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					Annex 1: Provisional law #31 for year 2003 Food and Drug
Administration FDA


Article (1): This law will be called the Food and Drug Administration
law # 31 for year 2003 and it will be in force from date of                    its
publication in the Gazette.

Article (2):
    a) Minister:          Minister of Health.
        Ministry:          Ministry of Health.
        Administration:   Food and Drug Administration.
        Council:           Board of Directors.
        Chairman:          Chairman of the Board.
        Director General: Director General of the FDA.

    b) For The aims and purposes of this law and as
       necessitated from the Food law # 79 for year 2001 and
       the Drug and Pharmacy law # 80 for the year 2001.


The Establishment of FDA and its goals:

Article (3):

   a) FDA will be established here in Jordan enjoys judicial person financial and
      administrative independence and by this capacity, it is entitled to exercise
      all legal actions that are deemed necessary to achieve its goals or
      purposes, including the possession of transferable and non transferable
      properties and enter into contracts and accept donations. It is also entitled
      to assign an attorney general to act on its behalf.

   b) The Establishment (The head office of the FDA) will be based in Amman.

Article (4): The Establishment aims to guarantee:

   a) The safety of food stuffs, their quality and their suitability for human
      consumption through out their use.
   b) The safety of Drug (medications) and their quality control.
   c) The safety of other stuffs specified in the Drug and Pharmacy law which is
      in effect.

Article (5): To achieve the goals specified in Article 4.The Establishment will
acquire all the responsibilities and jobs entitled to them as established in the law
of supervision and inspection of food stuffs and the Drug and Pharmacy law in
effect.
   a) Supervision and inspection of the quality and suitability of food stuffs in
      accordance with technical rules, specifications and standards stipulated in
      the legislations in force.
   b) To achieve the requirements and take measures in connection with drug
      and pharmacy law, also to guarantee and supervise the safety and quality
      of medication in accordance with the rules and standards specified in the
      legislations in effect.
   c) To exercise any other supervision and inspection in connection with food
      stuffs and drug specified in the inspection in Food Law and Drug and
      Pharmacy Law in effect in food.

The Establishment Administration

Article (6): The Administration will have a Board of Directors headed
by the Minister of Health and the following as members of                  the
Board:

   a) The Director General as Vise Chairman
   b) The Undersecretary of the MOH acting for Administrative and
      Financial Affairs.
   c) The Undersecretary of the MOH acting for Technical Affairs.
   d) The Director of Food Directorate at the FDA Establishment.
   e) The Director of Drug Directorate at the FDA Establishment.
   f) Four members with experience and specialization in the fields of Food
      stuffs and Drug to be appointed by a decision from the Council of
      Ministers according to Minister's nomination. Their membership will be for
      two years renewable for one term only by the same procedure any one of
      these four members may be replaced by another member for the
      remaining period of term.

Article (7): The Board of Directors will be entitled of implementing the tasks
and goals that the FDA will seek for:

   a) Implementing the general policy that relate to Food and Drug and the
      supervision on them and set plans and tasks required for good
      implementations.
   b) The agreement of enter into contracts with local and national and
      international organizations in parallel with the FDA goals and
      achievements. And authorize the vice chairman or the chairman to sign
      and approve these contracts.
   c) The accreditation of technical basis or documentation or evidence from
      other countries and national and international organizations.
   d) The approval of structuring and restructuring the FDA Establishment.
   e) The approval of future plans for FDA improvement in relation to staff and
      proceeding the studies and research to achieve organization goals.
   f) The approval of annual budget of the FDA and send it to the Council of
      Ministers for approval.
   g) The approval of annual report upon the general councils work and general
      budget and final accounts about and regarding previous year for the
      Establishment and submit it for council of Ministers for approval.
   h) Appointment of legal auditor and set his fees.
   i) Periodical revision for the Establishment achievement.
   j) Form any specialized committees that Establishment may need according
      to nomination from Director General and prescribe duties for each of
      them.
   k) Seeking for national and international support for the establishment.
   l) The approval for specified directions for Food and Drug inspection and
      quality control submitted by higher committee.
   m) Prepare the legislative draft that is related to the Establishment work.

Article (8):

   a) The Council should convene at an invitation from the chairman or the vice
      chairman upon his absence once every three months at least with not less
      than seven of its member conditioned by presence of chairman or vice
      chairman.
   b) The chairman in entitled to invite an expert to seek his opinion about
      issues in question for discussion with no right to vote.
   c) The Director General can appoint any of the FDA staff to be secretary for
      the Council to call for meeting and to follow up the decision made by its
      members.

Article (9): The Director General is appointed by a decision made by the
Council of Ministers upon Minister's nomination. The decision also specified his
salary and allowances and all his financial rights are determined by the same
decision. His service is terminated in the same procedure. The Council of Minister
decision to appoint the Director General is subjected to Royal Decree to that
effect.

Article (10):       The Director General has the responsibilities and duties
followed:

   a) Following up the general policy related to Food and Drug inspection that
      Council lay down and exercise the plans and programs related to it.
   b) Execution the decisions made by the Council.
   c) The Supervision on the executive body of the establishment for good
      cooperation at work to achieve the goals required.
   d) Decision making of what committees has recommended.
   e) Preparation of annual budget and submit it for the Council for approval.
   f) Preparation of annual report regarding the Establishment achievement and
      general annual budget regarding pervious year and submit it to the
      Council for approval.
   g) Any other responsibilities related to the Establishment work that the
      Council might authorize him by
The FDA Budget and Financial Resources

Article (11):            The FDA shall have an independent budget beginning on
the first of January till the thirty first of December of the same year.

Article (12):

   a) The Financial Resources for the FDA consists of:

        1- The appropriations allocated by the general budget.
        2- The income fees and service allowances stipulated in the Food and
           Drug in force.
        3- Any other resources accepted and approved by the Council of
           Ministers.

   b) Any excess sum of money is considered to the treasury and should be
      translated to it at the end of the year.

Article (13):       The Establishment enjoys facilities and exemptions that
other Ministers and Governmental Directories enjoys.

Article (14):        The Establishment money is considered general money and
collected according to the state money law in effect.

Article (15):      The Establishment account should be organized according to
proper accounting and submitted to Audition Department for revision.

Article (16):

   a) All the employees at the Drug Directorate and the Food Directorate and
      Food and Drug quality control Labs at the Ministry as well as some of the
      employees that work at the inspection domain at the Ministry of Health
      Shall be translated to the FDA Establishment with all their rights.

   b) Upon the Director General nomination, the Minister can delegate any of
      the Directors at Directorates at Governorates or any of the employees
      there to carry the inspection responsibilities upon the provision of this law.

Article (17):      The Establishment is entitled to issue incentives for its
employees according to certain criteria implemented by the council for this
purpose conditioned by Council of ministers approval.

Article (18):          None of the provisions included in any contradicting law or
articles will be put in force or in effect.

Article (19):       The Council of Ministers shall issue the required regulations
according to the provision of this law.
Annex 2: Drugs Testing Regime issued by virtue of Article
(104 b) of the Provisional Drug and Pharmacy Act No. 80 of
2001


Article 1:   This Regime is called (The Drug Testing Regime No…..of ……) and
becomes in force from the date of publishing it in the Official Gazette.

Article 2:   The following words and phrases, wherever they appear in the
Regime shall have the designated meaning thereto, unless the context indicates
otherwise.

Director General:
The Director General of the Food and Drug Administration

The Administration:
The Food and Drug Administration.

The Directorate:
The Drug Directorate.

The Director:
 The Director of the Drug Directorate.

The Laboratory:
 The Pharmaceutical Control Laboratory Directorate.

The Drug:
As mentioned in the Drug and Pharmacology Act No. 80 of 2001 and for the
purposes of implementing this Regime, wherever the word product appears it
shall mean drug and vice versa.

The Sample:
The number of drug units withdrawn from the batch whereby it is a
representation thereof.

The Batch:
A specific number of production units of a single drug that has been
manufactured from the same materials and under the same conditions all at
once, or a series of integrated manufacturing processes whereby the product is
uniform. Each batch shall carry a number and/or a code.

The Test:
The Descriptive and Laboratory Analysis of the Sample.
The Pharmaceutical Corporation:
The public or private pharmacy or the factory or the drug store by virtue of the
legislation in force.


The Quality Control Committee:
The Committee formed by virtue of this Regime.

The Responsible Pharmacist:
The Responsible Pharmacist in the drug store or the Technical Manger of the
factory.

ARTICLE 3:
The foregoing should be followed regarding the sample submitted for
registration:

   a) The Directorate delivers to the laboratory a copy of the Technical File in
      accordance with Appendix 1/ Third of the Criteria of Registration.
   b) The responsible pharmacist provides the laboratory with the Reference
      Standard, Degradation Products and Related Substances mentioned in the
      technical file.
   c) The instructions issued by the Administration regarding receipt and
      delivery of the sample, its size and the test result, must be followed.
   d) The laboratory conducts the tests and analyses to the Sample of
      registration in accordance with the methods of analysis and specifications
      submitted in the Technical File of the product and/or in accordance with
      the drugs codes of the pharmacopoeia products.

Article 4:
      The foregoing should be followed regarding the registered Sample:

   a) The drug batches that are registered after the issuance of this Regime
      shall be subject to laboratory analysis for a period of at least two
      consecutive years from the date of registration whereby the number of
      analyzed batches is at least seven for each drug.
   b) In the event that the batches mentioned in (a) pass the test, the
      Directorate issues a decision permitting the marketing of the batches that
      follow by applying the random principle in accordance with the instructions
      that shall be issued in that respect.
   c) A random choice of a drug is done for the purposes of laboratory analysis
      for a maximum of three batches annually.
   d) With due observance of the text of clauses (a, b and c) of this Article, it is
      forbidden to market any drug batch except after:
          1. Its successful passing of all laboratory tests in accordance with the
             approved specifications in the drug’s Technical File and/or in
             accordance with the drug codes of the pharmacopoeia.
          2. The issuance of the permission for the marketing, by the
             Directorate.
ARTICLE 5:
       The submitted Sample for the purpose of marketing the registered drug,
before the implementation of this Regime:

   a) The results of the last seven consecutive batches of drugs that were
      permitted to be marketed in the Kingdom prior to this Regime becoming
      into force, shall be relied upon for the purposes of implementing clause
      (b) of Article (4) of this Regime.
   b) In the event that the results of seven consecutive batches of the drug are
      not at hand, the completion of analysis is made until the number of which
      reaches seven

consecutive batches and then it shall be subject to the stipulations of clause (b)
of Article (4) of this Regime.


ARTICLE 6:

   a) If any of the seven consecutive batches fails as mentioned in Article (4-a),
      testing of the seven consecutive batches that follow is carried out.
   b) If any of the yearly random batches fails as mentioned in article (4-c),
      testing of the seven consecutive batches that follows is carried out.
   c) In the event of the failure of any of the batches mentioned in Article (5),
      test of the seven consecutive batches that follow is carried out.
   d) If any sample does not satisfy the special conditions of packing materials
      or secondary packing (information, stickers, carton containers) of any of
      the specifications mentioned in the Technical File, but it passes the
      laboratory, physical, microbial and biological tests, then the issue of this
      batch is referred to the Quality Control Committee to make the
      appropriate decision and it shall not be subject to clauses (a) and (b) of
      this Article.

ARTICLE 7:
The foregoing should be followed in respect of the non-conforming products:

   a) The non-conforming products shall be retained in accordance with the
      approved mechanism for recalling the violating drugs.
   b) The responsible Pharmacist is entitled to object to the Directorate about
      the test result within fifteen days from the date of retaining the batch
      provided the objection is supported by the necessary documents and
      justifications.
   c) The objection is reviewed by the Quality Control Committee formed by
      virtue of this Regime within special instructions, provided it makes a
      decision within a maximum period of fifteen days from the date of
      objection.
          1. In case the objection and justification of the responsible pharmacist
             is acceptable, a decision to permit the marketing shall be issued by
             the Director General.

          2. In case the objection and justification of the responsible pharmacist
             is not acceptable, a rejection for marketing shall be issued by the
             Director General provided the responsible Pharmacist is given a
             notice of one month from the date of the Director General’s letter
             to determine the fate of the retained drug.

ARTICLE 8: The marketing of any batch of any drug of the foregoing is
forbidden except after passing the approved tests in the Technical File of the
drug, as for the pharmacopoeia products, the approved specifications mentioned
in the codes of drugs shall be followed and the permission decision for marketing
shall be issued by the Directorate after the result of the test is issued:

   a) Donation Drugs
   b) The drugs of biological origin or where a substance of biological original
      enters in its composition.
   c) Medical Gases Drugs

ARTICLE 9:

   a) The marketed drugs existing in the public and private pharmacies are
      subject to testing and re-testing without a consideration, in accordance
      with instructions issued by the Director General.
   b) In case a decision is issued to discontinue the marketing, the batch or
      batches are recalled in accordance with the approved mechanism of drug
      recall.

ARTICLE 10: The Director General forms a Committee called (Drug Quality
Control Committee) on the following basis:
   a)
        1) The director of the Directorate – President.
        2) Director of the Laboratory – Vice President.
        3) (A pharmacist specializing in pharmaceutical control) named by the
           Jordanian Union of Drug Producers.
        4) a faculty member specialized in pharmaceutical analysis from any
           official school of pharmacology at any official university.
        5) A pharmacist representing the Royal Medical Services
        6) A pharmacist representing the Supply Directorate/Ministry of Health.
        7) A representative of drug importers.
        8) The division Head of the Pharmaceutical Control Division at the
           Directorate.
        9) A delegate from the registration division. The secretariat shall be
           from the Pharmaceutical Control Division.

   a) The Committee undertakes the following tasks and powers:
        1) Recommendation to the Director General to approve the laboratories
           of reference.
        2) to exclude the un-registered drugs imported with non-commercial
           quantities to specifically named patients, from the laboratory test as
           mentioned in the Pharmacology Act Article (5-a) Item (13).
        3) Acknowledge lists of drugs or batches excluded from tests or some of
           them.
        4) Look into submitted objections about results of drug tests and issue
           the appropriate decision within a maximum period of 15 days from
           the date of the objection submission.
        5) Make the appropriate decision regarding the marketing of batches
           mentioned in Article (6-d)
        6) Lay the ground work to be relied upon by the Committee to revise
           the situation of the drugs and the companies manufacturing it where
           failure of passing tests is recurring and to recommend to the Director
           General to make the appropriate decision.


Article 11: The laboratory shall charge a fee of JD. 25 for each batch against
issuing a marketing license for it.

Article 12: The Director General is entitled to issue the necessary instructions
to implement the stipulations of this Regime.

ARTICLE 13: Anyone breaching the stipulations of this Regime shall be
penalized by the penalties stated in the Drugs and Pharmacology Act No. 80 of
2001.

ARTICLE 14:
This Regime replaces and cancels the Drugs Testing Regime No. (7) of 1994.
Annex 3: Provisional Law No. (67) For the Year 2001, and the
amendment No. (44) For the year 2003

                            Law of Clinical Trials


Article (1): This law shall be named the (law of clinical trials 2001). It shall
come into force 30 days after its publication in the official Gazette.

Article (2): The following words and expressions wherever mentioned in this
law, shall have the meanings specified hereunder for it unless the context
indicates otherwise:

        •   The Ministry: Ministry of Health
        •   The Minister: Minister of Health
        •   Administration: Food & Drug Administration
        •   Director General: Director General of Food & Drug Administration
        •   Institutional Review Board Committee: The committee for review of
            clinical researches and studies formed in pursuance of the provisions
            of this law.
        •   Clinical Studies Committee: The committee formed at the
            Administration in compliance with the provisions of this law.
        •   Clinical Studies: Therapeutic and Non-Therapeutic studies conducted
            on human beings according to the provisions of this law.
        •   Bioavailability: Rate of absorption and availability of the drug on its
            receptors and blood or its sites of action in the body reflect the
            availability of it in the mentioned site. Or the extent (if or %) and rate
            of drug absorption into the blood circulation at the site of
            administration in reference to IV Dose.
        •   Bioequivalence: There is no statistical difference related in this drug
            when compared with other drugs of same pharmacological item
            resembling it.
        •   Reference Drug: Any preparation licensed for the first time for usage
            worldwide.

Article (3): Clinical Trials are divided into:

   a) Therapeutic clinical trials: Any clinical study performed on sick or healthy
      volunteers.
   b) Non-Therapeutic clinical trials: Any study performed on healthy volunteers
      in terms of effectiveness, kinetics, bioavailability and bioequivalence.

Article (4):

   a) (a)- Clinical trials shall not be conducted unless the conducting authority
      has obtained an authorization from the Minister upon a recommendation
      from the Clinical Studies Committee pursuance of the provisions of this
      law.

   b) (b)- Clinical trials shall be conducted by any authority licensed in
      accordance with the provision of paragraph (a) of this article:
         0) Public and Private Hospitals , which possess technical potential to
              provide the required emergency and intensive care in addition to
              diagnostic laboratory that caries out clinical tests .
         0) University, Academic institutions specialized scientific Research
              Institutions and Pharmaceutical Manufacturing Companies, which
              have the required technical potential in compliance with clause (1)
              of this paragraph. In case these entities do not have such potential,
              any of these entities may perform the clinical part of this study at
              any authorized Hospital.

   e) (c)- Analyses of biological samples dedicated for clinical trials shall be
      made by Accredited Laboratories which have the requirements necessary
      for conducting such analysis and assure they are accurate and precise.

Article (5):

   a) Clinical trials shall not be performed on human beings unless by his
      written approval (signed consent form) and after undergoing the medical
      tests necessary for his/her safety.
   b) Any authority requesting permission to conduct a clinical trials shall comply
      with the following :

          0) Prepare a protocol for the study to be conducted, provided that
             such protocol must include the scientific justifications for conducting
             the study in addition to any other details specified in this law.

          0) Sign insurance contract with an insurance company having business
             within the Kingdom of Jordan to cover any damage sustained by
             this study specially those related to the human beings undergoing
             such study , provided that cases where such contract can be
             concluded shall be defined with its terms and requirements under
             instructions to be issued by the Minister upon the recommendation
             of the Clinical trials committee .

Article (6):

   a) Requirements for licensing Research Centers and accrediting the
      Laboratories specified in article (4) of this law shall be defined by virtue of
      instructions to be issued by the Minister and upon the recommendations of
      the Clinical trials committee.

   b) The Minister, upon recommendation from the Clinical Trial committee, may
      temporarily suspend any license issued by him, or revoke the same in case
        of any violation to the provision of this law without prejudice to any other
        penalty specified in such license.

Article (7):

   a) A committee shall be formed within any of the entities stated in article (4)
      of this law to be called. (The Institutional Review Board Committee)
      consisting of at least five members from both sexes with enough
      experience and quite competent provided that one of them should be legal
      advisor in addition to a representative from local community.

   b)
           0) Membership of the Institutional Review Board Committee shall be
              valid for two renewable years.
           0) The Committee shall in its first meeting elect from among its
              members the chairman and his deputy.

Article (8):

   a) The Institutional Review Board Committee shall assume the following
      responsibilities and powers:

           0) Assure the authenticity of scientific justifications for conducting the
              clinical study.
           0) Approve the study protocol and authorize its conduction and follow
              up.
           0) Assure that the research team is competent and capable of
              performing such study, and that they comply with the good clinical
              practice.
           0) Assure that volunteers willing to accept, to undergo such study.
           0) Coordinate with the Clinical trials Committee and inform the same
              if any relative or unknown side effects related to the drug , which
              would appear during or after this study .

   g) The Institutional Review Board Committee shall meet upon a call from its
      chairman or his deputy upon his absence whenever necessary. Such
      meeting shall be deemed legal with the presence of at least two thirds of
      its members, conditioned, that the chairman or his deputy should be
      among them, and shall take its decisions with majority of its members.

Article (9):

   a) The Entity conducting the clinical study shall observe the following:

             0- Form a Research Team from scientifically competent members
                with enough practical experience to perform the same in
                accordance with the requirements of the study. The head of this
                team shall be responsible for executing this study in the most
                proper manner.
             0- Provide a physician to supervise the conduction of such study to
                be responsible for medical care while this study being conducted.

   b) The Entity conducting this study shall be legally responsible for any
      damages sustained by the volunteer.


Article (10):

   a) (a)- Conducting clinical trials on medicines that have a registered
      reference drug in Jordan for such usage, shall obtain prior approval of the
      Institutional Review Board, and inform the Administration of this approval.
   b) (b)- As for conducting clinical trials on medicines that the reference drug is
      not registered in Jordan, a prior approval of the Minister shall be obtained
      upon a recommendation from the Clinical trials Committee.

Article (11):

Any Entity conducting clinical trials shall observe the study protocol approved by
Clinical trials Committee, provided that “The Declaration of Helsinki” relevant to
conducting clinical trials on human beings is observed.


Article (12):

A committee shall be formed at the administration to be called (Clinical trials
Committee) and chaired by the Director General and the membership of the
following:

   a)   Drug Directorate Director (Deputy Chairman).
   b)   Director Assistant of drug control laboratory.
   c)   Pharmacy Director of at the Royal Medical Services.
   d)   Five persons representing universities and private sector who are
        specialized in the field of Kinetic, Analytical pharmacy, Biostatistics, Clinical
        pharmacy, Pharmacology. To be elected by a decision from the Minister
        upon recommendation from Director General for two renewable years.

Article (13):

The Clinical Study Committee shall assume the following responsibilities and
power:

   a) Approve the formation of the Institutional Review Board Committee and
      control their work.
   b) Evaluate the reports on studies presented to them for their approval.
   c) Conduct studies to verify the authenticity of information presented to them
      and take any procedures for this purpose.
   d) Assure that the Entities licensed to conduct clinical studies in pursuance of
      the provisions of this law are complying with the principles of Good Clinical
      Practice and Good Laboratory Practice conformant to the directions issued
      by the Minister for this purpose.

Article (14):

   a) The Clinical trial Committee shall meet whenever necessary, upon a call
      from the chairman or his Deputy, in case of his absence. And such
      meeting is legal document with the presence of the majority of its
      members, provided that the chairman or his Deputy be among, and shall
      pass its decisions either by plenary voting or by majority of at least five of
      its members..

   b) The Clinical trial Committee may form technical sub-committees to help in
      carrying out its responsibilities and in presenting the recommendation
      necessary to this respect.

   c) The Director General shall appoint a secretary for the Clinical trials
      Committee from among the staff of the Drug Directorate in the
      Administration to be assisted by a number of its personnel.

   d) The secretary shall assume the following responsibilities; preparing the
      agenda, call for meetings, follow up the decisions and archiving the files.

Article (15):

The Director General may delegate the responsibility of performing inspection
visits to, the Director of Drug Directorate or any of the Administration staff, in
any Entity licensed for carrying out clinical studies, at anytime to assure that they
are observing the requirements in terms of their license.

Article (16):

   a) Fees for licensing any Entities or for accreditation any Laboratories
      provided for in article (4) of this law shall be defined under a bylaw to be
      issued for this purpose on condition that such bylaw should be provided
      for cases of exemption from those fees.

   b) Charges collected by the Administration against the services provided by
      the Clinical trials Committee under the Minister's directions shall be
      defined, and any returns from those charges shall be used to cover any
      bonuses payable to members of the committee and any required
      expenses.
Article (17):

   a) Any person who accepts the conduction of clinical trials, supervise or
      perform the same without observing the terms and requirements specified
      by the law shall be punished either by one to three years of imprisonment
      or by payment of a fine not less than five thousand Jordanian Dinars not
      more that twenty thousand Dinars or by both penalties.

   b) Any of the following persons shall be punished either six months up to one
      year of imprisonment or by payment of a fine not less than two thousand
      Jordanian Dinars and not exceeding five thousand Dinars, or by both
      penalties:

         0) 1-Any physician appointed to supervise conducting a study in case
            of his absence during this process, or in case of his non-compliance
            with medical care responsibility required for the volunteers.

         0) 2-Any person who tries to conceal any previously unknown side
            effects of the drug or does not inform the Clinical trials Committee

   ) Any person non-complying with the protocol of this study without any
     scientific Justification approved by the Clinical trials Committee will be
     subjected to a penalty in the form of payment of a fine not less than two
     thousand Jordanian Dinars and not exceeding five thousand Jordanian
     Dinars.

   ) Any Hospital, Scientific Research Institution, Academic Institution
     University of Medicine, Pharmaceuticals Manufacturing Company, carrying
     out a clinical trials on human beings without being licensed, or any
     Laboratory performing any analysis on the biological samples without
     being licensed under this law or without observing its provisions shall be
     subjected to a penalty in the form of payment of a fine not less than
     twenty thousand Jordanian Dinars, and not exceeding fifty thousand
     Jordanian Dinars .

   ) The perpetration of any other breach to any of the provision of this law
     related to the conduction of clinical trials and no such penalty is being
     provided for to this respect in this law, will be subjected to a penalty in the
     form of payment not more than three thousand Dinars.
Annex 4                                           Organizational structure of Ministry of Health

                                                 Consultants
                                                                                                                                                    Minister Office
                                                                                          Minister of Health
                                                                                          Minister of Health
                                          Planing & Coordination
                                                Committee                                                                                      International Relations

                                          Non Jordanian Patients
                                              Service Office



               Dir. Gen. Development                                Legal Medicine Center                                     Dir. Internal Auditing                               Dir. Gen. Civil
                     & planning                                                                                                                                                   Health Insurance


                 Information Center                                                                                                                                               Financial Affairs
                                                                    Secretariat                                                   Chief of Specialists Committee
                     Education &                                                                        Secretary
                                                                                                        Secretary                                                                 Technical Affairs
                      Training
                                                                 Correspondence
                                                                                                         General
                                                                                                         General                         Attorney Office                               Auditing
                  Planing & Project                                  Office
                    Management
                                                                                                                                                                                 Studies & Research
                 Studies & Research
                                                                                                                                                                                Insured & dependants
                                                           Administrative Dev. Unit                                                      Public Relation
                                                                                                                                                                                      Computer



                   Dir. General Primary           Dir. General Health             Dir. Gen. Financial      Dir. Gen. Administrative       Dir. General Bashir               Dir. General Curative
                       Health Care                    Governorate                 Economical Affairs               Affairs                      Hosp.                             Services

                                                                                        Auditing               Purchasing
          Environmental                                                                                                                                           Nursing                           Drugs
             Health                        Health Safety
                                                                                        Expenses                 Supply


           School Health                  Disease Control                              Budgeting                Personnel                                          Dental                    Specialized Centers


                                                                                   Health Economics          Land & Building                                    Drugs Control                   Laboratories
          Nutrition & food                 Occupational
               safety                        Health
                                                                                   Finance & Accounting      Transportation

                             MCH                                                                                                                                             Med. Professions &
                                                                                                            Medical equipment                                                   Institutions
Annex 5: Hospital Accreditation (Work Plan) in Jordan (August 2004-September 2006) (Revised June 2005)

Goal #1:                                               2004                                  2005                                                  2006
To Establish a Hospital Accreditation
Organization, Which Manages the                                                         C = Completed
Accreditation System in Jordan and
Fosters a Culture of Quality Improvement
                                                              Q1           Q2           Q3            Q4             Q5              Q6            Q7         Q8       Q9
                                               A   S    O     N    D   J   F    M   A    M   J   J    A    S    O    N    De   Jan   F    M    A    m J   J   A    S   Oct
Activities / Tasks                             u   e    ct    o    e   a   e    a   p    a   u   ul   u    e    ct   o    c          e    ar   p    a u   u   u    e
                                               g   p          v    c   n   b    r   r    y   n   y    g    pt        v               b         r    y n   l   g    p
                                                                                                                                               i      e   y        t
                                                                                                                                               l

1.1 Conduct a two day national workshop for                        X   C
all key stakeholders to present hospital
accreditation concepts, principles, issues,
and a time frame for implementation


1.2 Recruit a PHRplus Resident Advisor to      x   x     x    x x      x   x    C
assist with the development and
implementation of hospital accreditation


1.3 Resident Advisor to evaluate and update                                X    C   X    C                 x                   x
Work Plan


1.4 Assist the Hospital Accreditation                                                    X   X   X    x x
Committee (HAC) to finalize Terms of
Reference (TOR) for itself for approval by
Sept 2005


1.5 Appoint a Task Force made up of                                                          X   X    X X
representatives from all hospital sectors,
primary healthcare facilities, and specialty
programs; professional associations; and
Goal #1:                                                    2004                                  2005                                                  2006
To Establish a Hospital Accreditation
Organization, Which Manages the                                                              C = Completed
Accreditation System in Jordan and
Fosters a Culture of Quality Improvement
                                                                   Q1           Q2           Q3            Q4             Q5              Q6            Q7         Q8       Q9
                                                    A   S    O     N    D   J   F    M   A    M   J   J    A    S    O    N    De   Jan   F    M    A    m J   J   A    S   Oct
Activities / Tasks                                  u   e    ct    o    e   a   e    a   p    a   u   ul   u    e    ct   o    c          e    ar   p    a u   u   u    e
                                                    g   p          v    c   n   b    r   r    y   n   y    g    pt        v               b         r    y n   l   g    p
                                                                                                                                                    i      e   y        t
                                                                                                                                                    l
legal, legislative, & financial experts to
develop the legislation, by-laws,
organizational structure, role and
responsibilities, and financial sustainability of
the Jordanian Healthcare Accreditation
Agency.


1.6 The NAC to approve recommendations of                                                                                      x
the Task Force that developed the JHAA


1.7 Help implement the JHAA with board                                                                          X    X    X X
membership represented by medical,
dentistry, nursing, pharmacy, consumers,
primary health care, MOH, RMS, private
hospitals, and others to insure broad
healthcare representation.




1.8 Establish a JHAA office with appropriate                                                                                   X    X     X    X
equipment and other resources, appoint Chief
Executive, and hire staff.
Goal #1:                                                     2004                                  2005                                                  2006
To Establish a Hospital Accreditation
Organization, Which Manages the                                                               C = Completed
Accreditation System in Jordan and
Fosters a Culture of Quality Improvement
                                                                    Q1           Q2           Q3            Q4             Q5              Q6            Q7         Q8       Q9
                                                     A   S    O     N    D   J   F    M   A    M   J   J    A    S    O    N    De   Jan   F    M    A    m J   J   A    S   Oct
Activities / Tasks                                   u   e    ct    o    e   a   e    a   p    a   u   ul   u    e    ct   o    c          e    ar   p    a u   u   u    e
                                                     g   p          v    c   n   b    r   r    y   n   y    g    pt        v               b         r    y n   l   g    p
                                                                                                                                                     i      e   y        t
                                                                                                                                                     l

1.9 JHAA develops a national strategy for                                                                                            X     X    X
accrediting healthcare facilities and a five
year work plan highlighting is accreditation,
education, and publishing goals including
activities, staffing needs, and budget


1.10 Establish membership of JHAA with                                                                                                               X X X X X X
International Accreditation Agency (ISQua)
and follow ALPHA guidelines for Healthcare
Accreditation


1.11 JHAA develops policies and procedures                                                                                      X    X     X    X    X X X X X X
on accreditation model, fees, methods,
standards, measurement instruments, hiring
and training of surveyors, self-survey
instruments evaluation process, and
database (These are separate , activities and will
take 2-3 years to develop and implement as
outlined below:)


1.11.1 Determine steps, application form, and                                                                                                   X    X X
timing that hospitals must take to be
surveyed for accreditation.
Goal #1:                                               2004                                  2005                                                  2006
To Establish a Hospital Accreditation
Organization, Which Manages the                                                         C = Completed
Accreditation System in Jordan and
Fosters a Culture of Quality Improvement
                                                              Q1           Q2           Q3            Q4             Q5              Q6            Q7         Q8       Q9
                                               A   S    O     N    D   J   F    M   A    M   J   J    A    S    O    N    De   Jan   F    M    A    m J   J   A    S   Oct
Activities / Tasks                             u   e    ct    o    e   a   e    a   p    a   u   ul   u    e    ct   o    c          e    ar   p    a u   u   u    e
                                               g   p          v    c   n   b    r   r    y   n   y    g    pt        v               b         r    y n   l   g    p
                                                                                                                                               i      e   y        t
                                                                                                                                               l

1.11.2 Determine fees paid by hospitals for                                                                                                    X X X
surveys (annual subscription, per survey,
other) and what hospitals will receive for
payment.


1.11.3 Develop a Manual for Surveyors and                                                                                      X     X    X    X X X
test out the manual


1.11.4 Prepare job descriptions for                                                                                                  X    X    X X X
surveyors, determine number needed, recruit,
interview, hire, and train


1.11.5 Continue to develop and upgrade                                                                                                         X X X X X X
standards and self-evaluation process with
feedback and refinement until satisfactory


1.11.6 Develop performance indicators,                                                                                               X    X    X
scoring, weighting, and compliance process

1.11.7 Develop the type and levels of                                                                                                                     X X X
Accreditation, Awards, and Incentives
Goal #1:                                                      2004                                            2005                                                        2006
To Establish a Hospital Accreditation
Organization, Which Manages the                                                                  C = Completed
Accreditation System in Jordan and
Fosters a Culture of Quality Improvement
                                                                     Q1           Q2                  Q3                 Q4             Q5               Q6               Q7             Q8       Q9
                                                     A    S    O     N    D   J    F   M     A        M       J    J     A    S    O    N    De    Jan    F     M     A    m J       J   A    S   Oct
Activities / Tasks                                   u    e    ct    o    e   a    e   a     p        a       u    ul    u    e    ct   o    c            e     ar    p    a u       u   u    e
                                                     g    p          v    c   n    b   r     r        y       n    y     g    pt        v                 b           r    y n       l   g    p
                                                                                                                                                                      i      e       y        t
                                                                                                                                                                      l
                                                                                                                                                                                         X X X
1.11.8 Develop computer program to generate
Accreditation Report and database




Goal #2:                                      2004                                     2005                                                              2006

To Develop Hospital                                                               C = Completed
Accreditation Standards
and Test Them Using Pilot
Hospitals
                                                     Q1             Q2            Q3                   Q4                Q5             Q6               Q7          Q8        Q9
                                      A   S    O     N    D    J     F    M   A   M    Jun       J        A   S     O     N    D    J    F    M     A    m J    J    A    S    Oct
Activities / Tasks                    u   e    ct    o    e    a     e    a   p   a              ul       u   e     ct    o    e    a    e    ar    p    a u    u    u    e
                                      g   p          v    c    n     b    r   r   y              y        g   pt          v    c    n    b          r    y n    l    g    p
                                                                                                                                                    i      e    y         t
                                                                                                                                                    l
                                                               X     X
2.1 Develop criteria for selecting
public, private, RMS and university
                                                                          C
hospitals to be pilot hospitals


2.2 Select pilot hospitals                                           X X      C
Goal #2:                                       2004                                  2005                                                  2006

To Develop Hospital                                                             C = Completed
Accreditation Standards
and Test Them Using Pilot
Hospitals
                                                      Q1           Q2           Q3               Q4             Q5           Q6            Q7         Q8       Q9
                                       A   S    O     N    D   J   F    M   A   M    Jun    J    A    S    O    N    D   J   F    M    A   m J    J   A    S   Oct
Activities / Tasks                     u   e    ct    o    e   a   e    a   p   a           ul   u    e    ct   o    e   a   e    ar   p   a u    u   u    e
                                       g   p          v    c   n   b    r   r   y           y    g    pt        v    c   n   b         r   y n    l   g    p
                                                                                                                                       i     e    y        t
                                                                                                                                       l

2.3 Select internationally accepted                                X X      C
standards clusters to be used for
the first standards (Patient/Family
Rights, Clinical Safety, Medical
Records, etc.)


2.4 Develop system for self-                                       X X      C
assessment, feedback, and work
plans for pilot hospitals


2.5 Prepare role and                                                    X   C
responsibilities for pilot hospitals


2.6 Conduct an orientation                                              X   C
workshop for all pilot hospitals on
their role and responsibilities as
pilot hospitals in the Jordan
hospital accreditation project.


2.7 Conduct first standards setting                                         X   C
workshop in April 2005 (Clinical &
Environmental Safety)
Goal #2:                                       2004                                  2005                                                  2006

To Develop Hospital                                                             C = Completed
Accreditation Standards
and Test Them Using Pilot
Hospitals
                                                      Q1           Q2           Q3               Q4             Q5           Q6            Q7         Q8       Q9
                                       A   S    O     N    D   J   F    M   A   M    Jun    J    A    S    O    N    D   J   F    M    A   m J    J   A    S   Oct
Activities / Tasks                     u   e    ct    o    e   a   e    a   p   a           ul   u    e    ct   o    e   a   e    ar   p   a u    u   u    e
                                       g   p          v    c   n   b    r   r   y           y    g    pt        v    c   n   b         r   y n    l   g    p
                                                                                                                                       i     e    y        t
                                                                                                                                       l



2.8 Conduct 3 regional orientation                                          X   X
                                                                                     C
workshops for those 75 hospitals
who are not pilot hospitals in May
2005


2.9 Send Draft 1 standards to all                                               X    C
92 hospitals for review and
comment


2.10 Obtain feedback from all 92                                                     X      X    X X       X    X
hospitals on standards and use
feedback to develop Draft 2 of
standards


2.11 Assist pilot hospitals with                                                X    X      X    X X       X    X X      X   X    X
their self assessments (beginning
with Clinical and Environmental
Safety standards) to determine their
present standards compliance and
the development of their work
plans to meet the standards
Goal #2:                                      2004                                  2005                                                  2006

To Develop Hospital                                                            C = Completed
Accreditation Standards
and Test Them Using Pilot
Hospitals
                                                     Q1           Q2           Q3               Q4             Q5           Q6            Q7         Q8       Q9
                                      A   S    O     N    D   J   F    M   A   M    Jun    J    A    S    O    N    D   J   F    M    A   m J    J   A    S   Oct
Activities / Tasks                    u   e    ct    o    e   a   e    a   p   a           ul   u    e    ct   o    e   a   e    ar   p   a u    u   u    e
                                      g   p          v    c   n   b    r   r   y           y    g    pt        v    c   n   b         r   y n    l   g    p
                                                                                                                                      i     e    y        t
                                                                                                                                      l



2.12 After standards have been                                                 X    C      X         X         X        X
distributed, hold meetings with the
pilot hospitals to determine their
progress, problems with self-
assessment and Work Plans and
how the project can assist them


2.13 Based on the pilot hospitals                                              X    X      X    X X       X    X X
work plans, develop a strategy on
how best to assist them in
preparing to meet the standards
within the limits of the project
resources


2.14 Continue standard setting                                                      X      X    X
workshops from June to August
2005 to complete the development
of all standards clusters by
September 2005


2.14.1 Conduct a 2 day standard                                                     X
setting workshop on the Human
Goal #2:                                       2004                                  2005                                                  2006

To Develop Hospital                                                             C = Completed
Accreditation Standards
and Test Them Using Pilot
Hospitals
                                                      Q1           Q2           Q3               Q4             Q5           Q6            Q7         Q8       Q9
                                       A   S    O     N    D   J   F    M   A   M    Jun    J    A    S    O    N    D   J   F    M    A   m J    J   A    S   Oct
Activities / Tasks                     u   e    ct    o    e   a   e    a   p   a           ul   u    e    ct   o    e   a   e    ar   p   a u    u   u    e
                                       g   p          v    c   n   b    r   r   y           y    g    pt        v    c   n   b         r   y n    l   g    p
                                                                                                                                       i     e    y        t
                                                                                                                                       l
Resources standards cluster in
June 2005


2.14.2 Conduct 2 day standards                                                              X
setting workshop on Medical
Records, Management of
Information, & Management and
Leadership clusters in July


2.14.3 Conduct 3 days of                                                                         X
workshops to write standards for
the Pt. & Family Rights, Access
and Continuity of Care, Pt.
Assessment, Patient Care, Quality
Improvement and Pt. Safety,
Support Services, Medical Staff, &
Nursing services clusters in
August


2.15 After standards have been                                                  X    X      X    X X       X
developed (draft 1), distribute them
to all 93 hospitals in Jordan for
feedback.
Goal #2:                                      2004                                  2005                                                  2006

To Develop Hospital                                                            C = Completed
Accreditation Standards
and Test Them Using Pilot
Hospitals
                                                     Q1           Q2           Q3               Q4             Q5           Q6            Q7         Q8       Q9
                                      A   S    O     N    D   J   F    M   A   M    Jun    J    A    S    O    N    D   J   F    M    A   m J    J   A    S   Oct
Activities / Tasks                    u   e    ct    o    e   a   e    a   p   a           ul   u    e    ct   o    e   a   e    ar   p   a u    u   u    e
                                      g   p          v    c   n   b    r   r   y           y    g    pt        v    c   n   b         r   y n    l   g    p
                                                                                                                                      i     e    y        t
                                                                                                                                      l



2.16 After pilot hospitals conduct                                             X    X      X    X X       X    X X
self assessment and determine if
standards need to be eliminated,
changed, or reclassified, Draft 2
will be written


2.17 Draft 2 standards will go to                                                                         X    X X      X   X    X    X X        X X X X
the NAC for approval until the
JHAA board is appointed who will
then take over the function of
approving standards


2.18 Prepare the final draft of all                                                                            X X
hospital standards and distribute
copies to all 92 hospitals
Goal #3: (revised March 1, 2005)           2004                                    2005                                               2006

To Prepare Pilot Hospitals
for Accreditation                                                             C = Completed
                                                    Q1           Q2           Q3            Q4             Q5           Q6            Q7           Q8       Q9
                                       A   S   O    N    D   J   F    M   A    M   J   J    A    S    O    N    D   J   F    M    A   M    J   J   A    S   Oct
Activities / Tasks                     u   e   ct   o    e   a   e    a   p    a   u   ul   u    e    ct   o    e   a   e    ar   p   a    u   u   u    e
                                       g   p        v    c   n   b    r   r    y   n   y    g    pt        v    c   n   b         r   y    n   l   g    p
                                                                                                                                  i        e   y        t
                                                                                                                                  l
3.1 Pilot hospitals will appoint a                                        X X      X   C
Quality Improvement Coordinator,
a Quality Improvement
Committee/Counsels and a Safety
Committee to help with standards
assessment and Work Plan
development.


3.2 Conduct a workshop for the                                                     x
pilot hospitals QIC to clarify their
role and responsibilities in
relationship to the hospital
accreditation project


3.3 Develop a manual entitled,                                                                   X    X    X
Guidelines for Implementing
Hospitals Standards to assist pilot
hospitals in preparing for
accreditation


3.4 Based on the pilot hospitals                                               X   X X      X    X    X    X X
self assessment and work plans
develop a strategy with each
hospital on how best to assist
them in meeting the standards
Goal #3: (revised March 1, 2005)           2004                                    2005                                               2006

To Prepare Pilot Hospitals
for Accreditation                                                             C = Completed
                                                    Q1           Q2           Q3            Q4             Q5           Q6            Q7           Q8       Q9
                                       A   S   O    N    D   J   F    M   A    M   J   J    A    S    O    N    D   J   F    M    A   M    J   J   A    S   Oct
Activities / Tasks                     u   e   ct   o    e   a   e    a   p    a   u   ul   u    e    ct   o    e   a   e    ar   p   a    u   u   u    e
                                       g   p        v    c   n   b    r   r    y   n   y    g    pt        v    c   n   b         r   y    n   l   g    p
                                                                                                                                  i        e   y        t
                                                                                                                                  l
3.5 Assist pilot hospitals by doing
an in-depth assessment of their
self assessments and Work Plans
and evaluate their commitment to
the hospital accreditation process


3.6 Prepare technical assistance                                                                                    X   X    X    X X      X   X X X X
(TA) required to develop a series of
workshops for all hospitals in
selected clusters as preparation
for accreditation survey by JHAA


3.6.1 Conduct workshop on how to                                                                                    X
meet nursing services standards


3.6.2 Conduct workshop on how to                                                                                        X
meet Quality Improvement and
Patient Safety, and Clinical, and
Environmental Safety standards


3.6.3 Conduct workshop on how to                                                                                             X
meet Management and Leadership,
Support Services, and Human
Resources standards
Goal #3: (revised March 1, 2005)       2004                                    2005                                               2006

To Prepare Pilot Hospitals
for Accreditation                                                         C = Completed
                                                Q1           Q2           Q3            Q4             Q5           Q6            Q7           Q8       Q9
                                   A   S   O    N    D   J   F    M   A    M   J   J    A    S    O    N    D   J   F    M    A   M    J   J   A    S   Oct
Activities / Tasks                 u   e   ct   o    e   a   e    a   p    a   u   ul   u    e    ct   o    e   a   e    ar   p   a    u   u   u    e
                                   g   p        v    c   n   b    r   r    y   n   y    g    pt        v    c   n   b         r   y    n   l   g    p
                                                                                                                              i        e   y        t
                                                                                                                              l
3.6.4 Conduct workshop on how to                                                                                              X
meet Patient & Family Rights,
Medical Records, and Management
of Information standards


3.6.5 Conduct workshop on how to                                                                                                  X
meet Access and Continuity of
Care, Patient Assessment, and
Patient Care standards


3.6.6 Conduct workshop on how to                                                                                                       X
meet Medical Staff standards


3.7 Do “mock surveys” on pilot                                                                                                    X    X   X
hospitals to determine the
readiness of surveyors and
hospitals for an actual
accreditation survey


3.8 Begin surveying those                                                                                                                      X X       X
hospitals which feel they can
achieve accreditation based on
Jordan hospital standards


Source: PHRplus, Jordan, 2005.
Summary Five Year Plan for Hospital Accreditation in Jordan (2005-2009)*

   Major Activity               Year:   2005                  2006             2007             2008        2009
Revised April 2005                             Q1   Q2   Q3    Q4    Q1   Q2   Q3     Q4   Q1    Q2    Q3   Q4   Q1    Q2   Q3   Q4   Q1   Q2   Q3   Q4
1. Develop and Implement a                               X     X     X
Jordanian Healthcare
Accreditation Agency (JHAA)


2. Develop and Pilot                                X    X     X     X    X    X      X    X
International Standards in
Jordan Hospitals


3. Implement International                               X     X     X    X    X      X    X     X     X    X      X   X    X    X    X    X    X    X
Standards in Jordan
Hospitals


4. Prepare hospitals for                                       X     X    X    X      X    X     X     X    X      X   X    X    X    X    X
survey by JCAA


5. Select and train surveyors                                        X    X    X      X    X     X


6. Begin mock surveys                                                     X    X


7. JCAA to begin to                                                                              X     X    X      X   X    X    X    X    X    X    X
“Accredit” Hospitals to
International Standards
Total = 93 Hospitals;           Private=56
MOH=28, RMS=7,                  University=2
* PHRplus commitments shown only through funding period, October 2006
Table 5.8: Profile of Contractual Arrangements between MOH and other Health Care Providers.

Source: The Role of Contractual Arrangements in Improving Health Sector Performance in Jordan, WHO, 2004.



                                                                                                                                           Manag.      Annual
                                              Length                      Geographical
              Type of              Date of               Services                         Payment              Co-         Performance     &           cost/
Provider                                      of                          scope of
              provider             contract              covered                          mechanism            payment     measures        financial   JD
                                              contract                    contract
                                                                                                                                           effort      Million
                                                           Tertiary/
                                                                                           Fee-for-service
   RMS         Public/ Military     1982       Open       secondary        All regions                          -------        ------        High        4.5
                                                                                           (30% discount)
                                                             levels
                                                           Tertiary/
                  Public/                                                                  Fee-for-service      If self-
   JUH                              1973       Open       secondary        All regions                                         ------        High        11
                 University                                                                (25% discount)      referred
                                                             levels
Al- Hussein                                              Hematology
                                                                                           Fee-for-service
  Cancer       Philanthropy/        2001       Annual     and cancer       All regions                           -----         ------        High        1.7
                                                                                           (25% discount)
  Center       not-for-profit                                cases
                                                            Mainly                         Fee-for-service      If self
   KAH        Public/ university    2002       Annual                     North regions                                                      High         6
                                                         tertiary level                    (25% discount)      referred        ------
                                                                                           Bed leasing (all
                                                           Mainly                                                             Direct
                                                                                               services
    Al-                                                  secondary                                                         supervision
                                                                                            included/MOH
Mowasah &                            July                 (General                                                             and
              Private/for profit               Annual                     East Amman           specialist       ------                       Low         1.5
 Al-Hayah                           /2003                medicine+                                                         monitoring of
                                                                                              physicians
 Hospitals                                                General                                                             MOH
                                                                                           provide care for
                                                           Surgery                                                          physicians
                                                                                          referred patients)
 Lozmila                                                 Secondary                         Fee-for-service      If self
              Private/for profit    2001       Annual                     Amman Area                                           ------        High        0.5
 Hospital                                                care level                        (25% discount)      referred
                                                                                           Fee-for-service
   Red
              Philanthropy/not-                          Secondary                        (30% discount) +      If self
 Crescent                           1999       Annual                     Amman Area                                           ------        High        0.4
                  for-profit                             care level                        prospective (per    referred
 Hospital
                                                                                                 case)
  Other
                                                         Emergency                                                                           Very
  Private     Private/for profit     ------     ------                     All regions     Fee-for-service      ------         ------                     6
                                                           cases                                                                             High
 Hospitals
        Table 3.2: Population by Directorate for 2004 and Projected for 2014


                                   Estimated Population 2004               Projected Population 2014
Region      Directorate    Estimated     Estimated                 Estimate      Estimated
                           Pop. > 1      Females      Total Pop.   d Pop. >      Females      Total Pop.
                           year          15-44                     1 year        15-44
            Capital        40,466        371,093      1,618,635    48,427        444,098      1,937,066
            East Amman     10,131        92,911       405,259      12,125        111,189      484,985
            Madaba         3386          31,053       135,446      4,052         37,162       162,092
Central     Zarqa          20,208        185,316      808,312      24,183        221,773      967,331
            Balqa          6,826         62,597       273,036      8,169         74,912       326,750
            Dair Alla      1,210         11,100       48,415       1,449         13,284       57,940
            South Shuneh   964           8,841        38,563       1,154         10,580       46,149
            Irbid          14,870        136,369      594,813      17,796        163,196      711,829
            North Agwar    2,231         20,456       89,227       2,670         24,481       106,780
            Ramtha         2,699         24,755       107,975      3,230         29,625       129,217
            Al-Kura        2,361         21,649       94,428       2,825         25,908       113,005
North       Bani Kenanah   1,991         18,254       79,622       2,382         21,846       95,286
            Ajlun          3,091         28,350       123,658      3,700         33,927       147,985
            Jarash         4,009         36,761       160,344      4,797         43,993       191,888
            Mafraq         2,627         24,088       105,066      3,143         28,827       125,736
            North Badiah   3,648         33,456       145,927      4,366         40,037       174,635
            Karak /1       5,326         48,839       213,028      6,373         58,448       254,937
            Tafieleh       1,964         18,013       78,570       2,351         21,557       94,027
South
            Ma’an          2,418         22,172       96,709       2,893         26,534       115,735
            Aqaba          2,654         24,340       106,168      3,176         29,129       127,054
NATIONAL TOTAL             133,080       1,220,413    5,323,200    159,261       1,460,504    6,370,426


        Sources: Preliminary results of the 2004 Population census, with age group proportions and
        annual population growth provided by the Department of Statistics in February 2005.
Table 3.1: Profiles of Health Sub-Systems in Jordan

Benefits by Health                  Coverage/ Special       Principal Financing         Provider-Payer         % of Population          Size of
Subsystems                          Categories              Source                      Relationship           Covered or Eligible      Operation

                                     Describes coverage                                      Describes
                                                                                                                 Number of people        As indicated by
                                        and eligibility                                     relationship
  Describes types of services                               Describes main sources                             covered or eligible by    staff, beds, or
                                       criteria, special                                between financing
    and benefits available.                                      of financing                                     health system            number of
                                    programs for specific                                   and service
                                                                                                                   nationwide.              facilities.
                                     population groups.                                 delivery functions.

Government Services/ MOH
a) Provides comprehensive             Civil servants and      Ministry of          Ministry of Health          20 percent (persons      Operates
   public health services;            dependents; and         Finance (general     integrated delivery         enrolled in CHIP).         53
   primary, preventive, and           individuals             tax revenues).       system-services                                        comprehensive
   curative care through its          certified as poor,      Ministry of Social   provided by                 Under public law, MOH      health centers.
   facilities.                        the disabled,           Affairs.             government facilities       is required to provide     340 primary
b) Performs the following             children under          Services fees        financed through            subsidized care to all     health centers.
   financing functions:               age of six, and         collected at         budget and salaried civil   Jordanian citizens.        260 village
   Administers Civil Health           blood donors.           health facilities.   services staff.                                        health centers.
   Insurance Program (CHIP).          Highly subsidized       Co-payment for                                                              353 maternity
   Insurer of last resort for the     primary and             services and                                                                and child
   poor.                              curative care for       pharmaceuticals.                                                            health care
                                      the entire              Payroll                                                                     centers.
                                      population.             deductions.                                                                 251 dental
                                                              Donor                                                                       clinics.
                                                              assistance.                                                                 11 chest
                                                              World Bank loan                                                             diseases
                                                                                                                                          centers.
                                                                                                                                          29 hospitals.
                                                                                                                                          3,456 hospital
                                                                                                                                          beds (37%)
Cont… Table (1)
      Benefits by Health            Coverage/ Special          Principal              Provider-Payer             % of Population       Size of Operation
          Subsystems                   Categories          Financing Source            Relationship             Covered or Eligible
Royal Medical Services
Primary and curative care           Military personnel     Government budget.     Integrated delivery         27 percent              Operates:
services.                           and their                  User fees.         system comprising RMS                                 5 health center.
                                    dependents.                Premiums           outpatient clinics and                                10 hospitals
                                       Other referrals     (based on army rank    hospitals.                                            1801 hospital
                                       From MOH and        and status).           Referrals to MOH                                      beds (19%)
                                       contractual         Minor cost sharing     facilities.
                                       agreements with     for pharmaceuticals.
                                       public firms.
Jordan University Hospital
   Serves as a fee-for-service      Covers its                Ministry of         Serves as fee-for-          1.33 percent.           Operates
 referral center for other public   employees and             Finance             service referral center                                1 hospital.
 programs and private payers.       dependents.               Ministry of         for other public
                                                              Health.             programs and private                                    540 beds
 Owns and operates outpatient                                 User fees           payers.                                                 (5.8%).
 clinics and inpatient facilities
 for primary and curative care.
King Abdullah Hospital
    Serves as a fee-for-service     Covers its employees        Ministry of       Serves as fee-for-service   1.0 percent             Operates:
    referral center for other       and dependents.             Finance           referral center for other                              1 hospital.
    public programs and private                                 Ministry of       public programs and                                    650 hospital beds
    payers.                                                     Health.           private payers.                                        (the hospital
Owns and operates outpatient                                    User fees.                                                               operates now 200
clinics and inpatient facilities                                RMS.                                                                     beds only).
for primary and curative care.
    Benefits by Health           Coverage/ Special           Principal           Provider-Payer         % of Population         Size of Operation
       Subsystems                   Categories               Financing            Relationship         Covered or Eligible
                                                              Source
United Nations Relief Work Agency
  Owns and runs primary         Provides primary         Financed through    Operates and owns        11 percent               Operates
  health care centers.          health care to 0.6       outside donor       primary health care                                 23 Health Centers.
                                million Palestinian      contributions.      clinics managed by its                              30 clinics.
  Refers hospital care to MOH   refugees.                                    staff.                                              23 family Health
  or private facilities.                                                                                                         Clinics.
                                                                                                                                 21 Dental Clinics.
Private Health
  Owns and operates                Beneficiaries of         Direct out-of-   Private hospitals and    All citizens with        Operates:
  private clinics and              any private health       pocket           clinics, by contract.    willingness to pay are     Number of clinics
  hospitals for primary and        plan self-insured.       payment.                                  eligible.                  not available.
  curative care.                   Company                  Payments         Fee-for-service, or                                 56 hospitals
                                   employees and            from             through a third-party                               3,275 hospital
  Own and operates                 their dependents.        insurance        payer (insurance                                    beds (35%).
  pharmacies.                      All citizens with        plans.           company or employer)                                1,564 pharmacies.
                                   willingness to           Payments
                                   pay.                     from
                                                            employees
                                                            and
                                                            employers.



Source: Jordan’s National Health Accounts, Draft Report, 2004.
  MOH Annual Report, 2003.

				
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