With health listed as one of the top priorities of the 11th Five-Year Plan, Health Minister Rida Said shares his vision to make health cover available to every Syrian.

Let’s start with the good news: life expectancy is up and child mortality is down; what are we doing right and what are the challenges ahead?

In principle, the health system is good. We have good hardware - that means hospitals, primary healthcare units, dispensaries etc, all over Syria - and we are planning more.
The main problem in the public sector is the human resources.
The latest health expenditure survey showed more than 50% of health costs are being paid out of pocket. Why are most people choosing to go private?
In the ideal health system we will have universal coverage for each and every citizen.
The main problem is mismanagement of the public health system. We don’t have full time doctors working in hospitals and we have a certain laxity in the culture of the public system. That’s partly because of low salaries and a lack of involvement and also a lack of a sense of responsibility (on the part of employees) towards their public function.
At the moment each doctor is obliged to work a second job because the salary is low, which means that they are not fully committed to their work in the public domain. This, of course, is not a problem with the Ministry of Health but a legislative problem.

Does this mean removing caps on doctor’s fees?

No, I’m talking about moving towards a different model, heading towards independent hospital units. That means hospitals will be independently operated - administratively and financially - allowing them to offer paid services to insurance companies and collect certain fees from patients without abandoning complete coverage for people in need. In this way, the hospital has a secured income and from that income there will also be incentives for medical staff, which will not only improve their financial situation but will allow them to fulfill their capacity as public employees.

What is the difference between what you call “independence” and “privatization?"

We are definitely not going to privatize our public hospitals. The income and policies of the hospitals will be managed by the government, hence they will remain public. They are free of charge for those that need it and emergency services will be free of charge for everybody. The fees to be collected will be fixed by the ministry, taking into consideration the social and financial status of the citizens involved.

That means fees will be tailored according to affordability?

Yes, but the key thing is that they remain public run. The idea is that we attract a higher quality of medical services because, under this system, medical staff will have a full time job at the hospital - they will get a higher basic salary plus incentives.

What about the move to increase health insurance coverage?

We are starting to introduce health insurance in Syria and we now have a public health insurance system that covers all government employees. Soon it will be extended to their families as well, which will mean we cover nearly a third of the entire population.

There is also an increase in the number of private insurance companies. All private companies are starting to insure their staff for medical services.

So, in the end we will have three categories of patient - the wealthy patient who is going to pay for his services, either at private hospitals or at public hospitals that have a private sector. Then you have the insured people who will be covered by their insurance. The ministry will foot the bill for the third category of patient, who have neither money nor insurance.

Let’s talk about the private sector. What is the role of private foreign investment in healthcare in this new model and how is private investment being encouraged?

The private sector is on the health map and we will continue to encourage this, whether they are not-for-profit or profit. We are encouraging investment in this field and giving incentives and facilities to investors on the condition that they meet international quality standards at their hospitals.

Private facilities with high international standards don’t have to comply with local charges for medical services. They are also allowed to have a certain percentage of foreign medical and administrative staff.
We will be setting up a system so that we can buy services from them in fields that do not exist in the public sector, according to the new PPP law.

We are enhancing investment opportunities; private investors give services to the wealthy and at the same time they might also assist in developing the health tourism industry in Syria.
We are going to create a national emergency system based on all levels of this service - that means ambulances, helicopters and a central command.
We will be financing all of these things through different sources. The plan is that the expansion of the insurance sector will help to cover a certain percentage of the health cost.

But this has nothing to do with the planning for full coverage by the ministry. Our plan is to increase coverage for Syrians whom the private sector is not prepared to cover. We will continue to insure Syrian citizens who do not choose to use these facilities. We will continue to provide medicines free of charge to all those people in need, and full coverage for those with diabetes, chronic diseases, hepatitis, that kind of thing - so the government is still acting in the role of the primary healthcare provider.

You say human resources are the challenge; what kind of investment is being set aside for medical training?

Under the new structure some hospitals will be accredited as teaching hospitals. These hospitals will have a council, run by the Ministry of Higher Education, to train medical students and residents in-house.
We are developing our training and educational facilities to produce graduates in needed areas of hospital management, health financing and other public health professions that are required.

We have a shortage of nursing staff in Syria - what is being done to address it?
At the moment we have 39 nurses for every 10,000 citizens. We need to double that number, at the very least.

We have created faculties of nursing in Latakia, Hama, and Deir ez-Zour but we are still giving support to the school of nurses. We will license new private nursing schools, which will also work on enhancing nursing services.

We have a young and rapidly growing population. How much of a burden is this on the public health system?

It’s a huge problem that we are taking very seriously. We are working with the family planning association on measures to lower the birth rate. Whatever investments we make, they cannot keep up with such a high growth rate. It doesn’t just affect health - this is a problem for all sectors.

What does this mean? Promoting birth control?

It’s about promoting sexual education, contraceptives, education across all societal levels. We are working with the education department and also religious authorities, for example to forbid the marriage of women below a certain age. This is a big task that will take coordination from all ministries.

One of the recommendations made as a result of the 2009 household expenditure survey, was that we need to target preventative medicine, particularly communicable diseases, What needs to be done to implement this?

The biggest problem is not infectious diseases. It’s non-communicable diseases - cardiovascular disease, hepatitis and cancer - that are costing the state most and which are the major causes of death amongst Syrians.

Care is given to all communicable and non-communicable diseases and we created a nationwide system to deliver the required services for patients with hepatitis, tuberculosis, leishmania, diabetes etc.
We have created a new directory for these and are restructuring the system in how we deal with the primary healthcare for these diseases.
In the prevention of inherited diseases, we have established the premarital exam and genetic counseling.

In summary, what is your vision for the next five years?

Big changes take time and we need some time to perceive some of the changes we have embarked on. I think the health system is going to be greatly improved in the coming years.
I want to see patient satisfaction from their very first encounter with any public health service. I want to see an efficient emergency system, which is a major responsibility of the ministry. I want to see every citizen, wherever they are in the country, getting access with equity to quality medical services through their local provider.

At the same time, I want to see the emergence of a very high standard of private hospitals.

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