News Features - Syria Report
Public health system
stretched
Syria’s public health system
is under severe strain.
Although the quality of its
health care remains regionally
strong, growing budget
deficits, ballooning demographics
and the influx of
an estimated 1.5 million
Iraqis, all of whom qualify
for free healthcare, means
the need for state hospitals
and clinics is soaring, even
as the money to pay for
them grows less each year,
reports IRIN News.
Syria’s budget deficit has
gone from bad to worse in
recent years.
Annual deficits
have increased from 1.7% of
gross domestic product
(GDP) in 2001 to 5% in
2005 and with spending
increases in 2006 Damascus-based
economists estimate
the deficit will reach 7.6%.
Annual spending on
healthcare is just 5% of
GDP, a slight increase from
the 2.5% estimated as of
1999, but considerably less
than neighbouring countries.
According to the
World Health Organisation,
Jordan spent 9.8% and
Lebanon 11.6% of GDP on
health in 2004.
The deficits are growing as
Syria’s demographics experience
massive change. Syria’s
population of 19 million is
growing at 2.5% a year,
around 475,000 people,
while the influx of up to 1.5
million Iraqi refugees has
further swelled the population
by around 8% since
2003 and put an unsustainable
strain on public services.
“Though there are a lot of
public hospitals, which are
free of charge, the quality is
not so good and is
decreasing,” said Syrian
economist, Samir Seifan.
“When you have 2.5%
population growth each
year you need to improve
the budget by more than
2.5% at minimum.
But the
state budget doesn’t have
enough resources; we’ve had
a deficit for the last few
years.”
Among a population long
weaned on low salaries and
state subsidies few are able
to afford private healthcare.
Modernisation drive
With the soaring demand
for healthcare, a European
Union (EU)-funded
modernisation programme
is helping the government
run its state hospitals and
clinics more efficiently.
On a hill overlooking
Damascus the recently
opened Centre for Strategic
Health Studies (CSHS) is the
most visible result of an
ongoing two-year 30
million euro health
modernisation programme
that aims to improve efficiency
in cash-strapped
hospitals and clinics by
improving their management.
The CSHS is aiming to
become the region’s most
advanced hub of health
studies, training health
sector staff in three key areas
– health economics, public
health and health systems
management.
The CSHS has been
funded through the Health
Sector Modernisation
Programme (HSMP),
receiving 5 million euros
from the EU and operating
in partnership with the UK’s
Liverpool University, which
has provided academic and
institutional expertise,
including professors for the
current crop of 24 students.
Six CSHS staff members
have been dispatched to
Europe to complete masters’
degrees to prepare them for
academic, research and
consultancy work. The
curriculum will focus on
health management issues
aimed at improving efficiency
and providing better
services within the health
sector, leaving the medical
care to the doctors.
“Health management
research is very weak in
Syria,” said CSHS director
Reem Akras. “We need
people to be specialised in
these areas so we can
support the health sector.”
Changing attitudes
At the heart of the
programme is the belief that
by improving the management
of, and attitudes in,
the Syrian health sector,
services and the utilisation
of public facilities on the
ground will improve.
“Modernisation needs a
long time and it’s difficult
sometimes to see tangible
results on the ground
because you are dealing
with changing mind-sets,”
said Omar Ballan,
programme coordinator at
the Ministry of Health.
“People have been working
for 40 years under this
system and you can’t
change that in one day.”
Six areas have been identified
as central to the HSMP,
according to Ballan:
improving policy and planning
capacities; better
matching the primary
healthcare system with the population needs;
improving the performance
of hospitals and other
health centres; enhancing
management capabilities;
strengthening quality
management and accreditation
processes; and creating
sustainable health financing.
Family clinics
Within the six target areas,
the role of primary health
care systems and health
insurance has taken centre
stage in the debate over
reform.
Officials estimate that
around half of Syrians
unnecessarily finance their
own health needs by buying
medicine from pharmacies
and going to private doctors
before they enter largelyfree
public hospitals.
The HSMP aims to
improve the quality and
availability of public
primary healthcare systems,
or family clinics, and create
“a rationalised pre-payment”
system to help relieve the
poor of the financial burden
of private care.
Health insurance
schemes, both private and
public, are being considered
as a means of covering the
individual and public financial
burden of healthcare.
Initially intended to be
completed by November
2007, the project has been
extended to 2009 and could
well continue beyond.
“We’re finally at the stage
where we’re starting to
deliver things on the
ground,” said Ryan Knox, programme officer for the
HSMP at the European
Commission in Damascus.
“The first two years were
mainly policy work to come
up with a vision for how the
health sector should
change.”
New equipment
The Health Ministry’s Ballan
said 30 health centres in the
pilot governorates of
Lattakia, on the west coast,
and Daraa, in the south,
have been renovated in
readiness for new medical
equipment and that 25,000
training days had been
logged since the project
began.
New medical equipment,
from simple blood pressure
machines to high-tech ultrasound
scanners, is now
being delivered to the renovated
health centres.
Date
of upload: 22nd Jan 2008
