Health and Human Capital

Chapter Overview

1. Executive Summary

Health in Iraq Vision 2045 begins with one productive and human question: how much of Iraqis' capacity to learn, work, create and live independently is lost through preventable illness, delayed primary care, uncontrolled chronic disease, untreated mental disorders, or treatment costs forcing households to defer care, sell assets or borrow? This question does not reduce patients to “production workers”; it establishes the connection between the right to health, quality of life and economic capability. ¹¹⁹²⁰

The baseline presents a mixed picture. Life expectancy at birth reached 72.4 years in 2024 according to the World Bank, and the universal health coverage service index reached 64 out of 100 in 2023. Conversely, household out-of-pocket expenditure remained 53.98% of current health expenditure in 2023, while current health expenditure was 5.53% of GDP and domestic government health expenditure 2.55% of GDP. Iraq's problem is therefore not merely “how much does it spend?”, but how financing becomes services, financial protection and health outcomes. ⁷⁸⁹

The latest Ministry of Health data confirm that the system is indeed large: its national comparison platform records approximately 557 public and private hospitals in 2025, 57,598 available beds, 47,241 physicians, 124,973 nursing staff and more than 40.2 million hospital visits. It also reveals that high activity does not equal quality or equitable access: some totals change between years because of coverage, definitions and reporting, and large differences appear between governorates. The Vision therefore does not treat visits or facility numbers as final success indicators. ⁵

The disease burden itself is changing. The World Health Organization estimates that noncommunicable diseases accounted for 63% of Iraqi deaths in 2021, with a 23% probability of premature death from them. Cardiovascular disease, cancer, diabetes and respiratory disease create not only clinical crises, but work absence, early retirement and disability, prolonged household expenditure and sustained pressure on families and the state. The centre of gravity therefore moves from “treating the case” to prevention, detection and continuous follow-up. ¹³

The turning point begins with primary healthcare. WHO itself is working with Iraq from 2026 to 2028 to review the National Health Policy for 2026 to 2035, develop a costed national primary care model, and align policy with universal health coverage. This official pathway prevents the Vision from inventing a parallel system. Primary care must become the continuous, coordinated first point of contact, supported by clear referrals and stronger hospitals for cases requiring them. ¹⁷¹⁹

Prevention offers immediately measurable gains. WHO/UNICEF estimates for 2025 put coverage of the third DTP vaccine dose at 84%, the first measles dose at 95%, the second at 79%, and rotavirus vaccination at 70%. The gap is not the absence of an immunisation programme, but reaching children left behind the average, closing gaps between doses and using data to identify neighbourhoods, villages and groups missing services. ¹²

For mothers and children, estimated maternal mortality was 66 deaths per 100 thousand live births in 2023, while UNICEF data show infant mortality at 20 per thousand and neonatal mortality at 12 per thousand. The Ministry of Health platform also shows recorded caesarean births rising from 46.9% in 2023 to 54.2% in 2025. The Vision does not impose one “ideal” caesarean rate, but makes clinical audit, maternal and newborn safety, and care before, during and after birth part of system quality. ¹⁰¹¹⁵

Iraq does not start from an institutional blank slate. The constitution guarantees healthcare, prevention and treatment; amended Public Health Law No. 89 of 1981 provides the public health framework; and Health Insurance Law No. 22 of 2020 is in force and being implemented gradually. In February 2026, the Health Insurance Fund announced coverage of 2.4 million citizens in Baghdad and plans to expand to nine additional governorates. The decision here is not to replace the law, but to measure whether expansion reduces out-of-pocket payments, improves quality and strengthens primary care rather than becoming merely a card or registration. ¹²³¹⁸

Transformation through 2045 rests on seven shifts: from late treatment to prevention; from hospitals at the centre to primary care coordinating the pathway; from financing institutions to purchasing outcomes; from household payment at illness to financial protection; from fragmented paper files to interconnected health data; from measuring activity to measuring quality and outcomes; and from health separate from the economy to national policy treating healthy life expectancy and functional ability as national wealth.

2. From the Capacity to Work to the Capacity to Remain Healthy

The preceding chapter, “Women and Productive Capacity”, stopped at a deliberate boundary: removing barriers involving transport, care, discrimination and flexibility is insufficient if illness, chronic pain, high-risk pregnancy, mental disorders or unrehabilitated disability make work itself unsustainable. This chapter therefore moves from “Who can enter the labour market?” to an earlier question: “Who has the health capacity needed to learn, work and live independently in the first place?”

This transition avoids two mistakes. The first is treating health as a consumption service competing with education and infrastructure for budgets: good health improves returns to education, extends effective working years, reduces interruptions and supports household income. The second is turning every health problem into an argument for more spending: poorly designed increases can purchase buildings or costly services without improving prevention, access or quality. This chapter's criteria are therefore health outcomes, functional ability and financial protection.

3. The Central Question and Methodological Boundaries

The central question is: how can Iraq, between 2027 and 2045, build a health system protecting life and physical, mental and functional capability, and make primary care, prevention, early detection and continuous treatment available at reasonable quality without financial hardship, so health becomes a driver of human capital rather than a burden awaiting illness?

This chapter addresses primary care, prevention, maternal and child health, chronic disease, mental health, nutrition, occupational health, the health workforce, quality, medicines and diagnosis, data, financial protection and health insurance, and geographical equity. It does not repeat the detail of water, sanitation, waste and municipal public health, covered in the infrastructure and services part, nor build a detailed pharmaceutical industry whose logic was established in the manufacturing chapter.

The evidence base spans several years. The latest documented year is used for each indicator, distinguishing national administrative series, WHO/World Bank databases and HeRAMS reports. Health centre counts from sources differing in the definition of “centre” and Kurdistan Region coverage must not be merged, nor should a fall in visits in one year be interpreted as improvement or deterioration before reporting completeness is checked.

4. Definitions and Measurement Rules

5. Iraq's Baseline: A Large System with Uneven Outcomes

The dashboard's main finding is that Iraq does not have an “absent system”. It has infrastructure, staff, activity, financing, laws and growing digital capabilities. The problem is that final indicators—financial protection, quality of care pathways, prevention, chronic disease and geographical equity—are not improving as quickly as activity expands. This is the difference between a large health sector and a high-performing health system.

A data problem must also become a reform. The Statistics Authority lists 1,970 primary healthcare centres for 2024, while the Ministry of Health comparison platform lists 2,935 main and subsidiary centres for 2024. Averaging the figures does not resolve the difference: definitions, coverage and unit classifications differ. A national health institution dictionary and a unique identifier for every facility, provider and service are required. ⁶⁵

6. Health as Productive Capacity

Health affects the economy in three ways. First, individual capability: people who learn and work in relatively good health produce more and remain active longer. Second, household decisions: chronic illness or expensive treatment can absorb savings and pull family members out of employment to provide care. Third, public finances: a system buying expensive late treatment for conditions preventable or controllable earlier crowds out education, infrastructure and investment.

The economic argument does not reduce health to GDP. Living without avoidable pain and retaining independence, employment and relationships have intrinsic value even without paid work. The Vision therefore combines “healthy life years”, “productive capacity” and “financial protection” rather than one economic indicator.

7. Primary Healthcare: The System's Gateway, Not a Marginal Clinic

Vision 2045 does not build “more centres” before defining their function. A centre may be open yet send most cases to hospital, lack hypertension medicines, glucose tests or basic mental healthcare, or be unable to retrieve referral reports. The basic unit is therefore a care team, community and referral pathway, not merely a building. ¹⁹

WHO is currently working with Iraq to assess primary care delivery and build a costed national model in pilot governorates during the 2026 to 2028 cycle. The Vision uses this pathway with one condition: subsequent national expansion must be measured by functional coverage, access time, treatment continuity and completed referrals, not new centre counts. ¹⁷

8. Universal Health Coverage: Services and Financial Protection

The UHC index of 64/100 in 2023 is a useful external compass, but neither a “health system grade” nor a direct measure of financial protection. The Vision therefore separates service coverage from protection against costs. Access can rise while out-of-pocket payments remain high, or costs can fall because people stop seeking care. Success requires both together. ⁸⁹²⁰

9. Health Insurance and Strategic Purchasing

Health Insurance Law No. 22 of 2020 established an existing legal pathway for coverage and financing. In early 2026, the fund announced coverage of 2.4 million citizens in Baghdad and plans to expand to nine governorates. The Vision does not measure success by card numbers. A year after enrolment, it asks: have point-of-service payments fallen, preventive care increased, medicine access improved and referrals become more orderly, and has the fund paid providers for value and quality or merely invoice volume? ³¹⁸

Strategic purchasing is the link turning finance into incentives. Fee-for-service payment can encourage excess; fixed payment can encourage underservice without quality oversight. The chapter therefore proposes a mix: primary care financing based on population and need with quality incentives; hospital case payments using diagnosis-related groups or equivalent mechanisms once data exist; exceptions for high-cost services; and medical review and transparent complaints. ²¹

10. Maternal and Child Health and the Beginning of Human Capital

Estimated maternal mortality of 66 per 100 thousand live births in 2023 shows that improvement is possible but incomplete. Building a maternity ward is insufficient; the chain begins before pregnancy and ends with postnatal follow-up, including rapid transport, referral, safe blood, newborn care and review of every maternal and neonatal death as an opportunity for system learning rather than automatic punishment. ¹⁰¹⁶

The rise in recorded caesarean births on the Ministry of Health platform to 54.2% in 2025 calls for standardised clinical audit and classification by risk and facility, not an arbitrary campaign to lower the number. Some caesareans save lives; some increases may reflect referrals of complex cases or unnecessary practice. The correct indicator is clinical appropriateness and risk-adjusted maternal and newborn outcomes. ⁵

11. Prevention, Immunisation and Early Detection

The 2025 estimates clearly illustrate the “last gap”: first-dose measles coverage of 95%, versus 79% for the second dose. The task is not proving the programme exists, but identifying who dropped out between doses and why: population movement, incomplete records, distance, refusal, vaccine stockouts or lost follow-up. Digital systems must turn that gap into a worklist for health teams. ¹²

12. Noncommunicable Diseases: The Long Burden on Work and Income

Noncommunicable diseases accounting for 63% of Iraqi deaths means the 2045 system cannot remain designed mainly around acute episodes and hospitals. Hypertension, diabetes, cancer, cardiovascular and respiratory diseases require years of follow-up, medication and risk modification. Failure appears later as stroke, kidney failure, amputation or disability—when health and productivity costs are much greater. ¹³

The Vision builds a “chronic risk register” at primary care level: a known population, screening by age and risk, standardised laboratory results, treatment plans, available medicines, reminders, control reviews and referral for complications. Success is not measured by registered patient numbers; these may initially rise because detection improves. The more important indicator is the share diagnosed who then achieve sustained clinical control.

13. Mental Health and the Capacity to Learn and Work

Mental health is directly part of human capital. WHO defines it as a state enabling people to cope with life's stresses, realise their abilities, learn, work and contribute. Iraq's Mental Health Atlas 2024 profile records a national policy/plan and law, but no national mental health survey during the previous ten years. This knowledge gap must not be filled with media estimates. ¹⁴

The required shift is decentralisation: detection and initial intervention skills in primary care, specialist referral pathways, community services, support in schools and workplaces, addiction care, and protection of rights and confidentiality. Specialist psychiatric hospitals remain necessary for cases requiring them, but must not be the system's only entry point.

14. Nutrition, Development and Healthy Ageing

Nutrition is not weight alone. Undernutrition or micronutrient deficiencies during pregnancy and childhood affect growth and learning, while excess weight and unhealthy diets raise diabetes and cardiovascular risks in working life. Nutrition policy therefore addresses a “double burden”: protecting early development, breastfeeding and micronutrition on one side, and reducing salt, sugars, trans fats and obesity-promoting environments on the other. ¹⁵

As the population gradually ages, preventing falls, maintaining mobility, hearing and vision, managing multiple medicines, and rehabilitation after strokes and fractures become part of preserving household independence. Healthy ageing reduces years of complete dependence even when it does not extend life itself.

15. Occupational Health, Injury and Productivity

Work itself can build or consume health. Vision 2045 connects the labour market to occupational health: risk assessment; protection from heat, dust, chemicals and noise; construction and factory safety; recording occupational injuries and diseases; gradual return after injury; and vocational rehabilitation. Workers leaving the labour market because of preventable injuries represent a double loss, human and productive.

The goal is not to turn every small firm into a bureaucracy. Requirements are classified by risk, and insurance, social security, labour inspection and health data identify sectors and locations with higher injury rates. This chapter therefore integrates with “Training and Work” and labour law rather than establishing a parallel system.

16. The Health Workforce: Numbers, Skill Mix and Distribution

The ministry platform records growth in physician and nurse numbers between 2023 and 2025, a positive direction. National indicators may conceal local shortages, however, and more physicians without nursing, rehabilitation, public health, laboratories, maintenance and technology do not make a complete team. The Vision therefore adopts a “health workforce matrix” for every governorate and care level, with minimum service standards and incentives for less attractive areas. ⁵¹⁰

17. Medicines, Diagnosis and Treatment Continuity

Good diagnosis does not help patients whose medicines run out, nor do available medicines help without tests establishing need and follow-up. Medicines, laboratories and imaging are therefore managed as a chain: essential list and protocol → needs estimation → procurement and storage → distribution → rational prescribing → dispensing → outcome and adverse-effect monitoring → early shortage alerts.

For chronic disease, “continuity of availability” matters more than one stock snapshot. Leaders must see interruption rates by medicine, facility and duration, with approved treatment alternatives and mechanisms for transfers between facilities. Digitalisation reduces shortages and waste; it is not another platform disconnected from patients.

18. Quality and Patient Safety

Quality is not an inspection layer applied after services. It must enter financing, licensing, accreditation, contracting and continuing education. In health insurance specifically, purchasers do not pay providers merely because they exist; payment occurs under contracts defining data, quality, rights, audit and appeal pathways.

19. Data and Digital Health

Iraq has a real foundation for transition. WHO documents DHIS2 deployment in 1,877 facilities for immunisation and training of more than 3,000 health workers, while the UN's 2025 report describes expansion across several surveillance programmes and thousands of users. The current Ministry of Health portal also presents EPI, reproductive health, event-based surveillance, tuberculosis, emergency obstetric and statistical databases. These are not “future digitalisation”; they are existing assets needing connection and governance. ¹⁶

The next step is not one enormous database. It requires patient/beneficiary identifiers where lawful, facility and provider identifiers, a shared data dictionary, interoperability, separated permissions, audit logs, data minimisation and measured data quality. Clinical decisions need detail; public planning needs aggregate data; research needs de-identification and controls. Conflating them creates risk rather than value.

20. Geographical Equity and Access

National averages conceal distance. The Statistics Authority's 2024 report shows varying physician densities between governorates—from approximately 7.3 per ten thousand in Maysan and 7.7 in Dhi Qar to 14 in Najaf within the report's coverage—illustrating that “adding a physician” and “bringing a physician to where needed” are different tasks. The Vision uses maps of travel time and health need, not administrative boundaries alone. ⁶

Equity also means access for persons with disabilities, rural residents, poor people, older people and women where transport costs or care time are barriers. Some solutions are physical: a centre, ambulance or road. Others are operational: mobile clinics, remote appointments, extended medicine supplies, regular service days or medical transport. Instruments are chosen by need rather than a project's appeal.

21. The Private Sector, Referral and Integration

The constitution permits private institutions under state supervision, and the private sector already exists. The Vision does not construct a “good public/bad private” dichotomy or its reverse. The state defines rights, packages, standards, data and oversight; public and private providers compete or contract under clear rules where they add capacity, quality or access. Service volume is not purchased without need, and patients are not stranded between providers over payment disputes. ¹

Referral tests integration. Primary care physicians must know where patients were sent, referral data must arrive, discharge reports and medication plans must return, and emergencies need a route free of bureaucracy. Without closure of the loop, every level becomes a separate facility, tests and prescriptions are repeated and information is lost.

22. Environment, Climate and Health

Heat, dust and storms, air pollution, water scarcity, salinity, communicable diseases and climate change are not “environmental files” remote from hospitals. WHO and Iraq developed a health and climate profile connecting environmental risks to health system resilience. For 2045, heat plans are therefore needed for hospitals, workplaces and schools, alongside climate-related disease surveillance, safe water, and continuous electricity and refrigeration for medicines and vaccines. ²³

This chapter does not repeat the water, sanitation and municipal policies addressed later. It specifies the health outcomes and requirements health must impose on those sectors: less disease, less exposure and services that do not collapse during heatwaves, floods or outages.

23. Emergency Preparedness and Resilience

A strong health system is not measured only on ordinary days. Iraq faces epidemic, climatic and security risks and mass-casualty incidents. WHO's health security portal gives Iraq a SPAR assessment of approximately 59% in 2024. This composite indicator does not summarise all preparedness, but justifies continued investment in surveillance, laboratories, supplies, operations centres, emergency care and essential service continuity. ²⁴

Resilience means that diabetes and pregnancy care, immunisation and urgent surgery do not disappear during crises. Every health directorate and critical service therefore needs a continuity plan, calculated operational stocks, alternative suppliers, communications, backup power, simulation training and patient transport agreements. Emergency preparation begins with routine system design, not with a crisis declaration.

24. Governance and Financing

Current health expenditure of 5.53% of GDP in 2023 does not support a simple conclusion that Iraq “spends little” or “spends much” from one figure. More importantly, over half of current expenditure came from households' pockets. The early priority is therefore to change the financing, purchasing and quality mix, then increase public funding where the package and implementation capacity demonstrate need and outcomes. ⁹

The Vision aligns with the current direction: WHO is working from 2026 to 2028 to align the national policy for 2026 to 2035 with PHC, UHC, financing reform and the workforce. The 2045 plan serves as the long-term strategic framework, while national health policy remains the sectoral instrument updated periodically. ¹⁷

25. International Comparisons: Transfer the Mechanism, Not the System

The common lesson is that health does not improve through one project. Coverage needs primary care capable of carrying the load, financing that purchases what is needed, hospitals supporting referrals, medicines, data and a workforce, and accountability preventing quality decline. Transferring one isolated solution outside the system reproduces fragmentation. ²¹²²

26. Iraqi Health in 2045

In 2045, citizens will not begin their health journeys in crowded emergency departments or through personal searches for specialists. They will have a known primary care point, records transferable between levels, teams following vaccination, growth, hypertension, diabetes, mental health and pregnancy, and clear referrals when specialists are needed. This does not abolish freedom of choice; it means a dependable, organised default pathway exists.

Hospitals will treat what actually requires hospitals, and be assessed by complications, readmissions, time and outcomes rather than bed numbers alone. Health insurance purchases a clear package from qualified providers; citizens know what is covered and what they pay, and cost shocks fall. Data travel from facilities to decision-makers and return as resources and corrections. Prevention becomes part of schools, workplaces and cities rather than a poster in a health centre.

27. Stages of Transformation from 2027 to 2045

Progression is evidence-dependent. Private-provider contracts do not expand merely because registrations increased, but because costs fell and outcomes and quality improved. Family doctor models are not universalised before suitable workloads, referral capacity, medicines, satisfaction and continuity are demonstrated. Health goals are not postponed to 2045; every stage must produce observable improvement.

28. Indicator and Target Dashboard

29. The Implementation Programme Package

30. Implementation, Cost and Financing Matrix

The chapter does not invent an “aggregate national cost”. Coverage costs depend on the package, population, service prices, wages, medicines and existing facility capacity. Before expansion, the benefit package, PHC model and core programmes are costed, then incorporated into a medium-term expenditure framework and demographic, disease and fiscal sensitivity tests.

31. Risks and Safeguards

The overriding rights safeguard is that health is a right, not a reward for production or contributions. This chapter must not be used to reduce care entitlements for non-workers, poor people or older people. The economic connection justifies health investment; it neither creates human worth nor determines entitlement.

32. Conclusion and the Bridge to Brain Drain

Health and Human Capital is not a chapter about hospital numbers. It designs national capability beginning before illness and accompanying people from pregnancy and childhood through work and older age: prevention, primary care, appropriate treatment, mental health, continuous medicines, financial protection, quality and data. When this chain works, Iraqis not only live longer; they live more years with capability, independence and productivity.

Iraq has infrastructure, laws, staff, digital programmes and expanding health insurance. It therefore does not need a slogan of “rebuilding the system from scratch”, but redirection of existing assets towards clear outcomes: PHC first, prevention before complications, a guaranteed package, value-based purchasing, unified data and household finances less exposed to shocks. This transformation is harder than opening a hospital, but makes the hospital itself part of a system.