• Primary health care in Iraq
• Primary health care as a strategy has been adopted in Iraq since Al-Ma-Ata declaration in 1978. To meet the basic needs of the population and to fulfill the requirements for primary health care, an extensive network of health care institutions was established.• Health care is provided to all 1.population through:2.Mobile units for remote areas and in campaigns.3.Primary health centres.4.District hospitals.5.General multispeciality hospitals.6.Specialized referral hospitals.7.Private clinics and hospitals.8.Cooperative clinics.
• These sources provide health care, which varies in sophistication from basic essential care to highly advanced care. The sources form an integrated infrastructure for providing promotive, preventive, curative and rehabilitative care.
• The list of the essential services adopted in Iraq is not different from the list recommended by the World Health Organization (WHO). They are clearly defined in the Iraqi Public Health Law No. 89 for 1981.
• A number of programes, however, received special attention and a good deal of effort and resources has been devoted to execute them on national level. They received international, national and local support.
• The principal objectives of primary health care programmes are:1.To reduce morbidity and mortality levels in population.2.To reduce morbidity and mortality levels in children aged under five years and women in the reproductive age.3.Specifically to reduce infant and childhood mortality which result from specific targeted diseases.
• 4.To improve peoples awareness and practices regarding health behaviour and child care.5.To encourage people participation in caring for their health and supporting health programs.6.Other specific objectives for each program.
• The major primary health care programs are:Expanded program on immunization [EPI].Control of diarrhoeal disease program [CDC].Control of acute respiratory infection [ARI].Maternal and child health [MCH].Promotion of breast feeding.Training of traditional birth attendant [TBAs].
• A brief account on each of these programs is given in the following sections. Any one interested in further practical details can obtain documents from the Ministry of Health. Elaborate theory on these subjects may be found in standard textbooks.
• 1. Expanded programme on immunization (EPI) Immunization services are provided through variety of health care institutions as routine activities supported frequently by national immunization days to improve coverage rates.
• Immunization services in Iraq have been offered to children since 1967 but EPI was launched since 1978. An intensive acceleration is being adopted since 1985, when the first national immunization campaign was launched and succeeded in bridging tangible gap in the coverage rate.
• Six diseases are targeted [Tuberculosis, Poliomyelitis, Diphtheria, Tetanus, Whooping Cough and Measles]. The coverage rates by the end of the 2000 ranged between 80-100%. It is evident that the targeted diseases showed massive reduction in incidence and mortality. Poliomyelitis is under eradication action and success is remarkable in this aspect.The main objectives of EPI are:
• 1. To cover 90-100% of eligible children by immunization against targeted diseases.2. To reduce infant mortality and childhood mortality from the targeted diseases by 25% of the level in the preceding year and to reach a level as low as 20/1000 live births.
• This objective was about to be achieved by the end of the 1980’s, but the war in 1991 and the continuing economic embargo caused serious deterioration in population health. Infant mortality rate has increased by more than three folds the level in 1990.
• 3. To encourage people to immunize their children at proper age and ensure adequate immunization doses for each and every eligible child in the target population.
• This program (EPI) is perhaps, the most successful one among all primary health care programs in Iraq, both in terms of popularity and accessibility and in its evident success in reducing the extent of targeted diseases.
• 2. Control of diarrhoeal diseases (CDC) Diarrhoeal diseases of childhood represent one of the major causes of morbidity and mortality among under five children in developing countries. Dehydration is the important preventable and correctable complication of diarrhoea.
• The main objectives of CDD are:1. To reduce infant mortality rate.2. To educate people regarding recognition of severe cases and home management of disease.
• The main measure to control diarrhoeal disease is oral rehydration therapy (ORT). Oral rehydration units exist in almost every health care institution concerned with primary health care.
• 3. Control of acute respiratory infection (ARI)Acute respiratory infections, together with malnutrition and diarrhoeal disease represent the three major causes of illness and death among children in developing countries.
• In Iraq, the situation is more or less similar to the above description. This led to put acute respiratory infection among the top priorities of primary health care activities.
• The main objectives are:1. To reduce mortality associated with severe ARI cases.2. To improve case management at PHC level.3. To rationalize the use of antibiotics.4. To educate parents about recognition of severe cases and about some home practices to deal with diseased children.
• The ARI control strategy includes the following components:Immunization against diphtheria, pertussis, measles and childhood tuberculosis.
• 2. Case management: This is based on two stages:a. Classification of cases according to clinical features into groups of different severity cough &cold, pneumonia, severe pneumonia and very severe pneumonia).b. Proper management guided by clinical severity of cases.
• The main lines of management are:a. Assurance and supportive treatment for cases of cough &cold..B. Supportive treatment and appropriate antibiotics for non-severe disease..C. Appropriate antibiotics and referral to hospital for severe cases.
• 3. Health education:The aims of health education include:a. Increasing the capabilities of families to differentiate severe from non severe cases and to take proper action.b. Educating the community regarding simple supportive therapy at home.
• c. Promoting timely immunization against measles, pertussis, diphtheria and childhood tuberculosis.d. Promoting breast feeding.e. Reducing parental smoking and other domestic pollution.f. Improving nutrition of children.
• 4. Maternal and child health (MCH)This program emphasizes the provision of comprehensive care to mothers and children through primary health care strategy.
• Services provided include:a. Pre-marital.b. Antenatal.c. Natal.d. Post natal.e. Under five clinics.f. School health.
• 5. Promotion of breast feeding . This program is intended to encourage breast feeding. Evidence from a number of studies indicated a tangible achievement in this field. In one study, it was reported that the percentage of women who breast-fed their infants increased from as low as 50-60% to as high as 85%.
• 6. Training of TBAs This program is intended to improve the conduct of traditional birth attendants . Many of such women are being exposed to training course and provided with basic package of sterile deliver.