US embassy cable - 03AMMAN4831

UNCLAS SECTION 01 OF 03 AMMAN 004831 
 
SIPDIS 
 
SENSITIVE 
 
USDOC FOR 4520/ITA/MAC/ONE/PTHANOS 
 
E.O. 12958: N/A 
TAGS: EAID, SOCI, PREL, IZ, JO 
SUBJECT: CPA SENIOR HEALTH ADVISOR HAVEMAN'S VISIT TO AMMAN 
 
 
Sensitive but unclassified; please protect accordingly 
 
1.  (sbu)  Summary:  CPA Senior Health Sector Advisor Jim 
Haveman and a team of CPA staff visited Amman July 28-29 on a 
fact-finding and appeal tour.  During meetings with an array 
of local and international groups, Haveman described current 
conditions in the Iraqi health sector, elicited outside views 
on progress being made in Iraq, and made a pitch for material 
and technical assistance.  CPA has already made enormous 
strides in getting the health sector up and running again, 
but used this trip to identify a number of remaining critical 
needs for which they are requesting assistance from the donor 
community, governments, and the private sector.  The GOJ has 
already begun to consider some of these needs and could be a 
natural conduit for rebuilding Iraq's health sector.  End 
summary. 
 
WHAT'S THERE 
 
2.  (u)  The health sector currently consists of:  One 
11-story MoH building; approximately 240 public hospitals; 70 
private hospitals; 5 hospitals that were previously the 
private reserves of Saddam Hussein and family; 1,200 primary 
care clinics; 13 medical schools.  The sector employs 85,000 
people, including MoH personnel and health care 
professionals.  The sector has 29,000 hospital beds, half of 
them empty. 
 
CURRENT CONDITIONS 
 
3.  (u)  According to Haveman, all 11 stories of the MoH 
building were completely gutted by looters, down to the 
switchplates and electrical wiring in the building.  Power 
supply to the country's hospitals is sporadic, and roughly 
50% of the medical equipment country-wide is not working. 
Resources tend to be concentrated in and around Baghdad, with 
significantly lower levels of supply and infrastructure in 
the south and in the north.  For example, Haveman noted that 
3 million northern Kurds share 3 MRI machines, and have not 
had access to basic painkillers like Demerol in over 14 years. 
 
4.  (u)  Medical capabilities in the country are relatively 
strong, with a healthy supply of qualified physicians and 
pharmacists.  However, lack of access to information over the 
past two-plus decades has put the medical community well 
behind the curve on modern techniques and therapies.  Nursing 
care is substandard, with nurses serving more as orderlies 
than as medical caregivers. 
 
5.  (u)  Management capabilities throughout the country are 
virtually non-existent.  Decades of oppression have stifled 
initiative, and much of the sector, as elsewhere in the 
country, is ruled by fear or reprisal for any independent 
thought.  Furthermore, the completely centralized nature of 
the sector under Saddam meant that only the MoH had 
administrative authority, leaving doctors in charge of local 
hospital administration.  The system currently has no 
hospital administrators as such. 
 
6.  (u)  The CPA MoH budget stands at $210 million for H2 
2003, exclusive of salaries.  This compares favorably to the 
$16 million Saddam spent in all of 2002 to provide health 
care for 23 million people.  Within the CPA budget, $30 
million has been earmarked for procurement of generators for 
hospitals, and another $125 million for 
purchasing/procurement of critically needed supplies (in 
addition to funds provided through the OFF program). 
 
WHAT THEY'VE DONE 
 
7.  (u)  Haveman's overarching goal is to decentralize the 
healthcare system and devolve as much responsibility as 
possible to the local level.  In conjunction with that, he is 
working to overhaul the MoH and bring supplies and services 
to communities that need them most.  Since the war ended, CPA 
has: 
 
-- delivered humanitarian supplies to critical needs areas, 
including 3,500 tons of medical supplies in the past 45 days. 
 
-- returned medical service levels to near or better than 
pre-war levels:  in the Kurdish north, service levels are at 
100%-plus of pre-war levels; in Basra and the south, service 
is at 85% of pre-war; and in Baghdad and central Iraq, 
service levels are at 75% of pre-war. 
 
-- restructured wages for health care professionals.  Doctors 
now earn $160-$260 per month (vice $20/month under Saddam), 
and pharmacists have seen their wages increase substantially 
from the $1/month they earned under the old regime. 
-- Purged the upper reaches of the MoH of Baathist 
leadership, removing 10 senior MoH officials. 
 
-- held the first country-wide meeting of provincial hospital 
managers in 40 years. 
 
-- held the first country-wide nurses' seminar in recent 
memory. 
 
-- launched the "Adopt-a-hospital" program, which seeks to 
identify sponsors from the international public or private 
sector who will refurbish, repair, and supply one of the 30 
hospitals designated by CPA has having the most critical 
needs. 
-- began prioritizing O-F-F contracts to ensure delivery of 
the most critically needed supplies.  CPA staff have 
categorized outstanding approved and funded contracts into 
four tiers, with tier one being the most critically needed 
supplies.  The top 50 tier one contracts were submitted to 
the UN on July 24, and notification to ship should go out to 
contractors by August 7.  Tier 2 contracts will be notified 
by end September; tier 3 by end October; and tier 4 (no 
priority) by November 21, when OFF terminates.  In addition, 
CPA is prioritizing approved but NOT funded contracts to see 
which if any contain critically needed supplies.  Those that 
do will be considered for filling from CPA's $125 million 
procurement budget.  Lower priority unfunded OFF contracts 
may be considered at a later date, depending on how needs 
develop.  Contracts with Iraq under programs other than OFF 
(e.g., the Jordan-Iraq oil and trade protocol) are not 
currently being prioritized by CPA. 
 
-- began plans to identify a "tiger team" of some 200 
engineers and repair specialists already in Iraq to conduct a 
rapid assessment and repair of inoperable medical equipment. 
That which can be fixed easily will be, that which is 
irreparable will be discarded, that which requires additional 
repair will be identified.  Announcement of this team may be 
made in as little as two weeks. 
 
WHAT THEY NEED - MATERIAL 
 
8.  (u)  CPA is developing a "wish list" of critical needs 
and of longer term needs for bringing the MoH and the sector 
up to international norms.  Broadly speaking, outstanding 
needs can be broken down into two categories:  material 
needs, and technical assistance needs. 
 
9.  (u)  Iraq is critically short of "tier one" drugs, i.e. 
high-quality pharmaceuticals and life-saving and more 
specialized drugs.  The Kimadia warehouse is awash in drugs 
purchased under OFF during the Saddam regime, but many of 
those drugs were purchased for purely political reasons and 
either do not work, are not safe, or were never intended for 
delivery.  CPA made a plea to multinational pharmaceutical 
company regional representatives for a commitment to donate 
and/or contract quality drugs on a long-term commitment 
basis, to ensure a continuous supply. 
 
10.  (u)  The country is also in critically short supply of 
basic medical supplies and equipment, and is seeking 
donations from the private sector and donor community to 
supplement current stocks.  CPA is also preparing a specific 
needs list for presentation to the planned UN donors' 
conference in October.  Haveman mentioned in particular a 
shortage of proper hospital beds, noting all the beds in the 
system date from the mid-1980's.  On a related note, he said 
bedsheets and blankets are virtually nonexistent. 
 
11.  (u)  The Ministry itself, and hospital administrative 
offices, are in need of basic office supplies - desks, 
chairs, wastebaskets, calculators, and the like.  CPA would 
welcome donations of such equipment.  Haveman was quick to 
note, though, that MoH is not yet prepared to accept IT 
equipment, as they have not planned out an IT strategy which, 
he noted, would have to be compatible with other government 
ministries and with the network of hospitals and clinics. 
 
12.  (u)  The healthcare system also needs updated medical 
textbooks, journals, and other recent medical literature, 
including on CD-ROM, both to supply medical schools and to 
bring practicing healthcare providers up to speed on current 
practices.  Finally, the system is in short supply of 
medical-grade oxygen.  CPA has indicated a desire either for 
a steady supply of such oxygen or, even better, investment in 
existing or new oxygen manufacturing plants to provide oxygen 
to hospitals on a commercial basis. 
WHAT THEY NEED - TECHNICAL ASSISTANCE 
 
13.  (u)  While material needs are the most critical 
currently, CPA has noted a number of areas where technical 
assistance would be welcome in the medium-to-long term. 
These areas include, but are not likely limited to, finding 
adoptive "parents" for the Adopt-a-Hospital program, 
providing training/skills upgrades for Iraqi pharmacists, 
repairing medical equipment not covered by the "tiger team," 
skills training for nurses, legislative and regulatory 
assistance to develop a streamlined registration/licensing 
regime, development of certification programs and exams for 
local healthcare providers, and training for EMT's/first 
responders. 
FOLLOW-UP FROM JORDAN 
14.  (sbu)  During Haveman's meetings in Amman, both the 
private sector and the GOJ expressed eagerness to help meet 
critical needs wherever possible.  CPA staff noted that 
virtually all of the OFF contracts that Jordanian suppliers 
inquired about had been prioritized as "tier one," indicating 
that many outstanding approved/funded Jordanian contracts 
would be settled expeditiously.  They further noted that, 
among the approved but NOT funded contracts, many Jordanian 
contracts would probably fall into areas deemed "critical 
needs."  In addition to contract-based support, Jordan 
offered the following: 
 
-- a group of local doctors has offered to establish a 
working group to provide training, teaching, and - to the 
extent possible - medical literature to Iraqi counterparts. 
 
-- The Jordanian Armed Forces have a field hospital currently 
operating in Iraq.  CPA has asked the GOJ to consider folding 
it into the Adopt-a-Hospital program, in an effort to 
eliminate the possibility of a parallel healthcare system 
choking off development of the sector.  The Embassy ad the 
GOJ will begin discussing this proposal next week. 
 
-- The Jordanian MoH is providing CPA with copies of all 
healthcare-related legislation and regulatory frameworks 
developed since Jordan acceded to the WTO.  In particular, 
they have offered to assist CPA develop regulations for a 
new, transparent and efficient drug registration regime. 
 
-- Jordan's MoH also offered to include Iraqi enrollment in 
its newly-founded nursing center. 
 
-- On a broader level, GOJ Planning Minister Bassem Awadallah 
has pledged the GOJ's full support for any future CPA MoH 
needs, noting that a stable, prosperous Iraq is in Jordan's 
best interest.  Haveman told Awadallah he would try to put 
together a specific "wish list" to highlight areas where 
Jordan might help. 
 
15.  (u)  CPA Senior Advisor Haveman did not have the 
opportunity to clear this message. 
 
16.  (u)  Baghdad minimize considered. 
GNEHM