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14 E s s e n t i a l S e r v i c e s Rebuilding Iraq’s Health System From vaccines and medicines to refurbishing health clinics and repairing sewage systems, American aid is reviving Iraq’s run- down health system. and mortar to complete a new water and sewage system for his hospital, As workmen hauled buckets of earth an Iraqi doctor described how the- buildings in the southeastern town had been neglected for years before U.S. aid arrived. “The hospital was run down—we had no toilets to use because they were always blocked up,” said the surgeon and director of the hospital just 10 miles from the border with Iran. “The patients suffered from the bad odor and it was hard to prevent infections after surgery.” But one of several U.S.-backed contrac- tors, running projects to improve health facil- ities and services in Iraq, discovered the need and offered to hire Iraqi contractors to fix the hospital. By September, 2003, new toilets were al- ready lined with smooth, easily-cleaned tiles. The water system worked well and there were no bad odors. The yard outside the clinic was still torn up as workmen finished the new septic tank to contain wastes. In April 2003, USAID set aside $150 mil- lion for health programs to reverse the disas- trous drop in Iraqi citizens’ health over the previous decade. The Hussein government had cut spending on health by 90 percent in that period but built many luxurious palaces and maintained its huge army. Health services favored specific political, ethnic and geographic groups. Maternal mor- tality grew close to three-fold in that period. It is estimated that 30% of women gave birth without a qualified health worker. Iraqi hospitals and clinics—once the envy of the Middle East—fell into disrepair. Many lacked medicines or equipment while doctors’ and other staff salaries shrank to as little as $20 per month. Iraq Life Expectancy Age 66 65 64 63 62 61 60 59 58 57 1980 Iraq invades Iran 1979 Saddam assumes power 1987 Age 65 1990 Iraq invades Kuwait 1996 UN oil- for-food program 2002 Age 63 1975 Age 60 begins 1995 Age 59 U.S. assistance aimed at improving mater- nal and child health, health infrastructure, health policy and management. The task would take forms as varied as massive immu- nization programs for millions of children to hiring backhoes and tile-cutters to create sep- tic tanks and clean toilets in clinics. In Basra, for example, looters had sacked the administrative offices where one Iraqi doctor runs 11 clinics in an area serving ‘76 ‘78 ‘80 ‘82 ‘84 ‘86 ‘88 ‘90 ‘92 ‘94 ‘96 ‘98 ‘00 ‘02 Source:World Bank estimates January ‘04 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ▲ Work begins on Sweet Water Canal plants ▲ Currency exchange completed ▲ Khazir Bridge reopens ▲ Master Teacher Trainers program completed ▲ Train-the-trainers health program Phase 2 ▲ Grant for Civic Education 15 Thomas Hartwell Results Debbi Morello/USAID USAID grants funded mobile health clinics to serve thou- sands of women in remote villages in northern Iraq. “Health care spending in Iraq has increased to 60 times pre-liberation levels.Two hundred and forty Iraqi hospitals and more than 1,200 primary health centers are operating and have been since last summer.More than 30 million doses of children’s vaccine have been distributed.” CPA Administrator, L. Paul Bremer, at the handover of the Ministry of Health, Baghdad, March 27, 2004 ● Procured more than 30 million doses of vac- cines with the Ministry of Health and UNICEF. ● Vaccinated three mil- lion children under the age of five, part of a cam- paign to provide vaccines for 4.2 million children and 700,000 pregnant women. ● Developed compre- hensive strategy with the Ministry of Health and transferred authori- ty on March 27. MOH was first ministry to re- vert to Iraqi control. ● Funded monthly im- munization campaign with UNICEF and the Min- istry of Health. ● Awarded $1.8 million in small grants to Iraqi NGOs for healthcare. ● Renovated 52 primary health care clinics and re-equipped 600 others. ● Trained 340 master trainers in acute respira- tory infections and diar- rheal diseases. ● Distributed high-pro- tein supplementary food rations to 240,000 pregnant and nursing mothers and malnourished children. ● Rehabilitated the Na- tional Polio Laboratory. ● Trained 1,000 health workers and volunteers to work with acutely mal- nourished children. U.S. funding is restoring Iraq’s neglected health sector. 350,000 people. “The electricity was dam- aged, the windows shattered and all the fur- niture were taken,” she said. But USAID provided $18,000 to repair the building. “They hired Iraqi contractors to fix everything and provide water pipes, electrici- ty, furniture, computers, a refrigerator, every- thing.” To deliver the $150 million in health aid, U.S. officials gave contracts to three groups: Abt Associates, the U.N. Children’s Fund and the World Health Organization. They launched programs aimed at reducing Iraq’s alarming infant mortality rate and improving overall life expectancy. By 1990, the year Saddam invaded Kuwait, Iraq’s health measures were among the poorest in the region. This is particularly true in the south. Malnutrition was high, sanitation poor and many diseases had re-emerged. Within months of the arrival of U.S. assis- tance, health service delivery in Iraq returned to pre-war levels. Health care spending has now reached 60 times pre-conflict levels. However, the hospi- tals and healthcare system is still sub-stan- dard due to years of neglect so U.S. assistance will continue to be provided to the ministry in the coming years. February ‘04 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 ▲ 32,000 teachers trained ▲ Agriculture grants total $394,000 ▲ Agreement on Marshlands restoration ▲ Free Women’s Association opens ▲ Japanese troops arrive ▲ Center for Women’s ▲ Baghdad phone exchange Rights in Karbala opens handed over to Ministry 800 tons of high protein biscuits delivered ▲