Letter to the Editor


The 21st century demand for sociopolitical reforms in the Middle East: will there be a fair focus on the health sector?


The recent waves of social and political movements that spread quickly in several countries of the Middle East are clearly carrying the same aspirations, though at times with more dramatic consequences. A major implicit demand of all these populous activities was the aspiration for unimpeded access to basic livelihoods and social rights, equity and greater public participation in the democratic process. At the peak of these revolutions, the national health workforce has evinced an exceptional dedication reflected by enhanced preparedness and response to medical emergencies exemplified by the Egyptian Tahrir Square show-cases, echoing a great deal of compassion, motivation and professionalism, that has effectively coped with the extraordinary health needs of the sick and injured. Formerly, poor incentives have forced many health professionals to seek part-time jobs in the private health sector to supplement their earnings, and this pattern has negatively affected the performance of public health institutions and more severely, the remote rural areas and economically marginalized communities, especially with regard to reproductive health [1].

The health care financing system of these countries is an uneven combination of social insurance, general revenue, and out-of-pocket payment, where the latter constantly prevails over the other two financing schemes. If the appropriate corrective measures are not factored in the envisaged reforms, health will further lag behind, projecting a real failure in attaining the peoples’ inspired social protection. These aspirations are challenged by the evolving global economic crisis; where the structural economic adjustment policies and privatization are erroneously regarded as the panacea for all the problems of the underfunded and poorly performing public sector. Evidence suggests, however, that these policies are detrimental to the underserved, unless they encompass meaningful health and other socio-economic interventions that acknowledge health as a fundamental right of every human being as stipulated in the WHO constitution, and address the inequities that undermine this right. These uprisings signal the need for: social distributive justice with enhanced support to those most in need; the provision of essential primary health care services with results-based accountability; the use of appropriate technologies and tested best practices; the promotion of community participation as an integral part of the democratic process; and the acknowledgment of the basic needs comprehensive concept, which correlates health with its social determinants and underlines the demand for intersectoral action [4].

Newly constituted governments must be cautioned against the common fallacy of solely investing in curative aspects of health by focusing on big hospitals with escalating health costs, which have an insignificant impact on the globally accepted indicators that measure nations’ true health status and wellbeing. Instead they need to promote the public health approach, concentrating on: primary and secondary prevention and the root causes of ill health; the building of a health infrastructure that ensures universal coverage and access to quality essential services, encourages health care utilization, and offers financial protection against the unaffordable catastrophic expenditures incurred by the poor. The rights of the health workforce need also to be acknowledged in terms of employment opportunities, effective training, equitable distribution, attractive retention strategies, improved working environment and incremental support to those in hardship zones. The impact of this investment will be realized only if coupled by a sustained policy of health system strengthening that offer the required capacity and support for the delivery of essential health services to the target population as shown by other experiences [5,6]. While the expectation of countries affected by natural and manmade crisis and conflicts is to salvage the vital health care services and avert the negative impact of disrupted health systems, the thrust of the countries successfully pressing for the 21st century sociopolitical reforms is to accord a high priority to this sector by effectively and equitably addressing the legitimate health demands of the population, without which the attainment of the people’s aspirations will be incomplete. 


  1. Afifi M. Wealth Index association with gender issues and the reproductive health of Egyptian women. Nursing and Health Sciences, 2009, 11(1):29–36.
  2. Janes CR, Chuluundorj O. Free markets and dead mothers: the social ecology of maternal mortality in post-socialist Mongolia. Medical Anthropology Quarterly, 2004, 18(2):230–257.
  3. Brezis M, Wiist WH. Vulnerability of health to market forces. Medical Care, 2011, 49(3):232–239.
  4. Vázquez ML et al. Los procesos de reforma y la participación social en saluden América Latina [The reform process and social participation in health in Latin America]. Gaceta Sanitaria, 2002, 16(1):30–38.
  5. Khodjamurodov G, Rechel B. Health systems in transition. Health Systems in Transition, 2010, 12(2):v-xix, 1–154.
  6. Bobiak SN et al. Measuring practice capacity for change: a tool for guiding quality improvement in primary care settings. Quality Management in Health Care, 2009, 18(4):278–284.

K.M. BileFormer WHO Representative, Pakistan( This e-mail address is being protected from spambots. You need JavaScript enabled to view it )


Strategic directions to improve health care financing in the Eastern Mediterranean Region: moving towards universal coverage 2011–2015

At the Fifty-seventh Session of the Regional Committee for the Eastern Mediterranean in October 2010, the Committee discussed how to improve health care financing in the Eastern Mediterranean Region in order to advance universal coverage and passed Resolution EM/RC57/R.7, which urged Member States to:

Adopt and adapt the strategic directions in accordance with national priorities and develop policies to remove financial barriers to access to health services for all citizens and residents;

Increase investment in health through improved policy dialogue with ministries of finance and planning and other stakeholders in order to provide social health protection for all;

Promote introduction and expansion of prepayment schemes to reduce out-of-pocket payments and the incidence of financial catastrophe and impoverishment;

Introduce purchasing mechanisms that give appropriate incentives to providers and users of health services to make efficient use of the available resources;

Allocate sufficient resources to generate evidence that guides health financing policies and the move towards universal coverage;

Monitor equity in health financing and assess the move towards universal coverage. 

Resolutions of the Regional Committee for the Eastern Mediterranean are available at: http://www.emro.who.int/governance/resolutions.htm