Etudes par pays volume 2, PDF, 346 p., 1,4 Mo - Femise

11873_2002 Study D2: Poverty, Informal Sector, Health and Labour
2.4. Phenomenology
Jordan is in the midst of an epidemiological transition with acute respiratory
infections and prenatal diseases still causing a large loss of productive life
while non-communicable diseases and illnesses are becoming increasingly
prevalent. Infant and child mortality indicators are favorable compared with
other countries in the region and with other countries at similar levels of
income, although they are still high by OECD standards. Despite significant
declines in fertility in recent years (from 5.6 children per woman in 1990),
Jordan’s total fertility rate (TFR) of 4.6 children per woman is still quite
high. Population growth is high largely as a result of high fertility, low
mortality, and migration.
- The Health Sector Study highlighted that while the health system
performs relatively well in terms of overall access and outcomes, it is
expensive and inefficient, and there are geographic maldistributions of
resources. Jordan spends about 8 percent of its GDP on health care, well
in excess of most middle income and even some western industrialized
countries. While Jordan provides coverage for its poor and disabled, an
estimated 20 percent of the population lacks formal coverage, and
Government financing for health care could be better structured to reflect
ability to pay. Lack of a coordinated policy apparatus and relevant data
for decision-making preclude effective policy-making across Jordan’s
multiple public and private financing arrangements and delivery systems.
- There are significant inefficiencies in the service delivery system. There
is excess overall capacity as evidenced by a hospital occupancy rate of 63
percent (69 percent in the public sector and 49 percent in the private
sector; 80 percent is the generally accepted benchmark). Inappropriate
hospital use results from lack of an effective referral system and a
hospital-based orientation for treatment. Inefficient case management
leads to costly inpatient treatment of conditions that could be treated on
an outpatient basis and excessive use of expensive drugs. The centralized
allocation process for supplying and equipping facilities and paying
personnel in the public sector provides few incentives for the efficient
delivery of services at the individual institution level. Finally, there are
inefficiencies in terms of overall management, procurement, storage,
distribution, pricing policies, and the rational use of pharmaceuticals,
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