Health systems priorities in the Eastern Mediterranean Region: challenges and strategic directions

Executive summary The aim of this technical paper is to assist the Member States in acquiring a perspective of health system priorities in the Eastern Mediterranean Region, identify the current challenges and carve out appropriate strategies. A fundamental theme that underlies health system priority-setting in the Eastern Mediterranean Region is the primary health care approach and the reiteration of the importance of the Health for All strategy, which continues to be the cornerstone of such efforts. Achievement of the Millennium Development Goals (MDG), especially those related to health, for reducing poverty and improving lives of people in countries of Eastern Mediterranean Region has also given impetus to this effort. A simple analytical framework has been used to assess health system priorities, which links health programmes with the health system and determinants of health. A set of core health system functions are suggested, which are not meant to be prescriptive, but to generate a healthy discussion and debate and lead to further refinement of the health system priorities, consensus on the operational definition and scope of each core health system function, and adoption of the core health system functions by Member States into national policies, to achieve the goal of improved health of the population of the Region. The Eastern Mediterranean Region covers 22 countries, 500 million people and has the demographic profile of a developing region. Overall it is a low middle-income region with a GNP per capita of less than US$ 1700 and an average Human Development Index (HDI) of 0.603. The geopolitical situation of the Region is extremely challenging because many countries are in a state of crisis or are emerging from conflict. Tuberculosis, malaria and HIV/AIDS are the major killers. The regional average immunization coverage for vaccine-preventable diseases is around 80% for children less than 1 year of age. Despite significant progress in poliomyelitis eradication, the remaining endemic countries continue to face constraints due to continued transmission of the wild virus. The maternal mortality ratio is high in several countries and although the neonatal mortality rate has decreased, those born dead or dying in the first weeks of life are estimated to account for 60% of infant deaths. Growth retardation is a serious nutritional problem in many countries, and is linked to unsatisfactory infant and young child feeding practices. Currently, over 40% of the regional disease burden is due to noncommunicable diseases, and this is expected to …