Middle East Health: An Area of Great Dynamism, Diversity, Need, & Innovation
Dr. M Abdi Jama Deputy Regional Director Eastern Mediterranean Regional Office, Cairo, Egypt
Annual Research Meeting – Orlando June 3-5, 2007
Challenges to the Middle East
Middle Eastern and Arab countries face major challenges, including foreign occupations, deficient liberties, poor governance, squandering of resources, economic regression, inequities, and illiteracy.
United Nations Development Programme, Arab Fund for Economic and Social Development. Arab human development report 2004. New York: UN, 2005.
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Challenges to Health in the Middle East
• Health indicators show stark differences between individual countries when disaggregated by stratifiers (gender, income, residence etc.); • Arab-Israeli conflict, the wars in Iraq, Lebanon, and Sudan have brought about hunger, epidemics, displacement, and death; • Patriarchal principles are embedded in the state structures of many countries; • Conservative values render public debates on sensitive issues unacceptable; • Multilateral and bilateral aid influences public policy making owing to demands for reform and reduced public sector spending.
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Source: BMJ 2006;333:859 (21 October), doi:10.1136/bmj.333.7573.859
“Boundaries of the Middle East?”
Traditional Definition of Middle East
G8 Definition of the Greater Middle East 4
Middle East: Geopolitics and Health
• Characteristics of conflicts and crises in the region:
– – – – Occupation and dislocation of population Destruction of social networks and ecosystems Insecurity Abuse of human rights
• All influence population health through
– Disruption of health systems and priority public health programs – Worsening of social, economic and environmental determinants of health
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Changing Dynamics and their Influence on Health in Middle East
• Changing demographic, epidemiologic and risk profile of the population; • Widespread distribution of risk factors for disease, such as smoking, obesity, and hypertension • Rising expectations of a more educated population; • Inability of governments to provide comprehensive healthcare services • Increasing influence of market forces • Sustaining health systems, especially in crisis countries
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Profile of Burden of Disease in the Middle East
• Communicable diseases continue to be a problem, especially in crisis countries • High incidence of non-communicable diseases, cancer, injuries • Increasing incidence of death and disability due to violence • High prevalence of problems of mental ill health due to unfavorable geopolitical and socioeconomic conditions
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Years
80 70 60 50 40 30 20 10 0
Algeria Bahrain Egypt Iran Iraq Jordan Kuwait Lebanon Libya Morocco Oman Palestine Qatar Saudi Arabia Sudan Syria Tunisia UAE Yemen
Life Expectancy Male
Years
Life Expectancy in Middle East Countries - 2006
90 80 70 60 50 40 30 20 10 0 Life Expectancy Female
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Al ge Ba ria hr ai n Eg yp t Ira n Ir J o aq rd Ku a n w Le a it ba no n Li by M or a oc co O m Pa an le st in Sa Q e u d ata iA r ra b Su i a da n Sy ria Tu nis ia UA Ye E m en
IMR and MMR in countries of the Middle East and North Africa
140
120
120 100 80 60
40 45 75 62
102
Infant Mortality Rate
per 1000 live births
40 20 0
8.1 8.2 8.2 8.9 10.3 17.1 18.6 19.1 20.5 20.5 20.6
28.6 22.1 25
ai t Q at Ba ar hr ai n O m an Sy Le ria Sa ban u d on iA ra bi a Eg Pa y pt le sti n Tu e ni sia Jo rd an Li by a I M ran or oc co Ira q Su da Y n em D en jib ou So ti m al ia
A U
E K
uw
700
590
600 500
546
Maternal Mortality Ratio
per 100,00 live births
400
294
366 227 88
300 200 100
0 1 4 12 21 22 23 37 40 40 48 58 63
0
ra in U A E K uw Sa u d ait ia ra Pa b ia le sti ne Q at ar O m an Ira n Jo rd an Li by Tu a ni sia Sy ria Eg y Le pt ba n M on or oc co q em en D jib ou ti Su da n Y Ba h Ira
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Expenditure on Health in countries of the Middle East and North Africa
Total expenditure on health as % of GDP
16 14 12 10 8 6 4 2 0
q at So ar m al ia O m an U A E K Sa uw u d ai iA t ra b Ba ia hr ai n Li by a Su M dan or oc co Sy r Tu ia ni sia Y em D en jib ou ti Eg yp t Ira n Jo rd L e an ba n Pa on le sti ne Ira Q
Per capita total expenditure on health
13.5 10.2 9.4
1000 900 800 700 600 500 400 300 200 100 0 366 278 72 21 23 32 47 55 59 171 177 131 137 138 862 661 555 573 579
4 4.1 4.1 4.3 3.3 3.5 2.7 2.7 3.1 3.2
5.7 5.8 5.1 5.1 5.4 5.5
6.5
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Somalia
Saudi Arabia
Yemen
Sudan
Oman
Lebanon
Jordan
Bahrain
Libya
Djibouti
Palestine
Kuwait
Tunisia
UAE
Syria
Iraq
Iran
(Average exchange rate (US $) 10
Morocco
Egypt
Qatar
Profile of the Health Workforce in the Middle East and North Africa
Number of physicians per
10,000 population
30 25 20 15 10
5.5 5.6 8.9 9.7 9.8 6.6 14.4 12.5 16.7 16.9 18 19 23.6 23.6 24.3 26.4 27.2
Number of nurses per 10,000 population
70
60
60 50 40
29.4 29.8 37 37 33.5 35 35.2 48
52.9
30 20 10 5.5 0
8 8.4 9 12.6 13.2 14.1 16 19
5 0
1.8 2.2
n sti n Tu e ni sia Li by a Sy ria Om an UA E K Sa uw ud ait iA rab i Jo a rd L e an ba no n Eg yp t Qa t Ba ar hr ain
Ye m Dj e n ib ou ti Su da M or n oc co I Le raq ba no n Ira Pa n les tin e Sy ri Jo a rd a Tu n ni sia Sa Egy ud p iA t rab ia UA E Ku wa it Om an Li by Ba a hr ain Qa tar
Dj ib ou Ye ti me n Su da M or n oc co
Ira
q
Pa le
Ira
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Numbers do not reflect the health problems in the Middle East!
• A pregnant mother in Palestine is unable to seek obstetric services due to the barricades erected by occupation forces; • A victim of violence in Baghdad is unable to receive care due to lack of a system for timely evacuation of such emergencies • People in Darfur die because they lack physical, geographical, financial access to basic services • Many migrant labor workers in the Gulf countries have no health cover and are sometimes deported if found to be positive for HIV or HCV
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Social Determinants of Health in the Middle East
• Women’s empowerment/enablement –status of women and their vital role in the health of families; • Child labor and street children – related to poverty and marginalization; • Lifestyle and behavioral issues – diet, physical activity, hygiene behavior, smoking traffic accidents; • Migrant workers – movements within and between countries can result in marked health inequities; • Inequitable health systems result in barrier in access to essential health care; • Conflicts and emergencies exacerbate existing health inequities
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Health Priorities in the Middle East
• Improving the leadership and governance of the ministries of health • Fair and adequate financing of the health system • Developing a balanced human resource for health • Providing universal access to an essential package of health services • Increasing the availability, access and use of information
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Health Priorities in the Middle East
• Identifying cost-effective interventions that target the major health problems • Developing health promotion programmes • Supporting community-based initiatives • Revitalizing disrupted health systems in countries in emergencies and disasters • Addressing the challenges of health determinants - globalization, poverty, gender and the environment
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Opportunities for Improving Health in the Middle East
Thinking Out of the Box • Health as a message of peace in the region! • Harnessing the potential of the Arab League for health improvement • Improved collaboration with development partners for optimizing external assistance to health • Mutual sharing of experience among countries of the region • Partnership with civil society and the private sector
– MENA Health Policy Forum
• Focus on improving governance of the health system
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Response of the World Health Organization
• WHO, Eastern Mediterranean Regional Office and country office provides technical support to all countries • Help revitalize and rebuild disrupted health systems in countries in complex emergencies • Assist in the design, monitoring and evaluation of health reforms • Development of surveillance systems to monitor diseases and control outbreaks • Capacity development of staff and institutions in health and health related fields • Assist national governments to better coordination with development partners to optimize resource use
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Envisioning a Future for Health in the Middle East
Heavy reliance on the geopolitical and economic situation of the region
Cessation of occupation Democratization of the states Increased economic growth and resource allocation to health
Health and health equity should be high on the political agenda of countries Democratizing structures, undoing hierarchies, and advancing transparency and accountability in institutions will contribute to wider reforms 18
Envisioning a Future for Health in the Middle East
Role and credibility of health professionals through increased engagement and responsibility towards the current situation and rallying to the cause of health reform Highlight the social and political health determinants among the public through engagement of civil institutions, opposition politicians, and even government agencies Health system actions - become more effective advocates for reform if we are successful at reforming our hospitals, clinics, and health ministries.
BMJ 2006;333:837-839 (21 October), doi:10.1136/bmj.38980.664074.94
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Thank you for your attention
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