The price of better health in Iraq: an extra US$ 14 per person per year
Madrid/Geneva/Cairo - As the international community gathers to consider the urgent reconstruction needs of Iraq, the World Health Organization (WHO), UNICEF and the World Bank will highlight the requirements for better health in Iraq and an effective health system for the Iraqi people.
"This meeting provides a key opportunity for the international community to decide to invest in the future of Iraq by investing in the health of its people”, said Dr LEE Jong-wook, WHO Director-General. "We must look beyond the current challenges. As we have seen in Afghanistan, Timor Leste and Cambodia, it is through responding to long-term needs that we help countries – and their peoples – recover from crisis. "
The people of Iraq have endured health problems for many years, and their sufferings have been reflected in child and maternal death rates that are much higher than they should be. More than a decade of under-investment has meant that health systems just do not respond to people’s basic health care needs.
“The challenge for Iraqi policy-makers and the donor community is two-fold: to re-establish basic services in the short-term, while transforming centrally planned services to a new model based on primary health care, prevention and evidence-based policies. The new system should reflect the health needs and the disease burden faced by the Iraqi people”, said Dr Hussein A. Gezairy, Regional Director of the WHO Regional Office for the Eastern Mediterranean. WHO will start to work on priority areas, such as nursing, public health and administration and maternal and child health.
Health facilities damaged and looted
During and immediately after the recent conflict, some 12% of hospitals were partially damaged and 7% were looted. More than 30% of the facilities that provided family planning services were destroyed. The country's two major public health laboratories, in Baghdad and in Basra, were destroyed. Health departments, hospitals, and Primary Health Centers lost vital equipment, refrigerators, furniture and air conditioners and four out of seven central warehouses were partially looted.
"Iraq’s health system needs adequate levels of well-focused financial and technical investment if it is to achieve its full potential. During the past three months, government officials and other stakeholders – including WHO, and UNICEF, NGOs and the World Bank - have worked hard to agree on priorities, repair critical services, work on critical policy issues and rebuild the health system. We have all given high priority to security for health workers and patients, to essential medical supplies, electric power and water for health facilities, and training opportunities for health personnel” said Dr David Nabarro, Representative of the WHO Director-General for Health Action in Crises.
Health services in Iraq are based around the 250 hospitals and 1200 health clinics in Iraq. Quality of available health care varies. Only one third of these facilities offers emergency obstetric care. The doctor to population ratio is satisfactory (5 per 10,000 population) but there is a serious shortage of nurses. The number of health workers offering basic – or primary – health care is far lower than required.
As a result around one third of Iraq’s women give birth without a qualified health worker in attendance. 15-20% of them face high risks to their health and need advanced medical support. This explains the high maternal mortality of 300 maternal deaths per 100,000 live births - much higher than in other countries of the region. The health stakeholders are committed to halve maternal and child mortality rates within two years. This target cannot be achieved without investment in infrastructure, supply of key equipment, medicines and vaccines, and recruitment, training and redistribution of health workers.
Financial resources urgently needed
In Madrid the Iraqi Minister of Health, Dr. Khodair Abbas, is expected to present the plans for rebuilding Iraq’s health system between 2004 and 2007 so that it can respond to the agreed health priorities and improve the health and well-being of Iraq’s people. The additional cost – over and above available resources, over the four year period, is estimated at US $1.6 billion, or US $14 per person each year. For 2004, the national authorities have indicated that $1 billion will be available for health, with a further $550 million being requested from external investors.
The Ministry of Health has established nine health sector working groups – drawing on the broad pool of national experts from inside and outside government, with support from the World Health Organization, the World Bank, development agencies and the Coalition Provisional Authority (CPA) health team. They are examining options for developing public health (including maternal and child health care), delivering quality health care, pharmaceuticals and supplies, health care financing, information systems and technologies, human resource development, certification of practitioners, and health legislation.