Health Sector Reform in the Kurdistan Region-Iraq: Primary Care Management Information System, Physician Dual Practice Finance Reform, and Quality of Care Training.

Since 2010, the RAND Corporation has worked with the Ministry of Health and Ministry of Planning of the Kurdistan Regional Government to develop and implement initiatives for improving the region's health care system through analysis, planning, and development of analytical tools. This third phase of the project (reflecting work completed in 2013-2015) focused on development and use of a primary care management information system; health financing reform, focusing on policy reform options to solve the problem of physician dual practice, in which physicians practice in both public and private settings; and hospital patient safety training within the context of health quality improvement. Most main primary health care centers serve too many people, and most sub-centers serve too few people. Staffing by physicians, nurses, dentists, and pharmacists is uneven across the region. The data also identified centers where laboratory, X-ray, and/or other equipment should be repaired or replaced and where users should be trained. Though the required workweek is 35 hours, and all physicians are paid for these 35 hours, most physicians spent only three or four hours per day working in the public sector. The remainder of the time was often spent working in the private sector, where pay is much higher. The vast majority of physicians (over 80 percent) indicated that if pay were higher and public-sector resources were increased, they would prefer to work only in the public sector. To resolve the problems associated with dual practice, the authors recommend full separation between public- and private-sector practice.