Photo: Iraqi doctor and patients

USAID/Iraq USAID/Iraq Photo: Iraqi doctor and patients Delivering Vital Health Services Delivering Vital Health Services and and Strengthening the Iraqi Strengthening the Iraqi Health System Health System infant mortality under five mortality Health Conditions Health Conditions - - Years of neglect Years of neglect Infant $0.72 per person for $0.72 per person for infant and under five mortality rates in Iraq health care (1996) health care (1996) 180 160 140 17% suffered 17% suffered 120 100 moderate to severe moderate to severe rate 80 malnutrition malnutrition 60 40 20 0 Maternal Mortality Maternal Mortality 1960 1970 369/100,000 369/100,000 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 mortality:1960: 118 - 1965: 103 - 1970: 90 - 1975: 75 - 1980: 63 - 1985: 50 1995 Under five mortality:1960: 170 - 1965: 150 - 1970: 135 - 1975: 105 - 1980: 83 - 1965 1975 1980 1985 1990 1998 year 2 2 Iraqi Health Resources Iraqi Health Resources Highly focused on Highly focused on tertiary care tertiary care • • 53 physicians per 53 physicians per 100,000 people 100,000 people Photo - Hospital in Iraq • • 44 nurses per 100,000 44 nurses per 100,000 people people Facilities Facilities • • 282 Hospitals (12% 282 Hospitals (12% damaged or looted) damaged or looted) • • 1,570 Primary Health 1,570 Primary Health Centers Centers • • Approx. 2800 Approx. 2800 Nutritional Nutritional Rehabilitation Centers Rehabilitation Centers 3 3 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 USAID Programming begins USAID Programming begins Planning began in fall 2002 Planning began in fall 2002 Technical assistance providers on the Technical assistance providers on the ground ground - - April 2003 April 2003 USAID Mission opened in Baghdad USAID Mission opened in Baghdad – – July 2003 July 2003 Funding for health programs Funding for health programs • • approximately $149 million (12 mos.) approximately $149 million (12 mos.) 4 4 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 USAID Principles USAID Principles Ensure Continued Access to Care • provision of medicines and supplies, emergency facility repairs, transportation and other vital needs. Support the Ministry of Health: • USAID supports, in collaboration with the CPA, development and implementation the Ministry of Health’s policies Develop the capacity of Iraqis: • USAID will train and provide resources to Iraqis in order to lay a sustainable foundation for better health care Collaboration: • USAID will collaborates with the Ministry of Health, CPA, UNICEF, WHO and other donor and implementing agencies in the country 5 5 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 What USAID Is Doing What USAID Is Doing Humanitarian Humanitarian Assistance Assistance • • $74.9 million $74.9 million Reconstruction Reconstruction • • $73.9 million $73.9 million Photo - Iraqi mother and child 6 6 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 Expected Results Include: Expected Results Include: Functioning and strengthened Iraqi Functioning and strengthened Iraqi Ministry of Health Ministry of Health 600 PHC centers and clinics rehabilitated, 600 PHC centers and clinics rehabilitated, equipped and functioning equipped and functioning 21 referral centers equipped and 21 referral centers equipped and strengthened with particular emphasis on strengthened with particular emphasis on OBGYN and emergency OBGYN and emergency More than 140 hospitals will be More than 140 hospitals will be refurbished. refurbished. Re Re- -establish routine health care services establish routine health care services 7 7 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 Humanitarian Assistance Humanitarian Assistance Fielded a 60 Fielded a 60- -person Disaster Assistance person Disaster Assistance Response Team (DART) Response Team (DART) USAID/OFDA supported emergency humanitarian USAID/OFDA supported emergency humanitarian activities including: activities including: • • food security food security • • Health and nutrition Health and nutrition • • Emergency shelter Emergency shelter • • water and sanitation water and sanitation • • Logistics and commodities support Logistics and commodities support 8 8 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 Support for International Organizations Support for International Organizations Develop coordination structures and Develop coordination structures and preposition relief commodities: preposition relief commodities: • • $5 million for logistics coordination (WFP) $5 million for logistics coordination (WFP) • • $5 million to for IDP preparedness with NGOs $5 million to for IDP preparedness with NGOs (IOM) (IOM) • • $4 million for water, sanitation, and health $4 million for water, sanitation, and health (UNICEF) (UNICEF) • • Nearly $1 million in support to a consortium of Nearly $1 million in support to a consortium of NGOs to facilitate assessments, coordination, NGOs to facilitate assessments, coordination, etc. etc. 9 9 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 Results of Humanitarian Assistance Results of Humanitarian Assistance Projects are ongoing in every governorate of Projects are ongoing in every governorate of Iraq. Examples include: Iraq. Examples include: • • 112 compact water treatment units and 7 plants 112 compact water treatment units and 7 plants completed to date; nearly 200 more ongoing or completed to date; nearly 200 more ongoing or planned planned 49 hospital/clinic rehabs completed; 131 more • • 49 hospital/clinic rehabs completed; 131 more ongoing or planned ongoing or planned • • More than 2,000 health care professionals trained More than 2,000 health care professionals trained 10 10 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 Highlights from our other partners Highlights from our other partners Abt Associates Abt Associates • • $43.9 million $43.9 million World Health Organization World Health Organization • • $10 million $10 million UNICEF UNICEF • • $20 million (for health) $20 million (for health) 11 11 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 Abt Associates Abt Associates Office opened in Baghdad, June 1 Office opened in Baghdad, June 1 • • 3 Regional offices open 3 Regional offices open Focus on 4 key areas Focus on 4 key areas • • Training and re Training and re- -equipping facilities equipping facilities • • Community education Community education • • Evidence for decision Evidence for decision- -making making • • Health services quality improvement Health services quality improvement 12 12 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 Accomplishments Accomplishments Train and Train and Community Community Improve Improve Evidence Evidence re re- -equip equip Education Education quality quality for for decision decision- - making making 600 equipment 600 equipment Community Community Syllabus for Syllabus for Cost of Cost of kits being kits being procured. procured. survey under survey under training training providing providing development development completed. completed. primary health primary health care assessed care assessed Training Training curriculum curriculum Three focus Three focus designed with designed with Baghdad Medical Baghdad Medical governorates governorates Disease Disease University. University. identified. identified. surveillance surveillance design design Target regions Target regions completed. completed. identified and identified and regional offices regional offices established. established. 13 13 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 North Central Heartland Map of hospital locations in Iraq South 14 14 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 Health Facilities, May 03 Health Facilities, May 03 23 23 Facility Type Facility Type Number Number Ministry of Ministry of 1 1 Health Health Health Health Directorates Directorates Pharmacies Pharmacies 268 268 Health Centers Health Centers 1570 1570 Hospitals Hospitals Warehouses Warehouses 15 15 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 282 282 142 142 WHO immediately post war WHO immediately post war WHO active with technical capacity WHO active with technical capacity in: in: • • Basrah, Basrah, • • Arbil, Arbil, • • Kirkuk/Mosul Kirkuk/Mosul • • as well as in Baghdad. as well as in Baghdad. Challenges of insecurity and Challenges of insecurity and communications. communications. 16 16 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 WHO immediately post war (Cont.) WHO immediately post war (Cont.) Focus on jump Focus on jump- -starting starting • • public health functions (disease public health functions (disease surveillance and response), surveillance and response), • • essential primary health care and essential primary health care and hospital functions hospital functions • • urgently required medicines urgently required medicines Effective communicable disease work Effective communicable disease work in Basra in Basra 17 17 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 Priority Setting Workshop 17 Priority Setting Workshop 17- -19 Aug 19 Aug CPA CPA CPA CPA MOH MOH WHO WHO WB WB CPA CPA Residents Residents MOH MOH IRDC IRDC CPA CPA Strategic Strategic A policy discussion on the A policy discussion on the MOH MOH Planning Planning prioritization of health care issues prioritization of health care issues DGs DGs UNICEF UNICEF to prepare for UN Donors to prepare for UN Donors Kurdistan Kurdistan Conference in October. Conference in October. ABT ABT South South JTF JTF- -7 7 18 18 NGO NGO Iraq Red Iraq Red EC EC DFID DFID USAID USAID ICRC ICRC Crescent Crescent Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 HEALTH PRIORITIES IDENTIFIED HEALTH PRIORITIES IDENTIFIED • • Reliable Information Reliable Information • • Accessible, affordable, good quality and Accessible, affordable, good quality and equitable care equitable care • • Emphasis on halving maternal and child Emphasis on halving maternal and child mortality mortality • • Support for “quick Support for “quick- -impact” programmes in all impact” programmes in all governorates governorates • • Sustain priority services especially for Sustain priority services especially for communicable diseases communicable diseases 19 19 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 Health Priorities (Continued) Health Priorities (Continued) Back efforts to upgrade health worker Back efforts to upgrade health worker training and accreditation, including training and accreditation, including health care administration health care administration Build capacity of Ministry of Health for Build capacity of Ministry of Health for stewardship stewardship Ensure a strong supply pipeline after the Ensure a strong supply pipeline after the end of the Oil for Food programme end of the Oil for Food programme 20 20 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 Reconstruction Conference Reconstruction Conference – – October 2003 October 2003 Health situation assessment: Health situation assessment: respond to immediate needs while reforming the health • • respond to immediate needs while reforming the health system system • • need for better data need for better data Increased focus Increased focus - - by Iraqi institutions by Iraqi institutions – – on: on: • • public health, primary health care, and evidence public health, primary health care, and evidence- -based based responses responses Limited financing available Limited financing available Human resources Human resources - - need to upgrade need to upgrade Challenges of: Challenges of: • • general insecurity general insecurity • • safety for women safety for women • • moving finances and accounting moving finances and accounting 21 21 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 Possible Priorities For WHO Possible Priorities For WHO Support Support • • For the MOH Health Planning For the MOH Health Planning steering steering committee committee and working groups and working groups • • For joint programming For joint programming - - with CPA and NGOs with CPA and NGOs - - to improve functioning of MOH to improve functioning of MOH • • For joint programming to support For joint programming to support public health priorities public health priorities financing of urgent actions in Governorates financing of urgent actions in Governorates • • For health professional training and continuing For health professional training and continuing education (especially nursing) education (especially nursing) • • For essential medical supplies, equipment, etc For essential medical supplies, equipment, etc 22 22 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 UNICEF UNICEF UNICEF has had continuous presence UNICEF has had continuous presence in Iraq in Iraq Prior to the conflict Prior to the conflict – – • • immunization rates increased immunization rates increased • • support for child health activities support for child health activities increased increased 23 23 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 UNICEF Accomplishments UNICEF Accomplishments Post Conflict Post Conflict 4 monthly vaccination days held 4 monthly vaccination days held • • More than 1.4 million vaccines administered to More than 1.4 million vaccines administered to children children 3 million oral rehydration packets 3 million oral rehydration packets distributed to treat diarrhea distributed to treat diarrhea 325 metric tons of high protein biscuits 325 metric tons of high protein biscuits distributed to malnourished children and distributed to malnourished children and breastfeeding mothers breastfeeding mothers 24 24 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 UNICEF Accomplishments UNICEF Accomplishments Over 8000 health workers undergoing Over 8000 health workers undergoing training training 20 delivery rooms in hospitals and primary 20 delivery rooms in hospitals and primary health care centers rehabilitated in health care centers rehabilitated in Basrah. Basrah. 25 25 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003 For more information For more information WWW.USAID.GOV WWW.USAID.GOV register for Iraq email list register for Iraq email list WWW.ABTASSOCIATES.COM WWW.ABTASSOCIATES.COM WWW.WHO.ORG WWW.WHO.ORG WWW.UNICEF.ORG WWW.UNICEF.ORG 26 26 Public Consultation Public Consultation - - Sept. 25, 2003 Sept. 25, 2003