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ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATION WHO health statistic Report 2011 Table 1: Health indicators in Eastern Mediterranean Region shown some improvement in health indicators in the region mainly due to social and economic development but these changes are slow, not uniform and have deteriorated in some countries probably because of poor focus on development of health care services10. Variations between and within countries are still very high. Maternal mortality in Somalia and Afghanistan is among the highest in the world making it a challenge to achieve the target of a two-thirds reduction in the 1990 mortality levels by the year 2015(10). (Table 1 - above) Non-communicable diseases (NCD) are on the rise (11, 12) and deaths secondary to them are projected to increase by 15% globally between 2010 and 2020. The greatest increase of over 20 % is predicted to be in the WHO regions of Africa, South-East Asia and the Eastern Mediterranean region (13). Family Physicians in the EMR There has been an increase in the number of physicians in almost all countries of EMR with the exception of Somalia (13). (See Table 2, page 10). This increase is not uniform and is greater in the oil rich countries of the region, with a significant number of physicians being immigrants of variable professional quality. Despite its established importance, comprehensive primary care is lacking in EMR countries. The number of trained family medicine specialists is low in the region due to imbalance between training needs and training programs and maldistribution of physicians, especially in rural and inner city areas. Deficiency created by the shortage of primary care physicians is either filled up by Family Physicians recruited from various western countries or by adhoc General Practitioners working in the country, who are often neither trained nor committed to the job and therefore fail to provide “Person Centered” care (14,15, 16). The uncooperative attitude of other specialties, poor support from the private sector with an inherent attitude for-profit orientation, along with limited awareness and acceptance among the general population regarding Family MIDDLE MIDDLE EAST EAST JOURNAL JOURNAL OF OF FAMILY FAMILY MEDICINE VOLUME • VOLUME 10 ISSUE 7, ISSUE 6 10
ORIGINAL CONTRIBUTION AND CLINICAL INVESTIGATION Table 1a: Infant mortality per 1000 births Physicians, decreases access to effective delivery of health care. The number of nurses and midwives in EMR countries is static with a fall in numbers in some low income countries due to migration (10). Provision of Primary health care The provision of primary health care facilities in the EMR is variable and several countries from all income groups have shown a reduction in the number of primary health care facilities over the past decades (17). Primary health care in Oman and Iran: Oman invested consistently in its Wilayat health system; a national health service based on principles of primary health care and is able to provide almost universal access to health care for the majority of its population with an overall improvement in health indicators18. Iran has been accredited as a pioneer in providing primary health care services to the community. The primary health care services in Iran rely on trained community health workers called behvarz, trained to meet the basic health-care needs of people living in rural areas and mainly designated to provide service to their own village. Marked improvement in health indicators was observed improving the overall health of the country with a prime focus on rural health, However, due to rapid epidemiological transition and in spite of these achievements, still there is a need to address challenges in relation to changing health needs and preferences from the population and with an emphasis on quality care. (19, 20). Primary health care in Pakistan: The national programme for primary health care and family planning in Pakistan, and lady health workers programme, has trained female community health workers to provide basic health care to the rural population of the country, but while expedient may not in itself guarantee quality of service. A huge improvement in coverage for immunization, antenatal and family planning services in the rural areas of Pakistan has been seen and is being MIDDLE EAST JOURNAL OF FAMILY MEDICINE VOLUME 10 ISSUE 6 MIDDLE MIDDLE MIDDLE EAST EAST EAST JOURNAL JOURNAL JOURNAL OF OF OF FAMILY FAMILY FAMILY MEDICINE MEDICINE MEDICINE VOLUME VOLUME • VOLUME 8 8 ISSUE ISSUE 7, ISSUE 3 5 10
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