Funding, service and resource gaps at primary health care centres in Iraq.

Abstract

Background: Limited resources have hampered progress towards Universal Health Coverage at the primary health care level in Iraq.

Aim: To analyse the cost of primary health care services in Iraq and identify the resource gaps.

Methods: Using the CORE Plus tool, we collected and analysed data on finance and other resources, and services provided by 15 primary health care centres across 11 governorates in Iraq. We calculated the normative utilisation and cost estimates and compared them with the actual figures.

Results: Primary health care services were underutilised: only 52% (33-67%) of the 81 listed services were utilised across the 15 centres, and there was an average of only 1.2 visits per capita per year, compared with the estimated need of 4.5 visits. The expenditure incurred for the actual number of services was 2.5 times higher than the normative cost, due to over-staffing, despite shortages of medicines and supplies. The cost of meeting the need for 4.5 visits would be 21% more than the actual expenditure, but staffing costs would have to be reduced by 39% and medicines and supplies financing increased by 640%.

Conclusion: Funding for services at the primary health centres in Iraq was insufficient although the centres were overstaffed. To improve access and quality of services and progress towards Universal Health Coverage, staffing should be aligned with service needs and adequate resources provided.