The factors impeding health system reform in Iraqi Kurdistan region

The relatively poor health outcomes in Iraq have been attributed to the inability to address the shortfalls in the public health model. Calls for health system reform in Iraqi Kurdistan Region started in 2004; however, few, if any, significant changes have been achieved since then. This research examines the factors impeding public health system reform in the Iraqi Kurdistan Region, as perceived by the health policy makers, through 11 in-depth, unstructured interviews. Participants attributed the delay in reform to 16 impeding factors that can be categorized into 5 major themes: historical, ethical, cultural, political and institutional. The intricate network of these inter-dependent factors provides a possible explanation for the failure or unsustainability of reform efforts. Reform initiatives might have a better chance of success if they take into consideration the well-established and unique background and social construct in Iraq, as well as the impact of decades of conflict and insecurity, both of which influence the individual and institutional reasoning and behaviour across the entire health system.