Geographic Disparities in Access to Haemodialysis Services in Northern State, Sudan: A Mixed Methods Analysis and a Call for Decentralization

Background Providing fair access to haemodialysis treatment is a major difficulty in regions with limited resources and large territories. This investigation explores how geographic obstacles, logistical constraints, and health system structure affect the delivery of haemodialysis services in the Northern State of Sudan. Methods We performed a mixed methods study, integrating operational data from September 2025 from all 13 haemodialysis centres in Northern State. Quantitative assessment employed Gini coefficients and Lorenz curves to evaluate inequality in the distribution of resources. For qualitative insights, we applied thematic analysis to open ended feedback from centre managers about operational difficulties and potential remedies. Results Services were found to be highly concentrated (Gini coefficient = 0.58). A single urban centre provided care for 44.4% of all patients, whereas the five smallest centres collectively served only 12.3%. For remote facilities, a strong link was observed between greater distance from the central supply depot and delays in receiving materials (Spearman’s ρ = 0.72, p < 0.01). These centres faced prolonged wait times (extending to 30 days), recurring shortages of critical medications, and increased operating expenses. Qualitative evaluation revealed three core themes: (1) Vulnerability of the centralised supply system, (2) Financial instability of outlying centres, and (3) The pervasive burden of distance as a fundamental barrier. Conclusions Inequities in haemodialysis access in Northern State are rooted in the structure of a centralised and vulnerable system. A deliberate policy move towards decentralising service delivery and supply management is crucial for promoting fairness in kidney care. These insights are relevant for reconfiguring specialised healthcare delivery in other resource constrained environments facing similar geographic hurdles.