Sudan Social Health Insurance: challenges towards universalaccess to health care

  • Mahgoub Abdelrahim

Student thesis: Phd


The University of ManchesterA thesis submitted by Mahgoub Abdelrahim to The University of Manchester for thedegree of Doctor of Philosophy (PhD) in the Faculty of Humanities July, 2014.Sudan Social Health Insurance: challenges towards universal access to health careTo achieve effective access to health care, countries have adopted various policies toimprove the populations' legitimate right to obtain health care when needed. Socialhealth insurance has been proposed by the WHO as a means to securing sustainableaccess to health care particularly for developing countries. As one of the developingcountries, Sudan launched SHI in 1994; however, population coverage still does notexceed 28.7% of the total population. Given the complexities of access to health carethe issue of achieving universal access by the adoption of SHI is faced with variouschallenges. Recognising the factors that influence an individual's decision to accesshealth care ultimately adds to the success of the policy intervention to meet the statedgoals. In addition, understanding and recognising the households' perspectives andmotives to affiliate with SHI is critical to the success of the devised policy initiative.Therefore, this thesis examines the determinants of both access to health care andenrolment in social health insurance in Sudan. It also examines the implication of theadoption of social health insurance as a means to improving the population's access tohealth care.To achieve the stated objectives the thesis adopted a quantitative crosssectionalstudy design involving a household survey in Kassala State in Sudan. Thehousehold survey (n=560) collected information from 280 voluntary insuredhouseholds as well as 280 uninsured households living in rural and urban areas ofKassala State. The study confirms that both access to health care and voluntaryenrolment in SHI in Sudan are influenced by factors embedded in the Andersen andPenchansky models of access to health care. These factors include the head of thehousehold's; age, place of residence, gender, health status, the number of familymembers, perception about the waiting time to see the doctor, perception about the stafftreatment, the level of knowledge about SHI and the monthly income.The study confirms that SHI does not act directly to improve utilization of health care;instead, its effect is mediated by other factors especially income level. Thus, access tohealth care is not merely the function of the health insurance status of the population;however, together with empowering the household's income level, improving thesupply side of the health delivery system and reducing the gender inequality SHI ismore likely to improve the population's access to health care. In addition, the studyproves that those who are able to pay the health insurance premium and joined thescheme, are either looking for additional value for money (e.g. getting health servicesat a cheap prices) or escaping an escalating cost of health care resulting from personalcostly health status (e.g. chronic illness). Thus, the success of improving voluntaryuptake of SHI depends on adding convincing value for money, raising the people'sawareness about the scheme especially female households, targeting rural residenceespecially those with large family size and otherwise adopting a compulsory enrolmentpolicy.The thesis contributed to knowledge through the development of a single theoreticalframework encompassing both the health seeking behaviour and the adequacy of thehealth delivery system. The theoretical framework not only studied access to healthcare but also the factors that influence enrolment in health insurance. The newconceptual framework and the thesis's policy implications are applicable to developingcountries that adopt SHI and express socioeconomic characteristic and problemsresembling that of Sudan. It is also worth mentioning it is the first study to evaluate theimpact of Sudan SHI in terms of population access to health care.
Date of Award31 Dec 2014
Original languageEnglish
Awarding Institution
  • The University of Manchester

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