Primary care clinical practice guidelines in Sudan: A qualitative survey exploring national stakeholders’ perspectives

Introduction: The health system in Sudan faces several challenges, including increasing numbers of patients, shortages of health supplies, and disparities in the distribution of health services. Guidelines implementation improves patients’ outcomes and ensures efficient use of the resources in such a resource-limited country. This paper explored the practice of family medicine at primary health care centers addressing the struggles that impede guideline implementation from the national stakeholders' perspectives. Methods: A qualitative facility-based survey conducted in the public referral primary health care centers in Khartoum and Gezira States of Sudan. The study population was composed of practicing family medicine doctors the medical directors in the referral PHC centers. All the focused group discussions and the interviews were audio-recorded. Recordings were transcribed verbatim, and the transcriptions were anonymized. Thematic content analysis was used to analyze the data. Results: Local Sudanese guidelines are lacking good publication and regular updating of the recommendations. Most of the surveyed doctors reported reduction of the training programs that are regulated and funded by the ministry of health due to the political and economic situations in Sudan. Barriers to guidelines implementation include limited health insurance coverage, patients’ factors, absence of regular training programs, lack of filing and referral system. Massive deterioration in the family medicine practice at Gezira state was observed due economic and some governmental issues. Conclusion: Successful development, adaptation, and implementation of the CPG depends on many factors, including adequate resources, quality assurance, widespread dissemination, appropriate monitoring and auditing for quality improvement. Efforts should be directed to encourage the development of local guidelines through a rigorous approach that involves a multidisciplinary team representing various stakeholders. The government represented by National Health Insurance Fund must expand the health insurance coverage and services. Contribution of the reestablishment of the electronic filing system and the telemedicine consultation in Gezira state and expand the program in Khartoum state and whole Sudan.