Sudan health system is based on the district health system approach, which emphasizes the principles of primary health care (PHC). Nevertheless, the decentralization of the public sector resulted in more deterioration of the PHC system particularly in rural and peripheral areas due to lack of financial resources and managerial capacities. The local health system act gave the responsibility of management of PHC level to the localities while, this wasn’t accompanied by ensuring availability of sufficient financing resources to localities to run this function. This condition is worsened by the focus of government spending on hospitals leading to an unbalanced health system. For instance, 36% of the total health expenditure goes to the secondary and tertiary hospitals. Moreover, over 90% of the government health expenditure is directed to the secondary and tertiary hospitals.