Health system challenges for the management of cardiovascular disease and diabetes: an empirical qualitative study from Syria
To explore through empirical qualitative data health system barriers to effective management of cardiovascular disease and diabetes in Syria before the crisis, and how such analysis can inform the building of a post-crisis system.
Data were collected through document review, semi-structured key informant interviews, and fieldwork in clinics.
Institutional commitment to address the increasing burden of CVD and diabetes in Syria was limited and uncoordinated. Challenges included an increasingly split healthcare system, with private provision for those who could afford it, and a residual state health sector for the majority. Public trust in the system had been declining.
We conclude that lack of effective management of CVD and diabetes indicated weaknesses of the state and its retracting role in providing effective healthcare. Such weaknesses that existed before the crisis are now compounded by new challenges resulting from wide destruction of the health system due to the ongoing war. The rebuilding of post-conflict heath care system may benefit from insights into the structural problems of the pre-crisis system.
KeywordsHealth system Syria Aleppo Cardiovascular disease Diabetes Qualitative study
The research on which this article is based was conducted as part of MedCHAMPS, a project funded by the European Commission under the Framework 7 Programme (Grant No. 223075).We would like to acknowledge the contribution of Professor Julia Critchley, the Scientific Coordinator of MedCHAMPS.
- Ahmad B, Sudermann Y (2012) Syria’s Contrasting neighbourhoods: gentrification and informal settlements juxtaposed. St. Andrews Papers on Contemporary Syria, BoulderGoogle Scholar
- Ben Romdhane H, Husseini A et al (2012) Non-communicable diseases—II: focus on cardiovascular diseases. In: Jabbour S, Giacaman R, Khawaja M, Nuwayhid I (eds) Public health in the Arab World. Cambridge University Press, Cambridge, pp 164–177Google Scholar
- Dashash M (2009) Mapping of health financing in Syria: MoH and WHOGoogle Scholar
- Fouad MF (2013) The Health Sector and Civil Society. In: Kawakebi S (ed) Syrian voices from pre-revolution Syria: civil society against all odds. Humanist Institute for Co-operation with Developing CountriesGoogle Scholar
- Hinnebusch R (2012) Forward: urban divergence under neoliberalism. In: Ahmad B, Sudermann Y (eds) Syria’s contrasting neighbourhoods. Gentrification and informal settlements juxtaposed. University of St Andrews Centre for Syrian Studies, FifeGoogle Scholar
- Jabbour S, Rawaf S (2012) Seeing the trees, not missing the forest. In: Jabbour S, Giacaman R, Khawaja M, Nuwayhid I (eds) Public health in the Arab World. Cambridge University Press, Cambridge, pp 357–361Google Scholar
- Palmer N, Mills A et al (2002) A new face for private providers in developing countries: what implications for public health? Bull World Health Organ 80:292–297Google Scholar
- Sen K, Al Faisal W (2012) Syria: neoliberal reforms in health sector financing: Embedding unequal access? Soc Med 6:171–182Google Scholar
- State Planning Commission (SPC) (2006) The tenth five-years plan 2006–2010. Health sector Damascus, SyriaGoogle Scholar
- WHO-EMRO (2008) Health system profile: Syrian Arab Republic. R. H. S. O. EMRO, WHO PublicationsGoogle Scholar
- World Health Organization, R. O. f. t. E. M. (2011) Plan of action for the prevention and control of noncommunicable diseases in the Eastern Mediterranean Region, WHOGoogle Scholar