1

2

• Iraq before 1990

• Trends in the Health Situation

• Observation and Implementation Activities.

The Contents in Brief

3

» A comprehensive health infrastructure.

• Wide access to Primary health care.

• Adequate referral support.

• Sufficient well-trained and skilled staff.

» Iraqi population enjoyed the benefits of one of the best health care systems in the Middle East .

» Heath indicators reflected health of Iraqi population comparable to middle income countries.

Health infrastructure ,Iraq, 1989

4

» Deterioration of socio-economic infrastructure.» Poor functioning of water treatment plants.» Potable water production fell by 40% (between 1990-1996)» Deterioration of environmental conditions» Deterioration of education system» Non-availability of essential drugs, medical supplies and

equipment.» Deterioration of physical infrastructure.» Poor conditions of communication, transport and logistics (cold

chain and ambulance services).» Poverty.» Malnutrition.» Re-emerging/high incidence of previously controlled diseases

(Cholera, Polio, Tuberculosis, Malaria, etc)

Iraq After 1990

5

1.39

1.921.86

1.97

1.82

2.03

1.88

1.99

1.61

1.2

1.3

1.4

1.5

1.6

1.7

1.8

1.9

2

2.1

2.2

1990 1994 1995 1996 1997 1998 1999 2000 2001

Mil

lio

ns

ARI cases in under 5 Iraqi children

* Data Source : WHO/RA Report

6

32.003

171.354

157.147

152.932

152.762121.343

94.272

110.74

105.418

0

20

40

60

80

100

120

140

160

180

1990 1994 1995 1996 1997 1998 1999 2000 2001

Th

ou

san

ds

Pneumonia cases in under 5Iraqi children

* Data Source : WHO/RA Report

7

882.375

1087.258

884.862

1002.549

976.526

1065.154

1046.022998.403

963.42

800

1000

1200

1990 1994 1995 1996 1997 1998 1999 2000 2001

Th

ou

san

ds

Diarrhea cases in under 5 Iraqi children

* Data Source : WHO/RA Report

8

4753

12355

19581

29897

25251

29410

26607

29196

2688219005

1352714735

14315

13394

0

5000

10000

15000

20000

25000

30000

35000

YR87 YR88 YR89 YR90 YR91 YR92 YR93 YR94 YR95 YR96 YR97 YR98 YR99 YR00

* Data Source : WHO/RA Report

SanctiSanctionsons

SanctioSanctionsns

withwith SCRSCR

BeforeBeforeSanctioSanctio

ns ns

Tuberculosis Cases in Iraq (1987-2000)

9

203

10678

4169

10

56

186

120

29

76

4 0

31

7553

32

200

50

100

150

200

250

years

PO

LIO

CA

SE

SPoliomyelitis Cases and Linear

Trend Iraq (1984-2001)

* Data Source : MOH/WHO

10* Data Source : Ministry of Health

Month

ly A

vera

ge

Rate

15125

6111

8668

5004

4442

4357

4679

5202

5477

6507

0

2000

4000

6000

8000

10000

12000

14000

16000

YR89 YR90 YR91 YR92 YR93 YR94 YR97 YR99 YR00 YR01

Major Surgical Operations

(1989 – 2001)

11

70.8

62.6

59.5

57.9

58.7

67.2

66.9

67

0

10

20

30

40

50

60

70

80

1990 1994 1995 1996 1997 1998 2000 2001

YEARS

RA

TE

PE

R

10

00 P

OP.

* Data Source : Ministry of Health

Hospital Admissions (1990-2001)

12* Data Source : Ministry of Health

1,494,0501,494,050

635,446

501,095

499,579

498,989

515,506

561.763 623,775

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

Y 89 Y 91 Y 95 Y 97 Y 98 Y 99 Y 00

Monthly Average of Laboratory Investigations, 1989-2001

Laboratory Investigations in Iraq

(1989-2001)

Avera

ge M

on

thly

No.

of

Invest

igati

on

s

Y 01

13

Main Observation Tasks

• Confirm arrival and distribution to health facilities • Observe items of special interest/concern to the

Committee (End-use/user observation) • Assess adequacy, efficiency and equity• Assess impact of Programme inputs on the

health status of the population

14

Observation Tasks -continued

• Items of high value.• Items of high utility.• Monitor availability of essential items (basic

drugs and supplies).• Whether goods are used for intended purposes.

15

»Priority to end use and end user observation

»A total of 1,982 end use and end user observations completed since June 2001

»End use and end user observations have improved inter- disciplinary /inter sectoral collaboration

Health Sectoral Working Group

(HESWG)

16

Tracking Observation Activities (Countrywide)

4,239 4,039 4,5535,655 5,600

1,016

25,102

0

5,000

10,000

15,000

20,000

25,000

30,000

97 98 99 00 01 Jan/Feb02

TOTAL

TOTAL NO. OF VISITS

17

»A total of 24 competent and qualified observers-12 from WHO and 12 from UNOHCI-representing Pharmacy, Biomedical Engineering, Public Health, Medicine, Management, Electrical Engineering, Bio-Chemistry and Nursing disciplines.

»Qualifications of observers are :

»Ph.D. (6 observers)

»Post-Graduate Studies (11 observers)

»Bachelor of Science (7 observers)

»A total of over 25,000 observation visits for tracking have been completed. (as of Feb. 2002).

 

Capacity of sector observation

18

3,147 3,051

2,434

2,251

459

1,687

1,285

0

500

1000

1500

2000

2500

3000

3500

US

$ M

illio

ns

Allocated Submitted Approved Funded Holds/InactiveHolds

Arrived Distributed

SCR 986 Programme Implementation Status as at 28 February 2002: Health Sector

Source: Oil for Food database / WHO Databases

Programme Implementation

19

Stock Report as of

February 28, 2002

Value in US $ Total

Arrived1,621,795,279 100.00%

Distributed1,285,114,231 79.24%

1- Stock awaiting distribution ( working stock ) 31,920,477 1.97%

2- Undistributed Stock : 140,375,945 8.66%

(a) Under quality control 116,943,278 7.21%

(b) Failed quality control / defective 15,262,752 0.94%

(c) Lacking complementary items / lacking spares or installation capacity 8,169,915 0.50%

3- Buffer stock 164,384,625 10.14% *Total Stock in the Warehouse 336,681,047

 

* Accepted standard should cover 3 months (25%)

20

Achievements of the Programme

• Availability of basic medicines and medical supplies, with a wide range .

• Some laboratory reagents are available though many critical ones are on hold.

• Improvement of production capacity of the Samara Drugs Industry.

21

Achievements of the Programme

• Increased efficiency in drug handling and distribution

• The range and quality of medical diagnostics improved and expanded.

• Declining trends in the incidence of common communicable diseases and stabilization of some others.

22

0

100

200

300

400

500

600

* Since October 2001, includes Inactive Holds

US

$ M

illi

on

s

Source: Oil for Food Database

Holds in the Health Sector Over the Last 2 Years

ITEMS ON HOLD

23

Summary of Hold Categories in the Health Sector as at 11 March 2002

(Percentage based on total value of US$ 446.3 million)

Transport Vehicles13%

Radiology and Imaging Equipment

21%

Hospital Systems Wquipment & Utilities

and Spare Parts21%

SDI Equipment & Materials, ACAI and

Medical Oxygen Plants22%

Environmental sanitation/Control

equipment and Supplies7%

Additional Biomedical Equipment and Supplies

7%

Laboratory Equipment and Supplies

6%

Dental Equipment and Supplies

2%

Communication and Data management Systems

0%

Drugs/Immunological Agents

1%

Source: Oil for Food Database

24

• Value : US$. 446.3 Million• No. of Contracts : 208Examples:

• Drugs including 13 pre-anesthetic medications.• Laboratory equipment (e.g. Spectrophotometers);

Laboratory reagents and Diagnostics Kits.• Blood bank refrigerators.• Raw materials, machinery and spare parts for

local drug production.

On Hold Items (As of 11 March 2002)

59% Account

25

Statistics on reasons for Hold (As at 04 March 2002)

Add. Info. yet to be Provided

11%

WMD "dual use"26%

Add. Info. Provided but still

on hold41%

1051 List (Secr.+Hold M)

8%

1051 list "disagreements"

6%

1051 list "Legacy comms)

4%

Others2%

Further Eval / consideration

2%

26

a) Intermittent disruption of essential medical services (Preventive/Curative).

b) Reduced local drug production capacity and consequently decrease public health access to medicines.

c) Reduced performance in Health Care delivery services.

d) Reduced ability of public health investigations (e.g. Epidemic Cholera, Typhoid, and other infections)

e) Render the safety and performance of surgical operations unpredictable and questionable.

f) Put chronic patients in severe trouble.

Impact of Holds

27

WHO’s Program in the Three Northern Governorates

• WHO is responsible for implementation of the Programme.

• Beginning with a supply-driven operation in 1997, WHO has moved towards sustainable health rehabilitation and capacity building since 1999.

• Four major components are:– Health Repairs (Medicines, Equipment and Building

Repair)– Public Health Programs– Medical and Nursing Education– Water Quality Monitoring and Laboratories

28

Programme Planning

• Developed 2-year (2002-2003) program framework with detailed activity plan.

• A list of 23 discrete programs is ready for implementation. Notable ones are Health System Development, Human Resource Development, Disease Eradication and Elimination, Integrated Management of Childhood Illness, and others.

29

• Established health information system and completed health facility profiles.

• Completed 124 rehabilitation projects (hospitals, nursing schools, workshops, warehouses, laboratories and provision).

• 10 new water quality control laboratories.• Drug supply system re-established in terms of management,

storage and distribution.• 90% increase in access to essential drugs and 80% to medical

supplies.• Significant improvement in medical diagnostic and therapeutic

service.• Completed 55 training courses on various medical equipment.

Main Achievements

30

• Disease Surveillance and Control has achieved zero cholera since 2000, no reported polio cases as well.

• Successful anti-malaria spraying operations reduced malaria incidence to 1991 level.

Main Achievements

Source: TB center/ DOH/ Suleimanyah

6969

27202

10617

31 262

9079

255718714187282649

Pul. TB cases in Sul. Malaria cases in Sul.

Main Achievements

32

1901

0 00

200

400

600

800

1000

1200

1400

1600

1800

2000

1999 2000 2001

Trend of Cholera in Sul.

266334

326060

228847 224975

0

50000

100000

150000

200000

250000

300000

350000

1998 1999 2000 2001

Incidence of Diarrheal Disease in Sul.

Main Achievements

33

Commodity (Millions USD)

Medicines &

Supplies

Health Repairs,

Nursing & Epidem.

Surveillance

Water Quality

Control

Higher

Education

Arrivals 91.7

62.6

1.1

8.3

Distribution 74.5 56.3 1.1

8.3

Per Dist. %

81.26 90 100 100

Implementation in the

northern governorates, as of 30-Nov.-2001

34

• Nature of the humanitarian programme.

• Complex procurement process.

• Holds.

• Lack of cash component for south/centre.

• Erratic and incomplete arrivals.

• Lack of commercial protection for the Government of Iraq.

Constraints

35

Constraints

402

1250

565

371

51

657

262

127

697

302218

1,242

476435

3,563

1,536

435

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

VALUE

US$ MILLIONS

1997 1998 1999 2000 2001 TOTALS

YEAR

IMPLEMENTATION RATE : CONCLUDED CONTRACTS vs ARRIVALS 1997-2001

CONCLUDED CONTRACTSARRIVEDCUMULATIVE ON HOLD

Implementation Rate = 43.21%

36

»Some improvements in health status. Amelioration of water, sanitation and nutrition would make a significant impact on public health.

»Improving the health situation requires a needs based approach instead of the current supply driven operation .

»Population health needs a multi-sectoral approach.

Conclusions

37

Recommendations

• We strongly urge the 661 Committee to consider the release of all holds in the health sector, particularly those 15 priority contracts, submitted by Health Sector in Iraq and recently highlighted by the ED/OIP, as an effective observation mechanism is in place.

38

Thank you for your attention