Department of Global Health Policy, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
Hitotsubashi Institute for Advanced Study, Hitotsubashi Daigaku, Kunitachi, Tokyo, Japan.
BMJ Open. 2024 Sep 30;14(9):e080492. doi: 10.1136/bmjopen-2023-080492.
Two decades have passed since the beginning of the Iraq War in 2003. Iraq has long suffered from conflicts and instability, where the people have limited access to healthcare. The coronavirus disease (COVID-19) pandemic brought additional disruption to health service provision.
At the midpoint towards universal health coverage (UHC) in 2030, this study aims to gain a better understanding of the trends of UHC progress in Iraq in the context of the conflicts and the COVID-19 pandemic and to indicate possible pragmatic options.
This study employed Bayesian hierarchical regression models to estimate trends and projections of health service availability and coverage indicators up to 2030. Furthermore, for health service coverage, four scenarios were defined based on the availability of health services, and projections were made for each scenario up to 2030.
Our approach used the yearly data from the Ministry of Health and four nationally representative household surveys between 2000 and 2020. We evaluated the subnational-level progress in three health service availability indicators and 13 health service coverage indicators in 18 governorates in Iraq from 2000 to 2030.
The findings from 2000 to 2020 revealed a lack of progress in the indicators of health facility and inpatient bed, and pronounced detrimental effects from major conflicts and the pandemic on all measured health service coverage indicators. Despite these setbacks, several health service coverage indicators demonstrated resilience and elasticity in their recovery. The projected trends for 2021 to 2030 indicated limited alternations in the health service availability. By 2030, five health service coverage indicators will achieve the designated 80% targets. A scenario-based analysis predicts improved coverage of antenatal care, and child immunisation and treatment if health service availability is bolstered to globally recommended standards. Under this scenario, several governorates-Anbar, Baghdad, Nainawa, Qadissiyah, Salahaddin, Thiqar and Wasit-presented improved health service coverage in more indicators.
Strengthened health service availability has the potential to significantly improve fragile health service coverage indicators and in more vulnerable governorates.
自 2003 年伊拉克战争爆发以来，已经过去了二十年。伊拉克长期以来一直饱受冲突和动荡的困扰，人民获得医疗保健的机会有限。冠状病毒病（COVID-19）大流行给卫生服务提供带来了额外的破坏。
在 2030 年实现全民健康覆盖（UHC）的中点，本研究旨在更好地了解在冲突和 COVID-19 大流行背景下伊拉克 UHC 进展的趋势，并指出可能的务实选择。
本研究采用贝叶斯层次回归模型来估计 2030 年之前卫生服务可用性和覆盖指标的趋势和预测。此外，对于卫生服务覆盖，根据卫生服务的可用性定义了四个情景，并对每个情景进行了 2030 年之前的预测。
我们的方法使用了卫生部 2000 年至 2020 年的年度数据和四个全国代表性家庭调查数据。我们评估了伊拉克 18 个省在三个卫生服务可用性指标和 13 个卫生服务覆盖指标方面的次国家一级进展情况。
2000 年至 2020 年的结果表明，卫生设施和住院床位指标没有取得进展，并且主要冲突和大流行对所有衡量的卫生服务覆盖指标都产生了明显的不利影响。尽管存在这些挫折，但一些卫生服务覆盖指标在恢复方面表现出了弹性。2021 年至 2030 年的预测趋势表明，卫生服务可用性的变化有限。到 2030 年，将有五个卫生服务覆盖指标达到指定的 80%目标。基于情景的分析预测，如果将卫生服务的可用性提高到全球建议的标准，将改善产前保健、儿童免疫接种和治疗的覆盖率。在这种情况下，安巴尔、巴格达、纳杰夫、卡迪西亚、萨拉赫丁、提克里和瓦西特等几个省在更多指标中呈现出改善的卫生服务覆盖。
加强卫生服务的提供有可能显著改善脆弱的卫生服务覆盖指标，并在更脆弱的省份实现这一目标。
