Healthcare Architecture Company in Iraq
HEALTHCARE SCENARIO OF IRAQ
Are you planning to build or restructure or venture in any healthcare venture in Iraq? Looking for information about the major healthcare players in government, private diagnostic centers that are available in Iraq? Are you looking to find out which part of the cities is best to venture in or what all facilities are available and what all should be planned for new setup? In this article Hospaccx Healthcare Consultancy has mapped all on major players in terms of medical facilities and healthcare scenario of Iraq.
This is the superficial and macro level survey if you need a refined market and financial feasibility or any other study related to healthcare is required you can contact Hospaccx Healthcare business consulting Pvt. ltd on Hospaccx.India@gmail.com or you can visit our website on hospaccxconsulting.com
INTRODUCTION
Iraq belongs to Eastern Mediterranean health region of WHO and were classified as upper middle income countries according to World Bank income classification 2013. The state of health in Iraq has fluctuated during its turbulent recent history and specially during the last 4 decade. Iraq had developed a centralized, free, and universal healthcare system in the 1970s using a hospital based, capital-intensive model of curative care. The country depended on large-scale imports of medicines, medical equipment and even nurses, paid for with oil export income, according to a “Watching Brief” report issued jointly by the United Nations Children’s Fund and the World Health Organization. Unlike other poorer countries, which focused on mass health care using primary care practitioners, Iraq developed a Westernized system of sophisticated hospitals with advanced medical procedures, provided by specialist physicians. The country had one of the highest medical standards in the region during the period of 1980s and up until 1991, the annual total health budget was about $450 million in average. The UNICEF/WHO report noted that prior to 1990, 97 percent of the urban dwellers and 71 percent of the rural population had access to free primary health care; just 2 percent of hospital beds were privately managed.
The 1991 Gulf War incurred Iraq’s major infrastructures a huge damage including health care system, sanitation, transport, water and electricity supplies. The annual total health budget for the country, a decade after the UN economic sanctions had fallen to $22 million which is barely 5% of what it was in 1980s. The Iraq War destroyed an estimated 12% of hospitals and Iraq’s two main public health laboratories. The collapse of sanitation infrastructure in 2003 led to an increased incidence of cholera, dysentery, and typhoid fever. Malnutrition and childhood diseases, which had increased significantly in the late 1990s, continued to spread. In 2005 the incidence of typhoid, cholera, malaria, and tuberculosis was higher in Iraq than in comparable countries. In 2006 some 73 percent of cases of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) in Iraq originated with blood transfusions and 16 percent from sexual transmission. There was a threefold rise in maternal mortality and the infant mortality rates more than doubled. Conditions were especially serious in the south, where malnutrition and water-borne diseases became common in the 1990s. The treatment and diagnosis of cancer and diabetes decreased in the 1990s, complications and deaths resulting from those diseases increased drastically in the late 1990s and early 2000s. There was also a drastic decline in the salaries of medical personnel and the overall quality of medical facilities detoriated. Between 2000 and 201l, the child immunization rates dropped by 20%. Iraq had not achieved its Millennium development goals number 4 and 5 by 2015.
STATISTICS OF IRAQ
| Total population (2016) | 37,203,000 |
| GNI per capita (PPP international) | 15,220 |
| Life expectancy at birth m/f (2016) | 68/72 |
| Probability of dying under five (per 1000 live births (2018) | 27 |
| Probability of dying between 15 and 60 years m/f (per 1 000 population, 2016) | 213/133 |
| Total expenditure on health per capita (Intl $, 2014) | 667 |
| Total expenditure on health as % of GDP (2014) | 5.5 |
SOCIO-ECONOMIC OVERVIEW
Iraq is in a fragile situation. It faces a difficult fiscal crunch, arising from the collapse in international oil prices coupled with persistent political and social turmoil. This situation is exacerbated by the rapid spread of COVID-19, which the country’s healthcare system has limited capacity and limited fiscal buffers to contain and manage.
In October 2019, young Iraqis took to the streets in mass protests to denounce rampant corruption, poor services, and high unemployment. These demonstrations exposed the fragility of the Iraqi socio-economic system. To appease demonstrators, the Government of Iraq (GOI) announced a stimulus package consisting of a considerable expansion in public sector employment, pensions, and transfers. This response was seen by some as ineffective, as boosting job creation, stimulating private sector participation, and enacting meaningful anti-corruption measures require longer-term structural reforms that did not feature in the package. Nevertheless, with record level oil production and agricultural yields, the expansion of electricity production, and fiscal loosening, overall GDP growth finished the year at 4.4%. Inflation remained subdued at an average of 0.2% in 2019. This was largely driven by cheaper imports from neighboring countries, prompting the GOI to raise tariffs and impose import bans on selected food items in response to calls from domestic producers.
The fiscal stimulus has reduced the 11.2% of GDP budget surplus in 2018 to 3% of GDP in 2019 and came at the expense of critical spending on both human capital and reconstruction. Indeed, although investment spending has slightly increased (by 5%), its execution rate has remained at only 45% of the amount budgeted. Most of the spending went to oil-related investments. Non-oil sector investment execution stood at a mere 18%, raising concerns over public service delivery, a rising infrastructure gap, and a stalled reconstruction program.
Going forward, the economic outlook for Iraq is challenging. The collapse in international oil prices and other unfavorable global conditions, including disruptions caused by the spread of COVID-19, are expected to hit Iraq hard, leading to a 5% contraction in its economy in 2020. In the absence of significant reforms to boost private sector participation, it will be difficult to jump-start the economy; growth is projected to gradually revert to its low-base potential of 1.9-2.7% in 2021–2022. The budget rigidities, compounded over the past two years, are expected to have detrimental fiscal effects amidst weaker oil-related revenues. At US$30 oil barrel and in the absence of planned consolidation measures, the budget deficit was projected to surge to a staggering 19% of GDP by end-2020. As a result, the GOI is expected to face a severe financing gap which could not only lead it to postpone vital infrastructure projects in service delivery sectors, as well as postponing human capital programs, but also reduces the country’s ability to respond to post-COVID-19 recovery needs.
In short, Iraq is expected to face a persistent current account deficit in 2020, driven as well by lower oil prices and sticky imports. The gap is expected to be financed by the Central Bank of Iraq’s reserves and State-Owned Banks, increasing the country’s vulnerability in the near-term.
HEALTHCARE SYSTEM IN IRAQ
Iraq’s healthcare system is classified as primary by the world health organization, which indicates it is based on practical, scientifically sound and socially acceptable methods and technologies made universally accessible to individuals and families in the community through their full participation in the spirit of self-reliance and self-determination.
The Iraqi healthcare system needs rebuilding since the invasion of 2003 and fall of the Saddam regime. According to the Multiple Indicator Cluster Surveys administered by UNICEF and the Iraqi government, the number of immunized children dropped from 60.7% in 2000 to 38.5% in 2006. It bounced back to 46.5% in 2011, but this number is still considerably lower than pre-invasion rates. According to the World Health Organization, in 2011 Iraq’s doctor to patient ratio was 7.8 to 10,000. This rate was exponentially lower than surrounding countries—Syria, Lebanon, Jordan and Palestine.
HEALTH INFRASTRUCTURE
Primary Health Care
- The number of primary health centers, headed by mid-level workers: 1146
- The number of primary health centers, headed by medical doctors: 1185
- There are 229 hospitals (general and specialized) including 61 teaching hospitals
- Deliveries taking place in a hospital/health center/private clinic: 65.1% (IFHS 2006/7)
Primary Health Care (PHC) is essential health care based on practical, scientifically sound, and socially acceptable methods and technologies made universally accessible to individuals and families in the community through their full participation in the spirit of self-reliance and self-determination.
The health care system in Iraq had been on a centralized, curative and hospital-oriented model. Such a system had lacked the capacity to deliver services that address the major health problems faced by the majority of the population in an equitable and sustainable manner. The current structure of PHC is not based on cost-effective interventions that would ensure maximum health gains for available resources. Neither is it capable of responding effectively and efficiently to the complex and growing health needs of the population.
The implementation of Basic Health Services Package (BHSP) will therefore address these issues and ensure the timely delivery of cost-effective, integrated and standardized health services tailored to meet the priority health issues faced by the majority of the population. The BHSP will ensure delivery of equitable and accessible health services through four layers of health facilities, starting from the community health house up to the district hospital level.
National Health Account
Currently, WHO is assisting MOH in the establishment and institutionalization of a National Health Account (NHA) to compile information on the country’s health expenditures and help in development of policies and health care financing systems and social insurance. WHO collaborative activities for establishment of NHA have trained staff and have developed the necessary tools.
Health Information System
Although there has been progress, the existing system is still not tuned to reflect the values of timeliness and completeness of reporting. The system has difficulties in providing comprehensive information for evidenced-based management. The lack of computerization makes data analysis and information flow slowly, though some progress has been achieved in some of the governorates eg. Missan, Basra. The current reporting system is from the PHC centers to the Directorate of Health at the governorate level, and to the related directorates at the central level in the Ministry of Health.
HEALTH EXPENDITURE
- Creation of the first national health account was started in 2010, and subsequently incorporated into the Iraq private sector modernization report.30 Earlier health financing data include the Iraq Household Socio-Economic Survey (IHSES) and WHO expenditure estimates.
- Iraq spent about 8·4% of its estimated gross domestic product (GDP) of $82·2 billion on health.
- External resources spent on health amounted to only 0·8% of GDP. The actual amount was estimated to be $247 (purchasing power parity $340) per person, a substantial increase from $118 in 2010. For 2014, 18·8% of health expenditure was estimated to be out-of-pocket.
- In the IHSES survey, 18% of the out-of-pocket expenditure went to Ministry of Health hospitals, 34% to doctors’ private clinics, 39% to pharmaceuticals, and 9% to transportation. Figures from the national health account show that whereas the bulk of government funding goes to provide clinical services the costs for pharmaceuticals takes 36·8% of the national health-care budget and administrative costs 2·3%. The growing private pharmacy sector now accounts for 28% of expenditure on drugs.
- Hospitals do not have the flexibility to manage their services effectively, because budgets and procurement procedures are handled centrally. The poor connections between the finance and planning directorates of the Ministry of Health create many of these difficulties.
IRAQ HEALTH INSURANCE
Currently 96.4% of Iraqi-s are without health insurance. There is no health insurance system to serve the public, and so they rely on the Iraqi central government-run public health care system, with little advocacy or diversity of treatment options.
CHALLENGES
The major challenges facing the health system in Iraq stem from the current political and security situation, which affects national stability and hinders the country from reaching the strategic goals required to implement UHC (universal health coverage). These challenges include:
- Ongoing technical problems in identifying and deploying the workforce required to overcome shortages in health labor.
- Internal as well as external brain drain (the majority being external) among professional health service providers affecting quality of performance and quality of services provided.
- Developing and improving the capacity, skills, and education of government leadership as well as health professionals (especially in nursing and allied health) to meet the needs of a population in which the annual growth rate (3.5 percent) and total fertility rate (4.3 percent) are both high Facing a competitive (rather than integrated, coordinated, and innovative) relationship between the Ministry of Health and other partners and stakeholders.
- Adverse effects of both high youth unemployment and child labor, though no accurate statistics are provided yet.
- Escalating numbers of internally displaced persons (around 350,000 in the Kurdistan Regional Government.
- Previous health strategies that focused more on clinical services rather than public health problems like the increase in morbidity and mortality of non-communicable diseases, which affected the accessibility and equity of health services provided, especially for hard-to-reach areas.
- Health care financing and elucidating the financial role of the private sector.
BURDEN OF DISEASES
The above figure explains the percentage of total deaths caused by various diseases in Iraq. Most of the deaths have occurred due to coronary heart disease that is 40% (total deaths 32,582 per100,000 populations). Least number of deaths has occurred due to hypertension that is 2% (total deaths 1,993 per 100,000 populations).
OPPORTUNITIES FOR INVESTMENT
The top concern among most governorates in Iraq is the increasing rise of cancer rates. The number one priority of service provision was oncology centers. The need for these oncology treatment centers is great as increasingly diagnosed patients are having to seek treatment outside Iraq—in more developed countries with stronger healthcare systems, such as Dubai, Lebanon, or the United States.
Patients pay a high price for travel expenses and for healthcare outside Iraq, but they are willing to do so because the treatment in these regions is of much more quality than what is offered in Iraq.
KEY PLAYERS IN IRAQ HEALTHCARE SYSTEM
The World Health Organization supports the Government and health authorities at central and local level in strengthening health services, addressing public health issues and supporting and promoting research for health. Other key players include USAID, United Nations agencies, such as UNDP, other humanitarian organizations as well as development partners.
MAJOR HOSPITALS IN IRAQ
PAR Private Hospital:
PAR hospital is prepared to be a center of excellence dedicated to provision of the highest quality clinical care to patients in Erbil and lraq. Our medical staff, over 50 consultant physicians and surgeons, together with our outstanding nursing staff and all the other healthcare professions at Par Hospital makes it their mission to improve the health and wellbeing of patients and communities
Faruk medical city:
The hospital is 50 bedded hospital and has 73 doctors, 7 departments, 7 surgery rooms.
Almoosawi Private Hospital:
Almoosawi Private Hospital is recognized as:
- The first hospital that introduced correction of vision by laser technique in Iraq.
- The first hospital that used scopes in neurosurgeries in Iraq.
- The first hospital that continuously use the up to date surgical techniques in Iraq.
Services offered:
- Lacroscopy
- Gastrointestinal endoscopy
- Orthopedics
- Neurosurgeries
- Ophthalmology
- Obstetrics and gynecology
- Cardiology
Azadi teaching hospital:
Azadi teaching hospitals the largest national hospital in Duhok province it has been built in(1984),the hospital has 8 floors and several accessories around with the capacity of 480 beds it provide a wide range of services for more than two million people in Duhok and around Ninava province. The hospital also consists of 19 departments within their units.
Heevi teaching hospital:
Hospital Departments included in Hospital
- General pediatrics.
- Pediatric surgery.
- Laboratory department.
Area of the Hospital Outpatient clinic = 265 meter square.
Hospital building = 1410 meter square.
The number of population depending on this hospital for pediatric services = 1 million persons. The number of employed people in the hospital = 206 employer. The average daily number of patients visiting hospital = 110 patients. The services introduced by the hospital:
- Medical services
- Treatment of pediatrics diseases.
- Pediatric surgical treatment.
MAJOR DIAGNOSTIC CENTERS IN IRAQ
- Medya Diagnostic Center
- Lokman Hekim Diagnostic Center
- Dr. Dlovan Khoushnow Clinic
- Saaeda
CONCLUSION
Decades of sanctions and war have seriously compromised a once proud and functional health system. It now struggles to rebuild itself, having adequate financial resources, but with a shortage of skills and strategies. Although the fragmented health policy seems to emphasize further development of a health system based on the family health-care model, resources are heavily directed toward expansion of secondary and tertiary health-care facilities. Human resource development fails to link needs, strategic plans, and training programmes together. As the public sector loses its monopoly on the employment of doctors, major changes loom in the health system, for which there are as yet no policies. Missing from the discussions of strategic planning is a solid evidence base on which to build policy. Additionally, the continuing sectarian insecurity in Iraq makes even the best plans difficult to implement.
It is the superficial and macro level study for more details kindly contact Hospaccx Healthcare business consulting Pvt. ltd on Hospaccx.India@gmail.com or you can visit our website hospaccxconsulting.com
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