Decentralisation, conflict and pathways to Universal Health Coverage in Sudan

Decentralisation may strengthen health systems and advance Universal Health Coverage in conflictaffected Sudan, but this is yet to be sufficiently examined.

To examine how decentralisation shapes progress towards Universal Health Coverage in conflict-affected Sudan.

Using the Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for Scoping Reviews guidelines, we searched published documents focusing on health sector decentralisation in conflict-affected settings on PubMed, Scopus, Google Scholar, and JSTOR, as well as reports and policy documents from several related international organizations.

Our findings showed major structural weaknesses in health care decentralisation in Sudan, including wide disparities in workforce distribution and the closure of nearly 70% of hospitals in conflict-affected states. Evidence showed improvements where financing and accountability were strong, but weaker performance where authority was fragmented. Inadequate funding and capacity contributed to stockouts, disrupted referrals and widening inequities.

Decentralisation can support progress towards UHC in conflict-affected settings when backed by predictable financing, adequate capacity and clear accountability. Progress in Sudan will depend on conflict-sensitive governance that strengthens local decision-making while maintaining system-wide coordination.