Privatization of public hospitals, Syria’s health sector in intensive care

The entrance of Al-Assad University Hospital in Damascus (Enab Baladi)

The entrance of Al-Assad University Hospital in Damascus (Enab Baladi)

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Enab Baladi – Jana al-Issa

On March 17, the Minister of Health in the Syrian regime’s government, Hassan al-Ghabbash, announced the government’s intention to devise a plan related to opening the door for investment in the health sector.

The minister’s announcement took place during a symposium titled “Investment in the Health Sector.. Possibilities and Goals,” where several topics were discussed including the partnerships between the public and private sectors in managing medical facilities.

The minister pointed out that the government has started to work on converting all hospitals into public autonomous bodies with their own administrative and financial independence.

Under the pretext of service improvement

The regime’s move towards the privatization of the medical sector comes while it simultaneously leans towards privatizing most of the productive and service sectors under its control.

Privatization implies the transfer of ownership, management, or organization of a government sector to the private sector and it encompasses three levels:

The first level: Full transfer of the government sector to the private sector with governmental oversight.

The second level: Partial or partnership privatization, which the Syrian regime is following, involves selling only a part of the public sector with governmental oversight.

The third level: Complete liberalization of privatization without any governmental control, allowing the private sector to set prices freely.

Countries decide to privatize certain sectors to reduce the burden of their management on the government, integrate the private sector into the economy, and attempt to improve the quality of the targeted sectors and enhance productivity and individual income.

Especially in the medical sector, the regime attributed its direction to open investment doors to “the advancement of providing health service, which has become extremely costly, and not to turn the service health sector into a profit-making one,” according to what the Deputy Minister of Health, Ahmad Damiriyeh, said.

Reducing support

Abdul Azim al-Mugharbel, a research assistant at the Jusoor for Studies Center specialized in economic affairs, told Enab Baladi that the regime’s orientation toward privatizing the medical sector comes within a series of previous policies indicating its attempt to reduce financial burdens and achieve financial returns to lighten the accumulated debts by partially withdrawing from some sectors.

Al-Mugharbel sees that the implications of opening investment in the healthcare field revolve mainly around the regime’s weak financial management of this sector and its proper medical supplies provisioning. Therefore, leaving the health sector to invest reduces many expenses and obligations from the regime’s shoulders, as well as converting the financial support provided to the health sector to ones it deems more effective.

A study issued by the Jusoor for Studies Center in July 2022 indicated that the regime follows a policy of turning institutions into “independent bodies” to seek mechanisms to diversify the government’s resources “in order to pay back the accumulated debt to its allies and enhance the government’s ability to continue its operations.”

The period of establishing public bodies in Syria experienced a noticeable interruption and was divided into two phases, the first was concerned with improving the efficiency of government institutions and their management capacity, and the second was with improving state resources, according to the study. It drew on both the nature of the bodies established before 2011, which had an administrative nature to improve the situation of the sector, such as in the case of the “Real Estate Financing Authority” and the “Syrian Badia Development Authority,” and the nature of entities recently established, such as an authority to manage each university city, an authority to manage a hospital itself, and an authority to manage fish wealth at the branch level in each region. The second aspect is the general context of the recent establishment of public bodies, which comes amid a financial reform campaign and diversification of government sources through subsidy reduction, tax increases, and the introduction of general fees.

The social market accelerates

Karam Shaar, the director of the Syrian program at the Observatory of Political and Economic Networks and economics doctor, told Enab Baladi that this direction began with the beginning of the work of the Syrian regime’s president, Bashar al-Assad, on the social market economy plan versus moving away from the socialist thought in 2005.

This approach is associated with reducing support for basic commodities and services to decrease state spending and rely more on the private sector, according to Shaar, noting that this approach has gone through several stages since 2005 until the present, where this proposal has appeared very accelerated after 2019, the year the regime faced an unprecedented economic crisis.

Shaar believes that this direction carries economic implications, including an attempt to reduce state expenses to respond to the current economic situation, and political implications, the most important of which is that the Syrian regime thinks with a mentality that denies the existence of any political settlement that could lead to an investment boom or increase state revenues.

The market economy, free market, or capitalist economic system, is a system that allows individuals to engage in any economic activity they want and to open any project in addition to freedom of contract between individuals and institutions, without state or its agencies interference, meaning that the state leaves the market to regulate itself without any intervention in economic activities.

The existence of a free market system does not mean the absence of the state and the public sector in organizing economic life within society, as the free economy may lead to monopolization of some institutions and individuals of the market by monopolizing products, so the idea of “social economy” emerged, which is between capitalist and socialist economy, and the state seeks through it to achieve balance and equality among the citizens, and give the middle and poor classes their rights.

The main benefits of the free economy are increased market efficiency and the emergence of a variety of goods at lower prices, resulting from competition that leads to providing goods with the best quality and prices.

However, its disadvantages lie in the dominance over certain sectors and control of prices (monopoly), in addition to increasing the size of economic activity at a certain period and its contraction and recession in another period, which causes economic volatility and increased unemployment.

People are affected

During the symposium held by the Ministry of Health, the minister, Hassan al-Ghabbash, stated that absolute free medical service in a certain place is a duty, but also has many disadvantages stemming from the fact that free service should go to those who deserve it, and the necessity of modifying some basic legislations related to this subject.

Residents in areas under regime control, who already suffer from difficult living conditions and a minimum wage that is insufficient for basic expenses of food and drink except for a few days a month, are among the most affected by the decision to privatize the sector.

In this context, Dr. Karam Shaar considered that the government intends to provide health services for free to a very narrow group, according to its definition of people in need of support, regardless of international standards.

The infrastructure of basic health services, such as hospitals and health centers, requires maintenance and rehabilitation, according to a report by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), which documented the health sector crisis in Syria for the year 2022.

The report mentioned that the health sector is suffering from a crisis, with a large percentage of centers either out of service or partially stopped, while the number of people in need of health care reached 15 million, in addition to 6.9 million internally displaced persons in Syria.

During the year 2022, there were 113 hospitals across Syria, 26% of which operate partially and 27% are out of service. Among 1789 health centers, 21% are operating partially and 32% are completely out of service.

The report clarified that these gaps cannot be addressed except through long-term investment.

There is a chronic shortage of healthcare workers due to displacement, attacks, and low wages.

Estimates suggest that up to 50% of the health workforce has left Syria, according to the report.

 

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