The role of contractual arrangements in improving health sector ...

Jordan
region. This, coupled with the continued decline in infant mortality (22 deaths per
1000 live births for 2002) and the rise in life expectancy at birth (70.6 and 72.4 years
for males and females, respectively), represents a significant social and economic
challenge to the government (Ministry of Health Annual Book, 2002).
Jordan has a small economy with limited natural resources, arid land mostly
unsuitable for agriculture, and chronic water shortages. It imports most of the energy
it consumes. The economic situation is aggravated by the political environment,
which makes efforts to revive the economy difficult task. Although the GDP growth
rate slightly improved between 2001 and 2002 (4.2% versus 4%), the cost of living
also increased. The unemployment figure is still high between 14.7%–16% according
to different estimates. Nearly 12% of the Jordanian population is below the national
poverty line (World Bank Group, 2002).
Based on the commonly used development indicators, Jordan fares better than
most countries in the low–middle income category. The majority of the population
has access to basic infrastructure such as safe water, sanitation and electricity, and
lives in permanent dwelling structures. Government commitments to improve the
overall quality of life and the social standards of its people have borne impressive
results. Primary and secondary health care services are distributed all over the country
with 98% to 100% population access to local health services (WHO, Country
Profiles, 2003). The total literacy rate is 89.7% and Jordan has a well developed
human resource base.
Health sector brief
Jordan has one of the most modern health care infrastructures in the Middle
East. Jordan’s health system is a complex amalgam of three major sectors: public,
private and donors. The public sector consists of two major public programmes that
finance as well as deliver care: the Ministry of Health and Royal Medical Services.
Other smaller public programmes include several university-based programmes, such
as Jordan University Hospital in Amman and King Abdullah Hospital in Irbid. In
2001, the total expenditure on health services accounted for about JD 598 million,
9.5% of the GDP. Health expenditure per capita was JD 115 (Jordan’s National Health
Accounts, Draft Report, 2004). Each of the health care sub-sectors has its own
financing and delivery system that reflects directly on contractual arrangements
among these sectors. The following description gives an institutional overview of the
health care financing and delivery of each sector.
Ministry of Health
The Ministry of Health is the major single institution financer and provider of
health care services in Jordan. It is the largest in terms of the size of its operation and
utilization as compared to Royal Medical Services, Jordan University Hospital, King
Abdullah Hospital, or others in the private sector. The Ministry owns and operates 27
hospitals in 11 governorates, with 3462 hospital beds accounting for 37% of total
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