1. 9 Rural and community medicine
Sudan rural health and community
medicine
Dr. Siham Gritly
University of Bahri

2. Definition of rural communities
• There is no international standard for defining
rural areas, and standards may vary even within
an individual country (WHO).
• The most commonly used methodologies fall into
two main camps:
• population-based factors
• and geography-based factors.

3. • The methodologies used for identifying rural
areas include;
• population size,
• population density,
• distance from an urban center,
• settlement patterns,
• labor market influences,

4. Rural area
• English dictionary defined rural area as a
geographic area that is located outside cities
and towns
• Usually those areas having fewer than 1000
persons per square mile and less than 20,000
people

5. • The rural poor depend largely;
• on agriculture,
• fishing
• and forestry,
• and related small-scale industries and services.

6. • rural areas are different from those in
urban areas,
• These differences are the result of
• geographic,
• demographic,
• socioeconomic,
• workplace,
• and personal health factors.

7. • People living in rural areas also have;
• poorer socioeconomic conditions, (high rates
of poverty amongst)
•
• less education,
• higher mortality rates when compared to their
urban counterparts

8. Why rural areas characterized by
poverty
• How rural poverty is created
• Numerous characteristics of a country's
economy and society, as well as some external
influences, create rural poverty
• political instability and civil war;

9. • systemic discrimination on the basis of gender,
race, ethnicity, religion, or class
• ill-defined property rights or unfair
enforcement of rights to agricultural land and
other natural resources;
• high concentration of land ownership and
irregular rental arrangements;

10. • corrupt politicians
• economic policies that discriminate against or
exclude the rural poor from the development
process
• market imperfections owing ‫مديون‬ to the high
concentration of land and other assets and
imperfect public policies;

11. • natural causes (for example, climatic changes)
• The right to adequate land and water is
importance in reducing rural poverty in many
developing countries.
• large and rapidly growing families

12. • Basic health care
• immunization,
• provision of clean water,
• and family planning
• and education (literacy, schooling, and
technical training)—particularly for women
and children—are essential building blocks
and should be accessible at reasonable cost.

13. characteristics of rural life
• More space; greater distances between residents
and services
• Cyclic/seasonal work and vacation activities
• Informal social/professional interactions
• Access to extended relationship systems
• Residents are related or acquainted

14. • Small enterprises
• fewer large industries
• Economic orientation to land and nature (e.g.,
agriculture, mining, fishing)
• High-risk occupations are more prevalent
• schools are social organizations
• Preference for interacting with localities
• Mistrust of newcomers to the community

15. Rural health or rural medicine
• In medicine, rural health or rural medicine is
the interdisciplinary study of health and health
care delivery in rural environments.

16. • The concept of rural health incorporates many
fields, including;
• geography,
• midwifery,
• nursing,
• sociology,
• economics,
• telemedicine

17. Sudan rural areas often suffer from
a lack of access to healthcare.
• Poor coverage in rural areas
• Health threats
• Common illnesses include malaria, measles, and
tuberculosis.
• In areas with poor sanitation to the south and
west, water-borne diseases like cholera are a
threat.

18. Difficulties in health care delivery
• The problems of receiving adequate health
care are particularly high in rural regions,
which lack trained staff and facilities.
• Recruiting and retaining qualified health
professionals in rural communities is difficult
• In some areas, people also suffer from lack of
food.
• In South Kordofan, for example, four in ten
households do not have enough food.

19. • This compares to wealthier states such as
Khartoum, where less than one in ten
households have a poor diet.
• Infant mortality rates among children are high
in some regions.

20. • Some factors that influence where health care
providers work are
• 1) geographic location,
• 2) population density, and
•
• 3) distance from an urban center.

21. Factors that prevent women in developing
countries from getting the health care they
need include
• -distance from health services,
• -cost (direct fees as well as the cost of
transportation, drugs, and supplies),
• multiple demands on their time,

22. • -women’s lack of decision-making power
within the family
• -poor quality of services, including poor
treatment by health providers, also that almost
50% of the births in developing countries take
place without a skilled attendant (UNICEF).

23. The services needed are include:
• *Routine maternal care for all pregnancies,
including a skilled attendant (midwife or
doctor) at birth
• *Emergency treatment of complications during
pregnancy, delivery and after birth

24. • *Postpartum family planning and basic
neonatal care
• *Educating women and their communities
about the importance of maternal health care,

25. • *Research on social and psychological factors
affecting maternal health
• *Development of better interventions (and
evaluations of interventions) for complex
problems (e.g., behavioral, social, biological

26. Health system in Sudan
• The design of the health care system in Sudan
is based on primary health care which is
considered as a decentralized health care
system able to integrate, the existing
programmes, including;
• preventive,
• curative
• promotional activities

27. • For provision of service, health care is
organized at three levels:
• 1- primary health care,
• 2- secondary level
• 3- tertiary level

28. primary health care,
• The “first” level of contact between the individual
and the health system.
• Essential health care (PHC) is provided.
• A majority of prevailing health problems can be
satisfactorily managed.
• The closest to the people.
• Provided by the primary health centers.

29. 2- secondary level
• More complex problems are dealt with.
• Comprises curative services
• Provided by the district hospitals
• The 1st referral level

30. 3- tertiary level
• Offers super-specialist care
• Provided by regional/central level institution.
• Provide training programs

31. Primary Health Care,
• a basic level of health care that includes
programs directed at;
• the promotion of health,
• early diagnosis of disease or disability,
• prevention of disease.

32. Definition of PHC
• Primary health care is essential health care
made universally accessible to individuals and
acceptable to them, through full participation
and at cost the community and country can
afford

33. The ultimate goal of primary health care is
the attainment of better health services for all.
• World Health Organization (WHO), has identified five
key elements to achieving this goal;
• reducing exclusion and social disparities in health
(universal coverage reforms);
• organizing health services around people's needs and
expectations (service delivery reforms);

34. • integrating health into all sectors
• pursuing collaborative models of policy
dialogue (leadership reforms);
• increasing stakeholder participation.

35. Elements of primary health care
• 1. Health Education
• 2 Promotion of food supply and proper
nutrition
• 3 An adequate supply of safe water and basic
sanitation

36. • 4 Maternal and child health care, including family
planning
• 5 Immunization against the major infectious diseases
• 6 Prevention and control of locally endemic diseases
• 7 Appropriate treatment of common diseases and
injuries

37. • 8 Basic laboratory services and provision of
essential drugs.
• 9 Training of health guides, health workers and
health assistants.
• Referral services

38. Principle of PHC
• The guiding principles of primary health care
include
• Accessibility,
• Public Participation,
• Health Promotion,
• Appropriate use of Technology
• Inter-sectoral Collaboration

39. Philosophy of PHC:
• 1-Health is fundamental related to availability
& distribution of resources
• not just health resources such as doctors,
nurses, medicines but also by; other
socioeconomic resources such as;
• education,
• water supply, & food supply

40. • 2-PHC is concerned with equity to ensure that
the available health& social resources are
distributed equal
• 3- Health is an integral part of the overall
development, thus factors which influence
health care are social, cultural, economic as
well as biological & environmental.

41. • 4- To achieve better health, requires much
more development by people themselves as
• individuals & families,
• communities
• in taking action on their own behalf adapting
health behavior & ensuring healthy
environment

43. efficient PHC services must be :
• Accessible
• Acceptable
• Affordable
• Efficient administrative, professional and
technical procedures.
• Community participation
• Comprehensiveness
• Continuity

44. Rural and primary health care
• At village level, primary health care units
represent the first level of contact between the
community and the health services.
• Secondary health care is available in small
towns through rural hospitals and urban health
centres

45. Promoting access to high quality primary health
care services in Sudan,
ref. World Health Organization, regional office for Eastern Mediterranean and
Sudan Ministry of Health 2012
• Access to high quality PHC services is one of
the major problems of Sudan’s health system,
in term of the following three main factors:
•
• 1. The burden of communicable and non-
communicable diseases is rising which put
more demand on PHC services.

46. • 2. PHC minimum package is below the
standard that most of the needy do not have
access to it.
• 3. the current health system governance,
financing and delivery practices do not
support best access to high quality PHC
services.

47. Barriers to Option Implementation
ref. World Health Organization, regional office for Eastern
Mediterranean and Sudan Ministry of Health 2012
• 1. Small size of health insurance pool and low
revenue to health due to lack of unified health
financing policy.
• 2. “Hospital centrism” approach of health
system and lack of PHC oriented policies and
laws jeopardize access to good quality PHC
services.

48. • 3. PHC standards are not comprehensive and
its implementation is not enforced.
• 4. Low resources are directed to peripheries
and remote areas which hinder the expansion
of PHC in these settings.

49. Implementation Strategies:
ref. World Health Organization, regional office for Eastern Mediterranean and
Sudan Ministry of Health 2012
• The overall strategies to deal with the above-
mentioned barriers are:
• 1. Development of national health system
financing policy supported by the necessary
health system reform.
• 2. Shift of health system orientation towards PHC
through development of PHC supporting policies
and laws and support PHC management capacity.

50. • 3. Development of comprehensive PHC
accreditation system while ensuring resources
for its implementation.
• 4. Reform of PHC implementation policies and
financing scheme as well as mobilization of
resources.

51. references
• 1. How healthy are Rural Canadians? An Assessment of Their Health Status
and Health Determinants. Ottawa: Canadian Institute for Health
Information. 2006.ISBN 978-1-55392-881-2. Archived from the original on
2008-06-20.
• 2. Healthy Horizons- Outlook 2003-2007: A Framework for Improving the
Health of Rural, Regional, and Remote Australians". Australian Health
Ministries’ Advisory Council’s National Rural Health Policy Sub-committee
and the National Rural Health Alliance for the Australian Health Minister’s
Conference. 2003. ISBN 07308 56844.
• 3 Ministerial Advisory Council on Rural Health (2002). "Rural Health in
Rural Hands: Strategic Directions for Rural, Remote, Northern and
Aboriginal Communities". Ottawa: Health Canada.
• 4. Population density and urbanization". United Nations Statistics Division.

52. references
• Declaration of Alma-Ata International conference on Primary Health Care, Alma-
Ata, USSR, 6-12 September 1978
• World Health Organization (2005). Sustainable health financing, universal coverage
and social health Insurance. Ninth plenary meeting, Eighth report 2005.
• World Health Organization (1978), Declaration of Alma Ata, International
Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September, 1978.
• Park's Textbook of Preventive and Social Medicine 21 Edition, by K. PARK
• World Health Organization, regional office for Eastern Mediterranean and Sudan
Ministry of Health 2012; An Evidence-Based Policy Brief Promoting access to high
quality primary health care services in Sudan