Commentary
June 19, 2004
Syria: Gains in Healthcare
Health services in Syria, fully state-supported and free at the primary level, are impressive not only because of their spread and accessibility but their efficiency.
Sadhna Shanker
These days the media provides a nearly unidimensional coverage of west Asia. It is an area where violence seems to be a way of life. In all this din and chaos, often, small wonders that have occurred in this area do not get highlighted. Syria is a country that due to its geographical location remains in the news. It shares borders with Iraq and Israel, apart from Turkey, Lebanon and Jordan. It has 180 kms of coastline along the Mediterranean sea. The country has an area of 1,85,180 sq km. In 2003 the population stood at 17.57 million. It is growing at the rate of 2.45 per cent. More than 40 per cent if its population is below 15 years of age. The overall literacy rate is 76.9 per cent. Currently, 73.7 per cent of women and 90.3 per cent of the men are literate. The GDP is contributed 27 per cent by agriculture, 23 per cent from industry and 50 per cent through services (2000). The per capita income is $ 1,225 one of the lowest in the west Asia. The incidence of poverty is 22 per cent and the unemployment rate is as high as 20 per cent.
The country is situated in a difficult geopolitical area, it has a political system of single party democracy, poverty and unemployment are major issues, yet it has demonstrated commendable progress in its primary health status. Syria spends 5.4 per cent of its GDP on health. (In India also we spend only 5.2 per cent.) Administratively the country is divided into 14 governorates. These have 71 health districts, with 1,444 health centres. They are not uniformly distributed with some areas of the country having more and others less. Nationally, 70.6 per cent of households are within 0 to 3 kms of a government health facility. The minimum services provided at the health centres are reproductive health, family planning and immunisation. Curative services are also provided. Some of the better-equipped ones also provide services of dentists and laboratories. The health sector at the primary level is totally state funded and all the services are provided completely free.
The 'statist' tradition took root early in most west Asian countries giving rise to a large public sector, highly centralised governments and dominant executive branches. They invariably gave high priority to social welfare with varying results in different countries. In Syria this emphasis has produced results that make it one of the better-performing countries in the west Asia.
Child health is an area where Syria has made excellent progress, as is clear from the data in the table.
Indicator 1990 2000 2002 Decadale
Per CentDecline
Infant mortality rate 33 24 18.2 45
Under five mortality 44 29 20 55
The world average of IMR is 57 and the average in the Arab world is 77. In India IMR stands at 68. The world average of under five mortality today is 83 and in the Arab world it is 56. In India the under-five mortality is 20.4. The improved status of child health in Syria is primarily due to a successful national immunisation programme pursued from 1978. Today it includes protection from the six vaccine preventable diseases, Hepatitis B vaccine and a TT immunisation programme for women. The immunisation coverage is well over 90 per cent. The last polio case here was in 1999, imported from India. They eliminated neonatal tetanus in 1997 and hope to eradicate polio, measles and rubella by 2005. The challenge before Syria in the next few years is going to be reduction of neonatal and perinatal mortality so as to bring down the IMR to the level of the best nations in the world.
In the area of reduction of acute malnutrition and chronic malnutrition there has been good progress in Syria. What is interesting is that surveys have shown an absence of any significant male-female differences in the levels of malnutrition. They show, in fact, a marginally lower incidence of malnutrition in females. This is noteworthy considering that in terms of social norms and structures Syria is very much like India - patriarchal and with a bias towards the male.
Maternal health indicators in Syria are also promising. The maternal mortality rate was 123 per 1,00,000 live births in 1990. It came down to 71 in 2000 and to 65.4 in 2002. A decline of 53 per cent in a decade. In India the corresponding figure is a high 407. The total fertility rate was 7.7 in the early 1970s and has declined to 3.66 in 2000. The government has been pushing a family planning programme for two decades and the contraception prevalence rate in 2000 stood at 45.8 per cent. (The corresponding figure for India is 48.2 per cent.) However, as far as family planning is concerned Syria cannot be said to be the most successful countries in this region.
Neighbouring Jordan has a contraceptive prevalence rate of 53 per cent and Lebanon 63 per cent. 'Traditional' family planning methods remain more popular in Syria and it is also a culturally sensitive issue. In many of the writings it has been suggested that the principal cause of decline in the total fertility rate during the last decades has been due to a steady increase in the age at marriage in this period. This has come about because of greater literacy among women. The primary school enrolment of girls was 91 per cent in 2000.
[Continued]