https://doi.org/10.47108/jidhealth.Vol4.Iss2.100 Ali Jadoo SA, et al., Journal of Ideas in Health 2021;4(2):380-388 e ISSN: 2645-9248 Journal homepage: www.jidhealth.com Open Access Evaluation of health system in Iraq from people's point of view: a comparative study of two different eras Saad Ahmed Ali Jadoo1*, Adil H. Alhusseiny2, Shukr Mahmood Yaseen3, Mustafa Ali Mustafa Al- Samarrai4, Anmar Shukur Mahmood5 Abstract Background: Since the 2003 United States–British coalition military invasion, Iraq has been in a state of continuous deterioration at all levels, including the health sector. This study aimed to elicit the viewpoints of the Iraqi people on the current health system, focusing on many provided health services and assessing whether the public prefers the current health system or that was provided before the invasion. Methods: A cross-sectional survey designed to explore the Iraqi people’s opinions on their health system. A self- administered questionnaire using a multi-stage sampling technique was distributed in five geographical regions in Iraq to collect the data from the head of household between 1st October and 31st of December 2019. Multiple logistic regressions were recruited to determine the significant contributing variables in this study. Results: A total of 365 heads of households (response rate: 86.1%) with the mean age of 48.36 + 11.92 years (ranged 35-78) included in the study. Most of the respondents (61.4%) complained of healthcare inaccessibility, 59.7% believed that health resources were not available, 53.7% claimed a deterioration in the quality of care, and 62.2% believed that the political / media position did not contribute to positive changes during the past two decades. Indeed, most respondents (66.0%) believe that the current healthcare system is worse than before. In the multivariate analysis, there was a statistically significant relationship between the characteristics and opinions of the respondents. Old age group (p = 0.003), men (p = < 0.001), married (p = 0.001), low educated (p = < 0.001), rural resident (p = < 0.001), unemployed (p = 0.003), monthly income of less than USD 400 (p = < 0.001), consider themselves to be unhealthy (p = 0.001), and those who think that people are unhappy now than two decades ago (p = 0.012) have a more negative opinion of the health system. Conclusion: Most Iraqis surveyed expressed disappointment from the health system after the 2003 United States– British Coalition military invasion. The current health system is faltering at all levels and does not meet the citizens' basic needs. Health Transformation Program (HTP) has become inevitable to develop an accessible, affordable, high- quality, efficient, and effective health system. Keywords: Health System, Reform, Point of View, People, Two Decades, Invasion, Iraq Background (the ancient historical region extending between the Tigris and Iraq is a member of the United Nations (UN), the Non-Aligned Euphrates). Ancient Mesopotamia, part of the so-called Fertile Movement (NAM), the Organization of the Petroleum Crescent, covers the regions between the Euphrates (East) and Exporting Countries (OPEC), the World Trade Organization the Nile (West). Iraq is a well-known home of ancient and (WTO), and several other regional and international modern human civilizations such as Assyrian, Sumerian, organizations. Moreover, through a jointly agreed Individual Babylonian, Akkadian, and Islamic [2]. The Iraqi people in Partnership and Cooperation Program (IPCP), the North Mesopotamia are innovators and skilled makers of human Atlantic Treaty Organization (NATO) agreed to grant Iraq civilization. They taught the humanity of the writing and were partner status in 2011 [1]. Historically and geographically, Iraq the first to convert the language of speech into letters and the constitutes the most significant part of ancient Mesopotamia first who established written legal code for humanity. Moreover, Iraqis were the first who invented the wheel in ___________________________________________________ history, and the first electric battery was "Baghdad Battery" and [email protected] agriculture, urban planning, foreign trade, astronomy, medicine, 1Department of Public Health, Faculty of Medicine, Bezmialem Vakif University, engineering, mathematics, and many other sciences [3]. Istanbul, Turkey A full list of author information is available at the end of the article © The Author(s). 2021 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article unless otherwise stated. Ali Jadoo SA, et al., Journal of Ideas in Health (2021); 4(2): 380-388 381 Modern Iraq studies published over the past two decades have extensively Among the First World War's outcomes was establishing the discussed what is happening in Iraq. modern state of Iraq from three cities (Baghdad, Mosul, and Nevertheless, we can sum up the goals of the invasion of Iraq in Basra) that belonged to the Ottoman Empire until 1917 [4]. bringing down the modern Iraqi state and replace it with Several national governments succeeded in ruling Iraq under the sectarian parties and militias; destroying most of the Iraqi monarchy and the republican systems until the 2003 US–British infrastructure and making it a target for systematic looting and Coalition military invasion of Iraq. The discovery of petroleum sabotage; creating an environment for unprecedented at the beginning of the twenties of the last century contributed administrative and financial corruption; tearing apart the to the gradual improvement of the country's economic situation. societal fabric and pushing towards the sectarian tension and However, the real prosperity of modern Iraq occurred in the internal fighting, as it happened in the fabricated sectarian war 1970s when the government succeeded in using the vast in 2006 and allowing terrorist organizations to invade Iraq such resources of petroleum. Iraq reached a middle-income status in as the Islamic State in Iraq and Syria (ISIS) when storming the 1970s with remarkable improvements in most major most of the central and western parts in mid-2014 [6,11-12]. indicators such as healthcare, education, economic and human Unfortunately, the health sector has had its share of destruction. resource development [5]. However, Iraqis did not enjoy Despite the billions of dollars allocated to restructure the health prosperity for long because of the successive wars; eight years' system, all international and local promises and efforts have not war between Iraq and Iran (1980-1988), invasion of Kuwait succeeded. Since 2016, the Iraqi official authorities have (1990-1991), UN sanctions (1991-2003), and the unjustified announced a remarkable development in the number of US–British Coalition military invasion in 2003 and the government and private hospitals and primary health centers, subsequent comprehensive, systematic, and the continuous reaching 262,121,2669, respectively [13]. destruction of the physical and moral infrastructures. Iraq lost The announced statistics do not match what exists in reality, the concept of the modern central state and turned into a state of except in the prosperity of the private sector at the expense of decentralization in planning, management, and implementation. the public sector. This study was designed to elicit the views of Iraq is now ruled by rival sectarian parties and militias fighting the Iraqi people on the current health system using opinion to overpower, but with a common goal of destroying the polls. The focus was on five domains, including "the homeland, plundering its wealth, and impeding any effort to accessibility of healthcare, availability of resources, quality of rebuild it [6]. care, information by politicians and the media, and whether the public prefer the current health system or the one that was Health system in Iraq provided before the US–British Coalition military invasion in Historically, the health system in Iraq has been affected 2003". positively and negatively by the political and economic situation during the past five decades. Generally, Iraq has Patients’ satisfaction adopted a comprehensive, centralized, capital-based health Most of the previous national and international studies system that provides free curative health services through a conducted to assess the health care system in Iraq did not hospital-oriented model [7]. During the 1970s and early 1980s, consider the identification of people's thoughts and opinions which was "the golden period in modern Iraq", most essential about the direction of actual reforms in the health care system. health indicators have improved significantly compared to The rate of satisfaction with health care services varied greatly decades before. Just before 1991, the Iraqi government has across different regions of Iraq, which raises doubts about the allocated an annual budget of "USD 450 million to serve nearly validity in some studies and their results. Sa'adoon et al. [14] 97.0% of the urban and 79.0% of the rural population through a reported a low satisfaction rate towards