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Syria: Syria Health Profile 2012

2012/04/04

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Syria Health Profile 2012

Outline of the evolution of the Health Care System

The health situation in Syria
According to the preliminary results of the 2004 census (conducted during September  2004), Syria has a population of 17.735 million. This is compared to 13.782 million in 1994. The population growth rate has fallen from a high of 3.34% in the 1970-1981 period to 2.55% in the 1994-2004 period. The population growth rate is projected to fall further to 2.28% over the next ten years, and the population is projected to reach 22 million in 2014. Compared to countries of the Eastern Mediterranean region, Syria enjoys a middle rank for most indicators. The health situation for the population, especially in rural areas has witnessed tremendous improvements since the 1960s. The government has placed large emphasis on providing free health services to the Syrian population. During the 1960s, health policy focused on dealing with communicable diseases and malnutrition. In the 1970s, health policy focused on expanding the health infrastructure to provide basic health services. Since the 1980s, the focus has been on the provision of primary health care and preventative medicine (UNDP, 2000).


Constitution mentioned that all kind of health services and social care especially item 46 and 47 are under the responsibility of the Government of Syria to all people, for that until 1998 all Kind of health treatment free of charge after that some hospitals started to be autonomous hospitals. Most of the information and reference in Syria is related to year 1970. For that purpse all the health data gives a comparison between 1970 and 2002, 2004 or any other year. The information collected and analyzed reveals the complexity of the Syrian health sector. The core characteristics of the sector are given as under:

  • A substantial improvement in summary health indicators and life expectancy
  • Diseases profile expressing the magnitude of chronic diseases and existing risk of communicable diseases
  • A widespread, generally under equipped but well staffed free public offer of care with areas of high technology available in the main cities
  • The presence of a well established private sector working in integration with the public sector is performing below the targeted mark
  • A well established move towards modernization of the public health sector (reorganization of the MOH, autonomy of public hospitals, development of public health care)
  • The existence of various schemes of health insurance covering selected categories of the public and private employment

The Constitution of Syria defines the right of all the population units for comprehensive health coverage. The organizational structure of the statutory health system furnishes the responsibility of provision of coordinating and managing health services to the Ministry of Health. Added responsibilities for financing, administrating and providing health services are prearranged to the following bodies: Ministry of Finance (MoF), Ministry of Local Administration (MoLA), State and Planning Commission (SPC), Ministry of Higher Education (MoHE), Ministry of Social Affairs and Labour (MoSAL) and Ministry of Defence (MoD). Additionally, the other Ministries state companies and majority of the professional associations provide health care services for their employees as well as to the dependents upon them, directly and indirectly. The role played by the private sector for delivering health care services has substantially increased, in recent times.

Brief description of current overall structure
The Syrian health care system is a mix of private and public provision. The government is working to ensure availability of services in urban as well as in rural areas. Although most of the villages in Syria have a government clinic or health center, rural areas have smaller number doctors and clinics. Doctors who have finished medical school and who do not intend to specialize are obliged to practice in rural areas for at least two years, usually through a government health center. The same is obligatory from the dentists and pharmacists. Since government salaries for doctors are quite low. They are allowed to set a private practice, while working in a government health center, also.
Services are offered free of cost to all the citizens at government clinics and health centers. Government employees and their dependents can also fully or partly reimburse their charges / claims incurred during private health care and medication. Some Syrians prefer to pay for high-quality private services, rather than using free public services.

Trends in financing sources
The financing flowchart is opened in the figure. In general, there are three major types
of financing agents: the public sector, the professional associations and the households.
The public sector refers to the expenditures of various ministries, and it includes
expenditures of owned state companies. In terms of the primary sources of funding, the
public sector is mainly funded by the state budget through general taxes, while
professional associations are funded by private funding (employees/workers).

Levels of contribution, trends, population coverage, entitlement
On health care 43-50% of the total expenditure is directly from derived from the government budget. The health care services are technically “free” at the public facilities in Syria. The sources of public health financing in SAR are mainly a combination of oil revenues and general tax revenues. Tax revenues are progressive from 10% to 45% for societies, and, from 5% to 15.5% for personal income. However, few data are available concerning how progressive is the health financing system in respect of income. Nonetheless, it has been reported that 60% of the economy does not contribute to  income tax, and that private sector companies are evading high profit taxes. To drain resources from elusion and evasion toward the health sector may represent a double opportunity for the government as a larger income and profit basis will increase the source of public financing.
Key issues and concerns
In this framework, a policy of general tax reduction would hamper the chance to promote a fairer financing. Health inequalities will increase. The rich will be in receipt of far good health services with their own spending. The poor will cope with less health care than before. On the contrary, a fair health financing requires a larger and progressive taxable income to protect everyone’s health. Economic constraints limit the possibility of huge increases in tax collection and thus in public expenditure through this source. However, it is important to highlight that the experience of upper income countries shows that reasonable standards in terms of equity and quality of services require increasing amount of public funding. As a consequence, this scenario would rely on the government commitment to give high priority to public health funding and to show its value in terms of health improvement, reasonable equity and social cohesion. As an alternative source, financing health care may also be considered as the possibility of earmarked taxation for health.

The above comment show that there is a serious lack of published data on many aspects of the health sector in Syria. Specifically, data on the private health sector and on trade in health services is very scant. The MOH has identified health management and administration as a priority area for strategic direction over the next five years. This involves developing an evidencebased decision making system. The MOH has plans to introduce telemedicine, create electronic health records and electronic database systems. Collecting and processing such data on a timely basis will make the decision making process more transparent and efficient.


On the policy-making level, the important issues to consider when developing a strategy on trade in health services are:

  • − Making sure resources are not channeled away from the poor or from rural areas.
  • − Ensuring that the level of health care provided to the less affluent segments of  society sustains a minimum level of acceptable quality by increasing salaries of public sector health professionals to minimize the potential “brain drain” internally and externally.
  • − Ensuring that the same health services are available to foreigners and locals alike.
  • There are, on the other hand several potential opportunities that can arise from trade in
  • health services. These are:
  • − More accessible health services due to telemedicine
  • − Attracting patients and students from abroad can generate the funds required to improve the Syrian health care system
  • − Foreign investment in the local health care sector can generate additional resources for the government, lead to the transfer of knowledge and technology, and reduce the burden of government expenditure on the health sector.
  • − Remittances and transfers of professionals working abroad can have a positive effect on the balance of payments
  • − Syrian professionals abroad can learn new skills and become exposed to new technologies.

Encouraging and regulating private provision of health services, and encouraging private health finance schemes should, however, be the on the top of the government’s list of priorities. A well-organized, efficiently managed health system will be more successful at attracting foreign investments to the sector and at producing the  exportable caliber of medical staff.