View
217
Download
0
Category
Tags:
Preview:
Citation preview
WHO Collaborating Centre
Imperial College London
Iraq Health SystemCurrent & Future Challenges
Salman Rawaf MD PhD FRCP FFPH
Professor of Public Health
s.rawaf@imperial.ac.uk
© WHO C Centre, Imperial College London
Professor S Rawaf
Contents:
1. Achievements since 20032. Current Challenges 3. Way forwards 4. Learning from Experience 5. The Future
© WHO C Centre, Imperial College London
Professor S Rawaf
Iraq: Economic Indicators
Some data are estimates
23% of the population still live below poverty line 16% of population do not have access to clean water 36% of pop only have access to sanitation 78% of pop are ‘functionally’ literate
© WHO C Centre, Imperial College London
Professor S Rawaf
Current & Future Challenges facing HS in Iraq
Health System Performance
1
Substantial Improvements since 2003 Improved Finance Improved Manpower
The Gap still wideIncreased Public expectations
? Quality
© WHO C Centre, Imperial College London
Professor S Rawaf
Under 5 Mortality Rate /1000 live birth
2010 41/1000 live birth2015 (Target) 17/1000 live birth
© WHO C Centre, Imperial College London
Professor S Rawaf
Proportion of births attended by skilled health personnel
Excellent progress 50% in 1990 to >85% by 2010
8
Comparison of health outcomes in EMR countries
– 2010Countries Population
(000)Population growth rate (%)
TFR LE at birth
(years)
U5 MR MMR Per cap THE (in US$)
Jordan 6,113 2.2 3.8 73.0 28.0 19.1 357.4
Lebanon
4,189 1.8 1.9 81.5 18.3 23 651.0
Syria 20,619 2.5 3.5 73.1 21.4 58.0 96.6
Egypt 78,728 2.4 3.0 73.2 21.3 54.0 123.2
Iran 74,733 1.5 2.0 72.1 20.0 30.0 316.9
Iraq 32,326 3.4 4.3 71.0 39.0 84.0 246.8
Trend in Demographic Indicators
Indicator YEAR2005 2006 2007 200
82009
2010
Crude Birth Rate
37.4 32.9 34 37 38 40
Crude Death Rate
5.2 7.7 5 5 4 4
Pop Growth Rate
3.2 2.5 3 3 3.4 3.4
© WHO C Centre, Imperial College London
Professor S Rawaf
Current & Future Challenges facing HS in Iraq
National Constitutions1 Leadership and Governance
2
Strategic vision Projections based on population needs Command & Control Managing Performance Managing People
Untrained leaders at all level Politics and Leaders in Health
© WHO C Centre, Imperial College London
Professor S Rawaf
Legislature, Regulators, Executive
National Local
© WHO C Centre, Imperial College London
Professor S Rawaf
Current & Future Challenges facing HS in Iraq
National Constitutions1 Socio-economic Development
2 Laws & Regulations3
Lack of Independent Professional Regulations Lack of Providers Regulations Blurred Public and Private Practice Dated Public Health Laws Unclear Rights to Health
Control professional behaviours
(Clinical Governance)Medical and Research EthicConstitutional Rights
© WHO C Centre, Imperial College London
Professor S Rawaf
Current & Future Challenges facing HS in Iraq
National Constitutions1 Socio-economic Development
2 Health Systems3 Health System Organisation
4
Hospital-led, Disease-model Weak Primary Care Weak link between Health & Social Care Not person-centred Profit before health Little or no consumer protections
© WHO C Centre, Imperial College London
Professor S Rawaf
50-60m Contacts with
the Health System
1/3PRIMARY CARE
2/3HOSPITAL CARE
FP
HOSPITAL
1 2 3
Cost: 10% + 11% 45% Acute, 20% MH +Contacts: 85% - 90% 10-15%
NHS Direct
100%Registration
10% 10%
© WHO C Centre, Imperial College London
Professor S Rawaf
40%Healthy
40%Healthy
With Risk Factor(s)
10% Acute Illness
10% Disability
Rawaf’s Model for Burden of Disease - 2001
In Any Given Population
© WHO C Centre, Imperial College London
© WHO C Centre, Imperial College London
Professor S Rawaf
Current & Future Challenges facing HS in Iraq
National Constitutions1 Socio-economic Development
2 Health Systems3 Public Health Laws 4 Health System Finance 5
% of GDP allocated to health Public vs Private Financial Protection / OOP Payment To ensure or not to ensure
© WHO C Centre, Imperial College London Source: WHO, 2013 IPSM 2009
Professor S Rawaf
Iraq National Health Account 2011
4.6% of GDP on Health (2010) Health Budget:
80.5% Public18.7% Private (25.6% in 2008) ???
0.8% Donors 36.8 of H Budget spent on Pharmaceuticals 22.3% on Administration
Budgetary (Resource Allocation) is historical and NOT LINKED to Health Needs
In 2010, per capita THE (weighted average) in:
EMR = US$183
In Group 3 countries < US$ 40In Group 2 countries ≈ US$220In Group 1 countries > US$ 850
Source: WHO EMRO
The share of out-of-pocket spending is high in many countries of the Region, 2010
PA
L
Source: WHO EMRO
© WHO C Centre, Imperial College London
Professor S Rawaf
Current & Future Challenges facing HS in Iraq
National Constitutions1 Socio-economic Development
2 Health Systems3 Public Health Laws 4 Privatisation (Market capitalism)5 Human Resources for Health
6
number needed competencies Skill mix Training capacities / conflict (MoH/MoHER)
© WHO C Centre, Imperial College London
Professor S Rawaf
57,600
24,800
2,240
>500
Medical Schools (22)
In migration
?150
© WHO C Centre, Imperial College London
7300
57K
200
2450
1000
CompetentHR Needed(Physicians)
2400 1400
CCST
1400
10001000
All specialties
Family Medicine
<850
<100
>2,450 ……………………………………………………………………………………..<950
3500Yearly
2,100
57K
1,400
850
950
100
Current Supply
CurrentSpecialists
© WHO C Centre, Imperial College London
Professor S Rawaf
57,600
24,800
2,240
?100-500
Medical Schools (22)
In migration
?150
Gap:32,800
At current rateof Supply we need (MBChB):13 Years
All Specialists:25 Years
Family Physicians:230 years
© WHO C Centre, Imperial College London
Professor S Rawaf
HRH (Dr) Shortages:
Medical School Graduate: Supply 2,450 (needed 3,500) = [-1,050]
Family Medicine: Supply 100 (needed 1,400) = [-1,300]
Iraq needs 23,000 Family Physicians At this rate of production:230 years!!!
12345
F1F2
123
2345
1
A-level University
University(Medical School)
FoundationSchool (Virtual)
Med/Surg/PH/Diag General Practice
PMET Board +R. Colleges(Standards)
GMC
CST Principle GP Consultant
© WHO Centre, Imperial College London
Professor S Rawaf
3 Education & Training
© WHO C Centre, Imperial College London
Professor S Rawaf
Current & Future Challenges facing HS in Iraq
National Constitutions1 Socio-economic Development
2 Health Systems3 Public Health Laws 4 Privatisation (Market capitalism)5 Human Resources for Health
6
NCD Psychological Trauma War consequences System Adaptation
6 Burden of Disease
Burden of Noncommunicable DiseasesPer 1000 Population/2009 Data
Total Male Female
Hypertension 41.8 34.4 48.8
Diabetes 21 21.6 22.1
Joint Diseases 18.6 13.1 24.1
Heart Diseases 12.0 11.1 12.9
Gastro Intestinal Diseases
11.2 12.6 9.7
Asthma 8.3 8.8 7.7
Urinary Tract Diseases 7.4 7.2 7.5
Chronic Respiratory Diseases
5.2 6.3 4.0
Chronic Back Pain 4.9 4.3 5.5
Anaemia 3.7 1.9 5.5
Persistent Headaches 3.2 2.3 4.1
Chronic Skin Problems 2.9 3.6 2.2
© WHO C Centre, Imperial College London
Professor S Rawaf
Current & Future Challenges facing HS in Iraq
National Constitutions1 Socio-economic Development
2 Health Systems3 Public Health Laws 4 Privatisation (Market capitalism)5 The Arab Spring67
Electronic records Digital Technology connecting system
8 The Arab SpringInformation / digital Technology
© WHO C Centre, Imperial College London
Professor S Rawaf
Strengthen the Legislative and Executive Links: N/L
New modern Laws Public Health Law (regulations) Strengthen Parliamentary Monitoring Protect Patients and Public Institutional and Individual Accountability
© WHO C Centre, Imperial College London
Professor S Rawaf
Strengthen the Legislative and Executive Links: N/L Review MoH & Governorates Structures & Functions FfP
Current structure & functions do not FfP Move key players from politics
(Undersecretaries & below) Competent and well trained leadership
© WHO C Centre, Imperial College London
Professor S Rawaf
Strengthen the Legislative and Executive Links: N/L Review MoH & Governorate Structures & Functions FfP Strengthen Health System (PHC & PH)
Strong Health System
Primary Care Hospital Care
Public Health
© WHO Collaborating Centre, London
Professor S Rawaf
Developing Family Medicine
EquitableCommunity-basedInfrastructure
EquitableCommunity-basedInfrastructure
Strong Postgraduate Training
Strong Postgraduate Training
Solid UndergraduateLearning
Solid UndergraduateLearning
© WHO Centre, Imperial College London
Professor S Rawaf
1
2
New Entrance:Introduce A structured Training ProgramFamily Medicine 3-5 Years .. I/A BoardsCurrent PHC DoctorsOne Year on-the-Job Training Program Postgraduate Diploma in Family Medicine
© WHO C Centre, Imperial College London
Professor S Rawaf
Strengthen the Legislative and Executive Links: N/L Review MoH & Governorate Structures & Functions FfP Strengthen Health System (PHC & PH)
HRH: Bridging The Gaps
Clear Strategic Directions International Recruitments Effective use of current HR Regulate Private Practice - Only fully accredited specialists - No more than 10% of public Contract
© WHO C Centre, Imperial College London
Professor S Rawaf
Strengthen the Legislative and Executive Links: N/L Review MoH & Governorate Structures & Functions FfP Strengthen Health System (PHC & PH)
HRH: Bridging The Gaps
Strengthen Public Institutions (Regulations)
Independent Professional Regulators Providers Regulatory Body [Standards settings and Monitoring] Supporting Laws and Enforcements Governance (including Clinical Governance)
© WHO C Centre, Imperial College London
Professor S Rawaf
Strengthen the Legislative and Executive Links: N/L Review MoH & Governorate Structures & Functions FfP Strengthen Health System (PHC & PH)
HRH: Bridging The Gaps
Strengthen Public Institutions (Regulations)
Leadership for Health
All policy & decision-makers must be trained in
LeadershipAll must be assessed for their competenciesAnnual Appraisals including CPD and PDP
© WHO C Centre, Imperial College London
Professor S Rawaf
Service Provision
Universal Coverage Free at time of Delivery (Pre-Payments?) Person-centred care Integrated of Health and Social Care Competent Practitioners Safe and Quality Service
The Future?
Iraq is resource rich country
Look forward (not backward)
Invest in human being and infrastructures
Strengthen Institutions
The future will be bright
Recommended