Iraq struggles to revive health sector

Lubna Naji, Financial Times, August 8, 2012

Dr Zaid Al Naddaf, the manager of a primary healthcare centre in Iraq’s eastern Wasit Province, is on the front lines of the country’s efforts to rebuild its health system. But his sentiment towards the job reflects the frustration and disillusionment of many young Iraqi healthcare professionals.

“I want to stay here and serve my country,” he says. “But when I live in a country where I’m exposed and not protected, then it would be better for me and my family to leave.”

The doctors and nurses that power the country’s health sector work amid creaky infrastructure and poor security, running a public health system that offers universal free care, meaning patients should, in theory, be able to access all the services the system has to offer, at no cost.

But like most of the country’s public services, the health system has yet to recover from decades of conflict and neglect. Health accounts for just 4.9 per cent of the 2012 federal budget, and with World Health Organisation data showing annual health spending in Iraq running at around $250 per person – about a quarter of the global average – those delivering the services often question whether such funding is enough.

The numbers that are publicly available reveal an unpleasant truth. A 2010 report by the Iraqi Central Organisation for Statistics said Iraq had 34,276 hospital beds, 235 hospitals and 19,738 medical doctors, and is training just 2,000 new doctors each year.

With a current doctor-to-patient ratio of 0.7 per 1,000, according to the WHO, the country needs tens of thousands of new doctors to bring the ratio up to that of neighbours such as Egypt (2.8/1,000) or Lebanon (3.5/1,000). It would also need more than 100,000 new hospital beds to meet such standards.

Thanks to hefty oil revenues, the state is seen to have a relatively free hand in lifting spending on core services such as health. But money is not all that is needed to bring Iraq’s health system up to scratch, some say.

“The problem is not in the size of spending but in the way of spending,” Dr Naddaf says. “Due to mismanagement, lack of planning and administrative corruption, money is not being spent correctly and that’s why the public healthcare sector in Iraq is currently limping.”

The government is pushing forward with new investments, and this week signed a $152m deal with a group of European companies to build and supply 76 new operating rooms at 19 hospitals across the country. In June, Dr Majeed Hamad Amin, the health minister, signed a new five-year country co-operation strategy agreement with the WHO, focused on partnering the international institution to improve patient outcomes, manage the adequate financing of the healthcare system and guarantee universal access.

In July, Dr Khamees Al Saad, the deputy health minister, said the federal healthcare budget was inadequate and the ministry needed an immediate increase in funding to provide better services for Iraqi citizens.

“The ministry plans to develop the performance of primary healthcare centres all over the country,” Dr Saad said. “Last year the percentage of patients visiting primary healthcare centres was 60% of Iraqi patients. Our plan is to raise this percentage up to 80% to reduce the pressure on hospitals.

“The health departments in all Iraqi provinces must have the priority when it comes to assessing the situation of public services. We need the co-operation of the parliament and the local provincial councils in order to better develop healthcare in Iraq.”

While investment into the sector itself is crucial, Iraq’s central challenge of guaranteeing public safety and security extends even to its doctors and clinics. For those dealing with the public in often stressed environments – and particularly those in rural areas – the lack of protection by the state is a significant challenge.

Dr Samah Jasim, 26, a dentist working in the countryside, says she often feels endangered, and unprotected. “The prevalence of the tribal law over the state law here is alarming. If anything goes wrong for whatever reason you’re on your own, the state is not going to protect you,” she said.

“Some violent relatives of patients assault doctors on a daily basis all over Iraq, and no one is doing anything to stop them or bring justice to the victims. Awareness must be raised among the general public so that they know the challenges of our work.’’

But the underlying optimism of professionals such as Dr Jasim, in the face of insufficient funding, crumbling infrastructure and lax security, hints at a commitment to public service from many in the medical industry that the country desperately needs.

“I still believe that practising medicine here is worth it,” Dr Jasim said. “I like what I do and I’m proud of it. We just need to improve the level of care and that’s quite possible if efforts are intensified.”

Copyright The Financial Times Limited 2012.