Tour D'Horizon of Jordan's Health Sector: Cancer Driving

UNCLAS SECTION 01 OF 02 AMMAN 002394

SIPDIS

STATE PASS USAID

E.O. 12958: N/A
TAGS: TBIO SOCI KHIV JO
SUBJECT: Tour D'Horizon of Jordan's Health Sector: Cancer Driving
Regional Cooperation and Institutional Reform


1. Summary: Jordan's biggest health priority is non-medical; it
needs to develop a comprehensive national health strategy.
Jordan strongly supports the NIH-supported Middle East Cancer
Consortium. HIV/AIDS and cancer are not as problematic in Jordan
as are chronic, non-infectious "lifestyle" diseases such as heart
disease and diabetes brought on by diet, obesity, lack of
exercise, hypertension and smoking. End summary.

Health Issues Shift as Society Develops
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2. ESTHOff and ESTH Specialist reviewed Jordan's health
situation with Ministry of Health (MOH) Assistant Secretary
General for Hospitals Dr. Samir Al-Kayed, and with CEO of the
King Hussein Cancer Center Dr. Samir Khleif. Dr. Khleif was
seconded from the U.S. National Institutes of Health (NIH) and
came to Jordan two years ago to run the Cancer Center. The
picture that emerged from the meetings is of a society in
demographic and epidemiologic transition from an agricultural
society to an industrial, service-centered, essentially urban
economy, with corresponding changes in health status. "Medical
tourism" to Jordan from other Arab countries, including Yemen,
the West Bank, Djibouti, Algeria, Libya, Sudan and Saudi Arabia,
is an important component of Jordan's health care sector and
actually provides the revenues to support Jordan's entire health
care sector.


3. The biggest causes of mortality in Jordan are cardiovascular
diseases, accidental deaths (including car accidents) and cancer.
Dr. Khleif said that heart disease, Jordan's number one killer,
could be easily reduced through awareness programs on obesity and
smoking. He said 55 percent of Jordanian males above age 15 are
smokers.

Cancer in Jordan - Low but Will Grow
--------------

4. Overall, cancer rates in Jordan are one-third those in the
United States, although this is misleadingly low because of
Jordan's young population, where sixty-one percent of the people
are below the age of twenty-five. As population growth slows and
the population ages, cancer rates will rise. Dr. Khleif said
Jordan's biggest problem is the current emphasis on treatment
rather than on early detection. Cancer treatment (but not
detection) is free in Jordan, and represents a large fraction of
Jordan's medical budget.


5. Dr. Al-Kayed said that he is the head of the Jordan Cancer
Society, which has formed an innovative "Committee for Early
Detection." The structure of this committee is innovative
because it is chaired by a physician from the Senate, and
includes representatives from government, academia and the
private sector.


6. Dr. Khleif said the current emphasis on cancer treatment
versus detection highlights the lack of a long-term focus in
health care. Early detection programs and anti-smoking campaigns
would save money by reducing treatment and disease incidence, he
said. MOH is currently developing a ten-year strategic plan that
should address some of these planning deficiencies and take a
more comprehensive, long-term view of health and health-care
costs, he said.

Minister of Health Visits U.S. Twice in A Year
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7. An indicator of the level of interest in health care reform
is the fact that Minister of Health Said Darwazah recently
visited the United States for the second time in less than a
year. Darwazah had visits in Washington with NIH and the
Department of Health and Human Services, and went to Atlanta to
visit the Centers for Disease Control. Dr. Khleif described
Darwazah as open-minded and activist. One of MOH's goals,
according to Khleif, is developing a Jordanian Food and Drug
Administration that hews to standards set by the U.S. FDA. Mr.
Darwazah comes to MOH from the private sector, where he was CEO
of Jordan's largest pharmaceutical company, which exports 70
percent of its products. Minister Darwazah is an Industrial
Engineer trained at Purdue.

Human Resources: Need Training, Balance
--------------

8. Dr. Khleif said one deficiency in Jordan's health care system
is skewed human resources, with adequate numbers of well-trained
doctors but with insufficient support staff such as nurses and
technicians. MOH has more than 23,000 employees, among which are
7,000 nurses and 4,000 doctors, said Dr. Al-Kayed. Jordan has
twenty-nine public hospitals and sixty private hospitals. There
is demand for more, especially for specialized facilities, Al-
Kayed said. Dr. Khleif stated, that in his opinion, MOH health
facilities lagged behind private, royal and academic facilities
due to a lack of staff and resources. The large military health
system is separate from the MOH and covers 40 percent of the
population.

Healthcare More than Treatment
--------------

9. Dr. Al-Kayed said that MOH is strongly interested in training
in all fields, especially in administration and technical
training, and Dr. Khleif echoed these remarks in a separate
meeting. MOH's mission is not just medical services, Dr. Al-
Kayed said. MOH wants to expose its staff to "other experiences"
to give them a more rounded view of health care practices
internationally. He noted that training opportunities in the US
are decreasing because of visa difficulties, restrictive
regulations, and rising expenses.

Government Seeks to Expand Insurance Coverage
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10. Financial management and insurance are other key concerns of
the Ministry of Health, Dr. Al-Kayed said. Under the current
arrangement, over 300,000 people receive free care provided by
the government. He said that more than two million people pay
for insurance, including military and government employees. More
than 70 percent of Jordanians have some form of health insurance,
he said. Nonetheless, the government is looking for ways to
expand public insurance, to include senior citizens, for example.

MECC Gathering Steam Despite Israeli Connection
-------------- --

11. Dr. Al-Kayed is Jordan's representative to the Middle East
Cancer Consortium (MECC),which receives direct support from the
U.S. National Cancer Institute, part of the National Institutes
of Health. Jordan, the Palestinian Authority, Israel, Cyprus,
Egypt and Turkey are full members of MECC, and other Middle
Eastern countries, including Yemen, have participated in MECC
functions. MECC is reaching out to encourage participation from
Lebanon, Tunisia and Oman.


12. MECC will meet in Amman on March 26, when American Cancer
Society CEO Dr. John Seffrin will participate. It has a
Ministerial-level Steering Committee, and a Board of Governors
with one representative per member country. Al-Kayed is Jordan's
representative and is also the current head of the Board of
Governors. MECC's Executive Director is Dr. Michael Silbermann,
an Israeli based in Haifa.

MECC Programs: Cancer Registry, Training
--------------

13. MECC's flagship program is a National Cancer Registry in
each country, which captures data on cancer cases as a step
towards analyzing the demography and etiology of the disease.
The equivalent database in the United States is SEER
(Surveillance Epidemiology and End Results -
http://seer.cancer.gov/),run by the National Cancer Institute.


14. At MECC's most recent meeting in January 2005 in Larnaca,
Cyprus, members proposed a Middle East Regional School of
Oncology, perhaps located at the American University of Beirut.
While this is purely a notional idea without funding, the idea
itself demonstrates the seriousness and initiative with which
MECC members approach their work. The week of February 22, MECC
had a course in Cyprus on the mechanics of operating a cancer
registry. Jordan sent eight persons to that course, and Egypt
sent twenty. MECC also has two training programs in the works, a
course in Izmir, Turkey in May for radiological technicians, and
a course in the Fall on palliative care for cancer patients.

No Pain, No Gain
--------------

15. Comment: Jordan is well behind the United States in many
aspects of its healthcare system but clearly sees that sector as
critical and is willing to undertake the pain of reform to bring
it up to speed.

HENZEL