The World Bank has published a report calling for closer co-ordination between Middle East and North Africa governments and the bank in an effort to tackle healthcare challenges.
IHS Global Insight perspective | |
Significance | The World Bank has published a report highlighting what it sees as healthcare challenges for governments in the Middle East and North Africa (MENA) region and calling for closer engagement between governments and the bank in an effort to tackle these challenges. |
Implications | The report highlights a number of challenges in MENA healthcare systems including lower government expenditure on health than that seen in other regions and the increasing burden of non-communicable diseases. |
Outlook | There may be a number of challenges in adopting a unified policy for healthcare improvements in the region, given the political and economic diversity of the region. Healthcare challenges are likely to vary across the region, from providing basic healthcare services and tackling malnutrition to the development of long-term sustainable healthcare systems. |
The World Bank has published a report, "Fairness and Accountability: Engaging in Health Systems in the Middle East and North Africa", calling for increased government expenditure on health and greater accountability in Middle East and North Africa (MENA) health systems. A copy of the press release outlining the report can be accessed here.
The report argues that government expenditure on healthcare remains low in the region, noting that governments in the MENA region typically spend 8% of government budgets on healthcare, compared with the average of 17% in Organisation for Economic Co-operation and Development (OECD) countries. The World Bank goes on to argue that lower government expenditure leads to increased out-of-pocket (OOP) expenditure on health. OOP expenditure on health was found to amount to 40% of health expenditure in some MENA countries, compared with an average of 14% in OECD countries.
The World Bank goes on to suggest challenges for MENA healthcare systems due to the spread of non-communicable diseases, namely through the spread of obesity, with Bahrain, Egypt, Jordan, Kuwait, Saudi Arabia, and the United Arab Emirates being in the top 20 countries in terms of obesity prevalence. The World Bank also highlights challenges from the high prevalence of depression and smoking in women. The disease prevalence profile can vary across regions, with poorer parts of the region seeing challenges around issues such as malnutrition; some 60% of children in Yemen have stunted growth through malnutrition.
The report calls on governments within MENA countries to engage with the World Bank to consider solutions to healthcare challenges, institute healthcare reform, and build more "accountable" healthcare systems. One direction in which one of the report's authors, Aaka H Pande, saw scope for reform was for MENA healthcare systems to consider moving towards more of a disease-prevention model and away from systems that only treat sickness.
Outlook and implications
Although the report by the World Bank might be welcomed, given its record in assisting with capacity-building in healthcare systems, there may be a number of problems around the report. First, the political, cultural, and economic diversity of the MENA region makes it somewhat challenging to provide an overarching strategy. With this in mind, the report is probably aimed more at providing arguments for closer engagement between governments in the region and the World Bank.
The World Bank has already taken an active role in some parts of the region, with the World Bank assisting Egypt in rolling out a new health insurance scheme; the first stage of this scheme is to provide healthcare to underserved rural populations (see United States - Egypt: 9 April 2013: Egyptian health insurance scheme to be rolled out in underserved rural areas with World Bank assistance). Rather than building "accountable" systems, healthcare challenges in countries such as Egypt, Iraq, and Libya are likely to be primarily centred around providing basic healthcare. This will be increasingly challenging as political activists demand healthcare improvements be implemented almost overnight. Further short-term challenges for many countries in the region are likely to include the impact of refugees from political transition, with Jordan seeing significant pressures on its healthcare budget and limited international assistance (see Jordan - Syria: 12 April 2013: Jordan considers reducing medical assistance to growing Syrian refugee population). With the chance that political transition may spread in the region, this may have an impact on other countries' healthcare systems.
In the Gulf Cooperative Council (GCC) region (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the UAE), healthcare expenditure is already forecast to rise substantially as governments move to improve access to healthcare through healthcare infrastructure expansion. Healthcare expenditure in the GCC region is expected to increase to USD79 billion by 2015, with government expenditure on health anticipated to account for 63–80% of total healthcare expenditure (see Middle East and North Africa: 27 June 2013: Healthcare expenditure in GCC to reach USD79 bil. by 2015). Given the burden of high government expenditure on health in the GCC region, governments are beginning to look at moves to implement mandatory health insurance or health protection activities (see Qatar: 14 June 2013: Qatar to roll out first stage of health insurance in July and United Arab Emirates: 21 November 2012: Abu Dhabi to introduce health protection scheme).