Abstract:In Sudan despite the current implementation of universal health coverage policy, routine monitoring reports highlight that patients frequently bypass Primary Health Care (PHC) facilities in favor of higher-level hospitals, though hospitals are costly and time consuming. The main objective of this study was to study the extent of bypassing the public PHC facilities and factors associated with the decision of caretakers to bypass such facilities seeking care for their under-five year's children with common illnesses in Sharg-Alneel locality, 2015. The study proposed strategies and interventions to the Sudan government -Federal Ministry of Health (FMoH) -to improve PHC service utilization The study was cross-sectional comparative study, interviewer administered questionnaires and facility assessment checklist was used for data collection. The data was analysed using SPSS. The study interviewed 497 caretakers, 87% of them pursued health care for their children directly from secondary hospitals. The main reasons for bypassing the closest public health facilities were unavailability of doctors, lack of health insurance services and higher cost of services. The proportion of bypassing a PHC facility for child care is significantly associated with child sex, child age, presenting symptoms of diarrhea, fever, difficult breathing and severe vomiting, caretakers' occupation as well as the economic status. In a resource limited country, health policy to achieve universal health coverage is better to focus on quality of care as well as quantity. Community mobilization and interventions to improve access and utilization of quality PHC services are all recommended. Furthermore, more research on bypassing behaviour is also recommended.

Continuous professional development for all health care providers including nurses is vital to be updated and able to provide quality services. All types of continuing professional development programs are often described as a cycle. This cycle is composed of interrelated components that are the steps of a systematic process, usually starting with identifying learning needs and ending with assessing learning and training evaluation. Training Needs Assessment (TNA) is a method to determine performance gaps, and what training is required to fill in these gaps. Appropriate use of TNA can prevent unnecessary spending on improper, inefficient, and/or ill-targeted training programs, and maintain more focus on the real needs. It also helps save time and resources. The following paper will address the issue of TNA and its accompanying paper will consider the issue of training evaluation in Sudan. The study overall objective was to assess training needs among nurses in Sennar and Singa hospital and to compare the results. Specific objectives were: to identify training needs from viewpoint of nurses, doctors and sisters as well as to develop need-based training module. It was descriptive cross sectional study. A total of 173 nurses, 15 sisters and 13 doctors participated in the need assessment survey. Survey results showed that most of nurses had not attended any in-service training. There were clear gaps in equipment using, task performance, communication and ethical issues. The most important training needs were infection control, communication, ethics, and nursing emergency. Infection control training manual was developed accordingly. There were real and conceptual training needs for nurses identified by nurses, sisters and doctors. All of these training gaps and needs should be considered in the development of future training modules for nurses in Sennar State. In the future, continuous professional development should be promoted through sound evidence-based planning, which means that TNA must be an activity that precedes the preparation and implementation of training programs. Delivering training with the career path so that each nurse has the training opportunity is also strongly recommended as well as fair distribution of training opportunities in the state.

Background: Coronavirus (Covid-19) is a viral illness caused by a recently discovered coronavirus that began in the Chinese city of Wuhan in December 2019.(1). The impact of this global pandemic affects all social, psychological, and economic aspects of society , and health(1,2). The aim of the Saudi preventive health programs for Community health services was to increase awareness and decrease preventable diseases. This study aimed to assess the impact of the COVID-19 pandemic on key performance indicators of health programs at Makkah Al-Mukarramah City. Material and Methods: This comparative descriptive study was conducted to assess health programs’ key performance indicators and statistics before COVID-19 in 2019, in comparison with 2020 and 2021. KPI and statistics of health programs collected the data including that on chronic diseases Preventive programs, age categories and healthy life programs. Keywords: coronavirus-19, health programs, key performance indicators, preventive health, performance.

Sudan public sectors' has three levels of services delivery: primary, secondary and tertiary care. Primary level intended for health facilities that provide the basic package of health services and supposed to be the first contact for seeking medical help, advices and referral to high specialized services. Therefore, coordination between these three levels is important. As well as bypassing primary care level results in overburdening of referral facilities, increasing cost for the patients and depreciating health care system in terms of manpower, equipment and resources. Information about the health services utilizations' and it's the associated factors will be useful for improving service delivery to achieve universal health coverage. This paper intended to explore the experiences of caretakers seeking care for their under-five children related in public PHC facilities in Sharg-Alneel Locality, 2015. The study was descriptive cross-sectional applied qualitative research methods. Focus group discussions were conducted with caretakers who had experience with PHC services. Qualitative data was manually analyzed using thematic content analysis. This paper revealed that the main reasons that force the respondents to bypass the primary health facilities and seek care directly from the hospitals were related to the quality of the provided services. Accessibility issues, affordability issues, lack of knowledge of existing services, inadequacy of drugs, health staff competency and proper referrals system which is crucial to a functioning PHC, also reported to be lacking. Also, in this paper the respondents recommend the expansion of health insurance services coverage, provision of ambulances to all PHC facilities. Therefore, this paper recommends to educate and sensitize the individuals, families and community on PHC services role as the first line of health services to increase their knowledge and create awareness of services provided at the PHC facilities. This will increase demand for and improve access to PHC services. Also, to strengthen the implementation and facilitate the monitoring and evaluation by the authorities at the different levels. To enhance role of health insurance fund as purchaser rather than services provider and breach of free health care policy jeopardized affordability of PHC services need urgent actions, and continuous professional development for the PHC healthcare providers which will contribute in improving performance and providing quality PHC, and building their capacity on management of the under-5 common illness and by Malaz Elbashir Ahmed et al.: Experiences of Caretakers Seeking Care for Their Under-five Children Related to Public Primary Health Care in Sharg-Alneel Locality, 2015 strengthen the supportive supervision and monitoring.