Wars, terrorism, and embargos destroyed facilities and shattered the public health system of Iraq. Today, there is limited documented knowledge about the health situation of the Iraqi population, particularly because health data are not systematically collected. Therefore, the capacity of the health system to address the major health problems of the population is considerably reduced. This report describes the implementation, started in 2015, of an electronic system for epidemiological monitoring and health surveillance, designed to collect and manage health care data in Iraqi Kurdistan. The aim of the program is to network all of the main health centers and hospitals of the region, then of the whole country, and to train medical and administrative staff in the management and analysis of health data. In countries recovering from war, a functioning health monitoring system is essential in guiding the development of appropriate public health interventions, a key instrument to prepare the health system to respond to future emergencies.

Background: Iraq has endured several conflicts and socio-political tensions that have disrupted its public health system. Nowadays, because health data are not collected on a routine basis, the country still lacks proper statistics and, consequently, response plans to meet present and future health needs of its population. An international partnership is developing in the Iraqi Kurdistan a Health Monitoring System with the aim of supporting evidence-based health policy decisions. Methods: The pilot phase for assessing the feasibility of the programme was launched in 2015. In 2018 the implementation phase began. The first step was to choose the software platform and the coding system, as well as to identify the public hospitals (PH) and Public Health Centers (PHC) to be included in the e-health system. The technical infrastructure of each PHC or PH was updated. The staff of each center was trained in the use of the e-health system and in disease coding. Several seminars introduced regional and district health managers to the basic concepts of data-driven decision making. A local team of experts was trained to create a highly specialized staff with the objective of "training the trainers" and ensuring the future self-sufficiency of the system. Results: By September 2019, 59 PHC and PH were entering data in the Health Monitoring System, while 258 health operators (medical doctors, administrative staff, nurses, statisticians, IT and public health specialists, pharmacists) have been already trained. Currently, more than 600,000 disease events have been collected. Additionally, further 734 medical doctors, statisticians, and health managers have been trained on the basics of public health practice. The goal during the next 3 years is to reach 120 operative centers within the region, envisaging a subsequent expansion of the system to all Iraq. Emberti Gialloreti et al. Health Monitoring System in Iraq Conclusions: The creation of a functioning health monitoring system is feasible also in regions characterized by socio-political tensions. However, multiple stakeholder partnerships are essential. The provision of an e-health information system, coupled with the establishment of a team of local experts, allows the routinely and timely collection of health information, facilitating prompt responses to present and emerging needs, while guiding the formulation and evaluation of health policies.

Background: Mortality and causes of death are among the most important statistics used in assessing the effectiveness of a country’s health system. Several countries do not have information systems for collecting these data, and they must therefore be estimated from surveys. Objective: This study analyzes mortality data retrieved from official government databases in Iraqi Kurdistan to describe ten-year trends in natural causes of death. Methods: Data for natural causes of death, reported from 2009 to 2018, were extracted from the databases of the Registration Bureau of Births and Deaths and of the Forensic Medicine of the Province of Sulaymaniyah. A sample of 16,433 causes of death was analyzed. Results: Causes of death were coded according to the ICD-10 classification. Overall, cardiovascular diseases were the leading cause of mortality (52.6%), followed by neoplasms (17.7%), infectious and parasitic diseases (8.9%), and genitourinary diseases (6.3%). Neonatal conditions, congenital anomalies, and neurological conditions each accounted for less than 1% each. Numbers of natural deaths by cause and cause-specific mortality rates have been estimated for the entire Region of Iraqi Kurdistan. Comparisons with other sources suggest that there is a substantial amount of underreporting, especially in relation to deaths of infants and under-five children. Conclusion: Our findings confirm that the region is facing a burden of non-communicable diseases, coupled with high proportions of infectious diseases. However, the lack of effective vital statistics with combined under-reported data collection highlights the need for implementation of health monitoring systems. Advancements in generating high-quality data are essential in improving health and reducing preventable deaths. The establishment of a novel Health Information System is discussed.

PurposeThe purpose of this study is to present the workflow on the integration of Maternal and Child Health Care Services (MCHCS) into the electronic Health Information System of the Iraqi Kurdistan (KRG-HIS).Design/methodology/approachAs part of the cooperation between the University of Rome Tor Vergata-Italy and the Iraqi Kurdistan Ministry of Health, six PhD positions were granted for Iraqi students to create a local team of experts with the aim of supporting the scaling-up of the KRG-HIS. After specific training, the team then trained the staff members of the health centers, met health authorities and analyzed the local scenario to ensure that the KRG-HIS could be better tailored to regional needs. In 2019, the integration of MCHCS into the KRG-HIS was one of the main areas of research.FindingsHealth data collection was mostly paper-based, which made vital statistics and evaluation of outcomes difficult to measure. More than 15,000 paper-files from the Duhok Obstetrics and Gynaecology Hospital were retrieved from storage. Then data entered in the KRG-HIS. Theoretical and practical training sessions were conducted for local staff members, with 183 health operators already having been trained. Daily supervision of the online system and field visits were ensured.Originality/valueThere is a need to support health authorities in improving data collection on MCHCS, ensuring the future self-sufficiency of the HIS. Key to the process is the creation of a specialized team of local experts with the objective of “training the trainers”.