Frailty and barriers to healthcare access among older adults of the kurdistan region of Iraq: relevance of a health information system

Iraq’s health system could not adequately develop due to wars, terrorism, and embargoes, which damaged infrastructure and shattered the country's public health. A functioning health monitoring system is critical in driving the creation of suitable public health measures, as well as a significant tool for preparing the health system to respond to future emergencies and population needs. There is overall limited knowledge on the health situation of Iraqi population and on the primary health care (PHC) challenges due to the lack of electronic health information systems. Such systems might help monitoring the location, staff, equipment, and services across the region and identify problems that require management attention. To respond to this health priority, the University of Rome Tor Vergata (Italy) and the Ministry of Health of the Kurdistan Region of Iraq (KRI) started 2015 a cooperation to implement an electronic system for epidemiological monitoring and health surveillance in the region (based on the DHIS2 platform). The project began with a pilot in KRI, as this Iraqi region had not been occupied by ISIS; however, the project aims to set up the system in the whole country. Timely and reliable health information is one of the six building blocks of any health system. Among vital statistics, mortality (including causes of death) is one of the primary sources used to identify and monitor public health priorities. Ranking causes of death is a crucial factor in differentiating the magnitude of the various health problems. Our study observed that data collection on the causes of death were not reliable because there was no electronic health system to collect the data, so information on vital statistics were obtained only through surveys and estimations. Worldwide, the older adult population is increasing. This is the case also in Iraq and KRI, although the population is still relatively young. Like the rest of the world, the number of older adults is increasing due to major changes in birth and death rates over the last decades. Functional disabilities and impairment are part of normal ageing that lead to older adult frailty. These outcomes can be postponed and their effect on quality of life reduced through continuous health monitoring and specific programs focusing on older adults. Our study on older adult frailty and barriers to health care services in KRI pointed out 3 that older adults in this region are at high risk of frailty because of the insufficient social and financial support as well as health care access barriers, such as cost and transportation especially for the older adults in the rural region of KRI. The presented results highlight that an electronic health information system which can continuously observe the health status of older persons is a key element to identify and provide the needed interventions. In conclusion, the study suggests that also in a post conflict situation, such as the one of Iraq, a health monitoring system is crucial to timely monitor the health of the population so to support the health authorities in implementing appropriate public health programs.