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FEATURE STORY

Achieving Better Health Equity and Efficiency in the Middle East and North Africa

June 23, 2010

June 2010 – The Middle East and North Africa Health Policy Forum called for a better health equity and efficiency in the region during its last conference, organized in collaboration with the World Bank in Amman on June 6-8.

The Forum provides every year a platform for reviewing the state of research and evidence available from the region in order to identify key policy and research gaps. This year, the conference focused on two critical aspects of the health system: Equity in health and healthcare, and Quality and Efficiency of Healthcare.

A special focus was put on how to stimulate the development of effective health policy formulation, evaluation and information sharing in the region.

“The purpose of the Forum is to address issues related to health policy in the Middle East and North Africa (MENA) region, and to highlight the critical importance of health policy in the fulfillment of social justice and economic development in the region” noted Dr Ahmed Galal, Chair of the Board of trustees, the MENA Health Policy Forum.

The Forum also awarded prizes for winners of the best Scientific Papers and Documentaries as a mechanism for promoting and encouraging research in critical areas and celebrating excellence.

Several senior policy makers, representatives from civil society, academia, the media and Development partners active in the region participated to this Forum. They identified emerging challenges to which the policy makers and researchers should give priority in terms of reform agenda.

The Middle East and North Africa region has made remarkable progress over the past three decades in terms of expanding access to basic health services and improving the health status of its population.

The region has recorded one of the fastest rates of decline in child mortality among all the developing regions of the world. But it still characterized by inefficient and inequitable health outcomes. Despite efforts to improve their performance, the health systems in these countries continue to be challenged by inadequate and inequitable access to care.

Moreover, health care services tend to be inefficiently provided and of low technical quality. Inefficient health service in the public sector drives many, including the poor, to seek care in the private sector, which can lead to impoverishment in all but the richest population groups.

Poor health outcomes are also attributable to differences in the wider determinants of health, including education, exposure to risk and poverty.

The participants to the conference also debated the new challenges in meeting the changing health needs of the population:

  • The access to comprehensive health coverage is limited and distribution of health services is skewed towards urbanized areas and higher socioeconomic status.
  • Many countries show significant disparities in maternal and child health outcomes between rural and urban regions, and between rich and poor population groups.
  • Child malnutrition persists as a significant problem especially among the low income groups, and its negative effect lasts long as it hampers the child’s ability to learn and become a productive member of the labor force.
  • With the exception of the Gulf Cooperation Council (GCC) countries, most MENA countries show high dependence on direct, out-of-pocket payments by households, which account for more than half of the total health spending.

Middle East and North Africa countries have relatively young populations, a factor that has helped to keep down the cost of healthcare

Yet the current cohort of youths shows an increasing prevalence of risk factors such as obesity, sedentary lifestyles and tobacco smoking. These conditions predispose them to chronic diseases that will likely manifest during their middle age years, and will consequently add to the demand for healthcare among this group.

Participants’ highlighted governance and accountability in the health sector remain weak

Centralized public administrative structure remains a predominant structure for healthcare delivery in most countries in the region.

This condition is delaying the emergence of a modern governance structure in the health sector: the budget process remains focused on inputs rather than outputs; government facilities have little scope for, or incentives to take, independent actions to improve quality or productivity; and private sector remains largely outside of the formal health coverage framework.

There is an urgent need to develop quality and productivity standards and apply these to measure quality, safety and efficiency of health care. Independent assessment mechanisms are needed to oversee the performance of the health system, whether private or publicly provided, and to give greater voice to consumers of healthcare.