Abstract
BackgroundRelative to the amount of global attention and media coverage since the first and second Gulf Wars, very little has been published in the health services research literature regarding the state of health services in Iraq, and particularly on the semi-autonomous region of Kurdistan. Building on findings from a field visit, this paper describes the state of health services in Kurdistan, analyzes their underlying governance structures and policy processes, and their overall impact on the quality, accessibility and cost of the health system, while stressing the importance of reinvesting in public health and community-based primary care.DiscussionVery little validated, research-based data exists relating to the state of population health and health services in Kurdistan. What little evidence exists, points to a region experiencing an epidemiological polarization, with different segments of the population experiencing rapidly-diverging rates of morbidity and mortality related to different etiological patterns of communicable, non-communicable, acute and chronic illness and disease. Simply put, the rural poor suffer from malnutrition and cholera, while the urban middle and upper classes deal with issues of obesity and Type 2 diabetes. The inequity is exacerbated by a poorly governed, fragmented, unregulated, specialized and heavily privatized system, that not only leads to poor quality of care and catastrophic health expenditures, but also threatens the economic and political stability of the region. There is an urgent need to revisit and clearly define the core values and goals of a future health system, and to develop an inclusive governance and policy framework for change, towards a more equitable and effective primary care-based health system, with attention to broader social determinants of health and salutogenesis.SummaryThis paper not only frames the situation in Kurdistan in terms of a human rights or special political issue of a minority population, but provides important generalizable lessons for other constituencies, highlighting the need for political action before effective public health policies can be implemented - as embodied by Rudolf Virchow, the father of European public health and pathology, in his famous quote "politics is nothing but medicine at a larger scale".
Highlights
Relative to the amount of global attention and media coverage since the first and second Gulf Wars, very little has been published in the health services research literature regarding the state of health services in Iraq, and on the semi-autonomous region of Kurdistan
Summary: This paper frames the situation in Kurdistan in terms of a human rights or special political issue of a minority population, but provides important generalizable lessons for other constituencies, highlighting the need for political action before effective public health policies can be implemented - as embodied by Rudolf Virchow, the father of European public health and pathology, in his famous quote "politics is nothing but medicine at a larger scale"
The findings presented were later universally acknowledged and validated by a multitude of healthcare providers, academics, policymakers and patients spoken to at a healthcare conference in Erbil
Summary
Underlying these massive problems is a poorly designed and managed outdated health system (Figure 3). The use of public funds to establish and run private clinics serving the rich is fundamentally morally flawed, and would lead to massively widening the inequities in access and quality of care that already exist, and formally reinforce the already-existing two-tier system Most importantly, it would adversely affect the long-term socioeconomic development of the country, and lead to further impoverishment of a population exposed to catastrophic health expenditures with no social welfare or universal insurance safety net [22]. It is important to stress that policies promoting the use of public funds to establish and run private unregulated clinics will greatly widen inequities in access and quality of care, and adversely affect the long-term socioeconomic development of the country.
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