US embassy cable - 05AMMAN2394

UNCLAS SECTION 01 OF 02 AMMAN 002394 
 
SIPDIS 
 
STATE PASS USAID 
 
E.O. 12958: N/A 
TAGS: TBIO, SOCI, KHIV, JO 
SUBJECT: Tour D'Horizon of Jordan's Health Sector: Cancer Driving 
Regional Cooperation and Institutional Reform 
 
1.  Summary: Jordan's biggest health priority is non-medical; it 
needs to develop a comprehensive national health strategy. 
Jordan strongly supports the NIH-supported Middle East Cancer 
Consortium.  HIV/AIDS and cancer are not as problematic in Jordan 
as are chronic, non-infectious "lifestyle" diseases such as heart 
disease and diabetes brought on by diet, obesity, lack of 
exercise, hypertension and smoking.  End summary. 
 
Health Issues Shift as Society Develops 
--------------------------------------- 
2.  ESTHOff and ESTH Specialist reviewed Jordan's health 
situation with Ministry of Health (MOH) Assistant Secretary 
General for Hospitals Dr. Samir Al-Kayed, and with CEO of the 
King Hussein Cancer Center Dr. Samir Khleif.  Dr. Khleif was 
seconded from the U.S. National Institutes of Health (NIH) and 
came to Jordan two years ago to run the Cancer Center.  The 
picture that emerged from the meetings is of a society in 
demographic and epidemiologic transition from an agricultural 
society to an industrial, service-centered, essentially urban 
economy, with corresponding changes in health status. "Medical 
tourism" to Jordan from other Arab countries, including Yemen, 
the West Bank, Djibouti, Algeria, Libya, Sudan and Saudi Arabia, 
is an important component of Jordan's health care sector and 
actually provides the revenues to support Jordan's entire health 
care sector. 
 
3.  The biggest causes of mortality in Jordan are cardiovascular 
diseases, accidental deaths (including car accidents) and cancer. 
Dr. Khleif said that heart disease, Jordan's number one killer, 
could be easily reduced through awareness programs on obesity and 
smoking.  He said 55 percent of Jordanian males above age 15 are 
smokers. 
 
Cancer in Jordan - Low but Will Grow 
------------------------------------ 
4.  Overall, cancer rates in Jordan are one-third those in the 
United States, although this is misleadingly low because of 
Jordan's young population, where sixty-one percent of the people 
are below the age of twenty-five.  As population growth slows and 
the population ages, cancer rates will rise. Dr. Khleif said 
Jordan's biggest problem is the current emphasis on treatment 
rather than on early detection.  Cancer treatment (but not 
detection) is free in Jordan, and represents a large fraction of 
Jordan's medical budget. 
 
5.  Dr. Al-Kayed said that he is the head of the Jordan Cancer 
Society, which has formed an innovative "Committee for Early 
Detection."  The structure of this committee is innovative 
because it is chaired by a physician from the Senate, and 
includes representatives from government, academia and the 
private sector. 
 
6.  Dr. Khleif said the current emphasis on cancer treatment 
versus detection highlights the lack of a long-term focus in 
health care.  Early detection programs and anti-smoking campaigns 
would save money by reducing treatment and disease incidence, he 
said.  MOH is currently developing a ten-year strategic plan that 
should address some of these planning deficiencies and take a 
more comprehensive, long-term view of health and health-care 
costs, he said. 
 
Minister of Health Visits U.S. Twice in A Year 
--------------------------------------------- - 
7.  An indicator of the level of interest in health care reform 
is the fact that Minister of Health Said Darwazah recently 
visited the United States for the second time in less than a 
year.  Darwazah had visits in Washington with NIH and the 
Department of Health and Human Services, and went to Atlanta to 
visit the Centers for Disease Control.  Dr. Khleif described 
Darwazah as open-minded and activist.  One of MOH's goals, 
according to Khleif, is developing a Jordanian Food and Drug 
Administration that hews to standards set by the U.S. FDA.  Mr. 
Darwazah comes to MOH from the private sector, where he was CEO 
of Jordan's largest pharmaceutical company, which exports 70 
percent of its products.  Minister Darwazah is an Industrial 
Engineer trained at Purdue. 
 
Human Resources: Need Training, Balance 
--------------------------------------- 
8.  Dr. Khleif said one deficiency in Jordan's health care system 
is skewed human resources, with adequate numbers of well-trained 
doctors but with insufficient support staff such as nurses and 
technicians.  MOH has more than 23,000 employees, among which are 
7,000 nurses and 4,000 doctors, said Dr. Al-Kayed.  Jordan has 
twenty-nine public hospitals and sixty private hospitals.  There 
is demand for more, especially for specialized facilities, Al- 
Kayed said.  Dr. Khleif stated, that in his opinion, MOH health 
facilities lagged behind private, royal and academic facilities 
due to a lack of staff and resources.  The large military health 
system is separate from the MOH and covers 40 percent of the 
population. 
 
Healthcare More than Treatment 
------------------------------ 
9.  Dr. Al-Kayed said that MOH is strongly interested in training 
in all fields, especially in administration and technical 
training, and Dr. Khleif echoed these remarks in a separate 
meeting.  MOH's mission is not just medical services, Dr. Al- 
Kayed said.  MOH wants to expose its staff to "other experiences" 
to give them a more rounded view of health care practices 
internationally.  He noted that training opportunities in the US 
are decreasing because of visa difficulties, restrictive 
regulations, and rising expenses. 
 
Government Seeks to Expand Insurance Coverage 
--------------------------------------------- 
10.  Financial management and insurance are other key concerns of 
the Ministry of Health, Dr. Al-Kayed said.  Under the current 
arrangement, over 300,000 people receive free care provided by 
the government.  He said that more than two million people pay 
for insurance, including military and government employees.  More 
than 70 percent of Jordanians have some form of health insurance, 
he said.  Nonetheless, the government is looking for ways to 
expand public insurance, to include senior citizens, for example. 
 
MECC Gathering Steam Despite Israeli Connection 
--------------------------------------------- -- 
11.  Dr. Al-Kayed is Jordan's representative to the Middle East 
Cancer Consortium (MECC), which receives direct support from the 
U.S. National Cancer Institute, part of the National Institutes 
of Health.  Jordan, the Palestinian Authority, Israel, Cyprus, 
Egypt and Turkey are full members of MECC, and other Middle 
Eastern countries, including Yemen, have participated in MECC 
functions. MECC is reaching out to encourage participation from 
Lebanon, Tunisia and Oman. 
 
12.  MECC will meet in Amman on March 26, when American Cancer 
Society CEO Dr. John Seffrin will participate.  It has a 
Ministerial-level Steering Committee, and a Board of Governors 
with one representative per member country.  Al-Kayed is Jordan's 
representative and is also the current head of the Board of 
Governors.  MECC's Executive Director is Dr. Michael Silbermann, 
an Israeli based in Haifa. 
 
MECC Programs: Cancer Registry, Training 
---------------------------------------- 
13.  MECC's flagship program is a National Cancer Registry in 
each country, which captures data on cancer cases as a step 
towards analyzing the demography and etiology of the disease. 
The equivalent database in the United States is SEER 
(Surveillance Epidemiology and End Results - 
http://seer.cancer.gov/), run by the National Cancer Institute. 
 
14.  At MECC's most recent meeting in January 2005 in Larnaca, 
Cyprus, members proposed a Middle East Regional School of 
Oncology, perhaps located at the American University of Beirut. 
While this is purely a notional idea without funding, the idea 
itself demonstrates the seriousness and initiative with which 
MECC members approach their work.  The week of February 22, MECC 
had a course in Cyprus on the mechanics of operating a cancer 
registry.  Jordan sent eight persons to that course, and Egypt 
sent twenty.  MECC also has two training programs in the works, a 
course in Izmir, Turkey in May for radiological technicians, and 
a course in the Fall on palliative care for cancer patients. 
 
No Pain, No Gain 
---------------- 
15.  Comment: Jordan is well behind the United States in many 
aspects of its healthcare system but clearly sees that sector as 
critical and is willing to undertake the pain of reform to bring 
it up to speed. 
 
HENZEL