- The Iraqi health system has struggled since the 1990s due to wars, sanctions, and loss of infrastructure and health workers. While primary health care is the basis, the system remains centralized and hospital-focused. - The health situation in Duhok, Kurdistan has been burdened by large refugee and internally displaced person populations, increasing hospital admissions and outpatient visits significantly between 2013 and 2016. - Reforms are needed to better regulate doctors' work between public, private, and education sectors; strengthen the role of nurses; and expand community health nursing to provide more home-based and outpatient care.

2. • Introduction- Levels of Health Care
• Iraq Health System: Historical Background
• Now Health situation in Kurdistan & Iraq
• Some changes or Modifications on Health
system
• Community Health Nursing?

4. Levels of Health Care
system with primary health care as the basis. And the patient
gradually will refer to hospital according to his or her medical
situation.

5. After 12 years in primary and
secondary school
6 years in medical college
2 years as JHO
1 year in villages as GP
2 years as SHO
4 or 5 years as Board students
2 years Specialist Registrar
Specialist Senior
After 9 years in primary and
elementary school
3 years in
secondary
Nursery school
3 years in
secondary
school
2 years in
nursery
Institute
4 years in
college of
nursery
To be a Doctor or
Nurse in Iraq

7. Iraq Health System: Historical Background
• A formal health care system in Iraq began with British occupation
following the end of the First World War in 1918.
• In 1921 the first Directorate of Public health Services was formed
which was upgraded to become a Ministry of Health in September
of the same year.
• In 1978,Primary Health Care system & Department of Preventive
Medicine were declared.
• In 1981, a Public Health Law was enacted. It stated that health is a
right for each citizen and the responsibility of the state to provide
all means to promote health prevent and treat diseases.
• Referral systems, communications, and training to integrate health
centers into a primary care strategy were planned for in the early
1980s
• During the 1970s and 1980s, Iraqi health care and medical
education were said to be the best in the region

8. • After Saddam Hussein came to power, funds
were diverted from the health sector. The
1980–88 Iran–Iraq War killed perhaps half a
million people on both sides, and further
diverted resources and medical staff from
civilian facilities.
• In 1991, Iraq invaded Kuwait, triggering the
first Gulf War. The sanctions that followed had
a major effect and serious damage on Iraq’s
health system and the health status of Iraq.

9. • At the time of the 2003 , the health system was weak, with non-
functioning equipment, inadequate drug supplies, and fragile
infrastructure.
• The destruction and looting of health facilities that followed the
invasion resulted in heavy loss of equipment and pharmaceutical
stocks. Quality of care continued to deteriorate and shortages were
widespread.
• In 2012, millions people in Iraq were in need of assistance; and
millions people are internally displaced. Both refugees and
internally displaced individuals have unsatisfactory access to health
services .
• violence and political instability are continuous till now in most part
of Iraq which resulted in distraction of health system .

11. Now ????
• Iraq's health system is still struggling to recover from years
of war, sanctions, loss of health workers, looting, and
political interference.
• Health facilities and the health workforce are inequitably
distributed to meet the country’s health needs.
• Many skilled health workers have moved to other
countries, and young graduates continue to leave.
• system with primary health care as the basis. Yet the
health-care system continues to be centralised and
focused on hospitals.
• Health-care financing and the role of private health care
are looming issues for the health sector, which are now
only tentatively being addressed.

12. Health situation in Duhok 2016
Population
Indicator 2013 2016
Total inhabitants 1,298,944 2,345,903
Host community 1,336,944 1,467,196
Refuges & IDPs 212,000 878,705
Number of IDP camps 0 23
Number of Refuges camps 0 4
Burdens on health services in Duhok governorate
Indicator 2013 2016
Monthly average patients admission 1,976 3,887
Monthly average patients visit to outpatient department 7,556 20,284
Monthly average total surgery 537 1,326
Monthly average patients at emergency department 4,586 16,566

13. Health situation in Duhok 2016

14. Levels of Health Care
system with primary health care as the basis. Yet the health-
care system continues to be centralized and focused on
hospitals.

15. After 12 years in primary and
secondary school
6 years in medical college
2 years as JHO
1 year in villages as GP
2 years as SHO
4 or 5 years as Board students
2 years Specialist Registrar
Specialist Senior
After 9 years in primary and
elementary school
3 years in
secondary
Nursery school
3 years in
secondary
school
2 years in
nursery
Institute
4 years in
college of
nursery
Who will treat
patients in Private
sectors

16. Life of Doctors among different
sectors ???
doctor as specialist in public hospital doctor as specialist in private clinic
doctor as lecturer in college

17. Even Medias & Social media ??

18. Medical staff People
Victims ??

20. We have to do some changes or
Modifications

21. Levels of Health Care
system with primary health care as the basis.

22. Primary Health Care (PHC)
• Primary Health Care (PHC) is essential health care
based on practical, scientifically sound, and
socially acceptable methods and technologies
made universally accessible to individuals and
families in the community through their full
participation in the spirit of self-reliance and self-
determination.

23. Secondary and Tertiary health care
• Multidisciplinary teams need for secondary
and Tertiary health care
• Effective discharge planning & good follow up.
• Good co-ordination with PHC and other health
sectors.

24. Life of Doctors among different
sectors ???
doctor as specialist in public hospital doctor as specialist in private clinic
doctor as lecturer in college
Regulation of the
doctor jobs and life ?
Separation of the
Public, Education and
Private Sectors

25. After 9 years in primary and
elementary school
3 years in
secondary
Nursery school
3 years in
secondary
school
2 years in
nursery
Institute
4 years in
college of
nursery
Nurses treat
patients in Private
sectors
At the level of
Nurses ?

26. To increase capability of individuals,
families, and groups and community to
deal with their own health and nursing
problems.
To control and
counteract
environment.
To strengthen
community
resources
To prevent and control
communicable and non-
communicable diseases .
To conduct
research
Nurses Private clinic
to Office
At the level of
Nurses ? Plan ?
To provide specialized services for mothers,
children, adults, workers, elderly
handicapped and eligible couples etc.
To supervise, guide and help health personnel
in carrying out their functions effectively
1
2
3
4
5
6
7

28. Important Step??
• Deal with the patients away from hospital ??
• We need some persons at home? school?
Telephone ? Office?
• Community Health Nursing? “The utilization
of the nursing process in the different levels of
clientele-individuals, families, population
groups and communities, concerned with the
promotion of health, prevention of disease
and disability and rehabilitation.”

29. THANKS FOR YOUR
ATTENTION