Abstract
BackgroundAfter many years of sanctions and conflict, Iraq is rebuilding its health system, with a strong emphasis on the traditional hospital-based services. A network exists of public sector hospitals and clinics, as well as private clinics and a few private hospitals. Little data are available about the approximately 1400 Primary Health Care clinics (PHCCs) staffed with doctors. How do Iraqis utilize primary health care services? What are their preferences and perceptions of public primary health care clinics and private primary care services in general? How does household wealth affect choice of services?MethodsA 1256 household national survey was conducted in the catchment areas of randomly selected PHCCs in Iraq. A cluster of 10 households, beginning with a randomly selected start household, were interviewed in the service areas of seven public sector PHCC facilities in each of 17 of Iraq's 18 governorates. A questionnaire was developed using key informants. Teams of interviewers, including both males and females, were recruited and provided a week of training which included field practice. Teams then gathered data from households in the service areas of randomly selected clinics.ResultsIraqi participants are generally satisfied with the quality of primary care services available both in the public and private sector. Private clinics are generally the most popular source of primary care, however the PHCCs are utilized more by poorer households. In spite of free services available at PHCCs many households expressed difficulty in affording health care, especially in the purchase of medications. There is no evidence of informal payments to secure health services in the public sector.ConclusionsThere is widespread satisfaction reported with primary health care services, and levels did not differ appreciably between public and private sectors. The public sector PHCCs are preferentially used by poorer populations where they are important providers. PHCC services are indeed free, with little evidence of informal payments to providers.
Highlights
After many years of sanctions and conflict, Iraq is rebuilding its health system, with a strong emphasis on the traditional hospital-based services
To understand the perceptions and experiences of households with their local Primary Health Care clinics (PHCCs) facilities, a cluster of 10 households were surveyed in the catchment areas of 126 clinics randomly selected from the national list of all doctor-staffed PHCs in Iraq
Field work was done by the International Medical Corps (IMC) with assistance from Al Kindi College of Medicine and the Iraqi Red Crescent Society
Summary
After many years of sanctions and conflict, Iraq is rebuilding its health system, with a strong emphasis on the traditional hospital-based services. As the conflict stretched on from 2003, medical doctors began migrating within Iraq as well as leaving Iraq for neighboring countries [8,9]. Both the ongoing violence and the construction of barriers limiting travel in violence-affected areas have restricted patient access, especially in Baghdad. With the migration of experienced doctors from Iraq, there have been concerns about the quality of health services, and the ability of training facilities to replace those migrating, especially those with advanced specialty training [12,13]. Those doctors remaining work in a health system that is heavily centralized, politicized and functioning in a nontransparent, non-accountable manner [14]
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