Iraq | Programme areas | Iraq Public Sector Modernization (I-PSM)

Iraq Public Sector Modernization (I-PSM)

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The Iraq Public Sector Modernization (I-PSM) programme is a national exercise, technically supported by WHO, in consultation with other partners.

The approach of the I-PSM programme is to conduct functional reviews of the health sector/system with the aim of assessing the capacity of the health system by reviewing core functions, focusing on the central Ministry of Health, directorates of health at the governorate, district, service provision and community level. It covers clinical services and public health functions and also focuses on the links between the health sector and other sectors mandated to provide services with either a direct or indirect effect on health.

I-PSM is a four-year United Nations (UN) interagency comprehensive programme funded by the United Nations Development Group Iraq Trust Fund (UNDG-ITF) with total allocated funds of US$ 55 million.

Phase I (Year 1) of I-PSM focuses on conducting sector-based functional reviews and the formulation of a National Public Sector Modernization Programme, while Phase II (Years 2–4) focuses largely on sectoral reforms to strengthen service delivery, through well-articulated reform and modernization road maps. The programme covers the three sectors of health education, water and sanitation at central, regional, provincial and district levels.

I-PSM programme established six working groups to cover the six building blocks of Health System (BBHS), during the first half of the year, four blocks out of six where covered governance, health financing, health workforce, medicine and other technologies, information for health and service delivery.


Governance & Leadership Functions in Iraq Health Sectors

Ministry of Health is constitutionally mandated to provide necessary health care services in partnership with the private sector and to guarantee health and social security to all citizens.

There is no documented national health policy, per se, in Iraq, however there are strategies, sets of regulations and laws for health care provision and organization of health ministry. Twenty six laws in the constitution of Iraq cover different aspects of the health sector in Iraq, in addition to several byelaws covering all fields of health development and supporting the various functions of the Ministry of Health at national and sub national levels.

 Health care financing

National Health Accounts (NHA) was presented in April 2011 by the Ministry of Health and the World Health Organization to support the I-PSM. Total expenditure on the health sector during 2010 was Iraqi Dinar (ID) ID 8150 billion. In general, health care expenditure in Iraq is primary spent on curative care (more than 37%). Transportation absorbs 9% out-of-pocket health spending.

Health workforce

The average health worker to population ratio is 7.5/10 000 population. It is highest in Arbil (10.5), Basra (9.9), and Kerbala (9.2) and lowest in Missan (3.5), Diyala (4.30) and Thi-Qar (4.4). There are issues in equitable distribution of the health workforce across Iraq and especially in relation to availability of female health care providers. Shortage of nurses generally in the country as well as in the hospital was considered as a major issue.

Health Information

The Health Information System (HIS) supports all health system functions and building blocks and is often considered as a proxy for the level of development of the health system. Data is collected through the national information system and supplemented by population based surveys, vital registration system and health research.

Another important data source is the vital registration system, which the Ministry of Health at national and subnational levels, coordinates with the Ministry of Interior (MoI).

Service Delivery

The health care delivery system in Iraq has historically been a hospital-oriented and capital-intensive model. The Ministry of Health is the main provider of health care, both curative and preventive. The private sector also provides curative services. About half of the health centers are staffed with at least one medical doctor. The rest have trained health workers (medical assistants and nurses).

Access to personal health services in the public sector is almost universal, as all Iraqi citizens are entitled to public personal health services, with minimal user charges. While medical services in the public sector hospitals are free, the people choose to seek care in the private sector health centers due to longer waiting times and other problems.

Health technologies and pharmaceuticals

Health and biomedical technologies, including pharmaceuticals, constitutes the second major input in the provision of health care services.

Since 2008 until present, the Ministry of Health, with the technical support of the World Health Organization, has invested substantial resources to increase the awareness of health professionals and the public on the importance of rational use of health technologies, particularly the rational use of medicines.


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Key health-related statistics

Total population (000s) 37 140
Total health expenditure on health (% of general government expenditure) 6.5
Maternal mortality ratio (per 100 000 live births) 50
Number of primary health care units and centres (per 10 000 population) 0.7
Total life expectancy at birth (years) 69.8

Source: Framework for health information systems and core indicators for monitoring health situation and health system performance, 2018

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