Health in Iraq - who.int

1 Health in IraqThe Current Situation,Our Vision for the Future and Areas of WorkAla'din Alwan, MD, FRCP, FFPHM inister of HealthMinistry of HealthSecond Edition, December 2004 Health in IraqTable of ContentsPrefaceAbbreviationsExecutive SummaryChapter Features of the Current Health SituationPage 3 Page 5 Page 7 Page Demographic and Socio-Economic TrendsPage Health StatusPage Nutritional StatusPage Reproductive HealthPage Environmental HealthPage 46 DemographySocio-Economic StatusEducationMortality TrendsMorbidity DataCommunicable DiseasesChronic Noncommunicable DiseasesCardiovascular DiseasesDiabetesCancerMental DisordersInjuriesDisabilities1 Health in SystemChapter Issues and Main ChallengesChapter Vision and Strategies for

2 The Immediate FuturePage Management of the Health SectorPage Primary CarePage Secondary and Tertiary CarePage A Brief Assessment of InfrastructurePage Health Care UtilizationPage Health Care QualityPage People's Views on HealthPage Human Resources for HealthPage PharmaceuticalsPage Health Care FinancingPage 65 Page ChallengesPage Response to ChallengesPage 71 Page 732 Health in IraqPrefaceUntil two decades ago, the main indicators of the Health status of theIraqi people were improving substantially and Health care services wereachieving high standards. However, the regime which ruled iraq duringthe last three decades did not consider Health a priority; the healthsystem, therefore, suffered from progressive neglect and budgetaryallocations did not reflect population needs.

3 As a result, Health indicatorsfell to levels comparable to some of the least developed countries. Highlycompetent and experienced professionals left the country and seriousgaps developed in the provision of Health services. The decline wasexacerbated by major wars, disastrous military adventures, and politicaland economic country currently faces enormous Health challenges. Thisdocument describes one of the initial steps in our mission to addressthese challenges and rebuild the Health system. It provides a briefdescription of the Health situation and assesses current trends; it alsoestablishes a baseline for rehabilitation efforts, identifies the keypriorities for reconstruction, and offers strategies and a rationale forimmediate views and strategies outlined in this document are based on theanalysis of the current situation in iraq and discussions with a largenumber of Ministry of Health officials and staff as well as members ofthe Advisory Committees who represent the leaders of the healthprofessions in iraq .

4 The proposed short- and medium-term strategieswere also discussed with partners, including UN agencies, the WorldBank, and major donors in a seminar organised in Amman, Jordan in July2004. The situation analysis and strategies were subsequently subjectedto extensive discussion, during the National Conference on the CurrentHealth Situation and Future Strategies organised by the Ministry ofHealth from 30-31 August 2004. The conclusions and recommendationsof the National Conference, which was inaugurated by the PrimeMinister, were discussed again and finalised in a meeting organised on16 September 2004 and attended by key MOH officials in Baghdad andthe governorates as well as a large number of experts in public Health andclinical in IraqMore than 450 participants attended the National Conference and Iam grateful to the many colleagues, from the Health profession and othersectors.

5 Who provided valuable input and important contributions duringthe plenary and working groups' sessions of the also wish to express my appreciation to the persons who assisted meduring the preparation of the document. Drs Osama Abdul Azeez andMohamed Jabor were very helpful in providing available data on severalhealth programmes and updated reports from the Directorate of PublicHealth and other departments of the Ministry of Health . Mr AnthonyLaurence, Dr Hadi Al Taie and Mrs Nidhal Al Kadhim helped me in thefinal production of the 'din AlwanMinister of Health4 Health in IraqList of AbbreviationsACAIArab Company for Antibiotics IndustriesACEA ngiotensin-Converting EnzymeAIDSA cquired Immune Deficiency SyndromeARIA cute Respiratory InfectionsBCGB acillus Calmette GuerinBMIBody Mass IndexCDCC entre for Disease ControlCHDC oronary Heart DiseaseCSOC entral Statistical OrganisationCVDC ardiovascular DiseasesDOTSD irect Observation Short Therapy for TuberculosisDPTD iphtheria, Pertussis.

6 TetanusECGE lectrocardiographyESCWAE conomic and Social Commission for Western AsiaFAOFood and Agriculture OrganizationGCHSGulf Child Health SurveyGDPG ross Domestic ProductHAVH epatitis A virusHBsAGHepatitis B Surface AntigenHIVH uman Immunodeficient virusIHSSIraq Health System StrengtheningIMIRAIraq Multiple Indicator Rapid AssessmentIMRI nfant Mortality RateIRII nternational Republican InstituteISTI nternational Study TeamLBWLow Birth WeightMCHM aternal and Child HealthMICSM ultiple Indicator Cluster SurveyMMRM umps, Measles, Rubella5 Health in IraqMOHM inistry of HealthMOPDCM inistry of Planning and Development CorporationNBSDN ational Board for the Selection of DrugsNPHN eutral Protamine of HagedornOFFPOil for Food programmeOGTTOral Glucose Tolerance TestOPVOral Polio vaccinePHCP rimary Health CareQCQuality ControlRTARoad Traffic AccidentsSDIS amara Drug IndustriesSTDS exually Transmitted diseasesU-5 MUnder 5 MortalityUNDGU nited Nations Development GroupUNDPU nited Nations Development ProgrammeUNHDRU nited Nations Human Development ReportUNICEFU nited Nations Children's Emergency FundVPDV accine Preventable

7 DiseaseWHOW orld Health Organization6 Health in Iraq7 Executive SummaryHealth StatusHealth development is a pre-requisite for the sustainabledevelopment of iraq and an essential component of the task ofreconstruction. This document charts the disastrous decline in the healthof the population and in the standards of Health services over twodecades. It describes the challenges now facing the country in improvinghealth and rebuilding its Health services and it identifies priorities forinvestment and development over the next few population of iraq has more than doubled in the last 25 years.

8 Itnow stands at million and is growing at about 3% a year. The healthof the population was steadily improving between 1960 and this period, infant mortality fell by about two-thirds (from 117 to40 deaths per 1000 births) and child mortality fell by 70% (from 171 to50 deaths per 1000 births).But since about 1990, there has been a disastrous decline in peoples' Health . At a time when children's Health was improving in the vastmajority of countries, infant, child and maternal mortality rates in Iraqmore than doubled. Adult mortality increased and life expectancy fell - tounder 60 years for men and women by is currently rated by WHO as a country with high adult and childmortality alongside much poorer countries like Afghanistan, Djibouti,Sudan and number of different factors have contributed to this decline.

9 TheyincludeA sharp rise in poverty ( 11% of households, about million people,were extremely poor and food insecure while 25% of households weredependant on food rations according to a survey by the World FoodProgramme in 2003)Poor sanitation and water supplies (access to safe drinking water waslower than 40% in some areas; about two thirds of households are notconnected to functioning sewage nutrition (one in five children were underweight in 2000 and one!!! Health in Iraq8in three were chronically malnourished).A decline in educational enrolment and life styles-high levels of smoking, unhealthy diet, lack numbers of injuries and deaths from road traffic accidents of preventive Health serious decline in the accessibility and quality of Health servicesIraq currently suffers from a double burden of disease.)

10 Non-communicable diseases like cancer and cardiovascular disease are theleading causes of death but infectious diseases remain major causes ofmorbidity and mortality. Diarrhoeal diseases, acute respiratoryinfections (ARI), measles, mumps, typhoid and leishmaniasis havesubstantially increased since 1990 and are still leading conditionsreported from Health facilities and the main cause of morbidity andmortality in children:ARI and diarrhoea account for 70% of deaths among children. Eachchild suffers an average of 8 episodes of ARI a year and 6 episodes ofdiarrhoea.