Expansion of health facilities in Iraq a decade after the US-led invasion, 2003-2012.

Valeria Cetorelli,Nazar P Shabila

doi:10.1186/1752-1505-8-16

Abstract

BackgroundIn the last few decades, Iraq’s health care capacity has been severely undermined by the effects of different wars, international sanctions, sectarian violence and political instability. In the aftermath of the 2003 US-led invasion, the Ministry of Health has set plans to expand health service delivery, by reorienting the public sector towards primary health care and attributing a larger role to the private sector for hospital care. Quantitative assessments of the post-2003 health policy outcomes have remained scant. This paper addresses this gap focusing on a key outcome indicator that is the expansion of health facilities.MethodsThe analysis is based on data on health facilities provided by the World Health Organisation and Iraq’s Ministry of Health. For each governorate, we calculated the change in the absolute number of facilities by type from early 2003 to the end of 2012. To account for population growth, we computed the change in the number of facilities per 100,000 population. We compared trends in the autonomous northern Kurdistan region, which has been relatively stable from 2003 onwards, and in the rest of Iraq (centre/south), where fragile institutions and persistent sectarian strife have posed major challenges to health system recovery.ResultsThe countrywide number of primary health care centres per 100,000 population rose from 5.5 in 2003 to 7.4 in 2012. The extent of improvement varied significantly within the country, with an average increase of 4.3 primary health care centres per 100,000 population in the Kurdistan region versus an average increase of only 1.4 in central/southern Iraq. The average number of public hospitals per 100,000 population rose from 1.3 to 1.5 in Kurdistan, whereas it remained at 0.6 in centre/south. The average number of private hospitals per 100,000 population rose from 0.2 to 0.6 in Kurdistan, whereas it declined from 0.3 to 0.2 in centre/south.ConclusionsThe expansion of both public and private health facilities in the Kurdistan region appears encouraging, but still much should be done to reach the standards of neighbouring countries. The slow pace of improvement in the rest of Iraq is largely attributable to the dire security situation and should be a cause for major concern.

Highlights

In the last few decades, Iraq’s health care capacity has been severely undermined by the effects of different wars, international sanctions, sectarian violence and political instability
In 2003, there was an average of 5.5 Primary health care centre (PHCC) per 100,000 population, 2.7 small centres administered by medical auxiliaries and 2.8 large centres administered by doctors
Continuing insecurity and political instability hamper both public and private investments in health infrastructure in countries emerging from conflict and pose major challenges to health system recovery

Summary

Introduction

In the last few decades, Iraq’s health care capacity has been severely undermined by the effects of different wars, international sanctions, sectarian violence and political instability. Quantitative assessments of the post-2003 health policy outcomes have remained scant. This paper addresses this gap focusing on a key outcome indicator that is the expansion of health facilities. In the last few decades the country’s health care capacity has been severely undermined by the effects. Since the 1980–1988 Iran-Iraq War, resources were progressively diverted from the health sector [2]. During the 1990–1991 Gulf War and the following 13 years of embargo and economic sanctions, public health budget was cut by 90% and buildings and equipment fell into disrepair [2]. The violence-induced exodus of thousands of doctors and nurses in the subsequent years further weakened the health system [5]

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Results

Discussion

Conclusion