World Bank Engages in Building Fair and Accountable Health Systems in the Middle East and North Africa

June 27, 2013

TUNIS, June 27, 2013 – The Middle East and North Africa (MENA) countries have some of the lowest government spending on healthcare. Access to health services is inequitable and the quality of care is well below what people expect. According to the latest regional health sector strategy by the World Bank this could be reversed by investing in fair and accountable health systems.

Our health engagement strategy for the MENA region is very timely. It has been inspired by the aspirations of the people of MENA for fairness and accountability,” said Inger Andersen, World Bank Vice President for the MENA region.  "We at the World Bank Group are committed to working closely with all countries in MENA to identify feasible and sustainable solutions to improve access and quality of healthcare.

The report, Fairness and Accountability: Engaging in Health Systems in the Middle East and North Africa, launched today, highlights how MENA governments spend on average only 8 percent of their individual budgets on healthcare compared to an average of 17 percent spent by OECD countries. This means that MENA households end up paying the difference in out of pocket expenses reaching 40 percent of total health expenditures compared to 14 percent in OECD countries. As a result, many people end up foregoing or delaying much needed medical care because of the unaffordable and impoverishing costs.

This is at a time when the MENA region is witnessing a rise in death and disability due to non-communicable diseases (NCDs) and injuries. According to the report close to 73,500 people in MENA, including 35,900 younger men and 3,950 children, died in road injuries in 2010. Six Arab countries are in the global top 20 for obesity: Bahrain, Egypt, Jordan, Kuwait, Saudi Arabia and United Arab Emirates. Depression is a leading cause of illness for women and smoking a major risk factor among men. In lower income and lagging regions in MENA meeting the Millennium Development Goals (MDGs) remains a significant challenge with high levels of maternal and child mortality, and malnutrition with close to 60 percent of Yemeni children being stunted.

The response to the twin challenges of reaching the MDGs and coping with the rising burden of NCDs and injuries requires more than increasing health spending,” said Enis Barış, World Bank Sector Manager for Health in the MENA region and co-author of the Strategy. “Our strategy calls for revisiting the values and principles that underpin health systems and the existing institutional frameworks for more pluralistic and accountable health system governance. This has been the thinking driving our strategy development which was a year-long iterative process in response to voices of people in MENA.”

The transformative changes in the Region provide an opening for the World Bank to listen and engage with a wide spectrum of voices including government, civil society and private sector to identify solutions in a participatory manner in line with people’s demands and needs. The team held several consultations across the region to gather input for the Strategy, all leading to the need to have fair and accountable systems and services.

The World Bank is well positioned to work with all MENA countries on transformative health sector reforms mobilizing data, information, experiences and interventions stemming from its five decades of experience in the health sector in over 150 countries from around the world to create systems and institutions that are more fair and accountable to the people.

By re-orienting health systems in the region from systems only treating sickness to systems also preserving and promoting health, people can live longer and healthier lives at a lower cost to the state and the people themselves,” said Aaka H. Pande, Health Economist and Report co-author.

There are policy instruments and tools highlighted in the strategy on which the World Bank Group is committed to engage with MENA countries.  These include: empowering citizens with information about how well the system performs and how the services are provided; improving accountability of health professionals by incentivizing delivery of quality and timely preventive and medical care at a reasonable cost; raising awareness, especially among the youth, about risks and hazards related to smoking, alcohol abuse and road safety; providing financial and technical support to expand health coverage to the poor, unemployed and informally employed; and supporting practices that uphold patients’ rights to privacy and confidentiality.


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