The health care system in Iraq has been based on a hospital oriented and capital-intensive model that has limited efficiency and does not ensure equitable access. The Ministry of Health (MoH) is the main provider of health care, both curative and preventive. The private sector provides curative services to only a limited population on a fee-for-service basis. In addition, access to health care has been further affected by years of conflict, sanctions and ongoing military operations.
In acknowledgment of these concerns, over the last three years the MoH has undergone a process of re-orientation with the aim of basing Iraq’s health system on the primary health care (PHC) model. However, the current structure of PHC is not based on cost-effective public health interventions that would achieve maximum health gains for the money spent. Moreover, the services currently provided at the PHC level only partially meet the health needs of the population. This, combined with low perceived quality of care, has led the population to bypass the primary level and seek care at the secondary and tertiary levels.
In 2004, the MoH articulated its vision for primary health care as “an accessible, affordable, available, safe and comprehensive quality health service of the highest possible standard that is financially sound and founded on scientific principles in order to meet the present and future health needs of Iraqi people, regardless of their ethnicity, geographic origin, gender or religious affiliation.” This vision, therefore, calls for integrated reform of the existing PHC system. The development of a basic health services package (BHSP) was identified by the MoH as an appropriate initial step to achieving this goal.
The MoH began to develop the BHSP under the strengthening primary health care systems (SPHCS) project. The process started with a review of the health status of the Iraqi population to determine major health problems and to identify health services essential for addressing these problems (chapter 1.1). The PHC network was also assessed in terms of its infrastructure and human resources in order to determine the scope and type of services it is capable of delivering (chapter 1.2).
The results from the situational analysis (chapter 1.1) were concluded into suggestions for a range of basic health care services to be delivered as a standardized package along a “continuum of care” that links communities, local PHC centres and hospitals. The BHSP package presented in chapter 2 represents the vision of the MoH for a standardized package of basic health services that would form the core of service delivery in all PHC facilities. The package is a “living document” that needs to evolve over time to meet changing needs. With the benefit of experience, the package can be further improved and tailored to enhance the quality of health services.
The costing exercise and plan for the BHSP is expected to be finalized in August 2010. It will entail a method and summary of results for estimating the cost of providing the essential basic services package in Iraq. The costing method for the Iraq BHSP will be undertaken in accordance with global costing procedures with some necessary changes to adapt to the specific circumstances in Iraq.
Despite the limitations, the delivery of the BHSP will build on the existing system in order to meet the immediate needs while initiating change over time. Annex VI outlines both practical and strategic considerations for the implementation of the package.