History of Jordon
• Jordan is a small مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arab country that has limited natural resources.
• The current state of the healthcare system was developed after World War I
• Historically, the country’s land was well known as where major highways connecting the Middle East met and crossed. Thus, its location has always been of great strategic importance to trade and communications.
• Jordan has been under the control of various مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arab and Islamic dynasties, the last of these being the four centuries of Ottoman rule
• In 1946, Jordan received its full independence from the British and became known as the Hashemite Kingdom of Jordan, with King Abdullah named as the first king of the country.
Size and Geography
• Jordan has a coastline of 16 miles (26 kilometers).
• The land area is 34,318 square miles (88,884 square kilometers), and the water area is 127 square miles (329 square kilometers).
• Jordan’s total area is 34,445 square miles (89,213 square kilometers).
• The landforms in Jordan are generally flat desert plateau, east, and west.
• In the west, the Great Rift Valley (high hills and mountains) separates the East and West banks of the Jordan River.
• Significant bordering water bodies include the Dead Sea, the Gulf of Aqaba, and the Sea of Galilee. The highest point, Jabal Rum, reaches 5,689 feet (1,734 meters), and the lowest point is the Dead Sea at −1,338.6 feet (408 meters) below sea level.
Government and political systems
Jordon government system is parliamentary with a hereditary monarchy.
The king is the head of state, the chief executive, and the armed forces’ commander-in-chief.
The king exercises his executive authority by appointing a prime minister, who then organizes a cabinet of ministers that has to be approved by the king.
The prime minister and the cabinet must then be approved by the lower house of Parliament, the House of Deputies. If the House of Deputies votes against the prime minister, he and his entire cabinet must resign.
The Lower House can also vote any individual minister out of office. The king also appoints all of the upper houses of Parliament, known as the Senate. The number of senators cannot exceed one-half of the number of elected representatives.
The Constitution in Jordan specifically guarantees Jordanian citizens’ rights, including the freedoms of speech and press, association, academic pursuit, organization into political parties, religion, and the right to elect parliamentary and municipal representatives.
Macroeconomies
Jordan’s economic resources are based on phosphates, potash, fertilizer derivatives; tourism; overseas remittances; and foreign aids.
These are Jordan’s principal sources of hard-currency earnings. Jordan lacks forests, coal reserves, hydroelectric power, and commercially viable oil deposits.
Demographics
• Jordan faces a unique situation in terms of its demographic transition.
• In 1980, the population was 2.2 million, doubled by 1999, and is expected to double again by 2035.
• In 2015, there were an estimated 8,117,564 people in Jordan, with a median age of 22 years, reflecting a young population.
• Infant mortality rates had dropped from 160 per 1,000 live births in 1950 to only about 14 per 1,000 live births in 2016
• In 2015, the population’s age distribution was as follows: 35.42% were under the age of 15, 60.67% were between the ages of 15 and 64, and only 3.91% were 65 years of age or older.
Brief History of the Healthcare System
Pre-World War II
• Jordan’s healthcare system passed through two distinct phases.
• Before Jordan, the first phase (1921–1946) was recognized as a kingdom.
• In 1921, Math’har Pasha Arsalan was recognized as the first health consultant to work in Jordan, and Dr. Rida Tawfiq was appointed as director of health.
• That same year, Jordan’s first public hospital was established with 20 hospital beds. In 1923, Transjordan issued its first health law related to hospital medicine and was issued by the time’s advisory council.
Pre-World War II
• The first regulatory health law was decreed in Transjordan in 1926 and was used until 1971.
• About 28 male and female physicians worked in Transjordan by 1926, and the number increased to 39 by the end of the following year.
Since world war II
• The second phase started in 1948 and has continued until the present.
• During this phase, the مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arab-Israeli wars occurred, which added more burdens on the healthcare system because of the large influx of Palestinian refugees.
Description of the current health systems
Facilities
In 2015, there were 104 hospitals in Jordan, up from 95 in 2002, with 13,115 hospital beds, 38.3% were in MoH hospitals, 19.2% in RMS hospitals, 8.9% in the two university-based hospitals, and 33.6% in private hospitals.
In 2015, there were 104 hospitals in Jordan, up from 95 in 2002, with 13,115 hospital beds, 38.3% were in MoH hospitals, 19.2% in RMS hospitals, 8.9% in the two university-based hospitals, and 33.6% in private hospitals.
Description of the current health systems
Workforce
• In 2015, the private sector employed most health professionals, with 71% of all physicians working in the private sector, 92% of all pharmacists, 85% of all dentists, and 22% of all nurses.
• Jordan has a large workforce of health professionals.
• The rate of health professionals per 10,000 in 2015 was as follows: 27.30 physicians, 7.10 dentists, 12.70 pharmacists, 13.50 registered nurses, 5.24 associate degree nurses, 4.05 assistant nurses, and 2.02 midwives.
• Technology and equipment
• Jordan’s healthcare infrastructure is considered modern and better than many middle-income countries in the region.
• However, the country continues to lag in medical equipment production, which is generally below international standards and limited to beds, medical dressing, plastic syringes, some optical products, and dental supplies.
• In 2004, however, the MoH set a plan with public and private sectors to generate the annual US $1 billion in medical tourism by 2010.
• Jordan’s pharmaceutical industry was the second-largest exporting industry in 2014 (80% of Jordanian production was exported, and Jordanian firms are the biggest pharmaceutical exporters by trade volume in the region).
Technology and equipment
• There were 22 factories in the pharmaceutical sector, with 5 major companies dominating the export business.
• The sector has modern plants, established regional marketing channels, and a skilled, low-cost workforce.
Evaluation of the healthcare systems
Cost
Jordan spends a high percentage of its GDP on health.
In 2014, 5.10% of GDP was spent on health by the public sector alone, down from 5.92% in 2010.
The total healthcare expenditure in 2014 was approximately JD1.89 billion (the US $2.7 billion), which translated into a per capita healthcare expenditure of JD255 ($359).
One of the largest constraints of the healthcare system in Jordan has been pharmaceuticals’ high cost.
Jordan’s healthcare system is financed by three sources: (1) public funding, household spending, donor contributions.
Quality
In the country, chronic diseases are the leading cause of Jordan mortality. The leading cause of death in 2012 was circulatory system diseases, attributed to 36.7% of deaths.
Within this group, ischemic heart diseases rank first with 11.4%, followed by hypertensive diseases at 10.6% and cerebrovascular diseases at 9.1%.
Neoplasms were the second leading cause of death at 16.2%.
The leading causes within that group were throat and lung cancer, intestine cancer, and breast cancer.
The age-adjusted death rates were highest among the older age groups.
The total fertility rate in 2013 was 3.2. Although Jordan seems to have accurate mortality data, morbidity data are inadequate with almost all non-MoH clinics and health centers and most hospitals, not coding diseases
Jordan, however, has achieved universal child immunization since 1988. It has been polio-free since 1995, and no diphtheria cases have been reported since 1993, with a small number of pertussis and tetanus cases reported.
It is estimated that 97% of children have been immunized for polio, diphtheria, pertussis, and tetanus.
The public sector programs are comprehensive and include access to pharmaceuticals with minimal cost.
Access
Individuals in Jordon are eligible for more than one insurance program, and many choose to pay out-of-pocket premiums to maintain private insurances.
It was estimated that in 2015, 48% of the population was covered through the MoH or RMS, and an additional 20% was covered through private insurance or UNRWA. The remaining 32% that were not eligible for free health care through the public sector were still able to purchase all MoH facility services at highly subsidized prices, thus making it possible for everyone to receive health care.
Current emerging issues
Non-communicable diseases
• As Jordan has gone through both epidemiologic and demographic transitions, the expected declines in infant mortality, maternal mortality, total fertility rate, and infectious diseases have occurred. Still, these have given rise to an increase in non-communicable diseases, such as cardiovascular diseases and cancer.
• These changes have occurred at a fast rate, with the declines starting in the late 1970s, and have burdened the healthcare system, which was equipped to deal with the communicable diseases but not with the non-communicable diseases, which often require more expensive diagnostics, treatments, and more training for the health professionals.
Environmental factors:
• Jordan is considered one of the world’s 10 most water-stressed countries. In addition to the lack of water resources, pollution has worsened the situation.
• The majority of water pollution is linked to a lack of domestic wastewater management and disposal of industrial waste, which leaches from unsanitary solid waste landfills and agrochemical sources.
• It is estimated that the annual use of chemicals has increased dramatically, leading to increases in chemical poisoning and detrimental environmental impacts, which can be attributed to a lack of oversight and legislation.
• The decline in air quality has also been associated with the increased emission of pollutants.
Effects of refuges in Jordon
• There is a large influx of refugee populations in Jordon since its independence which has affected its healthcare system.
• UNWRA data indicated that over 2.1 million Palestinian refugees were registered in the country in 2015, and the UNFPA estimated the number of Iraqis residing in the country to be 481,000.
• There are differences in these two groups’ health statuses and health access.
• The UNWRA has been serving the majority (60%) of Palestinian refugees in Jordan. Their health status report for 2015 indicates that the Palestinian refugees have generally had similar health status to the Jordanian population.
• Fertility rates have dropped significantly for this population, largely because of UNWRA’s family planning programs supported by the MoH in providing contraceptives.
Health system challenges
• The demographic changes representing an increase in population and higher life expectancy.
• Considerable changes in lifestyles favoring the development of determinants and risk factors for chronic diseases, accidents, injuries, and substance abuse.
• The epidemiological transition and changes in the pattern of the disease characterized by a progressive increase in the magnitude of non-communicable diseases like cardiovascular diseases, cancer, diabetes, mental health problems, and accidents and health of the elderly.
• Inefficiencies are observed in the provision and financing of health services.
• The lack of a rigorous appraisal (and reorientation) of the current state of human resources development in health.
• The negative impact of poverty on accessibility to quality health care, particularly because of the high proportion of uninsured people.
• The public’s increasing demands and expectations for effective and accessible health care. The rapid advances in technology and rising healthcare costs.
• Inadequate coordination between the public sector and the increasingly significant private sector and the lack of effective monitoring and auditing clinical practice systems.
• The emerging environmental health issues.
• Reproduced from World Health Organization. Health System Profile—Jordan.
