Reform the Health System of Kurdistan

Health Workers' Election, An example of an authoritarian democracy

2011-01-11T04:42:00.000-08:00

On January 10th, 2011, the campaign for electing the members of the long overdue congress of the Kurdistan Health Workers (excluding physicians) started. The electoral process of this otherwise purely service oriented organization is tainted by huge political interferences and characterizations.
The health workers first organized themselves in lists that belong to the main political parties in Kurdistan. The PUK and KDP, as they did in the parliament and other elections, created a single list with candidates evenly distributed among the two. The Gorran movement also participates with a list, as did the Islamic Union, Islamic Group, the Communists and others. Lists carry names that are indicative of political party affiliation and the names of the candidates are not known, or only partly known, because the electoral lists are so called "closed" ones; meaning that the party will choose among a pool of candidates according to the vote the list receives in the election.
Apart from those disturbingly undemocratic processes of holding an election, the polarization of the health workers based on political lines, greatly undermine the ability of the new syndicate in advocating on their behalf. It is striking that the slogans, plans and programs of the lists are so similar that someone with no knowledge about the politics of the region would not be to distinguish among them. All the lists ask for a better pension, a better wage, and an equal opportunity policy with regard to health workers in the health care system. They all want the government to provide health education opportunities and continuous professional development program for them. There are no distinctively different ideological divide among the lists in terms of their attitude toward philosophical and/ or economic organization of the health care system.
The election will be a litmus test for the popularity of the political parties in the health care system, and it will not add any benefits neither to the health workers nor to the health system. The only benefit that health workers got was the series of invitations, lunches, dinners and prize distribution that the main political parties arranged for their affiliates.
It is disturbing that the political parties that regard themselves as opposition to the political establishment in Kurdistan use the same old anti-democratic mechanisms in relation to syndicates and associations. They use the latter as tools to advertize their political agenda inside the sections of the community that those syndicate exist. Political parties here in Kurdistan spend a significant chuck of their budget (which usually comes from public funds) on election campaigns and ads. This is not allowing a breathing space for a slow and progressive development of groups, associations and syndicates that are truly representative of their members and, willing to strongly advocate their rights and put pressure on the government and the political parties to fulfill their demands.

Health Policy: The New Taboo in Kurdistan!

2010-09-19T05:25:00.000-07:00

The Minister of Health in the Kurdistan Regional Government filed a lawsuit against me in the court of Erbil city. Dr. Tahir Hewramy, The Minster of Health, is asking for 200,000,000 Iraqi dinars which is equivalent to about $20,000.00 in compensation for the "damage" I incurred upon the Ministry of Health.
The source of all of this noise by the Ministry is that I had recently said in a magazine interview that the decision by the Ministry of Health to raise the fee doctors charge in their private clinics is "illegal, unscientific and unethical".
The Minister of health decided in an order that holds his own signature on 27th of April 2010, to raise the fee doctors charge in their private clinics. The order had resulted in a wide outcry and condemnation by civil society organization who managed or organize a campaign against the decision and were able in a matter of a week to collect 16 thousands signatures of angry people against the decision.
My fault was that I characterized the decision as "illegal, unscientific and unethical" and below is a description of why I said that.
The decision in itself is an illegal move by the Ministry of Health. According to the laws of the Kurdistan Parliament and specifically Bill number 15 of the year 2007; the Ministry of Health is not responsible for regulating the fees of the private market health activities. In another word, there are no specific provisions in that bill that award the Ministry the authority to intervene in the regulation of the fees that health professionals charge in return for the services they provide. Another Bill (number 6 of the year 2000) authorizes the Doctor's Syndicate to regulate the private activities of doctors including the fees they charge in their private clinics. Specifically, the constitution of the Syndicate indicates that only the general congress of the body can determine how much doctors can charge their clients in their clinics.
Besides, the Kurdistan Regional Government through its Prime Minister, Ministers and other officials, announced more than once that it is adopting an open market policy. The Minister's move to fix doctors fees in some areas and raise it in others are in direct conflict with the free market economy claims of the government and it may alienate foreign investors in the health care system of Kurdistan.
The decision by the Minister of Health is also unscientific. The World Health Organization identified a number of tasks for Ministries of Health around the world which include but are not limited to; helping to remove economic hurdles in access to health care, attending to the principle of equity in health care provision and trying to engage citizens in health policy decisions. The Ministry's decision is contradictory to all of those principles.
Furthermore, form the ethical point of view, the Ministry of Health should act for the best interests of the people. Everyone knows that the people of Kurdistan had suffered a lot from chemical attacks, torture, economic and social devastation. The people here are suffering from the physical and mental health and social consequences of decades if not centuries of violence and mistreatment and they are in need for a health care system that rises up to their expectations and needs. We need a health system that is putting the patient at the center of its interests. I don’t see any ethical bases for raising doctor fees in the private market by a governmental body given the socio-economic status of the majority of the population in the region.
I strongly demand that the Minister of Health withdraw his lawsuit and try to communicate his policies and actions in a more civil way. It would have been much better if the Minister could take the time to explain his policies to me and the people in a TV, newspaper, magazine or radio interview just like I did. That would have served him better and could have saved him the headache of all those phone calls from the media about my case.

Are Most Kurds Mentally Ill?

2010-08-29T22:34:00.000-07:00

In a recent media statement, the Minister of Health of the Kurdistan Regional Government announced that most of his fellow citizens “have mental diseases” . The minister presented this diagnoses during a conference to review the bill for a mental health act in Kurdistan. It was obvious that the minister wanted to make a point about the necessity of such an act for Kurdistan given that “90% of the Kurdish people" went through terrible atrocities like the Anfal and the gas attack on Halabja in the 80s of the last century.
The good intention of the minister of health to provide strong argument for the passage of the bill in the parliament doesn’t legitimize the betrayal of his scientific backgrounds. The minister, better than anyone else, knows the meanings of most, several, few and none in scientific language. The fact that the minister says “most” without providing scientific evidence brings into questions his scientific qualifications.
The only study done in the field of mental health in Iraq and Kurdistan was the Iraqi Mental Health Survey implemented by the World Health Organization issued in 2006/2007 in partnership with the Ministries of Health in Iraq and Kurdistan. The survey was conducted among 9,345 Iraqi families. The Kurdish families included in the study represented 16% of the sample. The study found that the life time prevalence of any affective disorder in Kurdistan was 8.97%, and that of any anxiety disorder 15.85% . The basic question given these numbers is; are these figures qualifying the Kurdish people to be diagnosed as having mental illnesses or psychiatric diseases?
Furthermore, in most of the standard classifications of mental illnesses including the International Classification of Diseases, mental illnesses are not classified as diseases, rather they are called disorders. There may be only subtle differences between the two terms. But at the ground and at the personal levels of people affected by mental disorders, it means a lot in terms of discrimination and stigma. The problem with the minister’s statement doesn’t only lie in its scientific ignorance, but also in its ramification for discriminating against people with mental illnesses in Kurdistan.
The minister of health need to be more cautious about his statements and not to forget his scientific backgrounds in presenting figures and numbers about health issues in Kurdistan.

http://www.sbeiy.com/ku/newsdetail.aspx?id=29321&cat=1
www.emro.who.int/iraq/pdf/imhs_report_en.pdf

Stop Throwing Money at Our Health Problems

2010-08-07T06:37:00.000-07:00

Today I was reading the local newspapers in Kurdistan and two different news attracted my attention. The first one was from the paper of one of the ruling parties in Kurdistan (Kurdistany Nwe), featuring the selling of an MRI machine costing one million, eight hundred thousands of dollars. The other news was from Rudaw newspaper, having a piece about the health consequences of using sewage water for growing vegetables in the governorates of Erbil.
When I was reading those pieces of news, I was developing an image of the poor man, lady or kid, who consumes contaminated vegetables waterd by the dirty water, and developing a pain in the back, lung, stomach or having a seizure because of a haydatid cyst in those locations.
Our government will go bankrupt if it continuous to ignore the basic human needs of the population of clean drinking water and sanitation. There is no point in throwing money at our simply solved problems that arise from inattention to basic health infrastructure.
This is if we ignore the huge amount of money spent on the scan. I googled prices of the machine and I found figures way less than what (kurdistany nwe) presented.

Who Benefits from Fixing Doctor Fees?

2010-05-12T01:58:00.001-07:00

The recent decision of the Minister of Health to fix physician fees in private clinics is a baseless act of policy confusion.
First and foremost, no legal provision allows the Ministry of Health to touch the private market with regulations. Ideally, Doctors’ Syndicate is the one who is supposed to propose regulations to the Ministry of Health and the cabinet.
Even if the Minister of Health allows himself jurisdiction over the private health market, the common sense is to do so in the best interest of the people. Fixing doctor fees is having unequal consequences in different geographic areas of Kurdistan. An ill person in Sluaimaniah may be hurt because of it while a person in Halwer will benefit. This is a consequence of the unequal socio-economic status of the people of this culturally, economically and politically diverse region. Such a decision will undermine the ability of the health system to provide universal coverage to the majority will diminish financial risks and will hurt efficiency in the delivery of health care services to the people of Kurdistan.
Furthermore, the decision is in total disagreement with the open market policies of the cabinet in general. The basic principle is clear; the government needs to intervene to prevent or fix market failures. These may arise as a result of the dominance of market monopoly. Fixing doctor fees will distort the natural power of competition and will prevent it from lowering costs and improving quality.
The Minister of Health should remember that he is responsible for not only the physical, mental and social wellbeing of the people of Kurdistan, but also their financial health. We don’t want our people to be one doctor’s visit away from bankruptcy and poverty. He should immediately suspend such a decision, otherwise the impression that he may be doing this for his own interest could gain credibility. Being a surgeon with a clinic in the market supports the evidence that the Minister is abusing his public position for private gains.

2010 Health Budget of Kurdistan

2010-02-06T23:21:00.000-08:00

Kurdistan Parliament is currently discussing the budget of 2010 for the Kurdistan Regional Government (KRG). The budget has been announced in a press conference by Dr. Berham Salih, the prime minister, before getting it to the representatives of the people. The budget was delayed for months before finalizing it and getting it to the parliament. Furthermore, the oil revenues of the region were not included in the budget and the opposition is furious about that.
The good news is, this is the first time in 19 years that the budget is openly discussed in the Parliament, some members of which, mainly from the opposition, had the courtesy of distributing it around and inviting professionals in particular and the public in general to provide comments, suggestions and input into the details of the budget openly. The government, through its administrative and judiciary branches, however, provided copies of the general provisions of the budget that was so vague that didn’t allow for any space for discussion.
The health budget that was included in the projects funded by the government and implemented by the Ministry of Health were devoid from any scientific analysis and calculations. The type of the projects and their geographic distribution seem to answer political worries rather than the real public health needs of the people.
This is clearly demonstrated in the amount of funds allocated to different geographical areas. In that regard, a disturbing inequality is evident in terms of the resources allocated to the governorates of Slemany, Erbil and Dohuk; (the three governorates officially under the jurisdiction of KRG). Hence, while Slemany governorate is the biggest in terms of population, the governorate comes in the third place after Erbil and Dohuk for the proportion of funds for Health projects in the governorate. The share of Slemany compared to the whole KRG region is 15.7% which is totally disproportionate to the population of the governorate.
This inequality in the resource allocation is not limited to the size of the governorates, but also applies to the rural-urban distribution. The 2010 health budget of KRG allocates a lion share to the urban areas of Kurdistan, while the rural areas are getting the minimum. The budget dedicates only 27% of the resources for health project to rural areas while urban areas are getting 73%. This is a outright miscalculation of the health priorities in the KRG. It is clearly evident that the rural areas that suffered from destruction, displacement and drainage of human, capital and infrastructure are in urgent need for greated attention in terms of resource allocation.
The 2010 budget of KRG ignore the systematic thinking of health policy development and implementation in general and resource allocation in particular. The natures of the projects that are funded in the budget are paying too much attention to building infrastructure while ignoring the other equally important components of the Health System in Kurdistan. In this regard, the budget is allocating more than 92% of the resources to building hospitals and health centers. The disturbing news is that about 22% of the whole budget allocated for projects in Erbil Governorate is dedicated to buildiing a new office for the Ministry of Health’s in Erbil City.
The budget contains no plans or provision to increase the numbers of the human resources serving in the health sector in Kurdistan. According to the human resources section of the budget, every 1000 citizen in Kurdistan will receive care from only 8 health care workers, who include physicians, nurses, paramedical staff, pharmacists, dentists, laboratory workers…etc. Furthermore, there are no plans to overcome the clear gender inequality in the health care workforce. The vast majority of Kurdistan healthcare workforce is consisting of males. Only 40% of the health care workers in Kurdistan according to the Budget are females.
The fragmented health care system of Kurdistan is in urgent need for Electronic Medical Records and some kind of health information technology in place. But the budget dedicated 0% of resources to this crucial component of the health care system which should take care of the production, analysis and usage of information in the system.
The budget doesn’t answer the question of how those health centers and hospitals that take 92% of the resource would be supplied with medical technology and other necessary supplies. The budget dedicates only 7.6% of the total resources to providing health supplies and medical technologies.
There are no provisions in the budget with regard to training and advancing the skills and capacities of health care leaders in Kurdistan. No clear planning are demonstrated through the resource allocation in the budget to how the whole system would be financed.
The health budget of KRG for 2010, confirms our previous diagnosis of the ways the health care system in Kurdistan is governed; politics rather than health policies are what running the system. And that is a prescription for disaster!

Health Public-Private Mix in Kurdistan

2010-01-18T23:34:00.000-08:00

Kurdistan is no longer the region we had known. Its political, social and economic elements are changing on daily bases. Although change is always a good thing; but it can bring with it unexpected ramification and consequences.
The economic arena of Kurdistan had started to change in the 90s. But after the Iraqi Freedom process in 2003, globalization, open trade and market mechanisms has been one of the basic characteristics of Kurdistan's economy.
This had significant impact on the health care sector. Health care has been strictly controlled governmental business, ruled through the notion of centralized planning, financing and administration. Opening up to outside trade and the growth of an active private sector, has changed that too.
A simple overview of the data available at the Directorate of Health in Erbil Governorate, demonstrate alarming expansion of the private sector at the expense of the public one. For example in 2009 the percentages of the patient’s beds in privately funded hospitals in Erbil city was two times higher than the same percentage for 2008. The percentage for 2008 stands is 5% while that of 2009 is 11%.
What is more interesting to examine is the rate at which that increase in the number of the privately funded patient bed had happened. Since 2005 (the year where data is available) the number of the beds remained the same through 2008. From November 2008 to November 2009, the number of the beds in private hospital increased from 96 patient beds to 216. This puts the rate of increase of those private patient beds at 120%.
Comparing that number to the 44% increase in the number of the publically funded patient beds, demonstrate the fact that the private sector in Erbil city is expanding at an alarming rate compared to the publically funded health infrastructure.
It is obvious that the government alone cannot finance and administer health services. The private sector can act as a crucial partner of the government in providing health care services that are either too expensive for the government or so necessary that cannot wait the bureaucratic procedures of the government.
What is interesting, however, is two things;
First, all those private beds where for profit businesses and none were not-for-profit private enterprises. Second, it is painfully evident that the government and the Ministry of Health has no regulations to control the work of the private health sector in order for the latter to rise to the mission and vision of the government in terms of health and health care.
The Ministry of Health and the Health Committee in the Parliament of Kurdistan should take this matter seriously and start to take action to regulate the enormously growing private for-profit health care in Kurdistan.

له‌ ئاوێنه‌وه‌/ وه‌زیری ته‌ندروستی له‌ به‌رده‌م ئاوێنه‌دا

2009-12-26T12:36:00.000-08:00

زۆر و که‌م/ باش و خراپ
د.گۆران عبدالله‌*
به‌ڕێز دکتۆر تاهیر هه‌ورامی، وه‌زیری ته‌ندروستی حکومه‌تی هه‌رێمی کوردستان چاوپێکه‌وتنێکی له‌ گه‌ڵ رۆژنامه‌ی ئاوێنه‌ له‌ ژماره‌ 202ی رۆژی 15/12/2009ئه‌نجامداوه‌، که‌ مایه‌ی تێڕامان و ڕاوستانه‌ و پێویست به به‌دواداچوون و هه‌ڵسه‌نگاندن ئه‌کات. سه‌ره‌تا ده‌ستخۆشی له‌ وه‌زیری به‌ڕێز ئه‌که‌ین بۆ ئاماده‌بوونیان بۆ قسه‌کردن له‌ سه‌ر کایه‌کی ژیاری و گرنگی وه‌ک ته‌ندروستی له‌ کۆمه‌ڵگای کوردستاندا. هیوادارین ئه‌مه‌ یه‌که‌م و دوا کرانه‌وه‌یان نه‌بێت بۆ ڕۆژنامه‌گه‌ری ئازاد و نموونه‌ی ئه‌و جۆره‌ چاوپێکه‌وتنانه‌ هه‌ر زۆر بێت.
دیاره‌ پێویست‌ به‌وه‌ ناکات بیری وه‌زیری به‌ڕێزبهێنینه‌وه‌ که‌ ژماره‌ و داتا بنه‌مای هه‌ر زانستێکه‌. چونکه‌ دواجار "ماتماتیک دایکی زانسته‌کانه‌". به‌ڵام ئه‌وه‌ی له‌ چاوپێکه‌وتنه‌که‌ی جه‌نابی وه‌زیر هه‌ستی پێ ئه‌کرێت ئه‌وه‌یه‌ که پێئه‌چێت‌ بۆ ساتێک بنه‌ما زانستێکانی خۆیان له‌ بیرکردبێت وه‌ک پزیشکێک و زانایه‌ک نا، به‌ڵکو وه‌ک سیاسه‌تمه‌دار و بیروکراتێک قسان ئه‌که‌ن. له‌ وه‌ڵامی پرسیاری که‌ ئایه‌ "بارودۆخی ته‌ندروستی" له‌ کوردستان چۆن هه‌ڵئه‌سه‌نگێنێت، جه‌نابی وه‌زیر ئه‌ڵێت به‌ به‌راورد له‌ گه‌ڵ ناوه‌ڕاست و خواری عێراق "زۆر" باشه‌، به‌ڵام به‌ به‌راورد له‌ گه‌ڵ ئه‌مریکا و بریتانیا...هتد "زۆر" خراپه‌. پێم وانیه‌ خوودی وه‌زیر خویشی قه‌ناعه‌تیان به‌و قسانه‌ هه‌بێت و ته‌نانه‌ت لێشیان تێبگه‌ن! چونکه‌ ئه‌و جۆره‌ ده‌سته‌واژانه‌‌ هیچ بنه‌مایه‌کی زانستیان نیه‌. زۆری و که‌می باشی یا خراپی به‌ ژماره‌ و داتا ده‌ستنیشان ئه‌کرێن، نه‌ک له‌ ڕێی به‌کارهێنانی ووشه‌و ده‌سته‌واژه‌ی سه‌رپێی و ناڕوونی وه‌ک زۆر و که‌م و باش و خراپ.
له‌ لایه‌کی تره‌وه‌ له‌ سیاسه‌تی ته‌ندروستیدا، زانستێکی تایبه‌ت هه‌یه‌ پێی ئه‌وترێت، سیسته‌می ته‌ندروستی به‌راوردکاری. گرنگترین بنه‌ماکانی ئه‌م زانسته‌ به‌راورد کردنی سیسته‌مه‌ لێکچووه‌کانه‌ به‌ یه‌کتری. واته‌ به‌ کورتی تۆ ناکرێت بێیت له‌ خۆڕا به‌راوردی برتقاڵ له‌ گه‌ڵ سێودا بکه‌یت، به‌ڵکو به‌راوردی برتقاڵ له‌ گه‌ڵ برتقاڵ و سێویش له‌ گه‌ڵ سێودا ئه‌کرێت. جه‌نابی وه‌زیر له‌ گه‌ڵ ئه‌وه‌ی هیچ داتایکمان پێ ناڵێن له‌ سه‌ر ئه‌وه‌ی بۆچی ئه‌وان پێیان وایه‌‌ سیسته‌مه‌ ته‌ندروستێکه‌ی ئێمه‌ له‌ هه‌مان کاتدا "زۆر باش" و "زۆریش خراپه‌‌" ، دێن له‌ گه‌ڵ ئه‌مریکا و بریتانیا خۆیان به‌راورد ئه‌که‌ن. ئه‌مه‌ له‌ کاتێکدا ئه‌مرێکایه‌کان خۆشێان پێیان باش نیه‌ سیسته‌می ته‌ندروستی ئه‌مریکا له‌ گه‌ڵ بریتانیا به‌راورد بکه‌ن، چونکه‌ ئه‌و دوو وڵاته‌ له‌ ڕووی سیاسی و کومه‌ڵایه‌تی و ئابووریشدا جیاوازیان هه‌یه‌ و زۆر قورسه‌ که‌ خاڵی هاوبه‌ش له‌ نێوان سیسته‌مه‌ ته‌ندروستێکانیان بدۆزرێته‌وه‌ بۆ ئه‌وه‌ی به‌راورد له‌ نێوانیاندا بکرێت. ڕاسته‌ له‌ جیهاندا، هه‌ر ماوه‌ی جارێک وه‌ڵاته‌ پێشکه‌وتووه‌کانی دنیا له‌ ڕووی باشی سیسته‌مه‌کانیانه‌وه‌ ڕیزبه‌ندی ئه‌کرێن، به‌ڵام دیسان ئه‌و کاره‌ به‌ پشت به‌ستن به‌ ڕێژه‌ به‌ده‌ستهاتووه‌کانی ئه‌و وه‌ڵاتانه‌ ئه‌کرێت له‌و ده‌ستنیشانگه‌له‌ی له‌ خواره‌وه‌ ئاماژه‌ی پێئه‌ده‌ین. هه‌ر بۆ زانیاری به‌ڕێزیشیان، سیسته‌می ته‌ندروستی ئه‌مریکا له‌ هه‌ندێ ده‌ستنیشانکه‌ردا به‌ به‌راورد له‌ گه‌ڵ سیستمه‌کانی ئه‌وروپا سیسته‌مێکی باش نیه‌ و خراپه‌‌ و لێره‌دا باش نیه‌‌ جه‌نابیان سیسته‌می ته‌ندروستی ئه‌مریکا وه‌ک نموونه‌ی سیسته‌مێکی "باش" به‌کاربهێنێت. ئه‌گه‌ر پێیان باشه‌، ئه‌توانێت هه‌وڵێک بدات سیسته‌مه‌کی ئێمه‌ وه‌ک ئه‌وه‌ی فه‌ره‌نسا لێبکات چونکه‌ ئه‌مه‌ی دوایی له‌ زۆربه‌ی ده‌ستنیشناکه‌رکاندا سه‌رکه‌وتوترین سیسته‌مه‌ له‌ جیهاندا . ئه‌وه‌ی که‌ بوارمان پێبدات ئه‌و به‌راوردکاریه‌ بکه‌ین دیسان هه‌بوونی داتا و ژماره‌یه‌ له‌ سه‌ر ئه‌و وڵاتانه‌ی ئاماژه‌مان پێدا. بۆ زانیاری زیاتر بڕوانه‌ www.oecd.org

دیسانه‌وه‌، ڕاگه‌یاندنی ئه‌وه‌ی که‌ بارودۆخی ته‌ندروستی هه‌رێم به‌ به‌راورد له‌ گه‌ڵ ناوه‌ڕاست و باشووری عێراقدا "باشه‌" هیچ به‌ڵگه‌یه‌کی زانستی بۆ نه‌هێنراوه‌ته‌وه‌. ئه‌کرێت بزانین له‌ چی ڕووێکه‌وه‌، بارودۆخی ته‌ندروستی هه‌رێمی کوردستان به‌ به‌راورد له‌ گه‌ڵ ناوچه‌کانی تری عێراق باشه؟‌. ڕه‌نگه‌ ئه‌و ده‌ستنیشانکردنه‌ ڕاست بێت، به‌ڵام به‌ بێ هێنانه‌وه‌ی به‌ڵگه‌ی بشتراست به‌ داتا و ژماره‌، ئه‌و ئاماژه‌یه‌ له‌ قسه‌ی سه‌رپێی و سیاسیانه‌ زیاتر ناکرێت مامه‌ڵه‌یه‌کی جیدی له‌ گه‌ڵدا بکرێت. ئه‌وه‌ی له‌م دوایانه‌دا سه‌باره‌ت به‌ ئاماده‌کارێکانی وه‌زاره‌تی ته‌ندروستی هه‌رێم بۆ ڕووبه‌ڕووبوونه‌وه‌ی ئه‌نفله‌ونزای به‌راز بینرا، ئه‌و ده‌ستنیشانکردنه‌ی وه‌زیر پشتراست ناکاته‌وه‌. ده‌زگا ته‌ندروستێکانی هه‌رێم، ئێستاشی له‌ گه‌ڵدا بێت، نموونه‌ی وه‌رگیراو له‌‌و نه‌خۆشانه‌ی که‌ ڕه‌نگه‌ په‌تاکه‌یان گرتبێت، ڕه‌وانه‌ی به‌‌غدا ئه‌که‌ن بۆ دڵنیابوون له‌وه‌ی که‌ ئایا ڤایرۆسه‌که‌یان هه‌ڵگرتووه‌ یاخود نا. ئه‌گه‌ر هه‌رێم و وه‌زاره‌تی ته‌ندروستی له‌ کارێکی ئاوه‌ها سه‌ره‌تایی وه‌ک ده‌ستنیشانکردنی نه‌خۆشی پشت به‌ به‌غدا ببستن، ئه‌کرێت بزانین چۆن و له‌ چی شتێکدا، هه‌رێمی کوردستان له‌ ناوه‌ڕاست و باشووری عێراق "باشتره‌".

ئه‌کرێت وه‌زیری به‌ڕێز بۆ ده‌ربازبوون له‌و ته‌مه‌م ومژییه‌ی ئه‌رگومێنتی باش و خراپ و زۆر و که‌مه‌دا، دوو کاری سه‌ره‌کی بکات. یه‌که‌م؛ جه‌نابیان له‌وه‌ تێبگه‌ن که‌ ده‌ستنیشانکه‌رگه‌لێکی‌ دیاریکراو هه‌ن که‌ باشی و خراپی سیسته‌می ته‌ندروسی پێ ئه‌ژمێردرێت. بۆ نموونه‌ له‌ هه‌موو جیهاندا، ڕێژه‌ی مردنی کۆڕپه‌ڵه‌ و مردنی دایک له‌ کاتی له‌ دایکبوون و ته‌مه‌نی مه‌زه‌نه‌کراو له‌ کاتی له‌ دایک بوون و ژماره‌ی پزیشک به‌ به‌راورد له‌ گه‌ڵ ژماره‌ی دانیشتووان و ئاماده‌یی سیسته‌مه‌که‌ بۆ به‌ده‌مداچوونی په‌یداویستێکانی کۆمه‌ڵانی خه‌ڵک و به‌کارهێنانی ته‌کنلۆژیای زانیاری و هه‌بوونی داتا و ژماره‌ و بودجه‌ی ته‌رخانکراوی شیاو بۆ که‌رتی ته‌ندروستی و ده‌ستنیشانکه‌ری تر به‌کار ئه‌هێنرێن بۆ زانینی باشی و خراپی سیسته‌می ته‌ندروستی و ئاستی ئه‌و خزمه‌تگوزاریه‌ی سیسته‌مه‌که‌ فه‌راهه‌می ئه‌کات. ئه‌گه‌ر جه‌نابیان ئه‌و جۆره‌ داتایانه‌یان هه‌یه‌ ئه‌وا با خه‌ڵکیان لێ ئاگاداربکه‌نه‌وه‌‌ و ئیتر پێویست به‌ ده‌سته‌واژی ته‌مومژاوی ناکات. ئه‌گه‌ر نیه‌تی ئه‌وا دووه‌م کارێک که‌ به‌ڕێزیان به‌ سوپاسه‌وه‌ ئه‌کرێ بیکه‌ن، دامه‌زراندنی ده‌زگایه‌کی تایبه‌ته‌ به‌ کۆکردنه‌وه‌ و به‌کارهێنان و هه‌ڵسه‌نگاندن و بڵاوکردنه‌وه‌ی داتای تایبه‌ت به‌و بوارانه‌ بۆ ئه‌وه‌ی بۆ خوودی خۆیان وهه‌موو خه‌ڵک و پسپۆرانی بواره‌که‌ و حکومه‌تیش ڕوون بێت که‌ ئایا سیسته‌می ته‌ندروستی له‌ کوردستاندا زۆر یا که‌م باش وه‌یا خراپه‌!
ئه‌کرێت جه‌نابی وه‌زیر و وه‌زاره‌ته‌که‌ی له‌م بواره‌دا، پشت به‌ گۆڕانه‌ خێرا و گرنگه‌کانی بواری ته‌کنه‌لۆژیا ببه‌ستن. ڕه‌نگه‌ دوای تێپه‌ڕبوونی مانگێک به‌سه‌ر بوونیان به‌ وه‌زیر، هه‌ستیان به‌وه‌ کردبێت که‌ ته‌نها له‌ ژووری کۆمپیوته‌ردا ئه‌و ئامێره‌ نامۆیه‌ به‌ وه‌زاره‌ته‌کیان هه‌یه‌، که‌ له‌وێش ته‌نها بۆ چاپکردن به‌کارئه‌هێنرێت. پێم وایه‌ ئێستا له‌ کوردستاندا چه‌نه‌ها شاره‌زایی بواری کۆمپیوته‌رو کۆکردنه‌وه‌ و به‌کارهێنانی داتا هه‌یه‌ که‌ ئه‌کرێت سوودیان لێوه‌ربگیرێت. له‌ هه‌مان کاتدا، ئه‌کرێت، پێگه‌یه‌کی ئه‌لیکترۆنی و داتابه‌یسێکی سه‌ردمیانه‌ی‌ ئاوه‌ها دروستبکرێت که‌ ببێت به‌ سه‌رچاوه‌ی ئه‌وانه‌ی تینووی داتا و ژماره‌ن بۆ ئه‌وه‌ی له‌ توێژینه‌وه‌ زانستێکاندا به‌کاریان بهێنن.
هێوادارین جه‌نابی وه‌زیر له‌ داهاتوودا تۆزیک وریاتر بن له‌ به‌کارهێنانی ده‌سته‌واژه‌ و ووشه‌ بۆ هه‌ڵسه‌نگاندن و ده‌ڕبڕینی ڕای خۆیان له‌سه‌ر سیسته‌می ته‌ندروستی له‌ کوردستاندا، وه‌ پۆسته‌ تازه‌کیان، بنه‌ما زانستی و ئه‌کادێمێکانیان پێ له‌ بیر نه‌باته‌وه‌ که‌ هه‌موو که‌سێک به‌ به‌نده‌شه‌وه‌ شایه‌تی بۆ ئه‌ده‌ین له‌ باشی و گه‌وره‌ی و سه‌رکه‌وتوویدا.

*ماسته‌ر له‌ سیاسه‌تی ته‌ندروستی
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به‌ڕێوه‌به‌ری فه‌رمانگه‌ی سلێمانی سێ مانگ له‌ دواوه‌یه‌

2009-11-23T08:19:00.000-08:00

به‌ڕێز به‌ڕێوه‌به‌ری فه‌رمانگه‌ی ته‌ندروستی سلێمانی له‌ کۆنگره‌یه‌کی رۆژنامه‌وانیه‌دا که‌ بۆ ده‌زگاکانی ڕاگه‌یاندن سه‌باره‌ت به‌ ئه‌نفله‌ونزای به‌راز ئه‌نجامیدا، ڕووی ئاشکرا به‌ڵام نه‌ناسراوی وه‌زاره‌تی ته‌ندروستی به‌ گشتی و فه‌رمانگه‌ ته‌ندروستێکان به‌ تایبه‌تی پیشان دا. جێگای ده‌ستخۆشی و مایه‌ی خۆشحاڵیه‌ که‌ به‌رپرسه‌ ته‌ندروستێکانی ئه‌م هه‌رێمه‌ له‌ ڕادیو و ته‌له‌فیزیون و ڕۆژنامه‌کاندا ده‌رکه‌ون و هاوڵاتیان له‌ پێشهاته‌ ته‌ندروستیه‌ مه‌ترسیداره‌کان ئاگاداربکه‌نه‌وه‌ و ئامۆژگاری پێویست له‌و ڕووه‌وه‌ پێشکه‌ش بکه‌ن. ئه‌م هه‌نگاوه‌ له‌ هه‌موو کاتێک زیاتر پێویسته‌ به‌ له‌ به‌رچاوگرتنی مه‌ترسی بڵاوبوونه‌وه‌ی په‌تای ئه‌نفله‌ونزا له‌م وه‌رزه‌ی به‌فر و باران و حه‌ج و چه‌ژن و کرانه‌وه‌ی ده‌رگاکانی قوتابخانه‌کان. ئه‌و هه‌موو بۆنه‌ و ڕووداوانه‌، فاکته‌ری ڕێخۆشکه‌رن بۆ بڵاوبوونه‌وه‌ و ته‌شه‌نه‌ کردنی نه‌خۆشێه‌که‌.
تا ئه‌و ساته‌ی که‌ به‌ڕێوه‌به‌ری به‌ڕێز باسی له‌ جیگا و ڕێگاکانی خۆپاراستن له‌ لایه‌ن هاوڵاتیانه‌وه‌ ئه‌کرد زۆر به‌ باشی ئه‌و کاره‌ی ئه‌نجامدا. به‌ڵام هه‌رکه‌ ده‌ستی به‌ قسان کرد له‌ سه‌ر ڕێوشوێنه‌کانی ده‌ستنیشانکردنی په‌تاکه‌و و میکانه‌زمه‌کانی پاراستن و چاره‌سه‌ر، ئه‌وا دکتۆری به‌ڕێز ئیسپاتی کرد که‌ زۆر له‌ به‌ دواداچوونی پێشهات و گۆڕانکاریه‌ ته‌ندروستێکانی جیهان دواکه‌وتووه‌ و پێویسته‌ تۆزێک کات ته‌رخان کات بۆ به‌لانی که‌مه‌وه‌ چاوخشاندنێک به‌ پێگه‌ ئیلکترۆنیه‌ ناسراوه‌کانی ئه‌م بواره‌ به‌ تایبه‌تی پێگه‌ی ڕێکخراوی ته‌ندروستی جیهانی که‌ به‌ WHO ناسراوه‌.
جه‌نابی د. ڕێکه‌وت له‌ وه‌ڵامی پرسیارێک ده‌رباره‌ی هه‌بوونی ڤاکسین دژی ئه‌نفله‌ونزای به‌راز له‌ کوردستاندا، زۆر به‌ سیقه‌وه‌ ئه‌ڵێت تا ئێستا ئه‌م ڤاکسینه‌ له‌ لایه‌ن WHO ه‌وه‌ هاتکۆ ئێستا بڵاونه‌کراوه‌ته‌وه‌ و هیچ وڵاتێک به‌ کاری نه‌هێناوه‌. ئه‌مه‌ جگه‌ له‌ چه‌واشه‌کاری و عوزر هێنانه‌وه‌ بۆ شکسته‌کانی وه‌زاره‌تی ته‌ندروستی و فه‌رمه‌نگاکانی ناتوانین ناوی هیچ شتێکی تری لێبنێن. ئاخر کاک دکتۆر ئه‌گه‌ر جه‌نبتان ته‌نها بزانن ئه‌نته‌رنێت به‌کاربهێن و بۆ ته‌نها جارێکێش له‌م چوار پێنج مانگه‌ی پێشوودا سه‌ردانی پێگه‌ی ئیلیکترۆنی WHO تان بکردایه‌، ئه‌وه‌نده‌ به‌ سیقه‌وه‌ قسه‌تان نه‌ئه‌کرد و لێدوانه‌کانتان واقعی تر و ڕوونتر ئه‌بوون.
پێم وایه‌ ئه‌گه‌ر WHO ئاگاداری قسه‌کانی جه‌نابی د. ڕێکه‌وت بێت ئه‌وا ئه‌مه‌ی دوای ڕه‌نگه‌ خۆی تووشی به‌ دوادووچوونی یاسایی بکات. چونکه‌ ئه‌م دکتۆره‌ به‌ڕێزه‌ به‌ ناوی ده‌زگایه‌که‌وه‌ قسه‌ئه‌کات که‌ به‌رپرسیارێتی ڕه‌سمی هه‌یه‌ و ناکرێت له‌ خۆڕا قسان بکات. بۆ زانیاری جه‌نابی به‌ڕێوه‌به‌رو وه‌زاره‌تی ته‌ندروستی به‌ڕێز، WHO چه‌ند مانگێکه‌ ڕۆژانه‌ زانیاری له‌ سه‌ر په‌تاکه‌ به‌ گشتی و ڤاکسین به‌ تایبه‌تی بڵاوئه‌کاته‌وه‌. بۆ نموونه‌ له‌ یه‌کێک له‌ بڵاوکراوه‌کانیدا ئه‌م ڕێکخراوه‌ پێشبینی ئه‌وه‌ ئه‌کات که‌ 3 ملیار ڤاکسینی H1N1 که‌ بۆ خۆپاراستن له‌ په‌تاکه‌ باکارئه‌‌هێنرێت دروست بکرێت. ئه‌گه‌ر ئه‌م زانیاریه‌ بچووکه‌ به‌ لایه‌ی دکتۆره‌وه جێگای بایه‌خ نیه‌و و هێشتا پێوایه‌ ناکرێت کوردستان ڤاکسینی هه‌بێت ئه‌وا پێویسته‌ بیرێک له‌ ئیشێکی تر بکاته‌وه‌ بۆ از له‌ فه‌رمانگه‌کی بهێنێت، چونکه‌ به‌ڕاستی پێئه‌چێت ئه‌وه‌نه‌ سه‌رقاڵی نه‌شته‌رگه‌ری بێت ئاگای له‌ دنیای ته‌ندروستی کۆمه‌ڵ نه‌مابێت.
له‌ لایه‌کی تره‌وه‌، نه‌ک ته‌نها ڤاکسین هه‌یه‌ و دکتۆر وه‌ته‌نی "پروڤ" کراوه‌، واتا تاقی کراوه‌ته‌وه‌ و دڵنیابوون له‌وه‌ی که‌ کاریگه‌ری هه‌یه‌، به‌ڵکو ڕێکخراوی ته‌ندروستی جیهانی له‌ ماوه‌ی ڕابووردوودا توانی 200 ملیون ڤاکسین بۆ 93 وڵاتی که‌م درامه‌تی جیهان بکات. ئه‌و وڵاتانه‌ی که‌ توانیان له‌ ماوه‌یه‌کی که‌م و ڕێژه‌یه‌کی زۆری ڤاکسینه‌که‌ دروست بکه‌ن، وه‌کو ئه‌مریکا و سویسرا، ڕێژه‌یه‌ک له‌ به‌شی خۆیان به‌خشی به‌ وڵاته‌ که‌م درامه‌ته‌کان. هه‌رچه‌نده‌ وڵاته‌کی ئێمه‌ که‌م درامه‌ت نیه‌ و ئه‌توانی ڤاکسین و ده‌رمان بکڕێت، به‌ڵام دیسان تکا له‌ به‌ڕێز به‌ڕێه‌وه‌به‌ری فه‌رمانگه‌ی ته‌ندروستی و وه‌زاره‌تی ته‌ندروستی ئه‌که‌ین که‌ زه‌حمه‌ت بکێشێت و په‌یوه‌ندی به‌ WHO بکات تا ئه‌گه‌ر ئه‌کرێت تۆزێک به‌شی ئێمه‌ش بده‌ن.
کاک دکتۆر ڕێکه‌وت، به‌ ڕێکه‌وت یا به‌ ئه‌نقه‌ست، به‌ هه‌ندێک وشه‌ و زاراوه‌ی ئینگلیزیه‌وه‌ که‌ زۆر جار پزیشکه‌کان بۆ سه‌رلێشه‌واندنی نه‌خۆشه‌کانیان و ڕاکردن له‌ به‌رپرسیارێتی به‌کاریئه‌هێنن، ئه‌که‌وێته‌ ته‌مومژاوی کردنی پرسیارێکی ڕوون و ئاشکرا سه‌باره‌ت به‌ چۆنێتی ده‌ستنیشانکردنی نه‌خۆشێکه‌. پێم وانیه‌‌ پێویست بکات وه‌ڵامێکی دوورودرێژ هه‌بێت بۆ پرسیاری؛ ئایا ده‌زگای تایبه‌تان هه‌یه‌ بۆ ده‌ستنیشانکردنی په‌تاکه‌؟ جه‌نابی دکتۆر له‌ وه‌ڵامدا خۆی و بیسه‌ر ئه‌خاته‌ ناو گێژاوی چه‌ند ڕسته‌یه‌کی بارگاوی به‌ ده‌سته‌واژه‌ی ته‌کنیکی و نا پێویست که‌ به‌ کورتی مانای ئه‌وه‌ ئه‌ده‌ن به‌ ده‌سته‌وه‌ که‌ نه‌خێر ناتوانین ده‌ستنیشانی په‌تاکه‌ بکه‌ین. ئاخیر نازانین ئه‌گه‌ر نه‌توانین ده‌ستنیشانی نه‌خۆشیه‌ک بکه‌یی به‌ علمی جن ئه‌زانیت چه‌ند نه‌خۆشت هه‌یه‌ که‌ تووشی ئه‌و ئه‌نفله‌ونزایه‌ بوون؟ دیاره‌ ئه‌و تۆزه‌ زانیاریه‌ی که‌ وه‌زاره‌تی ته‌ندروستی و فه‌رمانگه‌ی ته‌ندروستی سلیمانی هه‌یانه‌ له‌ سه‌ر ژماره‌ی تووشبووان ئه‌ویش له‌ ده‌ره‌وه‌ هاتووه‌. کاک دکتۆر پێمان ئه‌ڵێت جگه‌ له‌و چه‌ند یاریزانه‌ی باسکه‌ که‌ له‌ ئه‌مریکا بوون و هاوڵاتیه‌کی بیانی تر، که‌س نیه‌ له‌ کوردستان تووش بووبێت. پێم وایه‌ ئه‌گه‌ر ئه‌و یاریزانه‌ به‌ڕێزانه‌ له‌ عه‌مانی ئوردن تاقیکردنه‌وه‌یان بۆ نه‌کرایه‌، ئه‌وا ئه‌وانیش ئه‌چوونه‌ پاڵ ئه‌و هه‌موو که‌سه‌ی که‌ به‌ دڵنیاوه‌ له‌ کوردستان تووش بوون و پێیان نازانین. باشه‌ تێناگه‌م چۆن و به‌ چی میکانزمێکی زانستی یا کۆمه‌ڵایه‌یتی یاخود سیاسی، ئه‌م په‌تایه‌ له‌ هه‌رچوارده‌وره‌ی کوردستان بڵاوببێته‌وه‌ و ته‌نها ئه‌م وڵاته‌ باراناوی و به‌فراوی و پڕ ماچ و مووچه‌ی خۆمان توانیبێتی خۆی بپارێزی. پێم وانیه‌، ئه‌و ده‌مانچانه‌ی که‌ ئاراسته‌ی ده‌موچاوه‌تی ئه‌که‌نه‌وه‌ هه‌ر که‌ له‌ فڕۆکه‌ داده‌بزیت خۆیان وه‌ته‌نی بۆ ئه‌وه‌یه‌ بزانن پله‌ی گه‌رمیت چه‌نده‌، توانیبێتی به‌ قوده‌ره‌تی قادر ڤایرۆسه‌که‌ له‌ ناوببات.

Health Ministry Between Policy and Process

2009-11-20T02:38:00.000-08:00

The Selection of the Minister of Health in the New Kurdistan Regional Government (KRG) cabinet, says a lot about how politics in our country works. There is no doubt that Dr. Taher Hawramy, is a well known surgeon with excellent teaching qualifications. However, it is much nicer to imagine him as a dean of a medical school or a president of a University, rather than the Minister of Health. I will tell you why in a minute. First lets take a look at the priorities of our government.
Over the last 18+ years of its life, the KRG preferred politics over professionalism, process over policy and geography over governance. Politically, the Ministry of Health has been and stayed a Patriotic Union of Kurdistan (PUK) territory in the previous cabinet and stayed so in the new one. That has to do with the strategic agreement between the Kurdistan Democratic Party (KDP) and PUK rather than assigning the best person to the respective jobs in the government. The dirty policy of putting the nose of politics into every minute function of the government is so paralyzing for the latter. The experience of the last 18 years is a proof for that characterization. It is a disaster to continue this policy in the extremely crucial and vital area of health.
As for as governance goes, the KRG failed so far to prioritize health planning and policy development over the day to day process of how the functions of the Ministry are conducted. This is understandable given the failure of the Parliament of Kurdistan to pass a bill related to health policy. The only bill related to health passed by the former was a two pages law about the structure of the Ministry of Health and how it should be run. So in the absence of clear understanding of how this country is viewing health and health care, the logical outcome would be chaos when it is ran. What make matter even worse is the fact that people who are assigned to run the Ministry and not managers by training. They are just selected because they are "good" people, based on their clinical qualifications and their connections to the main two parties.
Dr. Hawramy spent most of his professional life doing surgeries. He has limited health policy and management credentials. That alone doesn’t qualify him to become the Minister of Health. The outcome would be a focus on the status quo way of doing things. So the forecast is not encouraging as far as policy making and planning for the health sector goes and we have to wait how the Minister will do on process. We need to develop a grading system for him to see if he fails or passes this test. Hope he does!

A Response to the MOH reply to an Earlier Article of Mine in Hawlati/ Translation by Hemin Sabir

2009-09-25T22:17:00.001-07:00

The Ministry of Health media agency published a response on the Hawlati newspaper (number 557) to my article on the same newspaper (number 555) which I wrote under the title of “Information schizophrenia of the Ministry of Health”. The response is a tirade of defamation and accusation of myself and is otherwise devoid of useful information to what we already know.

The ministry and its employees, including the minster himself, should be well aware that it is the legitimate right of any citizen of this region to monitor and criticize the ministry over its actions and inactions. This is not only a basic human right, but - especially the MOH concerned - a national obligation. The level of apprehension at the MOH for such a direct criticism is not surprising, given the failure of the dysfunctional last parliament in monitoring and holding government ministries accountable to their duties. It is therefore understandable that a citizen poking at MOH strategies towards the swine-flu threat should arouse such a shock. The time has come for officials to abandon their marble castles and succumb to public inquiry, and to acknowledge that our people are conscious enough to ask and inquire.

The MOH-media relations have palm-read their conclusion of myself not being a doctor, seemingly oblivious to the fact that when health is concerned anyone can question, even a lay person. It seems from this gesture that ordinary people are more conscious of personal health and its requirements than the minister himself. Indeed their retort is very much reminiscent of a haughty doctor dismissing a patient’s question by claiming “am I the doctor or you?”, and ultimately denying the patient the right for information. This policy used by the ministry to defame and belittle those who question, is a rotten totalitarian strategy that is doomed to failure.

In this respect one wouldn’t need to be medically certified to conclude that the Minister’s declarations on the government electronic pages that “we have the capacity to put 500,000 patients under medical observation” – is at best a murky statement that needs further clarification. These people accuse me of ignorance while themselves indulging in the mistake of equating medical care with the administration of Tamiflu®, and still expecting us to sheepishly acquiesce. Moreover, they acknowledge while accusing me of ignorance - that no system can properly put such a number of patients at observation – all the while turning a blind eye to the same misinformation given by their minister. May we ask further how many epidemiologists and infectious disease people have been consulted about this (swine flu) or other common transmissible disease in Kurdistan?

In another part of the retort they talk about “a proper, meticulous and open policy of the MOH” towards the problem – may we ask what policy? What policy does the MOH have towards cholera, child and maternal death during labour, female genital mutilation and mental health – let alone swine flu? What the ministry does is totally divorced from health policy and planning. Instead, the ministry and its head are not different from any other government cleric working in the office and ignoring the field – being preoccupied with signatures and routines and paperwork while ignorant of healthcare in Kurdistan. If this the policy adopted by the MOH then I guarantee you that it is nothing but a recipe for a public health disaster. It is imperative that the ministry reviews its policies and amend its strategies. From my expertise as a health policymaker – without schooling others – I suggest to the parliament and KRG that this ministry is no longer useful and it demands change. The MOH should be chiseled into a Ministry for Public Health, while abandoning the routine works (like administrative jobs, human resources etc) to the local Departments of Health (DOH).

An MOH still using technology from the mid-Twentieth century, with a computer spotted only in the print room – can hardly be expected to adequately face the current – urgent and demanding - health issues. I am surprised at the MOH-media relations having failed to establish an effective website or e-mail service yet having the nerve to brazenly boast an “open and meticulous policy”. They accuse us for being ill-read and ignorant of their “good achievements” while not acknowledging that much of these would have been impossible without the aid/supervision from the WHO, UNICEF and other NGO’s and organizations. You might accuse as of schooling you if we were to ask again how is health policy made without data, and in which domain have the MOH used meticulous data collection and analysis? Your claim that health systems in developed countries have stopped collecting data on infected cases is another misinformation from your media aimed at eluding the people and stifling public inquiry. Health specialists and ordinary people alike are thirsty for data and numbers, and if you can’t do the job properly yourself then it is no shame to request aid from NGO’s as you are so used to.

I would also like to ask about the stock of medications provided, and how it is distributed? Whether the PCR-technology that is claimed by the MOH is indeed used or not? What is the plan for those elderly “Hajjajs” who will come back soon? Will they all be tested? Has a database been established by the ministry of cases who were confirmed positive and improved/deceased, including demographics? These are a dozen of other questions are awaiting a response, and we will not go silent until we get a proper one.

Our humanitarian instinct and national responsibility demands a clearer and more effective approach from the MOH towards the health problems of our region. Furthermore, the MOH should be willing to acknowledge and instructively answer any question or inquiry from myself or any other member of the public.

Grow Up Kurdistan!!!

2009-09-21T10:54:00.001-07:00

Just a while ago, politicians in Kurdistan we responding to the courageous few voices of criticism through the claim that we are still going through the infancy stage of our nation building. That characterization had a lot of truth to it, however, it says more about what we are going through now. After 18 years of self-governance, it is time to admit that we are "suffering" from the adolescence stage of our growth and development.
I mean, take a look around you and will sense the truth of this diagnosis. There is a lot of hormone running around, creating more buzz and foolishness than what you expect from a teenager. We just went through a very teaching lesson of parliamentary and presidential elections that were tainted by black headed comedons of the acnes of irregularities. Our politicians wanted it all regardless of how to get it. Just like a teenager who wants the latest model of cars, laptops and mobile phones regardless of how to pay for it. And guess what, just like a spoiled adolescent, some of our politicians got it all the way they think its right. And on top of it, those who won engaged in a binge of celebrations, while those who lost started a temper tantrum. And exactly like a teenager who refuses that she is wrong, those who lost, started not only complaining but also accusing others for their own failures and shortcomings. So the "logical" move was to start firing and moving of teachers, soldiers and others. Doesn't that look exactly like a teenager who crushed her car and blames her parents and siblings for it?
We are suffering now from all the personality and physiological disorders and abnormalities coming up with the surge of resources "Hormones" of our adolescence. At this stage of our development, we don't have too many choices; we can continue being Schizoid and disregard the rule of law and be violent to the rights of others or we can grow to be respectful and mature adults. It is time to look around for the superego that we are so victimizing at the expense of our political ego. In this whole mess, the Id is using its most primitive defense of denial. Some deny that they just failed and their policies don't work anymore. It would be easier to resort to the superego of family, school and society in general for solutions
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What the Previous Minister of Health Can Do?

2009-09-18T23:03:00.000-07:00

The minister of health of Kurdistan Regional Government (KRG), complained in a recent media appearance in Hawlati newspaper of "corruption" and "Limits on his Power". He attributed his unwillingness to continue serving as the Minister of Health in the new KRG cabinet to those two main reasons.
The minister hit the bull's eyes when he identified corruption as one of the main ailments that is crippling our health care system in Kurdistan. This problem is rooted into the minute structures of public health care services. During my one year tenure, directing a health care center in a suburb of Erbil City, only 20% of our employees were actually working in the center. The remaining was just appearing to get their salaries or their wages were taken to their homes for them. Most of those "Masked Employees" were family members of prominent governmental officials who the administration staff at my center were seeking favor to them by employing their family members without necessary the latter having anything to do with health care. This is just one example of the crippling effects of corruption on the financing, quality and administration of the health care services in the KRG. Working as a Minister of Health, Dr. Abdulrahman needs to stay a fervent advocate to fight corruption in the health care sector even if after he leaves the Ministry. He doesn’t necessary has to serve in a higher position, as many are proposing for him, to be able to advocate on behalf of the Kurdish people, on the contrary, he may even be more effective, working at a grass root level given his experience in the health care system. However, this proposed move in part of the Minister would be unthinkable given the trend of the overall political system in the KRG, where the system is modified to accommodate the desires of its bureaucrats. The opposite should be done; the official of KRG should accommodate the needs and necessities of the system.
As right as the Minister was with regard to diagnosing corruption, which shouldn’t have taken him so long to get, he was wrong with the limits on his power as a reason for him to quit. The Minister should understand that we are a Federal Region, and one of the main characteristics of Federalism is decentralization. When The Minister refers to limits on his power, he obviously means the Directorates of Health in Erbil and Dohuk that are under the political control of Kurdistan Democratic Party, the rival of his own party; Patriotic Union of Kurdistan (PUK). Regardless of political rivalry and its influence on health care services, the ability of the Directorates of Health to gain some independence from the power of the Ministry of Health could serve well the prospect of decentralization in the KRG.
When it comes to routine administrative procedures, the Directorates of health in the KRG should be given more autonomy and greater power. The Ministry of Health doesn’t need to get involved in every detail of procedural and administrative issues that can be easily implemented by the directorates. This would help achieve two goals; the Ministry of Health will be more dedicated to health promotion and disease prevention at the regional level, and the directorates will be more responsive to the needs of their respective governorates.
While it is a personal choice to quit or continue working in a governmental position, we would like to see the Minister continue serving possibly in a lower position, may be the director of one of the directorates of health. This would provide him a better opportunity to apply the knowledge and skills he acquired during his tenure in the Ministry of Health.

Donate Infrastructure!!

2009-09-18T04:40:00.000-07:00

Some of the rich countries of the world announced today, September 18, 2009 their willingness to donate vaccine supplies for H1N1 virus to the developing world. While this announcement deserve applaud and brings to the attention the seriousness of the pandemic as a public health emergency of international concern, it also calls for a closer look at the developing-developed countries relationships when it comes to public health.
It is well known that health is an important component of the security and stability of any state. Without a special attention to the health and wellbeing of individuals and populations, political and economic efforts to establish stable democracy can prove fruitless and futile. This should be a lesson learned from the military involvement of the United States with Iraq. The US helped establish a democracy in the heart of the middle east, but it failed for understandable reason to establish the infrastructure necessary for an enduring and responsive health care system. That would come to no surprise given the difficult struggle the US is engaged in to reform its own health care system.
If it is true that helping to achieve stability at the expense of democracy is futile in politics, it is also so in the health care sector. It is useless to through money at the health problems of the east without engaging in a deliberate and long term effort to reform the health care system so that it would be more responsive to the health needs of our populations and individuals.
It goes without a question that it is of utmost importance to help us combat swine flu at this critical moment. However, what after this epidemic passes. Does the developed world has the capacity and the political will to help us with every single danger we may face, even if that danger would have international ramifications? Isn't it more wise and sustainable to help our countries and nations building an infrastructure that would be flexible and responsive to a wide range of public health emergencies?
Its time for the developed world to rise to the expectations set forth for it in the millennium developing goals. It is also time for the developing countries to wisely use the help we get from the former. We need to know our priorities, which include but not limited to having a robust surveillance system that allows sound policy making, build a solid infrastructure that help prevent disease rather than consume precious resources in treating them, and engage in a genuine and open national debate on health care reforms in our countries
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A Ministry for Public Health!

2009-09-08T03:37:00.000-07:00

During a few hours visit to the Ministry of Health of Kurdistan Regional Government, I was introduced to a crippling problem that plagues the work of the ministry and prevent it from fulfilling its mandates effectively. While I was waiting for a paper of mine to be signed by the Minister, a poor family with a 7 month kid who had bilateral phocomelia (Absent Arms above the elbow) was waiting to see him and beg for help for their toddler. My paper was signed and many others were as well while the heartbroken family couldn't have the chance to meet the busy minister and went back empty handed to the misery of abandonment.
The Ministry of Health has been extremely busy with a host of bureaucratic procedures that have no direct impact on health outcomes of Kurdistan Region. The Minister himself and his staff are engaged with activities that can be done by any directorate of health in Kurdistan, while they neglected the more urgent priorities of preventing illness and promoting health.
Throughout its 16 plus years of service, the Ministry of Health failed to accomplish the very basic tasks of any Ministry of health. It couldn't establish a robust surveillance system that could be endowed with the human and technological capacities to collect, analyze and utilize data about the indicators of health in Kurdistan. We still are ignorant about the incidence and prevalence of a range of crippling health conditions in Kurdistan. We don't know how many cases of Cholera do exist each year, how many infant die, how many mothers pass away during labor and what is the expected life expectancy at birth.
Furthermore, the Ministry of Health neglected a host of determinants of health that are extremely crucial for the well being and health of individuals and populations. The only part of the definition of health that the ministry paying attention to is physical health. It completely neglected the other social and mental aspects of health. The ministry failed to have at least a task force for mental health in Kurdistan, this if we forget talking about a mental health act that is so important given the disastrous mental health consequences of the suffering of the Kurdish people.
To partly fix all these disastrous plaguing of the Mini sty and the health care system in general, the Ministry of Health has to change. As part of the decentralization policies that should characterize every federal state, the Ministry of Health needs to be decentralized as well. It should give up doing some of the works that any administrative institution can do. For example employing doctors, medical staff and other health care related personnel can be done by the Directorates of Health. This would mean that even the name of the Ministry change to the Ministry of Public Health.
The new Kurdistan Parliament and Kurdistan Regional Government has to take this matter seriously. Time is long overdue to overhaul the Ministry of Health and look for more effective and efficient alternatives to the immensely disastrous status qua of the current Ministry.

شیزوفرینای ئاخاوتنی وه‌زاره‌تی ته‌ندروستی / له‌ هاوڵاتیه‌وه‌

2009-09-02T07:44:00.000-07:00

وه‌زیری ته‌ندروستی هه‌رێمی کوردستان له‌م ماوه‌ی ڕابووردوودا به‌ چه‌ند ڕاگه‌یاندنێکی له‌یه‌ک دوور و ناڕوون قسه‌ی له‌سه‌ر ئه‌نفله‌ونزای به‌راز له‌ میدیاکاندا ده‌رکه‌وت. چه‌ند هه‌فته‌یه‌ک پێش ئێستا جه‌نابی وه‌زیر ڕایگه‌یاند که‌ ئه‌نفلوه‌نزای به‌راز مه‌ترسیه‌کی زۆر گه‌وه‌ره‌ له‌سه‌ر خه‌ڵکی کوردستان دروست ئه‌کات و ڕه‌نگه‌ له‌ کۆتایی هاوین و سه‌ره‌تای پایز،‌ هه‌زاره‌ها که‌س تووشی نه‌خۆشێکه‌ بن له‌ کوردستاندا. له‌م چه‌ند ڕۆژه‌ی ڕابووردووش، د.زریان له‌ ڕێی پێگه‌ی ئیلیکترۆنی حکۆمه‌تی هه‌رێمه‌وه پێمان ئه‌ڵێت که‌ "هیچ حاڵه‌تێکی تر له‌ کۆردستان تۆمارنه‌کراوه‌" و وه‌زیری به‌ڕێز ئه‌ڵێت ”له‌تواناماندا هه‌یه‌ 500 هه‌زار كه‌س كه‌دووچاری نه‌خۆشیه‌كه‌ بێت بیانخه‌ینه‌ ژێر چاودێریه‌وه‌".
دیاره‌ پێشکه‌شکردنی زانیاری تۆکمه‌ و وورد له‌سه‌ر پێشهاته‌ ته‌ندروستیه‌کانی کوردستان یه‌کێکه‌ له‌ هه‌ره‌ گرنگترین به‌رپرسیارێتیه‌کانی وه‌زاره‌تی ته‌ندروستی. ئه‌م ئه‌رکه‌ی وه‌زاره‌ت ئه‌گه‌ر له‌ کاتی ئاساییدا زۆر پێویست بێت ئه‌وا بۆ کاتێکی وه‌کو ئێستا که‌ ‌هه‌ڕه‌شه‌ی ئه‌نفله‌ونزای به‌راز ڕووی تێکردووین زۆر گرنگتر و هه‌ستیارتره‌. لێره‌دا جێگای ده‌ستخۆشیه‌ که‌ جه‌نابی وه‌زیر له‌ ڕێی ده‌رکه‌وتنه‌ میدیایه‌کانیه‌وه‌ کۆمه‌ڵانی خه‌ڵک له‌ پێشهاته‌ ته‌ندروستیه‌کانی کوردستان ئاگادار ئه‌کاته‌وه. به‌ڵام، ڕه‌نگه‌ به‌ ته‌نها ده‌رچوون له‌ میدیاکان و قسه‌ کردن له‌سه‌ر بابه‌ته‌که‌ به‌س نه‌بێت بۆ ڕووبه‌ڕووبوونه‌وه‌ی ئاوه‌ها مه‌ترسیه‌ک له‌ سه‌ر سه‌لامه‌تی و ته‌ندروستی خه‌ڵک. وه‌زاره‌تی ته‌ندروستی پێویسته‌ کاری جدی بکات بۆ خۆپاراستن له‌ بڵاوبوونه‌وه‌ و ته‌شه‌نه‌کردنی درمه‌که‌، چونکه‌ ئێستا قسه‌کردن له‌ سه‌ر به‌رگری کردن له‌ هاتنه‌ ژووره‌وه‌ی ڤایرۆسه‌که‌ بۆ کوردستان، کارێکی بێمانیه‌، چۆنکه‌ هه‌موومان ئه‌زانین خه‌ڵکمان هه‌یه‌ تووشبوون.

وه‌زاره‌تی ته‌ندروستی له‌ ڕێی جه‌نابی وه‌زیره‌وه‌ له‌ دوو کاتی جیاوازدا، دوو ووتاری جیاوازمان پێ ڕائه‌گه‌یه‌نێت که‌ به‌ ته‌واوه‌تی پێویست بوو جێگۆڕکێ ئه‌و دوو شێوازی ئاخاوتنه‌ بکرایه‌. له‌ سه‌ره‌تای سه‌رهه‌ڵدانی په‌تاکه‌ له‌ جیهان و ناوچه‌که‌دا، وه‌زیری ته‌ندروستی به‌ تۆنێکی ترسناکئامێزیه‌وه‌ هاته‌ سه‌ر میدیکان که‌ له‌ تۆقاندن زیاتر هیچ مه‌به‌ستێکی تری نه‌پێکا. ئه‌مه‌ له‌ کاتیكا کرا که‌ له‌ کوردستان هیچ نه‌خۆشێکی ئه‌نفله‌ونزا وجوودی نه‌بوو. له‌و کاته‌دا که‌ مه‌ترسی بڵاوبوونه‌وه‌ی نه‌خۆشێکه‌ که‌م بوو، ئه‌کرا له‌ جیاتی ترساندنی خه‌ڵک، هه‌نگاوی پراکتیکی و سوودبه‌خش ئه‌نجامبدرایه‌ که‌ ئه‌گه‌ره‌کانی هاتنه‌ ناوه‌وه‌ی نه‌خۆشێکه‌ بۆ کوردستان که‌م بکاته‌وه. ئه‌وه‌ی که‌ وه‌زاره‌ت وه‌ک هه‌نگاوێکی زۆر گه‌وه‌ره‌ی خۆ پاراستنی پێفرۆشتنێوه‌ گرتنی پله‌ی گه‌رمی ئه‌وانه‌ بووکه‌ له‌ ده‌ره‌وه‌ دێنه‌وه‌، له‌ کاتێکا که‌ وه‌زاره‌تی ته‌ندروستی یا ئه‌نزانێ و خۆی گێل ئه‌کات و یا نازانی که‌ زیاتر له‌ 50% ئه‌وانه‌ی که‌ تووشی په‌تاکه‌ دێن هیچ به‌رزبوونه‌وه‌یکی پله‌ی گه‌رمییان نیه‌. ئه‌وه‌ی له‌و کاتدا ئه‌کرا بکرایه‌ و ئێستاش هه‌ر زووه‌و ئه‌توانین بیکه‌ین، هێنانی فه‌حسی پێشکه‌وتوونی PCRه‌ که‌ ته‌نها تاقیکردنه‌وه‌یه‌ بۆ ده‌ستنیشانکردنی سه‌رهه‌ڵدانی په‌تاکه‌. ئایه‌ وه‌زاره‌ت ئه‌توانێت پێمان بڵێت ئایه‌ ئه‌م فه‌حسه‌ی هه‌یه‌ یا نا، ئه‌گه‌ر نیه‌تی چۆن ئه‌زانێت له‌ کوردستاندا وه‌ک جه‌نابی وه‌زیر ئه‌ڵێت "هیچ حاڵه‌تێكی تر له ‌هه‌رێمی كوردستان تۆمار نه‌كراوه‌". بۆیه‌ ئه‌بوایه‌ وه‌زاره‌تی ته‌ندروستی پێش ترساندنی خه‌ڵک ده‌ستی بدایته‌ کاری جدی و پلانڕێژبۆکراو بۆ رووبه‌رووبوونه‌وه‌ی په‌تاکه‌.

ئیستاش که‌ په‌تاکه‌ له‌ کوردستان و عیراق بڵاوبووه‌توه‌ و ته‌نانه‌ت که‌سێکیش له‌ نه‌جه‌ف به‌هۆی نه‌خۆشێکه‌وه‌ مردووه‌، جه‌نابی وه‌زیر به‌ یاسای عوزر له‌ قه‌باحه‌ت خراپتره‌، مامه‌ڵه‌ له‌گه‌ڵ ئه‌گه‌ری ته‌شه‌نه‌کردنی ئه‌م مه‌ترسیه‌ ته‌ندروستیه‌ی که‌ ڕووی له‌ وڵاته‌که‌مان کردووه‌. وه‌زاره‌تی ته‌ندروستی نه‌یتوانیه‌وه‌ بچووکترین زانیاریمان له‌سه‌ر ئه‌نفلونزای به‌راز پێببخشێت. ئه‌وه‌ی له‌سه‌ر په‌تاکه‌ی ئه‌زانین ته‌نها له‌ میدیا جیهانی و پێگه‌ ئیلکترونێکانه‌وه‌ به‌ده‌ستمان ئه‌گات و ئه‌و زانیاریانه‌ش زیاتر له‌ سه‌ر وڵاتانی جیهان و ده‌رووبه‌ره‌. ته‌نانه‌ت وه‌زاره‌تی ته‌ندروستی عیراقیش زۆر له‌ وه‌زاره‌ته‌که‌ی خۆمان چالاکتربوو بۆ گه‌یاندنی زانیاری له‌ ڕێی کۆنگره‌ی ڕۆژنامه‌وانیه‌وه‌. وه‌زێری به‌ڕێزیش بۆ پاساوه‌ی ئه‌م که‌مترخه‌مه‌ی وه‌زاره‌ته‌که‌ی له‌ کۆکردنه‌وه‌ی داتا و ژماره‌ سه‌باره‌ت به‌ نه‌خۆشێکه‌ پێمان ئه‌ڵێت، " له‌هه‌رێمی كوردستان که‌مترین كه‌س دووچاری ئه‌م په‌تایه‌ هاتووه‌، چونكه‌ له‌وڵاتان ڕێژه‌كه‌ی هێنده‌ به‌رز بووه‌ له‌توانای ژماردندا نه‌ماوه‌، هه‌ر بۆیه‌ش ژماردنی حاڵه‌ته‌كان له‌زۆرێك وڵاتان ڕاگیراون، به‌هۆی ئه‌وه‌ی ئێستا زۆرێك له‌تووشبووانی په‌تایه‌كه‌ له‌ماڵه‌وه‌ چاره‌سه‌ریان بۆ ده‌كرێت".. خۆی ئه‌م پاره‌گرافه‌ ته‌نها له‌ سه‌رلێشه‌واندنی خه‌ڵک زیاتر هیچ ئه‌نجامگیریه‌ک به‌ده‌سته‌وه‌ نادات. ئاخر جه‌نابی وه‌زیر، "که‌مترین که‌س" مانای چیه‌، که‌مترین یه‌ک که‌سه‌ دووه‌ یا سه‌ده‌؟ ئه‌وه‌ی که‌ وه‌زیر ئه‌ڵێت که‌ له‌ وڵاتاندا له‌ به‌ر ئه‌وه‌ی گوایه‌ په‌تاکه‌ زۆر بڵاوبووه‌ته‌وه‌ و ژماره‌ی ئه‌و خه‌ڵکانه‌ی تووشی بوون ئه‌وه‌نه‌ زۆرن که‌ چیتر ناکرێت بژمێردرێن، له‌ خۆڵکردنه‌ چاوی خه‌ڵک زیاتر ناکرێت هیچی تری ناو بنێن. یه‌کێک له‌ ئه‌رکه‌ هه‌ره‌ سه‌ره‌تایه‌کانی هه‌ر وه‌زاره‌تێکی ته‌ندروستی، کۆکردنه‌وه‌ و به‌کارهێنانی داتایه‌، جه‌نابی وه‌زیر وه‌ک ئه‌وه‌ی بڵێت ئێمه‌ به‌ ته‌نها نه‌مانتوانیوه‌ داتا و زانیاری کۆبکه‌ینه‌وه‌ به‌ڵکو وڵاته‌ پێشکه‌وتووه‌کانی دونێاش له‌ کۆکردنه‌وه‌ی زانیاره‌ که‌مترخه‌میان هه‌یه‌. به‌ڕاستی کاراساته ئه‌م جۆره‌ ووتاره‌ ‌ له‌ که‌سێکی شاره‌زای بواری پزیشکی بیکات که‌ کاتێکی زۆری ته‌مه‌نی له‌ ده‌ره‌وه‌ بردبێته‌ سه‌ر و بزانێت که‌ له‌ وڵاته‌ پێشکه‌وتووه‌کاندا، هێچ شتێک بێداتا ناکرێت و تووژینه‌وه‌ی زانستی و ئه‌نجامدانی پرۆژه‌ و پرۆگرامی ته‌ندروستی بێ داتا هێچ مانایه‌کیان نابێت و هیچ ئه‌نجامێک ناپێکن.

له‌ به‌شیکی تری لێدوانه‌که‌یدا، وه‌زیر ئه‌ڵێت که‌ وه‌زاره‌ته‌که‌ی "به‌هه‌موو شێوه‌یه‌ك ئاماده‌كاریان كردووه‌ بۆ ڕووبه‌ڕوو بوونه‌وه‌ی... له‌توانایاندا هه‌یه‌ 500 هه‌زار كه‌س كه‌دووچاری نه‌خۆشیه‌كه‌ بێت بخه‌نه‌ ژێر چاودێریه‌وه‌". دیسانه‌وه‌ ئه‌مه‌ی که‌ وه‌زیر ئه‌ڵیت له‌ قسه‌یه‌کی سه‌رپێی زیاتر هیچ مه‌به‌ستێک و زانیاریه‌ک نابه‌خشێ. ئه‌کرێت جه‌نابی وه‌زیر پێمان بڵێت، مه‌به‌ستی چیه‌ له‌ "هه‌موو شێوه‌یه‌ک"، ئایا مه‌به‌ستی ئه‌وه‌یه‌ که‌ ئێستا له‌ کوردستان، قه‌ڕوێله‌ و شوێنی تایبه‌ت هه‌یه‌ بۆ خه‌واندنی ئه‌و نه‌خۆشانه‌ی که‌ خۆانه‌خۆاسته‌ به‌ ژماره‌یه‌کی زۆر تووشی نه‌خۆشێکه‌ ئه‌بن، ئه‌کرێت پێمان بڵێت له‌ کوردستان چه‌ند ڤاکسینمان هه‌یه‌ بۆ به‌رگریکردن له‌ بڵابوونه‌وه‌ی نه‌خۆشێکه‌، یا چه‌ند ده‌رمانمان هه‌یه‌ بۆ چاره‌سه‌ری په‌تاکه‌ ئه‌گه‌ر به‌ ئه‌ندازه‌یه‌یکی فراوان بڵاوبووه‌وه‌؟
ته‌نها ژماره‌یه‌ک که‌ له‌ ئاخاوتنه‌کی وه‌زیری به‌ڕێز هاتووه‌، ژماره‌ 500 هه‌زاره‌، ئایا ئه‌م ژماره‌یه‌ له‌سه‌ر چ بنه‌مایه‌ک ده‌ستنیشانکراوه‌؟ ژماره‌ی قه‌ڕوێله‌، پزیشک یا ده‌رمان و ڤاکسین؟ دیسانه‌وه‌ ئه‌و ووشه‌ی به‌ڕیزیان له‌ ڕه‌سته‌که‌دا به‌کاریهێناوه‌، مه‌ترسیمان زیاتر ئه‌کات به‌وه‌ی که‌ پێمان ئه‌ڵێت وه‌زیر هیچ پلانێکی نیه‌ بۆ ڕووبه‌ڕووبوونه‌وه‌ و چاره‌سه‌ری په‌تاکه‌. ئه‌وه‌ی که‌ جه‌نابی وه‌زێر باسی ئه‌کات به‌ وه‌ی که‌ له‌ توانا هه‌یه‌ که‌ ئه‌و ژماره‌ نه‌خۆشه‌ بخه‌نه‌ "ژێرچاودێری" ه‌وه‌ بۆ که‌سانێک ئه‌شێت که‌ نه‌خۆشیه‌کی مه‌ترسیداری وایان هه‌بێت که‌ ئه‌گه‌ری چاکبوونه‌وه‌یان که‌م بێت. چاودێری پزیشکی ئه‌کریت مانای ئه‌وه‌ بێت که‌ ته‌نها پاڵه‌په‌ستۆ و پله‌ی گه‌رما و نه‌بزی نه‌خۆش پێورێ و هیچی تر. ئه‌گه‌ر ئه‌مه‌ی دوای ڕاست بێت که‌واته‌ وه‌زاره‌ت ئه‌توانێ چ شتێکی زیاتر پێشکه‌ش به‌ کۆمه‌ڵانی خه‌ڵک بکات له‌وه‌ی که‌ نه‌خۆشخانه‌ و بنکه‌ ته‌ندروستیه‌کانی کوردستان حاڵی حازر ئه‌یکه‌ن.
هه‌ر هاوڵاتیه‌کی ئه‌م هه‌رێمه‌ مافی خۆیه‌تی که‌ بزانی وه‌زاره‌تی ته‌ندروستی جگه‌ له‌ ترساندنی خه‌ڵک چ تری پێیه‌ بۆ ڕووبه‌ڕووبوونه‌وه‌ی ئه‌نفله‌ونزای به‌راز. مافی خۆمانه‌ که‌ بزانین، ئایا وه‌زاره‌تی ته‌ندروستی چه‌ندێک ڤاکسین و ده‌رمان و قه‌ڕوێڵه‌ی هه‌یه‌ بۆ به‌گریگرتن و چاره‌سه‌رکردنی په‌تاکه‌. وه‌زیری ته‌ندروستی به‌ڕیز، تکایه‌ وه‌ڵامی ووردترمان له‌ جه‌نابتان ئه‌وێت.
*ماسته‌ر له‌ سیاسه‌تی ته‌ندروستی

ئه‌رکه‌ ته‌ندروستیه‌کانی په‌رله‌مانی داهاتووی کوردستان

2009-08-30T01:34:00.000-07:00

ئه‌رکه‌ ته‌ندروستیه‌کانی په‌رله‌مانی داهاتووی کوردستان
د. گۆران عبدولله‌*
په‌رله‌مانی نوێی کوردستان له‌ به‌رده‌م په‌ربرسیاریتیگه‌لێکی ته‌ندروستی گرنگن که‌ ناکرێت پشتگۆێبخرێن. کۆمه‌ڵیک له‌و کارانه‌ی که‌ په‌رله‌مانی داهاتووی کوردستان ئه‌کرێت بیانکات به‌ ڕواڵه‌ت په‌یوه‌ندیه‌کی ڕاسته‌وخۆیان نیه‌ به‌ بواری ته‌ندروستی به‌ڵام له‌ ڕاستیدا ئه‌بنه‌ هۆکارێکی ده‌ستنیشانکه‌ر و کاریگه‌ری به‌ره‌وپێشه‌وه‌بردنی ته‌ندروستی کۆمه‌ڵگای کوردستان به‌ گشتی و تاکه‌کانی کۆمه‌ڵگا به‌ تایبه‌تی.
هه‌وڵدان بۆ کرانه‌وه‌ی سیاسی زیاتر و فه‌راهه‌م کردنی بۆار بۆ کۆمه‌ڵانی خه‌ڵک بۆ به‌شداری له‌ دروست کردنی بڕیار له‌ لایه‌ن ئه‌ندامانی تازه‌ی په‌رله‌مان له‌ ڕێی ئاسانکردنی په‌یوه‌ندی ڕاسته‌وخۆی تاکه‌کانی کۆمه‌ڵگا له‌ گه‌ڵ نوێنه‌رانی خۆیان له‌ په‌رله‌ماندان دوو ئه‌نجامی گه‌وره ئه‌پێکن که‌ ڕاسته‌وخۆ په‌یوه‌ندیان به‌ ئاستی ته‌ندروستی خه‌ڵکه‌وه‌ هه‌یه‌،
له‌ لایه‌که‌وه‌، داتا و توژینه‌وه‌ زانستیه‌کانی بواری ته‌ندروستی کۆمه‌ڵ پێمان ئه‌ڵێن که‌ ئاستی به‌شداری سیاسی خه‌ڵک له‌ دروستکردنی بڕیاردا په‌یوه‌ندیه‌کی ئه‌رێنی هه‌یه‌ له‌ گه‌ڵ باشی باری ته‌ندروستی ئه‌وان. ئه‌مه‌ به‌هۆی کاردانه‌وه‌ی باشی به‌شداری له‌ دروستکردنی بڕیار له‌ سه‌ر ده‌روون و متمانه‌ی تاکه‌کان به‌ توانایان بۆ به‌ده‌ستهێنانی گۆڕانکاری له‌ ژیانی خۆیان و کۆمه‌ڵگاکه‌یانه‌.
له‌ لایه‌کی تره‌وه‌، ئه‌گه‌ر به‌و گریمانه‌ ڕازی بین که‌ به‌شداری کردنی خه‌ڵک له‌ دروستکردنی بڕیاری سیاسیدا ئه‌بێته‌ هۆی هێنانه‌ کایه‌ی‌ کۆمه‌ڵه‌ بڕیارێک که‌ له‌ خزمه‌تی خۆیان و بۆ به‌رژه‌وه‌ندی ئه‌و توێژه‌ بێت که‌ هه‌وڵی دروست کردنی بڕیارکه‌ ئه‌دات، ئه‌وا دیسان به‌شداری له‌ دروست کردنی بڕیار، ئه‌بێته‌ هۆی باشتر کردنی باری ته‌ندروستی خه‌ڵک و تاکه‌کان.
بۆیه‌ یه‌که‌مین کارێک که‌ ئه‌کرێت ئه‌ندامانی په‌رله‌مانی داهاتوو بیکه‌ن بۆ باشترکردنی ئاستی ته‌ندروستی تاکه‌کان و کۆمه‌ڵگای کوردستان ئه‌وه‌یه‌ که‌ ده‌رگا داخراوه‌کانی په‌رله‌مان له‌ سه‌ر پشت واڵا بکه‌ن بۆ کۆمه‌ڵانی خه‌ڵک. پێویسته‌ کۆتایی به‌‌ دڵه‌راوکێی کۆنتاکتی یه‌که‌می تاکه‌کانی ئه‌م کۆمه‌ڵگایه‌ له‌ گه‌ڵ ده‌سه‌ڵاتدا به‌ شێوازه‌ ته‌قلیدێکه‌ی بهێنین که‌ خۆی له‌ بینن و قسه‌کردن و مامه‌ڵه‌کردن له‌ گه‌ل پۆلیس و مرور و ئاسایش، به‌ ڕێزی ته‌واومان بۆ ئه‌و کۆمه‌ڵه‌ ده‌زگایه‌، ئه‌بینێته‌وه‌. مرۆڤه‌کان بۆ ئه‌وه‌ی تاکێکی توڕه‌ و توندوتیژیان لێدره‌نچێت و بتوانن له‌ سه‌رخۆ و خاوه‌ن بارێکی ده‌روونی ئارام بن پێویسته‌ بزانن که‌ نوێنه‌رانیان هه‌یه‌ له‌ په‌ره‌له‌مان که‌ ئه‌کرێت خاڵی کۆنتاکتی یه‌که‌می ئه‌وان بن له‌ گه‌ڵ ده‌سه‌ڵاتی کوردستان نه‌وه‌ک پۆلیس و ئاسایش و مرور. هه‌ر ئه‌ندامێکی په‌ره‌له‌مان پێویسته‌ ژماره‌ی ته‌له‌فونی تایبه‌ت و ئه‌دره‌سی ئیلیکترون و ماڵپه‌رو پۆستی هه‌بێت بۆ ئه‌وه‌ی هه‌رکه‌سێک بیه‌وێت بتوانی په‌یوه‌ندی پێانه‌وه‌ بکات و له‌ کار و چالاکێکانی ئاگاداربێت. ناکرێت په‌رله‌مان بۆ گۆێگرتن له‌ خه‌ڵک ته‌نها له‌وه‌دا بوستێ که‌ ده‌رگاکانی بکاته‌وه‌، به‌ڵکۆ ئه‌بێت ئاکتیڤانه‌ خه‌ڵک بدوێنی و گۆێبگرێت. کوردستان ئیستا خاوه‌نی ده‌یه‌ها پسپۆری بۆاری سیاسه‌ت و ستراتیج و پلاندانی ته‌ندروستیه‌ که‌ ئه‌کرێت سوودیان لێوه‌ربگێرێت و ڕاو بۆچوونیان به‌ هه‌ند وه‌ربگیرێت.
دیاره‌ گوێگرتن له‌ خه‌ڵک به‌ ته‌نها گه‌ره‌نتی ده‌سته‌به‌رکردنی کۆمه‌ڵگا و تاکێکی ته‌ندروستمان بۆ ناکات، به‌ڵکۆ پێویستیمان به‌ په‌رله‌مانێکی چالاکه‌ که‌ به‌ باشی ئه‌رکی یاسادانان و چاودێری کاره‌کانی حکومه‌ت ڕاپه‌ڕێنێت. په‌رله‌مانی پێشووی کوردستان له‌ چه‌ند یاسایاک زیاتر که‌ به‌ په‌نجی ده‌ست ده‌ژمێردرێن و په‌یوه‌ندیه‌کی ڕاستوخۆێان به‌ بورای ته‌ندروستیه‌وه‌ هه‌یه‌، وه‌ک یاسای جگه‌ره‌کێشان و یاسای وه‌زاره‌تی ته‌ندروستی، نه‌یتوانیه‌وه‌ به‌ باشی به‌ ئه‌رکه‌ یاسایه‌کانی خۆی هه‌ڵبسێت. بۆیه‌ په‌رله‌مانی داهاتوو له‌ به‌رده‌م ئه‌رکێکی قورسدایه‌ بۆ ده‌رکردن و هه‌موارکردنی کۆمه‌ڵه‌ یاسایاک و پرۆژه‌بڕیارێک که‌ خزمه‌تی به‌ره‌وپێشه‌وه‌بردنی باری ته‌ندروستی کۆمه‌ڵگای کوردستان بکات.
یه‌کێک له‌ بواره‌ هه‌ره‌ گرنگه‌کانی ته‌ندروستی کوردستان ستراکتۆری وه‌زاره‌تی ته‌ندروستی کوردستانه‌. پیم وایه‌، گه‌وه‌رترین خزمه‌تێک ‌ به‌ بۆاری ته‌ندروستی کوردستان گۆڕێنی وه‌زاره‌تی ته‌ندروستیه‌ بۆ وه‌زاره‌تێکی ته‌ندروستی کۆمه‌ڵ. وه‌زاره‌تی ته‌ندروستی ئێستا ئه‌رک و به‌رپرسیارێتیه‌ ته‌ندروستێکانی له‌ سه‌ر ئاستی کۆمه‌ڵکا و خه‌ڵک فه‌رامۆشکردووه‌ به‌ هۆی سه‌رقاڵبوونی به‌ کۆمه‌ڵه‌ ئه‌رکێکی کارگێری په‌یوه‌ندیدار به‌ کارمه‌ندانی ئه‌وه‌ وه‌زاره‌ته‌ له پزیشک و کارمه‌ندی ته‌ندروستی که‌ ئه‌کرێت هه‌ر ده‌زگایه‌کی تر بیانکات.هه‌ر بۆ نموونه‌ شێوازی مامه‌ڵه‌کردنی وه‌زاره‌تی ته‌ندروستی له‌ گه‌ڵ په‌تای ئه‌نفلونزای به‌راز باشترین به‌ڵگه‌یه‌ بۆ ئه‌وه‌ی که‌ ئه‌م وه‌زاره‌ته‌ به‌ڕاستی لاوازه‌ و پێویسته‌ بگۆڕێت. له‌ کاتێکدا وه‌زاره‌تی ته‌ندروستی ئه‌یتوانی به‌لای که‌مه‌وه‌ چه‌ند ڕۆژ جارێک به‌ کۆنگره‌یه‌کی ڕۆژنامه‌وانی له‌ ڕه‌وشی تووشبوون به‌ په‌تاکه‌مان ئاگادارکاته‌وه‌، وه‌زاره‌ت ئه‌مه‌شی نه‌کرد. په‌رله‌مانی داهاتووی کوردستان ئه‌توانێت هه‌نووکه‌ له‌سه‌ر سێ ئاست هه‌وڵی باشترکردنی باری قه‌یراناوی وه‌زاره‌تی ته‌ندروستی بدات. یه‌که‌م پرۆژه‌ یاسایاک بۆ گۆڕێنی ستراکتۆر و ئه‌رک و به‌رپرسیارێتی وه‌زاره‌ته‌که‌ و یاریکردنی ڕۆڵێکی کاریگه‌ر له‌ ده‌ستنیشان کردنی وه‌زیری داهاتووی ته‌ندروستی که‌ ئه‌کرێت پرۆفیشناڵێکی بواری ته‌ندرستی کۆمه‌ڵ بێت بێ گۆێدانه‌ بیڕوڕاوی سیاسی ئه‌و و دواتر ئه‌نجامدانی چاودێریه‌کی ووردی هه‌موو کاره‌کانی وه‌زاره‌ته‌که‌ له‌ بواره‌ ته‌ندروستیه‌ جیاجیاکاندا. بۆ نموونه‌ بۆ زانیانی خۆئاماده‌یه‌کانی وه‌زاره‌ت بۆ ڕووبه‌ڕووبوونه‌وه‌ی په‌تایه‌کی ترسناکی وه‌ک ئه‌نفلونزای به‌راز، پێویسته‌ وه‌زیری ته‌ندروستی بانگی په‌رله‌مان بکریت و ڕووبه‌ڕووی پرسیار بکرێته‌وه‌.
ده‌ستخستنه‌سه‌ری ئه‌ندێشه‌و ناته‌ندروستیه‌کانی کۆمه‌ڵگای کوردستان و ده‌رکرندی بڕێار و یاسای گۆنجاو بۆێان و چاودێری جێبه‌جێکردنی ئه‌و یاسایانه‌ ئه‌رکێکی تری گرنگی په‌رله‌مانی کوردستانه‌. کۆمه‌ڵگای کوردستان به‌ ده‌ست کۆمه‌ڵه‌ ده‌رد و نه‌خۆشیه‌ک ئه‌ناڵێنی که‌ ته‌نانه‌ت نازانین ڕاده‌ی به‌ربڵاوی و ته‌شه‌نه‌کردنیان چه‌نده‌. دیاره‌ زانیاری له‌سه‌ر هه‌رشتێک به‌ ئامار و داتا ئه‌کرێت که‌ ئه‌رکی ده‌زگای تایبه‌تی ئه‌م بواره‌ن. له‌ کاتێکدا له‌ کوردستان به‌ ناو کۆمه‌ڵه‌ ده‌زگایه‌کی ئامار هه‌یه‌ به‌ڵام له‌ بواری ته‌ندروستیدا هه‌ر زۆر لاوازن و پێویستیان به‌ چالاککردن هه‌یه‌. په‌رله‌مان ئه‌توانێت به‌ پرۆژه‌ یاسایه‌ک که‌ ئه‌کرێت ناوی لێبنرێت، ئازادی گه‌یشتن به‌ زانیاری ته‌ندروستی، له‌م قه‌یرانه‌ زانستی و ئه‌خلاقیه‌ قوتارمانکات.
کایه‌ی ته‌ندروستی کوردستان له‌ حاڵی حازر به‌ده‌ست کێشه‌گه‌لێکه‌وه‌ ئه‌ناڵێنن که‌ ئه‌کرێت له‌ ڕێی چه‌ند پرۆژه‌ بڕیار و یاسایه‌کی په‌رله‌مانه‌وه‌ چاره‌سه‌ر بکرێن. ئه‌مه‌ نه‌ک ته‌نها سوودی ته‌ندروستی هه‌یه‌ به‌ڵکو بۆ ته‌ندروستی سیاسی کوردستانێش کارێگه‌ری باشی هه‌یه‌. بۆاری ته‌ندروستی له‌ کورستاندا به‌ به‌راورد به‌ وڵاته‌ پێشکه‌وتووه‌کانی دنیا ڕه‌نگه‌ یه‌کێک له‌ هه‌ره‌ که‌مترین ئه‌و بوارانه‌ بێت که‌ کێشه‌ی سیاسیان له‌سه‌ره‌. واته‌ ئێمه‌ له‌ کوردستان وه‌ک ئه‌وه‌ی له‌ ئه‌مریکا هه‌یه‌ دابه‌شنه‌بووین به‌ سه‌ر چه‌ند جه‌مسه‌رێکی له‌یه‌ک دوور بۆ تێگه‌یشتن و دنیابینینمان بۆ بواری ته‌ندروستی. بۆیه‌ ئه‌کرێت وتوێژ و دایه‌لۆگ له‌سه‌ر ئه‌رکه‌ ته‌ندروستیه‌کانی په‌رله‌مان ده‌رگایه‌ک بن بۆ شکاندنی سارد و سڕی په‌یوه‌ندی ئیستای ده‌سه‌ڵات و ئوپۆزوسوێن. له‌ ئێستادا ئه‌کرێت پرۆژه‌ یاسای ده‌ربکریت که‌ تایبه‌تن به‌ که‌سانی تووشبوو به‌ نه‌خۆشی و ئه‌ندێشه‌ی ده‌روونی و پرۆژه‌ یاسای نه‌هێشتنی ماده‌ی قورقۆشم له‌ به‌نزین و به‌کارهێنانی ئاردێک که‌ ماده‌ی فۆلیک ئه‌سیدی تیابێت که‌ ئێستا له‌ وڵاته‌ پێشکه‌وتوه‌کانی دونیا به‌کارئه‌‌هێنرێت و کارێگه‌ری ته‌ندروستی زۆر گه‌وریان هه‌یه‌. ئه‌مانه‌ کۆمه‌ڵه‌ کارێکی زۆر قورس نێن که‌ تێچوونێکی که‌م به‌ڵام به‌رهه‌مێکی ته‌ندروستی گه‌وه‌ریان لێ سه‌وز ئه‌بێت.
دیاره‌ له‌ کۆتایدا ئه‌وه‌ ماوه‌ بڵێن که‌ یاسا و ڕیسا و پرۆژه‌ی بڕیار بێ چاودێرێکی وورد و به‌رده‌وامی جێبه‌جێکردنیان هیچ مانایه‌کیان نابێت و هیچ مه‌به‌ستێک ناپێکن.

The Health of Politics

2009-08-22T03:14:00.000-07:00

In the heat of the debate about who should be what in the next Kurdistan Regional Government and the leadership of the Parliamant in Kurdistan, something important went unoticed and neglected. The health of those public figures that will be the future decision makers of Kurdistan didnt get a share in the attributes of the people under considertation.
Once individuals become public figures, nothing, yes nothing, should remain secret and not accessable to public scrutiny and examination. As much as this is important when it comes to the personal belongings and financial accounts of those public figures, it is not less so for their health status and medical records.
Politics is conducted in Kurdistan behind a veil of ignorace. This needs to end. Transparency is crucial for an active participation of people in the decision making process. Those public figures that ascend to the highest position of government and Parliamen should be courageous and confident of themselves enough to disclose their belonging, financial assets and medical records before they assume their position in government.
The discolsure of the health related information of he public figures will have two important advantages;
First, it serves the prospect of trasparency in the conduct of the work of the government. If we press now for the disclosure of the health information of public figures, it may be easier to push for similar steps when it comes to personal belongings and financial assets.
Second, the disclosure of the health information of public figures could be an effective tool in increaing the knowledge about many neglected conditions and diseases in the society. This would raise the awareness of people about illnesses and health in general. If public figures are open enough about their personal health conditions, reaching out to them through the media to talk about those condidtions and ways of preventing or coping with them could prove a critical tool in combating illness and promoting health.
We need to know who are those who lead us into the future, we have the right to be introduced to their health status, illnesses and bad behaviors. It takes a healthy person to think healthy and to make sound decisions in politics.

Ceremonies are Over, Lets Go to Work

2009-08-20T14:11:00.000-07:00

The Parliament of Kurdistan launched today its third session. The even was a ceremony rather than a serious work day. All the members of the parliament were inaugurated by pledging to be faithful to serving the people of Kurdistan. Although, this marks a great step in our strife for democracy, but the event itself was tainted by a number of irregularities.
First of all, the head of the parliament and his or her assistants should be elected not selected by the parliament. The way the new head of the parliament was chosen today, was exactly the same way, the heads of the political establishment are chosen; i.e through announcing their names and being selected without any competition and through claps rather than votes. This is a bizarre move in a democracy. It puts our efforts for being democratic under serious questioning.
Second, It is not understandable why should all those people be invited to a legislative session as important as the first meeting of the new parliament. Was the first day of the new parliament a political campaign or a legislative session that requires adhering to the rules and the regulations that the body set forth for itself. Why should all the consulates present in Erbil invited to this meeting? What was the purpose for them to be invited? If it was to show them that we are democratic and have a parliament, I think we just did a big dissevers to our cause by showing them that although we are trying to be so through holding elections, but we failed to behave democratically in the first day of this legislative cycle.
It is a failure to predetermine will be the head, his deputy and the secretary of the Parliament without even casting a vote for those people by the new members of the Parliament.
We need transparency in our political behavior, it is not enough to claim democracy only through words without matching those words with deeds. It is very hard to stay optimistic after the end of the first day of the new parliament. We cant justify any optimism just by hearing our national anthem and a big participation of the international representation in the ceremony.
The lesson learned here is that power doesn't bow to the rules of democracy just because it is good to do so. There should be pressure from outside to make it accountable. This should be very clear when the new government is selected. The parliament should have a strong say in choosing the ministers to serve the new cabinet.
It is very difficult to assume the ability of the new parliament to bypass the political stalemate that could result from the failure of tr ascending politics to policies and moving from conflict to consensus.

A Mental Health Act for Iraq

2009-08-17T09:14:00.000-07:00

My friends, This is an act that was signed by the Iraqi Prime Minister Ayad Allawy, but never passed in the Parliament. We need to make it pass with some amendments. Please feel free to contribute in editing. Goran

Iraqi mental health council
The Objectives of mental health act are to put the basic and wide rules which organize the quality and ways in dealing with the individuals who this law will apply on ( including the individuals who are being mentaly assessed and need compulsory admission to psychiatric hospital , or units for treatment ) , according to criteria and conditions used internationally and as follow :

1. Keeping with international laws and traditions as regard to human rights .
2. Taking in consideration the basic needs of the individuals and within the available sources with the guaranty to provide these needs with the improvement of the sources .
3. Give them the necessary medical treatment and care according to their needs to this treatment , and ensure their own and society safety .
4. The treatment and care should include maintainance , and provide the method of gaining their confidence , and personal feeling to take responsibility in accordance with their needs and wishes .
5. To ensure the discharge the patients from detention imposed on them according to this law , and to free them from all conditions imposed on them accordingly , when it becomes clear that the application of this law is no longer needed.

Definitions
Section one of the law specified wide technical terms meant to include the following conditions :
A- Psychotic Disorders :
Include all psychotic disorders wheather organic or functional in origin .
B- Neurotic Disorders :
Means the disorders which the patient suffer subjectively and which have effect on patient psychological stabalization emotion , feeling and his ability for social adaptation , without lossing his mental ability
C- Other Disorders :
1. Mental Retordation
( Mild – Modrate – sever )
There are two criteria to include mental retardation within the application of the law
a- It has to be a condition of arrested or incomplete development of the mind characterised by impairment of skills manifested during the period , which contribute to the overall level of intelligence i.e cognitive , langnage , motor and social .
b- The condition is accompoined by abnormal and dongerous aggressive behaviour .
2. Psychopathic personality disorder :
It is a techincal broad term which doesn’t mean ( psychopathic personality ) and which has aggressive tendency against the society , whic encompass, deeply ingrained maladeptive patterns of behaviour ( wheather or not has a noticeable limitation of intelligence ) and which lead to aggressive behaviour without awareness of its consequence by the affected individual .
3. Other disorders not mentioned above :
These include disorders which may be used as a result of clinical skill and experience as a mitigation factor and according to the type and circum stances of the crime .
Note :
Treatment means :
All medical effects including , nursing , different ways of care , rehablitation of patient under medical supervision .
( This law ) means
Mental Health Law 2004 where ever used .
Taking effect of the law section one specified
The application of this law will take effect on patient who suffers from one or more psychotic or neurotic disorders and other disorders specified by the psychiatrist .
The patient will be considered as a voluntry “( informal ) if he consults the psychiatric services voluntrly , and a formal ( unvoluntry ) patient if his consultation done without his will for purpose of treatment .

In order to establish and increase awreness of the importance and mental health and the laws of mental health , and to facilitate the procedure of building all units and establishments needed to provide diffrent psychiatric services , and to ensure continuty to develop these services , it was decided to set up this body ( NCMH ) from representatives of different society leaders with the guaranty of its openess on movement of scientific and service development in the world .
The setup of the council is a guarantee to fullfill the following objectives :
1. To establish and increase awareness of the importance of mental health in general and the laws of mental health specifically .
2. To create a suitable enviroment for the body to give its decisions the strenght , the effectiveness and the understanding needed for the purpose of continuation to provide actual psychiatric services on both scientific and practical side .
3. To guarantee continuation the development of these services and people working in their sectors by activation of local and internal abilities , and to benefit from the openess on advanced international experiences .
4. To work in a way of organized , and united method , and best utilization of time and efforts .
The decision of establishment :
The council is established by a decision of the minster of health
The body is chaired by the National Mental HealthAdvisor , and members from experts and specialists from the following minsteries :
Ministry of Health – Ministry of Higher Education – Ministry of Defence – Ministry of Interior Affair – Ministry of Justice – Ministry of work and social Affair – Ministry of Human Right , and two members of experienced forensic psychiatrists .

The target of the nature of NCMH duties in the above item are the following :
1. Ensure protection of interests and caring the welfare of the patients suffering from mental disorders within the national programme of mental health accredited in the ministry of health with co- operation of WHO programms .
2. Preparation and avaliability of human and other resources ( including , hospitals , unit building and instrument needed for the care of the patients .
3. Arrangment of foundations and specific criteria which secure providing mental health services for patients in the required way wheather by co-ordination or participation in preparing these foundations and criteria and which secure the type of service needed , And to ensure establishment of psychiatric Hospitals, Units and psychiatric outpatient clinics wheather govermental or belong to public sector, and to ensure that these psychiatric service adhere to the required criteria .
4.To ensure continue scientific development, to improve the performance of all workers in these services by activation of all scientific activities such as conference, workshops, or taking part in periodic litletchers, wheather inside or out side country especially with international organisations to exchange skills and experiences .
5. Pay attention to the rehablitationpart for patients and invite other authorities with same interest to arrange and prepare social and professional programmes and activities to care for patients.
6. To examine and review the mental health laws, by studying the reports provided by subdivision committees in baghdad and other governorates, and other forensic committees provided for this purpose, by direct observation on all mental health establishments, therefor the NCMH in this way will take part in legislation of mental health law more developed in future .
7. Ensure speed up and utilization of time by giving the Extra authority to the chairman of the body to take suitable measures after consultation with other specialists in the body .
8. The work to establish specialized medical unit to care the detained , charged and sentenced patients whom are involved by this law in all governorates.
9. Ensure the immunity and security and support of all workers in this field, and issue clear and correct criteria for this purpose.

The procedure of setting up these committees aimed at widening the network of mental health services in the countryboth in quality and quantity .
The responsibilities of subdivision committees are :
a- Follow up the excusion of the bodys decisions .
b- Direct supervision of treatment of voluntry patients, the detained patient in psychiatric hospital and units.
c- Examine closely the psychiatric reports raised by different hospital adminstrations, and the reports of forensic psychiatric committees .
d- Also to follow up the interests of the patients to fit the lists of human rights , by studying objections and complaints in respect of the patients, and by checking the work and decisions of forensic psychiatric committee issued against the patients. And by applying appeal to some of these decisions when needed, ( according to item 94 of public health law No.89 .
e- Finally the body also raises all cases related to detained patient to all ministries and bodies responsible for .

This section reassured that there should be a co-operation of all ministries, and bodies not attached to a ministry of health , and other interested with the ( NCMH ) and its subdivision committees to ensure a streamlined work, easy practice, to excute and provide best psychiatric services .

Caring the patients :-
Detention of the patient :

According to the lists of human rights which stated :
Any man has the right of freedom and safety, and no one can deprive him her from this right except in the following conditions and according to certain measures imposed by the law :
1. Legal detention of any human to prevent an infecious disease .
2. Legal detention of mental patients, and those who are alcohol or drug addicts, and there is a geniune mental disorder verified on abasis from a practical clinical experience, and the mental illness is from the type which necessate compulsory detention to avoid risk on patient or society or both .

Section -7-
Two
Period of detention maximum for 72 hours
Requirments :
The psychiatrist has the authority to admitt a patient in a closed psychiatric unit after completing needed form for admission, clarifying clinical features which necessate this procedure after exhausting other means to admitt the patient voluntrly .
Conditions :
1. The patient suffers from unspecified mental disorder accompanied by obvious behavioural disorder .
2. The admission to closed psychiatric unit should be in the interestof the patient and to protect others .
3. According to the above point the detention of the patient in this unit is for the purpose to correct his condition which could end to a treatment plan and according to his state .
4. The patient should be referred to a specialized psychiatric committee to evaluate his illness state .
5. In the current circumstance the country is going through, and due to shortage of doctors in other governorates it is best the chairman of the committee be at least specialized in forensic psychiatry, or has completed a training course which make him able to deal with these cases .
6. And for the same reason ( shortage of doctors ) , and there is no available specialized psychiatric committee , the patient can be seen by a second psychiatrist who has knowledge or experience in forensic psychiatry ( specialized or completed atraining course, or has an experience in forensic psychiatry no less than 3 years ) .
7. This second psychiatrist should examine the patient and give his second opinian within the 72 hour and from the time of admission . The same procedure can be applied in Baghdad in emergency cases, and when it is impossible to hold ameeting for the psychiatric committee within the detention period ( 72 hours )
he Closed Treatment Unit
Section – 7 –
Three
a- The unit should have all facilities of precautionary treatment .
b- In emergency cases and when needed to give the patient treatment on compulsory admission this treatment should be given on patient requirments and according to condition development, taking in consideration how to deal with the patient .
While in case of treatment decided by the medical committee, it has to be under the supervision of responsible medical officer ( the psychiatrist ) .
c- When possible get the help of the police to bring the patient or during admission procedures.
d- The specialist doctor who admitted the patient ( compulsory admission ) should be the responsible medical officer during the period of detention ( 72 hour ) until the patient is seen by the committee or having second opinian .

One
Period of admission is 30 days conditions :-
a- The patient suffers from Acute mental illness such as
Acute psychotic Disorders ( functional or organic ) or the patient suffers from mental retardation , or personality disorders with dangerous behavioural disorder with serious conseguenceand which when treated :
The condition improved or, stop the progress of his condition .
b- Threre should be utmost necessity to secure patient's health and safety as well as other's safety, by detaining the patient for 30 days according to assessment and the opinion of the committee weather there is any chance of improvement of the patient state during this period .

Requirements :
a- The specialized psychiatric committee should submit a report about the patient seen, containing a recommondation to detain this patient in a treatment medical unit for the purpose of medical treatment for 30 days, unrenewable .
b- In case the specialist psychiatric committee is not available, the psychiatrist who proceed for compulsory admission should consult another psychiatrist therefore the two doctor will deputize the specialist psychiatric committee for the purpose above .
c- The forensic psychiatric report, should be examined by a specialist investigation judge within 72 hours to issue an agreement decision to detain the patient .
d- The above decision will be referred to attorney general .
e- The hospital manager or the responsible social worker will inform the patient's relative or the patient about rights under this law .
f- The patient or his relatives have the right to appeal against this detention with 14 days from the date of admission by writing to hospital manager or subdivision committee .

1. The specialized psychiatric committee ( when available ) or the two psychiatrists who recommonded emergency admission will discharge the patient when his condition improves , and will issue a forensic psychiatric report recommonding a medical follow up if needed .
2. A copy of this report should be sent to attorney general to let him know about discharge .
3. If the patient absconds from the hospital , help from police ( according to section 90 ) can be sought to bring him back , and in case he remains absent during the period of detention he will be automatically discharged and attorney general will be informed .
4. The hospital manager has to try not to let patient to apply for appeal hoping to discharge from the hospital, if the responsible medical officer considers that the patient will be risk to himself and to others .

Period 180 day or less renewable
Conditions :
The same as section – 8- one except treatment time
Requirements :
The same as section – 8 – one except that the admission is for compulsory treatment for 180 days or less renewable.
Also section – 8 – two can be applied befor the end of treatment period ( 30 days ) mentioned in section – 8 – one if the detained patient did not improve . The forensic psychiatric report should be submitted to responsible investigation judge to issue decision of admission to hospital for treatment .
The investigation judge should inform the attorney general for follow up .
Right for appeal :
The patient or his relative or his lawyer have the right to appeal against this section within 30 days from its date of issue .
Requirments of discharge :-
The same as requirements mentioned in section – 8 – one .
Section – 9 –
The hospital management can seek the help of the police in order to help admission of the patients or returning them back when they abscond to treatment units ( those included in section – 8 – one and two mentioned before .

Section – 10 –
he hospital manager has the right to give leave to patient no longer than 48 hours , after the patients relative guaranty to bring him back to the unit after knowing the address of the patient .
This is i.e the leave is considered to be part of the treatment and after recommondation of the responsible medical officer .

Chapter Four
The care of charged patients :
With exception of legal procedures required , the patients subjected to this law have the same rights given to other patients concerning assessment and given treatment .
The charged patient where ever found such as police stations , dentention centres , or prisons has the right to be treated if needed this psychiatric treatment due to mental disorder and which could not be done in proper except in hospitals .
There fore the patients in these places i.e police stations , prisons , etc are subjected in great deal to psychological stresses caused by these places , which render them to be at risk of suicide or dangerous behaviour to them selve or others .
Especially and taking into account that the medical care centres in prisons for example , donot give the right specifications , which referred to in this law , to describe the treatment units .
There fore it is necessory for all specialities dealing with such patients within this section to be a ware of the terms and termenologies of this law in addition to health requirements wheather legal came from interior minstry , or from ministry of health informed by the National Council of Mental Health .
In addition to this , doctors , and other specialitises working in this field should be aware of all responsibilites , changes and requirements , referred by the international laws of human rights which work to secure best and fair medical care for these patients .

The forensic psychiatric committee
Section – 11 – one
This committee established at present time in Baghdad , and it will possible to establish it in other governorates when the specialist medical team will be available in future .
The authority of establishment :-
It is the authority of minster of health to nominate the chairman and members of this committee at the suggestion of national mental health advisor , or his deputy .
The chairman : -
Must be a forensic psychiatrist , or has passed a training course in this field or has experience in forensic psychiatry 5 years or more .
Members :-
The committee comprises of two members each one should be a forensic psychiatrist or as the chairman , or has experience in forensic psychiatry no less than 3 years .
Duties of the committee :-
1. The committee carries out examination of charged patients referred to it , by investigation authority or court according to arequest submitted by the attorney general or the patient , his relative or his lawyer, or at the request of the court , for the purpose of examination of his mental state and to provide a forensic psychiatric report , and which comprises some needed recommondations about the patient .
2. The committee carries out examination of patients jailed in prisons spending their sentences, to assess their mental states and to indicate their need for treatment and where to be treated .
The committee carries out examination of patients included in section - 7 – two referred to it , to give reports about them .
3. The committee carries out examination of all patients under its care , wheather they charged and referred by courts or they are spending their sentences in prisons , or the referred patients under section – 7 – two , periodically for follow up or to give final reports about them .
The action period of the committee :-
The forensic psychiatric committee carries out its duties for a period notless than six months and no more than one year , then , it will be changed according to the advice national council of mental health , and the agrement of minister of health , except in the governorates where there are no enough doctors in the field of psychiatry .
4. Admission of the charged patient to a closed treatment unit for the purpose of assessment and providing a forensic psychiatric report about him
Section -11-2,3,and 4
Undertake the procedure of examining the charged patient and providing the needed forensic psychiatric report about him .

Requirements :-
1. There should be a clear decree from the investigation judge or the court ,clarifying exatly the reason of the requested report , or the included requests of the report .
2. using the special referral form accomponied by a summary of the case regarding the charged patient and its circumstances , and any notes about the behaviour of the patient , before and at the time and after committing the supposed crime if possible .
A copy of the referral should be sent to subdivision committee of that governorate ( when the forensic psychiatric committee available ) and which mentioned in section – 4 – of this law .
3. All report about the patients state ( mental or physical condition if present ) i.e the previous state should be enclosed with , and the type and periods of treatment given to the patient .
4. All social reports and documents stating the patients background should also be enclosed .
5. All detailed investigations papers in order to the details of event and statements of witnesses which could highlight , to understand the patients state he suffers from .
6. A working arrest warrant to confirm his detention , and this should be renewed when it is expired and the patient is not attending if necessary .
Conditions :-
1. The order of transferring a patient from prison , or detention centre to the hospital should come from the court or the investigation, judge which secure the transfer of the patient to the hospital or closed treatment unit .
2. To secure admission of the patient to the hospital or closed treatment unit within 7 days of issuing the requested referral for the purposeof presenting the patient to the above committee .
3. The detention of the patient should be done according to item 2 and 3 of section – 11 – in a closed treatment unit , and secured under psychiatric supervision , and the patient will be presented to the forensic psychiatric committee on a regular bases to prepare a psychiatric report about his mental and psychiatric state within 30 days , renewable up to 90 days without the need for the patient to attend the court .
4. The patient will be returned back by the police , after finishing and giving the needed report about him to the same place i.e the detention centre or the prison .
Special conditions :-
1. The committee has the right to send for all other independent sources in order to provide all medical and social informations which serve the purpose ( to give the needed forensic psychiatric report ) .
2. To aim at the , delicateness and caution in using and studying the formal documents , the committee will appoint certain people responsible for checking these documents ( formal and informal ) as will follow later on .
The forensic psychiatric report
General points :
The importance of the clinical medical opinian has a great role in outweighting the decision the court will take , depending on the meaning and the item of that opinian which included in the medical report presented before the court . There for the following points must be considered in writing any kind of this report :-
1. Referring to all preliminaries and indications the committee relied on .
2. Mentioning the ways linked these indications by making the forensic psychiatric opinian .
3. Confirmation and clarification of the medical condition ( mental illness ) which will be used as a defence in the court .
4. clarification of the elements linked to that mental illness and which can lead the patient to be risk to himself or other .
5. clarify the mechanism which affected the medical condition in causing to committee the crime through explanation the effect of this mechanism on insight and will , for example , the time of committing the crime .
6. The medical report should comprise all medical recommondations needed , such as admitting the patient for treatment , the type and time of this treatment if needed .
7. The element of the report should be an accurate answer to what investigation body or court asked .
8. The report should not refer to the charged patient as guilty or not , because this will be decided by the court .
Section – 12 – writing the report
1. taking in consideration the points mentioned above .
2. The report should contain evaluation , of the patient mental and psychiatric state and their effect on his insight and will at the time of committing the event .
3. Wheather the patient can stand before the court and his ability to plead himself .
4. Wheather the patient is a risk to himself and others .
5. The recommondation to treat the patient in a closed treatment unit improvement , or the cessation of his risk , if needed .

Section – 13 – one , two , three
Period :-
Unlimited unless the court define a special time , renewable and according patient ( charged ) state .
Requirements :-
The decision of the court which decided to send the patient to hospital , and whom a medical report had been issued about by a forensic psychiatric committee and which according to this report together what has the court believed that the patient is not responsible for the crime ( due to mental illness ) and the courts satifaction to send him to hospital for treatment .
Note :-
No one else apart from the court is entitled tosend charged patient subjected to section – 12 – of this law .
Conditions :-
1. Section – 13 – two refers that the sent patient who mentioned above . needs, treatment and rehablitation programme, until the disappearance of dengerouness risk , under the care of a doctor specialized in psychiatry , and who provides on a regularperiods reports about the patients mental and psychiatric state to the torensic psychiatric committee , which supervise the treatment procedure on a whole , and decides the new time of treatment , and the type of treatment after discussion with that psychiatrist .
2. Section – 13 – three refers that the court which sent the charged patient and who included on section – 12 – of the law , and after issuing the decision of treatment in a closed treatment unit , cannot discharge the patient mentioned in item one of section – 13 – unless at the recommondation ( by a report ) of the forensic psychiatric committee confirming his improvement and disappearance of risk .

The right to appeal against the forensic psychiatric report :-

Section – 13 – Four
Item 4 of this section refers that it is the right of the patient or next of kin or his lawyer or attorney general , or the subdivision committee to appeal against the decision of the forensic psychiatric committee issued according to section – 12 – of this law , before the appeal committee and within 30 days of the decision date .
Discharge from the closed treatment unit :-
The committee produce a report confirming that the patient , or patients state has improved , and the disappearance of his risk of dangerousness , the report also include the need of the patient for periodical follow up as well as the need for rehablitation programme and social adaptation , the patient will be referred back to the court to issue a suitable final decision .

Medical care after discharge from the closed treatment unit
Section – 14 –
When the patient returned back to the cour and according to the psychiatric report which contain the following :
1. The need of the patient to treatment in periodical way .
2. His need to undergo rehablitation programme , and social adaptation reguraly and which is decided by the national council of mental health .
3. The patient or his guarantor should define the geographical place he wishes to be follow up for treatment and usually will be his resident area .
4. The hospital or the treatment unit where the patient had been treated during his detention period provide all informations about his state and his need for treatment and the necassity to subject his to rehablitation programme , to the psychiatrist who will be responsible for his treatment .
5. The responsible medical officer will submitt medical report about patients treatment every 3 months in the first year , and every 6 months in the following years , to the subdivision committee in the governorate .
6. After treatment services will cease, according to the reports raised from subdivision committee to the national council of mental health and after discussion with the responsible medical officer , the detail will follow later .

Sending a charged patient for treatment and for a limited period
Section – 15 –
The court may send a patient ( with a charge ) and according to a report from forensic psychiatric committee for treatment in a closed unit until his improvement and which became clear to this committee that the responsibility of the patient is limited ( or partial ) .
The time is not specified exatly , unless the court define a determined period , and the court can cease this treatment time , depending on what its seen reasonable .
The requirements and the conditions are the same as in section – 13 – one and two only with the guaranty of right to appeal mentioned in section – 13 – four .
And in case the satisfaction of the forensic psychiatric committee . that the patient has improved , and he is no more a risk , he will be returned back to the court according to a report ( psychiatric ) including , treatment follow up only if this needed and especially in prison , or what can the court see reasonable .
Adherence of the patient's relatives to follow up the charged patients treatment and ensuring bringing hin to rehablitation programme's appointments
Section – 16 – as to what refer to section – 14 –
One of patients relative ( from first degree or who follows incase the first degree is not available ) guaranties before the court in writing , to follow up , patients treatment , by presenting the patient to the responsible medical officer ( responsible psychiatrist ) and to bring him to psychiatric and social rehablitations appointment .
- The guarantor or the patient verifies the geographical place ( usually Residency ) .
- The guarantor gives his or the patients address or any method they can easily be contacted .
- The patient should be periodically seen by the psychiatrist , and he should attend the rehablitation appointments in times .
The psychiatrist will raise reports every three months for the first year , to the subdivision committee , which will then pass these reports to the national council , then the reports will be raised every 6 months after that .
- The need for this follow up will cease , according to reports raised to the subdivision committee by the treating psychiatrist , and according to a request from the patient after a year from starting the treatment , and after every 6 months there after , to the subdivision committee , which will in turn , sends the patient to the closed treatment unit , for the purpose to present him before the forensic psychiatric committee , which will decide to cease the rehablitation treatment period , or extends it according to the need .

Special Note :-
As regar the patients included in section – 8 – one and two a guarantor ( and according to previous criteria ) may apply a commitement in writing to the hospital manager or the chairman of the forensic psychiatric committee , to bring the patient periodically for treatment , and rehablitation .
- He should specify the geographical side for treatment .
- The same procedures mentioned before should be undertaken .
- The need for this care will crease according to the psychiatric committees report or the opinian of two psychiatrists one of them should a forensic psychiatrist .

Treatment of a detained patient during spending his sentence which took his freedom or will
Section – 17 –
Requirements :-
1.A request to refer the detained ( in mate ) from Iraqi reformation office to a treatment unit for the puprose of treatment .
2. A warrant of arrest .
- Renewed according to treatments time .
- All paperwork and informations available in the medical unit in prison accompained by notes documented by nursing staff or those responsible for treatment .
Conditions :-
- The patient will be seen by the forensic committee in Baghdad to evalute his state and his need and place for treatment .
- The report issued by the committee should fix a treatment time , renewable according to development of cases changes .
- The Iraqi reformation office , has the to finish the treatment time , incase of when the sentence becomes near to end , and in this case , the specialized medicalcommittee will provide a report containing the need to follow up treatment when the inmate released , and will be treated if he is still in need for treatment and according to requirements deal with patients included in section – 8 – and which mentioned in explanation of section – 16 – within the special note .
- The inmate patient will be treated in the treatment unit under supervision of a specialist psychiatrist , also will be examined periodically by the above committee unit his improvement , or a request to return him back to Iraqi information office .
- The above committee should inform both , the subdivision committee and reformation office in case of admission to discharge from closed treatment unit .

Chapter Five
Punishment Verdicts :
Checking information and punishment who produces reports contrary to truth .
Section – 18 –
All produced documents ( formal and informal ) will be subjected to chek by special persons appointed for this purpose above .
As concerns as the formal papers – and when there is any mistake , they will returned to producing or issuing side for correction .
As concerns as the informal reports or informations , and where they contradict the fact , or forged papers , section – 18 – one and two specified a punishment verdict or imprisonment for no longer than a year and a fine of no more than 100.000 L.D for those who committed this offence.
The violation of the written commitement mentioned in section – 16 – of this law
Section – 18 – three
The guarantor mentioned in section – 16 – of this land as regared section – 18 – i.e the charged patient , subjected after the disappearance of his to a social rehablitation programme and especially the patient ( charged ) whom sentenced by the court to detain him in a closed treatment unit , until the disappearance of his risk this guarantor and in case of violation of his comitement to present the patient to a treatment unit for examination periodically , will be subjected to the same punishments mentioned in section – 18 –

This section ( 18 three ) doesnot include the guarantor of patient under section ( 8 ) of this law .

Chapter Six
General and final rules
Section – 19 –
This section allows the police to arrest individuals whom reported to behave in an odd behaviours , or unusual and against the public general moral and ethics, or their behaviour is a risk to themselve, or the society .
The police will in turn bring these individual to a closed treatment unit to present them to the forensic psychiatric committee within ( 72 ) hour , and in case the referred individual is a mental patient needing treatment the committee will decide , type and time of treatment and according to section 7 , and the patient will be dealt with the same way , dealing with patient under section – 8 – one and two .
The report provided by the committee will be passed to the specialized investigation judge to get agreement for detention and compulsory treatment .

Section – 20 – and section – 21 –
It is not possible what so ever the forensic psychiatric services to be carried out in good way , and to improve it , and securing all suitable conditions , without the availability of these unit , wheather at the level of buildings or the multidisplinary team such as medical , rehablitation and others, there for section 20 of this law , states , to encourage the ministry of health ( with the cooperation of the council and related bodies ) to prepare the availability of these treatment units in all governorates , and section 21 stated the importance of continuos communication and discussion with the minister of health to facilitate excusion of this law .
Important Reasons
The important reasons , comprise the new viewof how to deal with individuals suffer from psychiatric and mental disorders by finding the skelton which works through by an orgnisation able to develop, its purpose is to provide and secure medical services for patients and enssure their human and social rights which include their improvement and disappearance of risk of dangerousness due to the nature of the illness , wheather this risk to patients or others , also the law aim at co-operation of all related side to participitate achievement of the objective above , or ensuring steadliness of practicality and scientically how to work between all forensic psychiatric committees and other specialities in this field ( medically ) and with forensic sides specialized in law .

( Finished with help of god )
June 2005

Who Could be The Next Minister of Health?

2009-08-14T21:14:00.000-07:00

Kurdistan parliamentary and presidential elections were the beginning of the start of a new era in Kurdish politics. The gains that the opposition made in the election through getting about 40 of the 111 seats of the Parliament is a dramatic change that promise good influence on the work of the future government.
One of the main functions of any Parliament is being able to oversight the work and functions of the government to ensure accountability, transparency and the adherence to the rule of law. This job of the new parliament should start right now. With the new members of the Parliament scheduled to have their first meeting next week, it is not too early to talk about what would be the priorities for the next few months.
In addition to such pressing and urgent issues like the return of those who were fired from their jobs just because they voted against the political establishment, it is necessary to address the structure of the new Kurdistan Regional Government (KRG).
It is important for the new Parliament to consider playing a positively significant role in the selections of the new ministers for the KRG. Without aiming very high and having reasonable expectations, that ensure preventing stalemate and political stagnation, the new parliament need to guarantee the transparency of not only the selection process but also vetting of those who are considered to be ministers in the next KRG.
Transparency should be one of the priorities of the new Parliament when it comes to the work of the government. The new Parliament can show us a gesture of good will through ensuring that highly qualified professionals get the chance to be at least vetted for governmental positions. This can be achieved through holding hearings for those who are considered to be members of the next KRG cabinet. For now even a ceremonial confirmation hearing for those minister will do. At least we need to start a transparent process of knowing who those ministers are and what are their plans for their respective ministries.
Having said that, the importance of abandoning patronage and introducing transparency, if important for other ministries, is even more so for the Ministry of Health. The selection of Ministers for this crucial governmental function had been based so far on political connections rather than professional qualifications and on being a good doctor rather than a good servant. This needs to end. The next Minister of Health, should be a prominent health or preferably public health professional with significant achievement in the field of health.
It is crucial for the next minister of health to combine academic and scientific knowledge with public health and field skills and experience. He or She should know the health conditions of our country in and out. Know and have the gut to introduce policies based on the priorities of the country. Be able to face the miscalculated moves of politicians by throwing money at our health problems to satisfy their constituents.
Having a leader of a political party without any health knowledge, a prominent physician with significant medical knowledge and authority, and finally a diaspora physician with long term service to the country in the mountains, didn't prove beneficial to the prospect of having a healthy society. Now it is time for change in these policies. Now is time for professionals and highly qualified public health personnel to get engaged in the decision making process. This needs courage in part of the political establishment, a sense of responsibility in part of the opposition and most importantly a will in part of professionals to get engaged in the political process.

Creating a HealthCare Network Bridge/ By: Martin Coyne

2009-08-09T13:56:00.000-07:00

Why Kurdistan Must Act:
While at times it seems the task of reforming Healthcare in Kurdistan is overwhelming in scope, paralysis by analysis is not an option. Immediate measures can, and must be made in order to show its citizens, healthcare providers, and the world, that Kurdistan is serious about entering into the 21st century. There is no more visible sign to the rest of the world that Kurdistan is open for business and investment, than building on the relative security of the region by providing a modern healthcare delivery system. But more importantly, reform is needed to save lives. Far too many holes exist in the system today that allow for the lack of necessary access and education of citizens to improve their lives through the proper prevention and treatment of illnesses.

Building the Foundation:
One of the fundamental building blocks that must be in place to affect change is the basic collection and sharing of clinical documentation and medical records. Today this process is archaic and paper-based, if done at all. The result is that every doctor is an island of information. A patient seen by one doctor can show up at another, or in an Emergency Room, and the receiving provider will have no knowledge of any previous history or conditions. Obviously, this environment cannot continue. Patient safety demands reform. But there are many other problems that this broken system creates. The abuse of this system by patients or even providers for personal gain has an enormous financial drain on precious resources that are needed for better patient care.

Even the most advanced nations of the world have significant challenges due to the historical development of the newest EMR and HER systems. Getting vendors and government agencies to agree on standards and then integrate the countless systems out there is a very complex and costly proposition. The advantage Kurdistan has, is that we have no such systems or prior investment to protect. While nirvana may be to have a single, robust, EMR system implemented throughout the region, there are many financial, technical, educational, and cultural reasons that is not realistic anytime soon.

But Kurdistan cannot wait on nirvana. It doesn’t exist yet. There are however steps that can be taken to prepare the way, and make an enormous immediate impact, both in patient care, and in driving out costs and abuse.

Recommended First Step:
One of the pioneers in the development of EMR systems and co-founder of the second largest medical transcription company in the world, Alex Poston, an American, recognized that all of the industry investment was being focused only on the largest University-based hospitals and systems, while smaller medical practices or even standalone doctors were being shut out of the progress made. So he set out to create a company to address this ignored piece of the market. In order to meet the need, the system would need to be able to integrate into virtually any system, be fully supported remotely without the need for onsite IT personnel, be simple for doctors to use, security compliant, and the information must be able to be accessed from anywhere at anytime via an online portal. And it goes without saying, that the market he wanted to serve, would not be able to pay a huge sum of money in capital expenditures. Thus, the creation of VocalEZ.

VocalEZ utilizes the power and ubiquity of the Internet, to securely capture dictation, create clinical documentation, and then make it available to anyone with permission to see the records. By allowing the doctors to simply speak into a microphone, the need for extensive training and support are negligible. The intelligence of the systems resides in the cloud; issues like integration, security, and maintenance are eliminated.

By implementing this solution, Kurdistan could instantly make an impact both in statement and in fact that Healthcare reform is on the way. Every doctor could use this system, regardless of where they are, or what infrastructure they have in place. The result would be a centralized repository for electronic clinical documentation. The healthcare delivery culture would be forever changed immediately. Abuse and inflated costs could be identified and contained. The cost for the system is outline on the attached sheet. These costs are minimal, even by western standards, and the financial impact in Kurdistan offset these expenditures many times over – all while saving lives.

As Kurdistan’s Healthcare system matures, all of the information that has been collected and stored can easily integrate/interface into other systems and processes that are adopted in coming years.

Because this architecture is so flexible, it can be adopted at a doctor, clinic, hospital, or even national level. There are many ways to utilize this system that each can address multiple issues Kurdistan faces in building its Healthcare delivery network. In addition to implementing their technology solution, VocalEZ also provides access to some of the brightest and most experienced Healthcare IT professionals in the world. That value-added insight and expertise can be very helpful as Kurdistan tackles the complex issues of setting the foundation upon which to build a modern Healthcare delivery system.

Kurdistan Parliament; Health Policy Challanges and Opportunities

2009-08-08T02:07:00.000-07:00

The parliament of Kurdistan faces a host of public health challenges that represent health policy opportunities. Addressing those public health issues through appropriate bills, that establish for policies at the health infrastructure levels, would prove beneficial not only for the ordinary people but also a great political move for gaining support and votes in future elections.
The people of Kurdistan face a range of public health risks that transcend political and partisan differences and conflicts. Addressing those risks could prove a chance to mitigate the political tensions arose during the election campaign and provide an avenue for starting a calm and responsible dialogue among the members of the parliament of different political lists and parties.
This is an invitation for professionals, policy makers and other stakeholders to start brainstorming about the public health priorities that can be addressed through bills in the Parliament,
1. Enrichment of Flour with Folic Acid: In my 10 years tenure in Medicine, I have seen many cases of Anencephaly, Spina Bifida and other neural tube defects in labor rooms and maternity hospitals. In fact my own sister and aunt had had abortions due to significant neural tube defects in their embryos. Despite the fact that we don't have solid data demonstrating the incidence and prevalence of neural tube defect, but I think enriching the flour we eat with folic acid would be much more cost effective even that starting a study to document the problem.
2. A Mental Health Act: The mentally ill people of Kurdistan are among the most disadvantaged people of the country. A host of political, economic and social factors had contributed to only increasing the incidence and prevalence of mental illness but also negatively impacted the stigmatization and further marginalization of this vulnerable population. It is necessary to address this issue by the parliament through passing an act that help to protect, respect and fulfil the rights of people with mental illness and retardation.
3. Eliminating Leed in Gas: Iraq is one of the developing countries that still have leed in the automobile gas. Leed has a host of serious health consequences that affect the intellectual capacities and cognitive functions of kids and adults. Its important to start thinking about ways of eliminating Leed from gas.
4. Use of technology in Health care: Modern technology is one of the prerequisite for an advanced and successful business in today's world. The health care system is way behind other industries in adopting new technologies like computers and the Internet for the provision of health care services. The latter tools would decrease the incidence of errors, enhance the quality of the provided health care and increase the speed with which health care services are provided in addition to providing a platform for research and data analysis. The archaic paper based system of health care provision in Kurdistan is so old to sustain and costing the system much needed resources while doesn't prevent human errors and undermine the quality of health care services.
There are other issues that are non-partisan and transcend political and partisan conflicts that we can start working on before addressing more sensitive and politically polarizing issues like the separation of public and private sector's of the health care system and paralyzing involvement of politics in health care.

From Politics to Policies

2009-08-01T23:36:00.000-07:00

When I was a kid, we had a couple of beehives at home. Every now and then, a group of bees were making a crowd in front of the hive and we, the kids, had to anticipate were they are going so that we could get them inside a new home and settle them close to the other beehives.
As similar as our life as human beings to the behavior of the bees, I wish we were less complicated. Once the new beehive settled in their new place, the only thing that was shared between the neighboring beehives with the inability of their members to invade the other beehive.
At this stage, the political picture in Kurdistan is very similar to that metaphor. The opposition was mainly created by prominent members of Patriotic Union of Kurdistan, the party of the Iraqi president Jalal Talabni, whose sun is the representative of the Kurdistan Regional Government in the United States.
it is understandable that the electoral process in Kurdistan have been rigged by a number of irregularities that we should not stop exposing and trying to fix. This could be a great political move for the present time in part of the opposition. But the strategic challenges that face us as Kurds are much bigger than tactical political maneuvering. We need to transcend our individual and political differences and disagreements and think about the bigger picture.
This becomes even more important and necessary when we take into consideration the little if any ideological differences between the leading two main political parties the PUK and KDP on one hand and the main opposition list on the other. In fact I don't see any differences, ideology-wise between the two. The only difference is the demand of the Change list, rightly, for more accountability and transparency in the work of the government, the eradication of corruption, patronage and limits on the rule of law.
The failure to transcend individual, political and regional differences and conflicts between the political establishment and the opposition, can results in political stagnation and stalemate.
What the people of Kurdistan need now are policies rather than politics. Lets go to work with bills in the parliament that can be passed in a bipartisan way. The embryos of Kurdistan need the flour that the mothers eat be enriched with folic acid, the kids of Kurdistan need the air they breath be empty from the lead our cars are emitting, the mentally ill need a mental health act in the parliament that respect, protect and fulfil their rights in a humane way, and our girls need a bill that protect their body from genital mutilation, this to name only few urgent matters in the public health arena.
Public health people, this is for you, lets come up with a bill that protects the health of our people and wish that politicians will forget their differences and go to work with us.

Democracy in Kurdistan, Where Are We?

2009-07-30T23:13:00.000-07:00

Now the elections in Kurdistan are over, it is time to sit down and think about what happened and identify the lessons learned. Understanding the political situation in Kurdistan has important health policy implications.
Kurdistan is now going through its second wave of democratization. The first wave started with freeing Kurdistan in the aftermath of first gulf war through the upraising of the Kurdish people in 1991. This stage of Kurdish politics has resulted over the last 18 years in an authoritarian democracy. The two main political parties that were crucial in creating and maintaining this first stage of Democratic development, the KDP and PDK, were neither internally democratic nor externally accountable. The failure to introduce a host of notions like accountability, transparecy and the rule of law has crippled the government with corruption, inefficiency and patronage. The unwillingness and fear of the KDP and PUK to test their popularity and a host of mutual narrow interest led to giving a fatal blow to the prospect of democratic development in Kurdistan by entering into a strategic agreement to assign the governmental positions between the two.
A host of political, social and economic factors had delayed the progress of Kurdish society from the authoritarian democracy of the first wave to a liberal democracy of the second wave. At the social levels, the people of Kurdistan are still far away from the individualism necessary to establish, support and sustain any liberal democracy. A quick look at the political campaigning period of the elections demonstrates the fact that most of the people that were talking on TV or Radio were refereeing to their tribes or families and talking on their behalf to express their support to this political party or that. It was a rare incidence to see a person talking on his own behalf.
In this first wave of democratization, tribes, families and other traditional social groups were and are still more important than individual members of those gatherings. However, the most prominent individual person in those groups and tribes is more important than the sum of the individuals in them.
This replacement of the importance and position of individuals with tribes have been transferred to the political arena. The political institutions, specifically the political parties, became more important than the individual members of those parties and political bodies, except for the prominent leaders of the party. The fact that Mr. Barzani won about 70% of the votes in the Presidential elections of Kurdistan while his list won about 10% less than the votes he won, is a proof that the most prominent person in a political institution is more important than the latter.
Without a respected individualism which is protected by political institutions, it is very hard for democracy in Kurdistan to progress from its authoritarian stage to a more liberal, accountable and transparent way of governance that respects the rule of law. Politically, the ascent of the change list to a competitive position in the parliament of Kurdistan can hopefully provide a push toward the second wave of democratization. But getting a little less than 40% of the seats of the Parliament by the apposition, can make the labor of a liberal democracy in Kurdistan a painful process. Lets cross our fingers and hope that the political calculus would not result in a stalemate and even more political stagnation.

Kurdistan's Election: A Chance for a Better Health Care System

2009-07-26T03:05:00.000-07:00

The people of Southern Kurdistan went to the polling stations yesterday July 25, 2009. Although the elections was tainted by some irregularities in terms of the easily removed secret ink and the disenfranchisement of thousands from their rights to vote including Kurds in diaspora, the election was the right step toward a more representative and liberal democracy in Kurdistan.
Representative democracies are crucial in themselves to the health of individuals and populations. Providing the opportunity for people to participate in the decision making process and to be advocates on their own behalf can have positive consequences on their mental and in consequence physical health. It was scientifically recognized that the greater social justice and representative democracy the better the health of people and individuals. Although the direct mechanisms of such a relationship need to be furthered explored, it is clear that there are a myriad of indirect mechanisms that mediate such a relationship.
first, it is not only the ability of the president and other political leaders of Kurdistan to get to world-class hospitals and clinics that is making them able to live longer. More importantly, it is their socioeconomic status and their ability to be heard are what make them able to live longer, achieve a better life expectancy and a higher moral. To overcome the inequality of such an outcomes like life expectancy it is necessary to achieve better equality in terms of self-actualization by providing more opportunities for participation in the decision making process and political representation.
Second, progress toward liberal democratic representation will hopefully have positive impacts on the political orientation toward a health related host of factors like health care system. A transparent and accountable governance will logically lead to a more responsive health care system that takes into account the will, needs and wants of people. The needs of people for primary health services for example will hinder any miscalculated or benefit driven health care policies as privatization of primary and secondary health care institutions and services.
The elections on July 25, was a turning point in the history of Kurds and Kurdistan. It was the beginning of the end of the authoritarian representation in Kurdish politics. The existence and engagement of an active opposition in Kurdistan Parliament will advance the prospect of a liberal and truly representative democracy. Beside the direct political influences of such a development, liberal democracy can have positive impact on the life expectancy of people and a genuinely responsive health care system. The next term of Kurdistan parliament will be not only interesting to watch but also extremely attractive for professionals and other stakeholders to engage in the decision making process. Lets roll our sleeves and go to work. Let a lot lying ahead of us.

Stop Privatization of Public Health in Kurdistan

2009-07-22T01:08:00.000-07:00

Mr. Nechirvan Barzani, the Prime Minister of the Kurdistan Regional Government, opened yesterday July 20, 2009 Media Center for lab. investigation. The Prime Minister, described launching the center as a historic move and highly praised the role of the private sector in the progress of health care services in Kurdistan. Media is a world-class medical investigation center that is as the Prime Minster said is one of its kind in the whole Middle East.
This move is a disastrous step toward destroying the health care system of Kurdistan.
First, the financing and funding of this particular project raises a number of question marks about the use of public money for private aims and profits. The Prime Minister provided the land and an open budget for this project. There are un-confirmed accounts about the personal involvement of the Prime Minister in this project by being a partner. In the disastrous political situation of Kurdisan which is mired by corruption, fraud and a veil of misinformation behind which the financing of most projects are underwent, it should not be a surprise that this project too can be used for personal gains.
Second, The involvement of the private sector in such a crucial sector of the society as health and in particular secondary health care services is a prescription for disaster. While it is understandable that the private sector and open market mechanism can and should be used to promote competition and innovation for tertiary health care, the same move will produce disaster in primary and secondary health care arena. But the profit oriented mentality of the political leadership of Kurdistan is basing such a move on the premise that the most needed services would produce the largest profit.
While the people of Kurdisan are dying from Cholera and infants are dying from simple diarrhea, the profit minded political leadership is trying to improve its image through launching luxurious institutions and expensive clinics and investigation centers that are not accessible to the vast majority of people who the most in need for those services.
Privatization is not and will not be the panacea for all the problems that are crippling health care in Kurdistan. The use of open market mechanisms should be considered through careful planning and serious deliberation about the priorities of the system based on the needs of the ordinary people of Kurdistan.

The Revised Plan to Reform the Health Care System in Kurdistan

2009-07-17T07:45:00.001-07:00

A 5 years Plan to Reform the Health Care System in Kurdistan
2009-2015

The upcoming Parliament of Kurdistan has a historical responsibility to reform the Health care system in Kurdistan. The reform of the system is long overdue and can’t be further delayed. Despite the fact that there are no clear and solid data, it is well known that the expenditure on the health care system of Kurdistan is creating a huge burden on the budget of Kurdistan Regional Government. The high cost of health care didn’t succeed in offering an effective service. Kurdistan is trailing a lot of underdeveloped countries in a host of indicators like infant mortality, maternal mortality and expected survival. Furthermore, in spite of the existence of two colleges of Medicine and a Medical University and tens of Medical Institutions that graduate hundreds of doctors, nurses and medical staff, the people of Kurdistan are still suffering from a variety of communicate and non-communicable diseases like Heart Diseases, Cancers, and Cholera this beside the widespread existence of a host of medical and mental issues like suicide, addiction and female genital mutilation.
This report is an attempt to draw the broad lines for a plan of health care reforms in Kurdistan. Health care system not only in Kurdistan but also all over the world is characterized by great complexities and it’s hard to understand let alone trying to reform it and find solutions for its issues. Having said that, it is crucial for the political will in part of the authorities and the readiness of professionals to discuss, find and implement strategic plans for reforming the system. Furthermore, it is crucial to address the basic social and economic determinants of health like water, sanitation, welfare and electricity. This is just a start to begin an open, genuine and independent thinking about the system and the main ways for reform.
To arrive at an appropriate solution for the main issues of the system the following points should be addressed:
1) Reform should be a holistic, multiphase process that addresses most of the areas of the health care system. Those areas that without addressing them even talking about reform would be a loss of efforts and time are:
I. The mechanisms of financing the health care system. This should be at the top of the priorities of the health care reform initiative. Its obvious that without reforms in the overall financial system in Kurdistan that is suffering from a myriad of issues like corruption, absence of transparency and planning, it is difficult, if not impossible, to reform the financing of the health care system. The eradication and mitigation of the untoward effects of corruption is of utmost importance for the health of not only the health of the health care system but also the overall effectiveness and efficacy of the overall administrative process in Kurdistan. This would be the starting point of creating an efficient system that achieves high quality outcomes without an ever rising cost. With regard to the health care system itself, it is crucial to start thinking about the following initiatives;
i. Separating the publically funded from the privately funded services from the administrative and human resources point of view. The fatal mixture of those two sectors had proved risky to the health care system and the financial security of the Kurdistan Regional Government. Furthermore it has untoward influence on the quality of the health care services. Currently, the physicians of Kurdistan, particularly those with high degrees, are able to see patients in their private clinics in the market and admit them in publically funded hospitals. The total expenditure on those privately seen patients is shouldered by the publically funded hospitals. On the top of this very expensive state, the government is reimbursing physicians through fixed wages and salaries. To overcome this very expensive state, it is essential that physicians be faced with two options; those who are willing to work in the publically funded hospitals, have to have their clinics located in those hospitals and see patients based on discounted rates that then will be reimbursed by the government. Those who prefer to work in the private sector, have to be taxed based on the expenditure of admitting and treating their patients in the publically funded hospitals. This can be done through not offering them wages or salaries that are now provided without considering their public vs. status.
ii. The introduction and implementation of health insurance system for the financing of the publically funded system. This would be a waste of time and efforts without bringing transparency, accountability and planning to the overall financing of Kurdistan.
iii. 1) The promotion of greater transparency in decision-making and governance (i.e. budgets of Ministry of Health, balance sheet of hospital / primary care / drug expenditures / HRH salaries; clarify the roles and competency of the parliamentary health committee, MoH and Directorates of Health). The presence of competent and accountable people can fix most of the financial problems facing the system.
II. The quality of the health care services: to level up the quality of the health care services, it is necessary to address both sides of the health care equation; i.e the patient and health care workers and work out the most crucial failures of providing a world-class health care service. The following are some of the steps that would be implemented to do that;
1) The patient should be at the center of the attention of every health care system. This is crucial condition for the success of the system. There is a fatal displacement of the attention of the system between the patient from one hand and the health care workers on the other hand. To overcome this, it is necessary to have a holistic plan; the following are some of the ideas that can be used;
i. The dedication of a special class in this regard to teach medical students and students in the health departments of different other educational institution about the up-to-date mechanisms of the doctor and medical staff-patient relationship. The class should be based on the human rights principles in general and patients in particular. Currently, this important issue is addressed through a couple hours’ lecture that only addresses the moral and ethical faces of the patient-doctor relationship.
ii. The standardization and the respect for a define period of time that the doctor should spent with his patient. We suggest here a minimum of 15 minutes in outpatient clinics and 30 minutes in inpatients. Besides, dealing with the clinical complaints of the patients, this time should be used to build a long term and friendly relationship with the patient in part of the doctor and the medical staff. To monitor the adherence to this basic need the patient- doctor relationship can be evaluated through the distribution of an evaluation form to patient to identify the abuse or neglect of patients and the failure to spend enough time with the patients.
iii. The patient-doctor relationship should not be limited to the brief encounter between the two and the medical staff at the start of the clinical interview. It is crucial, particularly with regard to those doctors that are working in publicly funded hospitals and clinics, to adhere to a previously agreed upon timetable to follow up with the patient even after s/he leaves the hospital or clinic. This will help in building a long term relationship between the two and increase the odds of complaint in part of the patient with managements described by the doctor.
iv. The reimbursement offered to the doctors, particularly those who are working in publically funded hospitals and clinic, could be based on those evaluation forms. For instance, those doctors who admit the same patient for the same reason many times, should not be treated in their salaries and wages the same way that others who successfully decrease the rate of admission and length of stay of their patients.
v. The encouragement and support for the establishment of organizations that are specialized in advocating in part of the patients and demanding their rights.
vi. The introduction of mechanisms and tools that would reimburse or punish health care workers based on their performance according to those evaluation forms and other tools.
2) To consolidate and advance the positioning of the patient at the center of the health care system, it is necessary to advance the quality of the services offered to the patients. The following points will guarantee the minimum increase in the level of the quality of the health care services offered;
i. Doctors and the health care staff should undergo a continuous process of training and education. For the health care providers to continue in their job, they have to renew their license. Mechanisms like CME could be implemented to replace an official test for licensure renewal. Health care providers can through this system collect a specified score over 5 years to replace tests. Otherwise a specific test should be designed and implemented for the licensure renewal.
ii. Encouraging the conduction of scientific research. The characteristic feature of the health care system and the medical education in Kurdistan is the near absence of research in the field. To start implementing this crucial necessity for a high quality of health care services, the medical schools and institutions can be used to conduct research. The medical education in these institutions is characterized by an old and classic style of teaching. It is necessary to involve medical student in research through requiring a thesis at the last year of their education and involving them with those which are conducted by their professors which is also very limited and need scaling up.
iii. The decrease and finally the elimination of the bad influence of politics on the medical education and practice. It is necessary to adhere to scientific methods in the selection of leaders of the health care institutions. This selection process should be based on their qualifications and experience. This also should be applied to the selection of doctors and medical staff to undergo training in foreign medical institutions.
iv. Giving more attention to the quality control measures in the regulations of the import, distribution and use of medicines and medical instruments. A crucial step in this regard would be ending the use of medicine as a product that everyone can use without the prescription by physicians.
v. The use of the advanced technological tools to provide health care services. This will not only decrease the risk of mistakes in providing health care services but also decrease the administrative cost of the usage of classical methods; like the use of paper in the keeping patients’ medical records. It is necessary to take advantage from the widespread availability of cell phones for example to create and maintain a long term relationship between the patients and health care providers.
vi. The status of the surveillance system in Kurdistan is very poor. This system had failed so far in collecting, analyzing and using data in the implementation of health care programs in Kurdistan. The opportunity provided by the WHO to advance the performance of the surveillance system of developing countries to confront public health emergencies of international concerns can be used in this regard.
3) The promotion of free public health & primary care in urban and rural areas. This can be done by bringing together many GPs, nurses and pharmacists on board with this scheme by offering a decent salary, and incentives for research and further training, supported by organizations Good primary care will promote self-care, limit referrals and bad prescribing.
2) Reform should be adherent to a number of specific measurable goals and objective that should be implemented over a desired period of time. In addition to designating those goals and objectives, it is also necessary to have a system of evaluation and monitoring in place that oversee the implementation of such programs. To achieve such a noble cause, it is necessary to have active members of the parliament. Most of the points indicated above can be implemented over the next 5 years.
3) Without a widespread discussion that will reach out to the largest number of doctors, medical staff and other stakeholders will guarantee the implementation of a successful reform project.

2009-07-17T07:24:00.000-07:00

2009-07-15T09:46:00.000-07:00

2009-07-15T09:06:00.000-07:00

A 5 years Plan to Reform the Health Care System in Kurdistan
2009-2015

The upcoming Parliament of Kurdistan has a historical responsibility to reform the Health care system in Kurdistan. The reform of the system is long overdue and can’t be further delayed. Despite the fact that there are no clear and solid data, it is well known that the expenditure on the health care system of Kurdistan is creating a huge burden on the budget of Kurdistan Regional Government. The high cost of health care didn’t succeed in offering an effective service. Kurdistan is trailing a lot of underdeveloped countries in a host of indicators like infant mortality, maternal mortality and expected survival. Furthermore, in spite of the existence of two colleges of Medicine and a Medical University and tens of Medical Institutions that graduate hundreds of doctors, nurses and medical staff, the people of Kurdistan are still suffering from a variety of communicate and non-communicable diseases like Heart Diseases, Cancers, and Cholera this beside the widespread existence of a host of medical and mental issues like suicide, addiction and female genital mutilation.
This report is an attempt to draw the broad lines for a plan of health care reforms in Kurdistan. Health care system not only in Kurdistan but also all over the world is characterized by great complexities and its hard to understand let alone trying to reform it and find solutions for its issues. Having said that, it is crucial for the political will in part of the authorities and the readiness of professionals to discuss, find and implement strategic plans for reforming the system. This is just a start to begin an open, genuine and independent thinking about the system and the main ways for reform.
To arrive at an appropriate solution for the main issues of the system the following points should be addressed:
1) Reform should be a holistic, multiphase process that addresses most of the areas of the health care system. Those areas that without addressing them even talking about reform would be a loss of efforts and time are:
I. The mechanisms of financing the health care system. This should be at the top of the priorities of the health care reform initiative. Its obvious that without reforms in the overall financial system in Kurdistan that is suffering from a myriad of issues like corruption, absence of transparency and planning, it is difficult, if not impossible, to reform the financing of the health care system. The eradication and mitigation of the untoward effects of corruption is of utmost importance for the health of not only the health of the health care system but also the overall effectiveness and efficacy of the overall administrative process in Kurdistan. This would be the starting point of creating an efficient system that achieves high quality outcomes without an ever rising cost. With regard to the health care system itself, it is crucial to start thinking about the following initiatives;
i. Separating the publically funded from the privately funded services from the administrative and human resources point of view. The fatal mixture of those two sectors had proved risky to the health care system and the financial security of the Kurdistan Regional Government. Furthermore it has untoward influence on the quality of the health care services. Currently, the physicians of Kurdistan, particularly those with high degrees, are able to see patients in their private clinics in the market and admit them in publically funded hospitals. The total expenditure on those privately seen patients is shouldered by the publically funded hospitals. On the top of this very expensive state, the government is reimbursing physicians through fixed wages and salaries. To overcome this very expensive state, it is essential that physicians be faced with two options; those who are willing to work in the publically funded hospitals, have to have their clinics located in those hospitals and see patients based on discounted rates that then will be reimbursed by the government. Those who prefer to work in the private sector, have to be taxed based on the expenditure of admitting and treating their patients in the publically funded hospitals. This can be done through not offering them wages or salaries that are now provided without considering their public vs. status.
ii. The introduction and implementation of health insurance system for the financing of the publically funded system. This would be a waste of time and efforts without bringing transparency, accountability and planning to the overall financing of Kurdistan.
II. The quality of the health care services: to level up the quality of the health care services, it is necessary to address both sides of the health care equation; i.e the patient and health care workers and work out the most crucial failures of providing a world-class health care service. The following are some of the steps that would be implemented to do that;
1) The patient should be at the center of the attention of every health care system. This is crucial condition for the success of the system. There is a fatal displacement of the attention of the system between the patient from one hand and the health care workers on the other hand. To overcome this, it is necessary to have a holistic plan; the following are some of the ideas that can be used;
i. The dedication of a special class in this regard to teach medical students and students in the health departments of different other educational institution about the up-to-date mechanisms of the doctor and medical staff-patient relationship. The class should be based on the human rights principles in general and patients in particular. Currently, this important issue is addressed through a couple of hours lectures that only addresses the moral and ethical faces of the patient-doctor relationship.
ii. The standardization and the respect for a define period of time that the doctor should spent with his patient. We suggest here a minimum of 15 minutes in outpatient clinics and 30 minutes in inpatients. Beside dealing with the clinical complaints of the patients, this time should be used to build a long term and friendly relationship with the patient in part of the doctor and the medical staff. To monitor the adherence to this basic need the patient- doctor relationship can be evaluated through the distribution of an evaluation form to patient to identify the abuse or neglect of patients and the failure to spend enough time with the patients.
iii. The patient-doctor relationship should not be limited to the brief encounter between the two and the medical staff at the start of the clinical interview. It is crucial, particularly with regard to those doctors that are working in publicly funded hospitals and clinics, to adhere to a previously agreed upon timetable to follow up with the patient even after s/he leaves the hospital or clinic. This will help in building a long term relationship between the two and increase the odds of complaint in part of the patient with managements described by the doctor.
iv. The reimbursement offered to the doctors, particularly those who are working in publically funded hospitals and clinic, could be based on those evaluation forms. For instance, those doctors who admit the same patient for the same reason many times, should not be treated in their salaries and wages the same way that others who successfully decrease the rate of admission and length of stay of their patients.
v. The encouragement and support for the establishment of organizations that are specialized in advocating in part of the patients and demanding their rights.
vi. The introduction of mechanisms and tools that would reimburse or punish health care workers based on their performance according to those evaluation forms and other tools.
2) To consolidate and advance the positioning of the patient at the center of the health care system, it is necessary to advance the quality of the services offered to the patients. The following points will guarantee the minimum increase in the level of the quality of the health care services offered;
i. Doctors and the health care staff should undergo a continuous process of training and education. For the health care providers to continue in their job, they have to renew their license. Mechanisms like CME could be implemented to replace an official test for licensure renewal. Health care providers can through this system collect a specified score over 5 years to replace tests. Otherwise a specific test should be designed and implemented for the licensure renewal.
ii. Encouraging the conduction of scientific research. The characteristic feature of the health care system and the medical education in Kurdistan is the near absence of research in the field. To start implementing this crucial necessity for a high quality of health care services, the medical schools and institutions can be used to conduct research. The medical education in these institutions is characterized by an old and classic style of teaching. It is necessary to involve medical student in research through requiring a thesis at the last year of their education and involving them with those which are conducted by their professors which is in turn very limited and need scaling up.
iii. The decrease and finally the elimination of the bad influence of politics on the medical education and practice. It is necessary to adhere to scientific methods in the selection of leaders of the health care institutions. This selection process should be based on their qualifications and experience. This also should be applied to the selection of doctors and medical staff travel abroad to do trainings in their fields.
iv. Giving more attention to the quality control measures in the regulations of the import, distribution and use of medicines and medical instruments. A crucial step in this regard would be ending the use of medicine as a product that everyone can use without the prescription by physicians.
v. The use of the advanced technological tools to provide health care services. This will not decrease the risk of mistakes in providing health care services but also decrease the administrative cost of the usage of classical methods like the use of papers in the keeping patients’ medical records. It is necessary to take advantage from the widespread availability of cell phones for example to create and maintain a long term relationship between the patients and health care providers.
vi. The status of the surveillance system in Kurdistan is very poor. This system had failed so far to collect, analyze and use data in the implementation of health care services in Kurdistan. The opportunity provided by the WHO to advance the performance of the surveillance system of the developing countries to confront public health emergencies of international concerns can be used in this regard.

2) Reform should be adherent to a number of specific measurable goals and objective that should be implemented over a desired period of time. In addition to designating those goals and objectives, it is also necessary to have a system of evaluation and monitoring in place that oversee the implementation of such programs. To achieve such a noble cause, it is necessary to have active members of the parliament. Most of the points indicated above can be implemented over the next 5 years.
3) Without a widespread discussion that will reach out to the largest number of doctors, medical staff and other stakeholders will guarantee the implementation of a successful reform project.