Thanks Neil,
On these questions I would like to reflect on an advocacy campaign that was involved in. [*see note below]
Around 2014, Iraq was going through a devastating security, financial and political crisis. ISIS has occupied the second largest city in the country, oil prices have plummeted and there was political stalemate. The Kurdistan Regional Government at the time simply did not have the resources to continue providing essential health services. It decided to introduce what has become known as the 'semi-private' system. Essentially this meant that after 1 pm, government facilities were allowed to charge private market fees for the publicly funded services they were providing. The revenues from this system are used mainly to pay for health professionals salaris.
A number of civil society organisations came together to advocate against this policy. We had meetings with policy makers including the ministry of health and the health committee of the Parliament. We provided evidence regarding the negative impact of such policy on people's financial wellbeing. We offered real life examples of people who had to sell properties, lands, borrow money... etc to pay for healthcare. We cited World Bank research that suggested that out of pocket healthcare expenditure was one of the main causes of impoverishment in Iraq. We presented evidence about the impact this policy will have on the failure to achieve SDGs and UHC in the country. We also offered suggestions on how to raise revenues, pool them and spend them in a more efficient manner.
Unfortunately, we were (and still are) unsuccessful in stopping and reversing this policy. I think we were against strong odds. On one hand the financial situation was really bad. On the other hand, the doctor and nurses pressure groups were stronger and were forcefully behind the policy. Furthermore, there were strong interest groups who were advocating against measures such as taxes on tobacco, alcohol, sugar...etc.
So in relation to question 4. I guess we did not lack evidence both researched and anecdotal. However, it seems to me that the answer in relation to the questions about barriers to the uptake of such evidence lies in the political economy of the context. However, and this is related to Q5, it seems to me that without those advocacy activities that we engaged in, the situation could have been even worse. Therefore, having mechanisms such as civil society advisory committees within ministries of health might be a useful start.
HIFA profile: Goran Zangana is a medical doctor and Associate Research Fellow with the Middle East Research Institute, Iraq. He is a HIFA country representative for Iraq and is currently based in the UK. He is the current holder of Country Representative of the Year 2021. He is also is a member of the HIFA working group on SUPPORT-SYSTEMS - How can decision-making processes for health systems strengthening and universal health coverage be made more inclusive, responsive and accountable?
https://www.hifa.org/support/members/goran
https://www.hifa.org/projects/new-support-systems-how-can-decision-makin...
goran.zangana AT meri-k.org
[*Note from NPW, moderator: Thanks Goran. As we enter our final week, here are the five guiding questions in full:
1. What does civil society participation in health policy mean and why is it important to have civil society participation in health policy processes?
2. Have you ever participated, either through a civil society organization or as an individual, in health policy processes at a national or sub-national level? What was your experience?
3. Can you share examples of the role of CSOs in policymaking at national or sub-national levels?
4. What do you think are the different types of evidence that civil society can provide, that otherwise would not be considered? What are the main drivers and barriers to uptake and use of such evidence?
5. From your perspective, what are promising practices for creating greater space for civil society participation in health policy processes and for using evidence from civil society more effectively to improve health policymaking for UHC at national and global level?]
