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The health policies in Iraqi Kurdistan, a
prescription for disaster!
7.2.2010
By Dr Goran Zangana
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February
7, 2010
2010 Health Budget of
Kurdistan
Kurdistan Parliament is currently discussing the
budget of 2010 for the Kurdistan Regional Government
(KRG). The budget has been announced in a press
conference by Dr. Barham Salih, the prime minister,
before getting it to the representatives of the
people. The budget was delayed for months before
finalizing it and getting it to the parliament.
Furthermore, the oil revenues of the region were not
included in the budget and the opposition is furious
about that.
The good news is, this is the first time in 19 years
that the budget is openly discussed in the
Parliament, some members of which, mainly from the
opposition, had the courtesy of distributing it
around and inviting |
Dr. Goran Zangana, Erbil, Kurdistan, Iraq. Medical
Doctor Master of Public Health Fulbright Fellow/
Emory |
professionals in particular and the public in
general to provide comments, suggestions and input
into the details of the budget openly. The
government, through its administrative and judiciary
branches, however, provided copies of the general
provisions of the budget that was so vague that
didn’t allow for any space for discussion.
The health budget that was included in the projects
funded by the government and implemented by the
Ministry of Health were devoid from any scientific
analysis and calculations. The type of the projects
and their geographic distribution seem to answer
political worries rather than the real public health
needs of the people.
This is clearly demonstrated in the amount of funds
allocated to different geographical areas. In that
regard, a disturbing inequality is evident in terms
of the resources allocated to the governorates of
Sulaimaniyah, Erbil and Duhok; (the three
governorates officially under the jurisdiction of
KRG). Hence, while Sulaimaniyah governorate is the
biggest in terms of population, the governorate
comes in the third place after Erbil and Dohuk for
the proportion of funds for Health projects in the
governorate. The share of Sulaimaniyah compared to
the whole KRG region is 15.7% which is totally
disproportionate to the population of the
governorate.
This inequality in the resource allocation is not
limited to the size of the governorates, but also
applies to the rural-urban distribution. The 2010
health budget of KRG allocates a lion share to the
urban areas of Kurdistan, while the rural areas are
getting the minimum. The budget dedicates only 27%
of the resources for health project to rural areas
while urban areas are getting 73%. This is a
outright miscalculation of the health priorities in
the KRG. It is clearly evident that the rural areas
that suffered from destruction, displacement and
drainage of human, capital and infrastructure are in
urgent need for greated attention in terms of
resource allocation.
The 2010 budget of KRG ignore the systematic
thinking of health policy development and
implementation in general and resource allocation in
particular. The natures of the projects that are
funded in the budget are paying too much attention
to building infrastructure while ignoring the other
equally important components of the Health System in
Kurdistan. In this regard, the budget is allocating
more than 92% of the resources to building hospitals
and health centers. The disturbing news is that
about 22% of the whole budget allocated for projects
in Erbil Governorate is dedicated to building a new
office for the Ministry of Health’s in Erbil City.
The budget contains no plans or provision to
increase the numbers of the human resources serving
in the health sector in Kurdistan. According to the
human resources section of the budget, every 1000
citizen in Kurdistan will receive care from only 8
health care workers,www.ekurd.netwho
include physicians, nurses, paramedical staff,
pharmacists, dentists, laboratory workers…etc.
Furthermore, there are no plans to overcome the
clear gender inequality in the health care
workforce. The vast majority of Kurdistan healthcare
workforce is consisting of males. Only 40% of the
health care workers in Kurdistan according to the
Budget are females.
The fragmented health care system of Kurdistan is in
urgent need for Electronic Medical Records and some
kind of health information technology in place. But
the budget dedicated 0% of resources to this crucial
component of the health care system which should
take care of the production, analysis and usage of
information in the system.
The budget doesn’t answer the question of how those
health centers and hospitals that take 92% of the
resource would be supplied with medical technology
and other necessary supplies. The budget dedicates
only 7.6% of the total resources to providing health
supplies and medical technologies.
There are no provisions in the budget with regard to
training and advancing the skills and capacities of
health care leaders in Kurdistan. No clear planning
are demonstrated through the resource allocation in
the budget to how the whole system would be
financed.
The health budget of KRG for 2010, confirms our
previous diagnosis of the ways the health care
system in Kurdistan is governed; politics rather
than health policies are what running the system.
And that is a prescription for disaster!
Dr. Goran Zangana, Erbil, Kurdistan, Iraq.
Medical Doctor Master of Public Health Fulbright
Fellow/ Emory
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