Iraqi health system in kurdistan region: medical professionals' perspectives on challenges and priorities for improvement

Abstract

BackgroundThe views of medical professionals on efficiency of health system and needs for any changes are very critical and constitute a cornerstone for any health system improvement. This is particularly relevant to Iraqi Kurdistan case as the events of the last few decades have significantly devastated the national Iraqi health system while the necessity for adopting a new health care system is increasingly recognized since 2004. This study aims to examine the regional health system in Iraqi Kurdistan from medical professionals' perspectives and try to define its problems and priorities for improvement.MethodsA survey questionnaire was developed and administered to a convenience sample of 250 medical professionals in Erbil governorate. The questionnaire included four items; rating of the quality of services and availability of resources in the health institutions, view on different aspects of the health system, the perceived priority needs for health system improvement and gender and professional characteristics of the respondents.ResultsThe response rate to the survey was 83.6%. A high proportion of respondents rated the different aspects of services and resources in the health institutions as weak or very weak including the availability of the required quantity and quality of medicines (68.7%), the availability of sufficient medical equipment and investigation tools (68.7%), and the quality of offered services (65.3%). Around 72% of respondents had a rather negative view on the overall health system. The weak role of medical research, the weak role of professional associations in controlling the system and the inefficient health education were identified as important problems in the current health system (87.9%, 87.1% and 84.9%, respectively). The priority needs of health system improvement included adoption of social insurance for medical care of the poor (82%), enhancing the role of family medicine (77.2%), adopting health insurance system (76.1%) and periodic scientific evaluation of physicians and other health staff (69.8%).ConclusionMedical professionals were generally unsatisfied with the different aspects of the health system in Iraqi Kurdistan region. A number of problems and different priority needs for health system improvement have been recognized that require to be studied in more details.

Iraqi primary care system in Kurdistan region: providers’ perspectives on problems and opportunities for improvement

“…Several suggestions to improve the primary care system in Iraq that were identified by this study correspond well with other studies from Iraq including application of a family medicine approach [5,12,28], regulation of public-private practice [12] and improving the quantity and quality of medications [5]. Moreover, new priority needs were emerged from this study including establishment of a functioning recording system, increasing the health awareness of the population, provision of incentives to retain staff, integration of health education services in the primary care system and establishment of a strong planning, evaluation and monitoring system at the Directorate of Health and Ministry of Health levels.…”

“…The uneven distribution of the health workforce, with doctors or other skilled workers concentrated in main PHCCs and not in smaller PHCCs or in the PHCCs located in city centers and not outside the city centers, is an inefficient allocation of staff and contributes to inequity in health provision [22]. Poor professional development for health care providers has also been reported by other studies from Iraq where poor training of primary care providers and the importance of increasing public investment in this area and reviewing the professional and medical standardization have been emphasized [12,23,24]. This is also a common problem in other post-conflict countries like Serbia where few opportunities for professional development of primary care providers have been reported [25].…”

The range and diversity of providers’ viewpoints towards the Iraqi primary health care system: an exploration using Q-methodology

“…Problems related to workforce development including uneven distribution, rapid turnover and lack of professional development opportunities were also reported by two other studies from Iraq [13,36]. In Turkey, primary care physicians are unevenly distributed provincially [37].…”

“…The general preference for the establishment of a family medicine system has been emphasized by several studies from Iraq [9,11,13,25]. Introduction of the specialty of family medicine as the population’s first line of care and adapting the current PHC centers into family health centers staffed with physicians trained in family medicine was similarly recognized in Serbia as a main priority to improve the organization of the primary care in Serbia [2].…”

“…In fact, regulations that prohibit selling drugs without prescription are poorly implemented. There is no clear separation between the public and private health sectors in Iraq as most of the health providers work in the public sector in the morning and in the private sector in the evening leading frequently to conflicts of interest [7,13]. …”