Yacoub AA. Public health medicine in Basra, Southern Iraq: A report of an initiative in audit. The medical Journal of Basra University 2000; 18 (2): 1-2.

1. The Medical Journal of Basrah University, Vol. 18, No.2, 2000
Alim A-H Yacoub, PhD., MFCM, College of Medicine, University of Basrah, Iraq
PUPLIC HEALTH MEDICINE IN BASRAH, SOUTHERN IRAQ: A REPORT OF AN
INITIATIVE IN AUDIT
Alim A-H Yacoub
INTRODUCTION
Audit of public health medicine (also called
community medicine or preventive
medicine) aims to contribute to improvement
in the health of the population by improving
the standards of practice of public health
physicians (Report of a working group on the
audit of public health medicine, Faculty of
Public Health Medicine, 1989). Jacobs and
Gabbey in their report (A Reflection on
Reality: An action research report on audit in
public health departments, 1994) stated that
audit in its essence is that colleagues
reflecting on their work systematically,
critically and openly to enable them to agree
how to do it better and check that
improvement occurs. The mechanism by
which audit is carried out ranges from formal
activities (Departmental audit meeting, audit
of public health reports..etc.) to informal
activities integrated in the daily practice of
public health. Whatever the case, the key is
that it should be carried out voluntarily and
by professional peers as fellow specialists or
consultants in public health or by colleagues
from academic departments. We report here
an initiative to introduce audit to Department
of Public Health Medicine in Basrah,
southern Iraq. (This report covers the first
two audit meetings of this initiative, which
was facilitated and coordinated by the
Department of Community Medicine of
Basrah Medical College).
Public Health Medicine in Basrah
The Department of Public Health Medicine
(formally called Department of Primary
Health Care PHC) is responsible for the
provision of public health services in Basrah
Governorate. It is administratively
accountable to the Director General of Health
(DG) in the Governorate. The department is
responsible for the implementation of the
plan prepared centrally by the Directorate of
Preventive Medicine in the Ministry of
Health, which in actual fact monitors and
evaluates the performance of Departments of
PHC in all governorates in Iraq. The central
plan is usually prepared based on annual
reports of these departments of the preceding
year. The department of PHC consists of four
sections, each is responsible for one of the
following functions: control of
communicable diseases, implementation of
primary health care programmes,
management of primary health care centers
and environmental health. Each section is
composed of units, which are responsible for
specific activities. For example, the Control
of Communicable Diseases Section consists
of units for malaria control, rodent and insect
control, zoonosis, surveillance and control of
sexually transmitted diseases. The section of
PHC programmes consists of maternal and
child health, EPI, non- communicable
diseases and mental health units. The units
and sections are usually run by public health
practitioners, few of them are holders of
Diploma or Master degrees in Public Health.
An exercise in Audit
Since audit in any of its forms mentioned in
the introduction is not practiced by the
department of PHC in Basrah (not in fact in
any other department in Iraq) it was decided
to make an attempt to introduce it by

2. The Medical Journal of Basrah University, Vol. 18, No.2, 2000
Alim A-H Yacoub, PhD., MFCM, College of Medicine, University of Basrah, Iraq
one of the staff members of the Department
of Community Medicine of Basrah Medical
college (the author of this report) who works
in close liaison with the Directorate of Health
in Basrah. The idea was discussed with DG
of health in Basrah (who himself holds an
MSc. degree in Community Medicine) and it
was agreed to carry out the initiative. The
audit meetings were convened in the
Department of PHC itself in the presence of
all public health doctors who were in charge
of the units and sections and the DG himself
attended the first meeting. The author of this
report who acted as facilitator explained at
the beginning of the meeting the concept of
audit, its aims and objectives and the audit
cycle. The voluntary nature of the exercise
was emphasized. It was agreed that the
annual central plan for 1998 was a suitable
entry point to the audit cycle. The written
plan was reviewed by the audience and was
agreed that the functions to be achieved by
the Department of PHC. at governorate level
are suitable targets to monitor the current
practice and to review progress made. Since
the plan was comprehensive, specific
functions and activities were selected;
examples of which are mentioned below:
1. Programme of the control of acute
respiratory infection among
children activities audited:
Whether a plan at governorate level was
prepared, whether the required monthly
statistical returns compiled from PHC
centers to morbidity and mortality due ARI
were completed and whether feedback was
done. Whether a community based study on
morbidity and mortality due to ARI was
carried out.
2. MCH Programme
● Whether a plan to be implemented to
governorate level was prepared.
 Whether training of midwives in using
programs was carried out.
 Whether a study on childhood and
maternal morbidity and mortality was
carried out.
 Whether death conferences on
maternal mortality was carried out
and reported.
3- Programme of control of communicable
diseases:
● Whether a community survey to assess the
incidence of diarrheal diseases among
children was carried out.
● Whether the target coverage of PHC
centres with ORS units was achieved.
Other target indicators discussed were related
to aspects of school health, promotion of
breast- feeding, surveillance of
communicable diseases and expanded
programme of immunization. Each of the two
meetings lasted for about two hours. The
participants felt that the meetings gave them
the opportunity for the first time to sit
together and reflect on their performance.
The facilitator emphasized that continuity is
important and minutes of the meetings should
be recorded. The participants also
appreciated that such practice is especially
relevant in the light of the limited resources
because of sanctions imposed on Iraq and that
audit would be helpful in management of
public health services in a more cost-
effective way.
REFERENCES
1. Faculty of Public Health Medicine, report
of a working group on the audit of public
health medicine, 1989.
2. Jacobs R. & Gabbay JA. Reflection on
Reality: An action research project on audit
in Public Health Departments. Faculty of
Public Health Medicine, 1994.