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Report on Iraqs PHC System Identifies Resource Gaps, Lack of Services for Needy Population
A report released by URC's USAID-funded Primary Health Care Project in Iraq provides a comprehensive view of the state of the Iraqi health care system. Based on surveys of more than 800 people in nine provinces, the report reveals a health system struggling to provide services with limited resources and a population facing a high burden of both communicable and noncommunicable diseases (such as diabetes, heart disease, and cancer). For instance, one in ten Iraqis aged 25 to 65 have diabetes, and about four in ten have hypertension; pneumonia, diarrhea, and other diseases contribute to many deaths in children under five.
The USAID Primary Health Care Project in Iraq (PHCPI) is partnering with the Iraqi Ministry of Health (MoH) to strengthen the delivery of quality primary health care (PHC) services throughout Iraq. This report serves as a first, baseline assessment of the health system; PHCPI is working with national, provincial, and local counterparts to address critical gaps revealed in the report.
The report provides rich detail on barriers to quality primary health care gleaned through interviews and focus group discussions with stakeholders at all four levels of the health system: national, district, hospital/health facility, and community. The report also incorporates available documents, including health databases, survey reports, and facility records as well as observation of more than 70 health clinics. The PHC clinics, private clinics, and hospitals surveyed provide services to more than 21 million Iraqis, about two-thirds of the population.
Lack of resources: Nearly all respondents at the district level identified lack of resources as a significant barrier to achieving PHC goals, with human resources (91%) cited most frequently, followed by financial resources (73%) and community support (64%) (see Figure 1).
Lack of medicines and medical supplies: Nearly 70% of PHC clinics interviewed reported a need for medicines, and half reported a need for medical supplies. These included a lack of medicines for hypertension (44% of clinics); diabetes (56%); and supplies for maternal, newborn, and child health care (77%).
Lack of data: While statistical data and health reports are generally available, there was a lack of data and information related to maternal health; HIV/AIDS; and cancer, particularly breast and cervical cancer.
Need for services: The need for services for mental health, chronic and noncommunicable diseases, and maternal and newborn health is growing. For example, skilled personnel attended about seven in ten births, yet only half of pregnant women received full antenatal care services and less than half of mothers and newborns visited a doctor's office for postnatal care.
Need for higher quality care: While the majority of those surveyed in provinces reported the presence of guidelines, standards, and protocols, less than half of clinicians reported the existence of regulations to ensure quality performance.
To address these critical gaps, PHCPI is partnering with the Iraqi MoH to focus on three priority areas:
1. Strengthening Management Systems
Highly functional management systems are critical to ensure accessible, efficient, and quality health services. To improve primary health care management systems, the project will 1) establish, mobilize, and manage health care teams responsible for the development of quality management systems and operational guidelines and 2) improve facility management and logistics systems to ensure an uninterrupted supply of drugs and medical commodities.
2. Improving Care Quality
To ensure the availability and utilization of high quality clinical services for maternal, newborn, child health; nutrition; and management of chronic illnesses, the project will: incorporate innovative quality improvement models to improve compliance with evidence-based standards of care, update/revise treatment protocols and clinical standards/ guidelines related to the basic package of PHC services, and improve human resources capacity through pre-service and in-service training programs.
3. Fostering Community Collaboration
PHCPI will facilitate strong relationships with clinics and communities, including internally displaced persons, by developing and disseminating a Patients' Rights Charter that promotes and builds feedback mechanisms to ensure health system responsiveness to community and patient needs and supporting the development of effective community partnerships.
August 13, 2012