HEALTH SYSTEM PERFORMANCE, MITIGATION, AND IMPERATIVE REFORM APPROACHES IN THE KURDISTAN REGION OF IRAQ: A QUALITATIVE SWOT ANALYSIS FROM THE STAKEHOLDERS’ POINT OF VIEW
Keywords:
health system, Kurdistan Region, Iraq, SWOT, health reform, qualitative, stakeholder
Abstract
https://doi.org/10.31386/dmj.2023.17.1.7
Background: Health systems are dynamic and evolve over time. It is essential to look at the entire health system before implementing any intervention to modernize the whole health system or a component of it. This study analyzed the performance of the health system in the Kurdistan Region of Iraq and investigated potential reform steps to mitigate the identified challenges.
Methods: A qualitative study was conducted in 2021 to recruit 37 key informants and decision-makers, advisors, and experts from the Kurdistan Parliament, Ministry of Health, Ministerial Council, Ministry of Finance, and external experts in the field of health. Thirty-one responded to a self-administered questionnaire of open-ended questions.
Results: While the health system in the Kurdistan Region of Iraq had its own strengths and opportunities to modernize it further, there were much more weaknesses and threats to it. The areas that received much attention were the lack of vital laws such as the medical council, health insurance, public-private sector regulation, accreditation, food and drug administration, and the absence of a regional health policy and strategic plan. The parliament and executive authorities, represented by the different government agencies in the Kurdistan Region of Iraq, have a role in mitigating all the weaknesses and threats in the health system.
Conclusions: The study provides policy evidence and a framework of the potential health strategies for the current and the coming government cabinets and parliament rounds in the Kurdistan Region of Iraq to improve the health sector and contribute to achieving sustainable development goals by 2030. It provides a road map for researchers to explore the current health system problems further and find suitable solutions.
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References
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38. Shabila NP, Al-Tawil NG, Al-Hadithi TS, Sondorp E, Vaughan K. Iraqi primary care system in Kurdistan region: providers’ perspectives on problems and opportunities for improvement. BMC Int Health Hum Rights. 2012; 12(1): 21. DOI: 10.1186/1472-698X-12-21
39. Sripa P, Hayhoe B, Garg P, Majeed A, Greenfield G. Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review. The British journal of general practice : the journal of the Royal College of General Practitioners. 2019; 69(682): e294-e303. DOI: 10.3399/bjgp19X702209
40. Shabu S, Al-Tawil NG, Fuller MP, Sheaff R. Evidence-based health policymaking in Iraqi Kurdistan: Facilitators and barriers from the perspectives of policymakers and advisors. Zanco J Med Sci. 2015; 19(3): 1075-83. DOI: http://dx.doi.org/10.15218/zjms.2015.0035
41. Mikkelsen-Lopez I, Wyss K, de Savigny D. An approach to addressing governance from a health system framework perspective. BMC Int Health Hum Rights. 2011; 11(1): 13. DOI: 10.1186/1472-698X-11-13
42. Osypuk TL, Joshi P, Geronimo K, Acevedo-Garcia D. Do social and economic policies influence health? a review. Current epidemiology reports. 2014; 1(3): 149-64. DOI: 10.1007/s40471-014-0013-5
43. Shukor AR, Klazinga NS, Kringos DS. Primary care in an unstable security, humanitarian, economic and political context: the Kurdistan Region of Iraq. BMC Health Serv Res. 2017; 17(1): 592. DOI: 10.1186/s12913-017-2501-z
2. World Health Organization. The World health report 2000: health systems : improving performance. Geneva, Switzerland: World Health Organization. [cited Mar 17, 2020]. Available from: https://www.who.int/whr/2000/en/whr00_en.pdf
3. Manyazewal T. Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. Arch Public Health. 2017; 75: 50. DOI: 10.1186/s13690-017-0221-9
4. World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva, Switzerland: World Health Organization. [cited Mar 8, 2020]. Available from: https://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf
5. Domapielle MK. Adopting localised health financing models for universal health coverage in Low and middle-income countries: lessons from the National Health lnsurance Scheme in Ghana. Heliyon. 2021; 7(6): e07220. DOI: 10.1016/j.heliyon.2021.e07220
6. Sakolsatayadorn P, Chan M. Breaking down the barriers to universal health coverage. Bull World Health Organ. 2017; 95(2): 86. DOI: 10.2471/blt.17.190991
7. Witter S, Anderson I, Annear P, Awosusi A, Bhandari NN, Brikci N, et al. What, why and how do health systems learn from one another? Insights from eight low- and middle-income country case studies. Health research policy and systems. 2019; 17(1): 9. DOI: 10.1186/s12961-018-0410-1
8. Savigny Dd, Adam T. Systems thinking for health systems strengthening. Geneva, Switzerland: World Health Organization - Alliance for Health Policy and Systems Research. [cited Mar 9, 2021]. Available from: https://apps.who.int/iris/bitstream/handle/10665/44204/9789241563895_eng.pdf?sequence=1&isAllowed=y
9. Iraq Ministry of Health, World Health Organization - Iraq Office. Iraq public sector modernization: health sector assessment and functional review report. Baghdad, Iraq: Iraq Ministry of Health; 2012.
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11. Kurdistan Regional Government. KRG ninth cabinet - outline of the new cabinet agenda [Internet]. 2019 [cited Apr 14, 2021]. Available from: https://gov.krd/english/government/agenda/
12. QSR International Pty Ltd. NVivo Version 12. 2018
13. Shabila NP, Al-Tawil NG, Tahir R, Shwani FH, Saleh AM, Al-Hadithi TS. Iraqi health system in kurdistan region: medical professionals' perspectives on challenges and priorities for improvement. Confl Health. 2010; 4: 19. DOI: 10.1186/1752-1505-4-19
14. Al-Dabbagh SA, Sulaiman HM, Abdulkarim NA. Workload assessment of medical doctors at primary health care centers in the Duhok governorate. Hum Resour Health. 2022; 19(Suppl 1): 117. DOI: 10.1186/s12960-021-00664-2
15. Wahab MA, Husein VM, Al-Hadithi TS. Distribution of doctors’ workforce in Erbil Governorate. Zanco J Med Sci. 2016; 20(1): 1138-46. DOI: https://doi.org/10.15218/zjms.2016.0001
16. Kurdistan Region Statistics Office. Health indicators [Internet]. 2022 [cited Mar 8, 2022]. Available from: https://krso.gov.krd/en/indicator
17. GBD 2019 Human Resources for Health Collaborators. Measuring the availability of human resources for health and its relationship to universal health coverage for 204 countries and territories from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England). 2022; 399(10341): 2129-54. DOI: 10.1016/s0140-6736(22)00532-3
18. Makuku R, Mosadeghrad AM. Health workforce retention in low-income settings: an application of the Root Stem Model. J Public Health Policy. 2022. DOI: 10.1057/s41271-022-00361-x
19. Anthony CR, Moore M, Hilborne LH, Rooney A, Hickey S, Ryu Y, et al. Health sector reform in the Kurdistan Region-Iraq: primary care management information system, physician dual practice finance reform, and quality of care training. Rand Health Q. 2018; 8(2): 1.
20. Mendelson A, Kondo K, Damberg C, Low A, Motúapuaka M, Freeman M, et al. The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review. Annals of internal medicine. 2017; 166(5): 341-53. DOI: 10.7326/m16-1881
21. Das A, Gopalan SS, Chandramohan D. Effect of pay for performance to improve quality of maternal and child care in low- and middle-income countries: a systematic review. BMC public health. 2016; 16(1): 321. DOI: 10.1186/s12889-016-2982-4
22. Kovacs RJ, Powell-Jackson T, Kristensen SR, Singh N, Borghi J. How are pay-for-performance schemes in healthcare designed in low- and middle-income countries? Typology and systematic literature review. BMC Health Services Research. 2020; 20(1): 291. DOI: 10.1186/s12913-020-05075-y
23. Kyeremanteng K, Robidoux R, D'Egidio G, Fernando SM, Neilipovitz D. An analysis of pay-for-performance schemes and their potential impacts on health systems and outcomes for patients. Crit Care Res Pract. 2019; 2019: 8943972. DOI: 10.1155/2019/8943972
24. Tangcharoensathien V, Tisayaticom K, Suphanchaimat R, Vongmongkol V, Viriyathorn S, Limwattananon S. Financial risk protection of Thailand’s universal health coverage: results from series of national household surveys between 1996 and 2015. Int J Equity Health. 2020; 19(1): 163. DOI: 10.1186/s12939-020-01273-6
25. Tirgil A, Dickens WT, Atun R. Effects of expanding a non-contributory health insurance scheme on out-of-pocket healthcare spending by the poor in Turkey. BMJ global health. 2019; 4(4): e001540. DOI: 10.1136/bmjgh-2019-001540
26. Kohler JC, Mackey TK, Ovtcharenko N. Why the MDGs need good governance in pharmaceutical systems to promote global health. BMC public health. 2014; 14(1): 63. DOI: 10.1186/1471-2458-14-63
27. Maponga CC, Chikwinya T, Hove R, Madzikwa N, Mazambara F, Midzi SM, et al. Lessons learnt from implementing the Good Governance for Medicines Programme in Zimbabwe. BMJ global health. 2022; 7(1): e007548. DOI: 10.1136/bmjgh-2021-007548
28. Silva MEC, Zarsuelo M-AM, Naria-Maritana MJN, Zordilla ZD, Lam HY, Mendoza MAF, et al. Policy analysis on determining hospital bed capacity in light of universal health care. J Acta Medica Philippina. 2020; 54(6): 668-76. DOI: https://doi.org/10.47895/amp.v54i6.2596
29. Ravaghi H, Alidoost S, Mannion R, Bélorgeot VD. Models and methods for determining the optimal number of beds in hospitals and regions: a systematic scoping review. BMC Health Serv Res. 2020; 20(1): 186. DOI: 10.1186/s12913-020-5023-z
30. Falchetta G, Hammad AT, Shayegh S. Planning universal accessibility to public health care in sub-Saharan Africa. PNAS. 2020; 117(50): 31760-9. DOI: doi:10.1073/pnas.2009172117
31. World Health Organization. World health statistics 2022: monitoring health for the SDGs, sustainable development goals. Geneva, Switzerland: World Health Organization. [cited Jun 21, 2022]. Available from: https://www.who.int/publications/i/item/9789240051157
32. Sobel HL, Huntington D, Temmerman M. Quality at the centre of universal health coverage. Health policy and planning. 2016; 31(4): 547-9. DOI: https://doi.org/10.1093/heapol/czv095
33. Rubinstein A, Barani M, Lopez AS. Quality first for effective universal health coverage in low-income and middle-income countries. The Lancet Global health. 2018; 6(11): e1142-e3. DOI: 10.1016/s2214-109x(18)30447-9
34. Friebel R, Molloy A, Leatherman S, Dixon J, Bauhoff S, Chalkidou K. Achieving high-quality universal health coverage: a perspective from the National Health Service in England. BMJ global health. 2018; 3(6): e000944. DOI: 10.1136/bmjgh-2018-000944
35. Anwer RN. Health care quality: The impact of hospital quality system in private and public sector on patients’ satisfaction in Kurdistan region of Iraq. International Journal of Medical, Pharmacy and Drug Research. 2021; 5(3): 24-36. DOI: https://dx.doi.org/10.22161/ijmpd.5.3.4
36. Kwame A, Petrucka PM. Universal healthcare coverage, patients' rights, and nurse-patient communication: a critical review of the evidence. BMC nursing. 2022; 21(1): 54. DOI: 10.1186/s12912-022-00833-1
37. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan S, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet Global health. 2018; 6(11): e1196-e252. DOI: 10.1016/s2214-109x(18)30386-3
38. Shabila NP, Al-Tawil NG, Al-Hadithi TS, Sondorp E, Vaughan K. Iraqi primary care system in Kurdistan region: providers’ perspectives on problems and opportunities for improvement. BMC Int Health Hum Rights. 2012; 12(1): 21. DOI: 10.1186/1472-698X-12-21
39. Sripa P, Hayhoe B, Garg P, Majeed A, Greenfield G. Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review. The British journal of general practice : the journal of the Royal College of General Practitioners. 2019; 69(682): e294-e303. DOI: 10.3399/bjgp19X702209
40. Shabu S, Al-Tawil NG, Fuller MP, Sheaff R. Evidence-based health policymaking in Iraqi Kurdistan: Facilitators and barriers from the perspectives of policymakers and advisors. Zanco J Med Sci. 2015; 19(3): 1075-83. DOI: http://dx.doi.org/10.15218/zjms.2015.0035
41. Mikkelsen-Lopez I, Wyss K, de Savigny D. An approach to addressing governance from a health system framework perspective. BMC Int Health Hum Rights. 2011; 11(1): 13. DOI: 10.1186/1472-698X-11-13
42. Osypuk TL, Joshi P, Geronimo K, Acevedo-Garcia D. Do social and economic policies influence health? a review. Current epidemiology reports. 2014; 1(3): 149-64. DOI: 10.1007/s40471-014-0013-5
43. Shukor AR, Klazinga NS, Kringos DS. Primary care in an unstable security, humanitarian, economic and political context: the Kurdistan Region of Iraq. BMC Health Serv Res. 2017; 17(1): 592. DOI: 10.1186/s12913-017-2501-z
Published
2023-04-01
How to Cite
MUSA SULAIMAN, H., FETTAH MOHAMMED, R., & AHMED AL-DABBAGH, S. (2023). HEALTH SYSTEM PERFORMANCE, MITIGATION, AND IMPERATIVE REFORM APPROACHES IN THE KURDISTAN REGION OF IRAQ: A QUALITATIVE SWOT ANALYSIS FROM THE STAKEHOLDERS’ POINT OF VIEW. Duhok Medical Journal, 17(1), 76-100. Retrieved from http://dmj.uod.ac/index.php/dmj/article/view/213
Section
Articles
