Public Health Protection Network Kurdistan Policy Brief 1

The Public Health System: International Support Needed to Overcome Political Diversion

By George Wilkes

May 2021

Unplanned, underregulated privatisation had disastrous consequences:

Public health system desperately weakened, under-regulated and vulnerable to corrupt political diversion of resources

Patients reliant on corrupt private operations: one of the greatest sources of impoverishment today

Public health system requires well-regulated fiscal boost:

Iraq’s health budget declined dramatically: now less than 5% of public expenditure.

Low taxes [including on addictive, harmful substances] drain public health system. Natural results: systemic weakness, under-investment and increased health burdens; COVID and cancer care uncoordinated; much infrastructure delapidated (viz. May 2021 COVID19 hospital fire).

Much reduced public health workforce: a large proportion of which also work for private healthcare because public salaries are low.

International community should insist on strong oversight and regulation:

Weak oversight and minimal regulation of private sector causes significant harm to the public: massive diversion of public health resources.

Significant increase in corruption in the health sector. E.g. public institutions being taken away from the public sector and abused for private gain. One of many examples: Kurdistan Children’s Hospital in Erbil built by a UK based charity with corporate social responsibility money, taken over by a private company charging $10,000 a night.

Private practice within the public sector (e.g. the KRG’s ‘semi-private’ system) mean patients have to pay private market prices, one of the main causes of impoverishment in Iraq.

Vast amounts of medical supplies are smuggled - payments can be used for terrorist activities.

Politicians and political parties profit from diversion, public smuggling and illegal export; lack of oversight and regulation has been deliberate.

Dependence on international donors, working without comprehensive or transparent plan: the money is not going where it is most needed.

Recommendations:

Establish donor network for public health system

Condition funding on comprehensive, needs-based plans overseen by ministries and parliamentary committees at state and regional levels

Condition funding on effective anti-corruption measures covering public and private healthcare systems, including independent civil society role in all institutions

Coordinate with civil society to ensure transparency and needs-based, coherent, professional public health system geared to the needs of the impoverished population