PROVIDER SPLIT AND DIRECT SERVICE PROVISION UNDER THE NATIONAL HEALTH INSURANCE FUND IN SUDAN: PRIMARY CARE CASE STUDY IN WHITE NILE STATE

Abstract

Background: Gatekeepers in Sudan has a minor role in providing curative care and most of them are inactive and ignored by MOH. Objective: This paper is interested in assessing the performance of primary care units under National Health Insurance fund owned and contracted by this organization. Methods: Two dimensions were analyzed to assess performance of those facilities using historical cost data for the year 2013 to analyze the operational cost and a checklist developed by the author to measure the structure of the quality of services provided considering the lack of local accreditation system, a total number of 39 facilities serving in White Nile state were chosen for the study. The secondary cost data were collected from the register of the facilities. Data of the checklist obtained by observation for the available facilities of services provided within the care units was collected in March 2014. Results: expenditure of the NHIF facilities incurred in services reached 97% of their total costs while it was 96% for the contracted NHIF type of primary care. Considering quality NHIF provider showed also little increase in provided services with no significant variation from contracted ones. Conclusion: The overall outcomes seems to be direct health facilities provide high-cost services with decent quality of services compared to an acceptable costs for the indirect with variable quality of care. Recommendation: public financing of primary health care units will support affordable and higher quality of care closer to population homes. Moreover, the governance of those facilities is also need.