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German Legal Expertise in the Middle East since 1981

Healthcare in the Hashemite Kingdom of Jordan

Guiding Principle

Health conditions in theHashemiteKingdomofJordanare among the best in theMiddle East. This is due in large part to the Kingdom’s stability and to a range of effective development plans andprojects, which have included health as major component. The main goal ofJordan’s health strategy has been toprovide adequate health coverage to all. To accomplish this best, the government policy has deftly encouraged geographical complementarily services by encouraging private sector facilities in the urban areas for those being able to afford higher costs, while concentrating public sector facilities in the relatively poorer non-urban areas.

A.  Rules and Regulations related to Healthcare

There are many laws and regulations generally or specifically related to the healthcare in the Hashemite Kingdom of Jordan (hereinafter referred to as “Jordan”), the most important ones are:

I.    Public Health Law

Public Health Law, JO-Law No. 47/2008[1] is the most important law, which regulates issues related to the public health system inJordan. The Law governs allprofessions related to public health like doctors, dentists, nurses, anaesthetization, X-Ray, laboratories, medicine andprosthetic limbs.

The Law also governs all conditions and necessaryprocedures required for practicing in the medicalprofession. It organizes the functions of public and private hospitals andprovides regulations for operating these hospitals. The Public Health Law imposes punishments for a number of failures or violations of the Law on medicalprofessionals, employees or civil servants on the culprits.

II.  General Association for Food and Medicine

The General Association for Food and Medicine Law, JO-Law No. 31/2003[2] is another important law in the area of public health inJordan. The Law regulates all matters related to food and medicine to ensure health and safety of food and medicine. The Law also sets regulation to ensure the best quality of food and medicine are supplied to the markets. The Law appoints several committees to conduct inspection and to seize illegalproducts. Under the Law, no food or medicine shall be launched inJordan unless being previously approved according to theprovisions of the Law.

III. The Labour Law

1.   Basic Principles

Many relevant provisions for the healthcare are included in the Jordanian Labour Law[3]. The Ministry of Labourprovides general supervision for observing the above law.

An employment contract, which is subject to the JO-Labour Law, is null and void to the extent that it purports to erode rights, the Labour Law has conferred upon an employee.

2.   Sick Leave

Every employee shall be entitled to fourteen days a year of sick leave with full pay on the basis of a report by the medical practitioner approved by the employer. Sick leave may be extended to a further fourteen days with full pay if the employee is hospitalized and with half pay if the worker is not hospitalized butprovides a report from a medical commission approved by the employer.

3.   Maternity Leave

Female employees shall be entitled to maternity leave with full pay for ten weeks including rest before and after delivery. Leave after delivery shall be no less than six weeks. The expiry of such employment before the end of the period shall beprohibited. After expiry of the maternity leave period, every female employee shall have the right, within one year of delivery, to take time off with pay for the purpose of nursing her newborn baby,provided that total time off does not exceed one hour a day.

4.   Occupational Safety and Health

Every employer shall take the necessary precautions and measures toprotect employees against hazards and diseases that may result from work or machines used therein. The employers shallprovide employees with the necessary personal material, such as special clothes, glasses, gloves or shoes, toprotect them from work hazards and occupational diseases. They shallprovide employees with first-aid material and equipment in the establishment in accordance with standards prescribed by the Ministry of Labour.

If an employee sustains a work injury that results in his death or involves a bodily injury that prevents him from continuing work, the employer shall transport him to a hospital or medical center, notify the competent security authorities of the accident and send notice of the accident to the Ministry of Labour within a time limit of 48 hours. The employer shall bear the costs of the employee’s transportation to the hospital or medical center for treatment.

IV. Healthcare Insurance Law

Healthcare insurance is regulated by the Jordanian Social Security Law of 2001[4]. The Social Security Corporation (abbrev. “SSC”)provides general supervision for observing the above law.

The Social Security Law includes the following insurances:

1. Insurance against work injuries and occupational diseases;

2. Insurance against old age, disability and death;

3. Insurance against temporary disability due to sickness or maternity;

4. Health insurance for the worker and the beneficiaries;

5. Family allowances; and

6. Insurance against unemployment.

Insurance with the SSC shall be compulsory for the employers and the employees, and the insured shall not bear any share of insurance expenses unless it is specifically stated herein.

The benefits of insurance against work injuries and occupational diseases shall include the medical care necessitated by the condition of the injured, daily allowances for temporary disability, if the injured is rendered disabled to work as a result of the accident, monthly pensions and the lump sum compensations, survivors’ pensions and funeral expenses.

Medical care shall include the expenses of medical treatment and hospitalization, the expenses of transferring the injured from his place of work or residence to the place appointed by SSC for his treatment and theprovision of rehabilitation services, including artificial limbs.

With regard to insurance against old age, disability and death, “old-age pension” may become due when the insured male reaches (60) years of age, resp. the insured female reaches the age of (55).

Jordan’s health system is financed by four principal sources: 45% public funding, including general taxation, premiums paid by public firms, and contributions to charitable non-governmental organizations; 43% household spending, including payroll deductions for insurance, user fees, and purchase of pharmaceuticals and other health commodities; 8% donor contribution including the United Nation Refugee Work Agency (UNRWA); and 4% private firms, which pay health insurance premiums for their employees. The government ofJordanis committed to attaining the goal of universal health insurance. It is also worth mentioning that about 70% of Jordanians had medical insurance in 2007, the Jordanian government plans to reach 100% in 2011.

B.  Healthcare in the Day to Day Life

Health conditions inJordanare among the best in theMiddle East. This is due in large part to the Kingdom’s stability and to a range of effective development plans andprojects, which have included health as major component.Jordanhas approached development from a holistic perspective, realizing that poverty, illiteracy and health form a triangle which must be addressed together. Advances in the struggle against poverty and illiteracy, in addition to the spread of sanitation, clean water, adequate nutrition and housing have been combined to makeJordanhealthier.

Jordanhas quite an advanced healthcare system, although services remain highly concentrated onAmman. Government figures have put total health spending in 2002 at some 7.5 percent of Gross Domestic Product (GDP), while international health organizations place the figure even higher, at approximately 9.3 percent of the GDP.

The main goal ofJordan’s health strategy has been toprovide adequate health coverage to all. To accomplish this best, the government policy has deftly encouraged geographical complementarily services by encouraging private sector facilities in the urban areas for those being able to afford higher costs, while concentrating public sector facilities in the relatively poorer non-urban areas. Like its policy of favouring spending on basic education over higher education,Jordan’s public health has concentrated on primary health care in all parts of the country, while leaving tertiary health care mostly to the private sector.

Over the past two decades,Jordan’s basic health indicators have improved greatly. According to UNICEF statistics, between 1981 and 1991Jordanachieved the world’s fastest annual rate of decline in infant mortality – from 70 deaths per 1000 births in 1981 to 37 per 1000 in 1991, a fall of over 47 percent. This figure fell even further in 1996 to only 32 deaths per 1000 births. Perhaps the clearest example ofJordan’s emphasis on primary health care is in the area of childhood immunization. In 1996, 98 percent of Jordanian children were fully immunized. The spread of adequate sanitation and potable water, improvements in dietary intake, accessibility to advanced and affordable health care, improved pre-natal care and childhood immunizationprograms are some of the primary factors, which have combined to lower infant mortality rates and raise life expectancy. The success ofJordan’s health care system is therefore a major reason for the high natural growth rate of population growth. While average fertility levels have actually declined – from 7.3 percent in 1984 to 3.9 percent in 1998 – a higher childhood survival rate means more Jordanians entering marriageable age. Life expectancy is higher inJordanthan in most developing countries, averaging 64 and 68 years for men and women, respectively.

According to 2003 estimates, the rate of prevalence of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) was less than 0.1 percent. According to a United Nations Development Program report,Jordanhas been considered malaria-free since 2001; cases of tuberculosis declined by half during the 1990s, but tuberculosis remains an issue and an area needing improvement.Jordanexperienced a brief outbreak of bird flu in March 2006. Non-communicable diseases such as cancer also are a major health issue inJordan.

Jordan’s health needs are met by a high ratio of medical personnel per capita. For every 10,000 Jordanians, there are 28 doctors, 10 nurses and certified midwives, 7 dentists, 9 pharmacists and 16 hospital beds.Jordan’s only real health personnel shortage is in trained local nurses. The government is establishing new nursing colleges and encouraging students to specialize in this field by offering incentives for trained nurses and giving priority in employment for both male and female Jordanian nurses. Sixty-nine percent of Jordanians receive free health care, due to their status as public sector employees or their dependents.

Jordanwas ranked by the World Bank to be the number one healthcare serviceprovider in the region and among the top 5 in the world. In 2008, 250,000 patients sought treatment in the Kingdom including Iraqis, Palestinians, Sudanese, Syrians, GCC citizens, Americans, Canadians, and Egyptians.Jordangenerated over $1 billion dollars in 2008 from medical tourism. The World Bank rankedJordanas being the top medical tourism destination in the Middle East and North Africa, followed byDubai,Abu Dhabi, andIsrael.

C.  Healthcare in the Public Sector

The Ministry of Health (abbrev. “MoH”) has adopted the “Health for All Policy”, which considers health as a basic right for every citizen. The government continues to support primary health care towards “Health for All” and has committed to extend health insurance coverage. The civil health insurance bylaw has been updated to allow more sectors of the population to benefit from health insurance. The health system inJordanincludes the following sectors:

  • The Public Sector;
  • Ministry of Health;
  • Royal Medical Services;
  • Public University Hospitals;
  • The Private Sector;
  • The International and Charitable Sector including UNRWA.

The country’s healthcare system is divided between public and private institutions. In the public sector, the MoH operates 1,245 primary health-care centers and 27 hospitals, accounting for 37 percent of all hospital beds in the country; the military’s Royal Medical Services runs 11 hospitals,providing 24 percent of all beds; and theJordanUniversityHospitalaccountsfor 3 percent of total beds in the country. In addition to the MoH network, UNRWA operates 21 primary care centers and 30 special care clinics forJordan’s Palestinian refugees.

In 1984, the Jordanian government granted the approval for the innovativeproject, theKingHusseinCancerCenter. The building was established with generous support from public charities, under the supervision of the Union of Voluntary Societies.

The King Hussein Cancer Center (KHCC) is the only specialized cancer treatment facility in theMiddle Eastthat treats both children and adults with cancer. It is one of the top cancer treatment facilities in the world. Since KHCC founded in 1997 in Amman, it has been committed toproviding state-of-the-art comprehensive cancer care,providing access to education, training and cancer research, andpromoting health awareness in order to decrease mortality and alleviate suffering from cancer with the highest ethical standards and quality care to the people of Jordan and the Middle East region.

D.  Healthcare in the Private Sector

The mainprovider of health services inJordanis the public sector, complemented by the private sector, international and charitable organizations such as UNRWA, non-government organizations (NGOs), and other charitable societies. Local and international agencies, which offer free medical services include UNRWA, charitable societies under the umbrella of the General Union of Voluntary Societies (GUVS), the Zakat Fund (Islamic alms giving) and foreign community centers administered with assistance from international groups such as Caritas and Radda Barnen (Swedish Save the Children).

The private sector is active inproviding primary care, accounting for nearly 40% of all initial patient contacts. The private sectorprovides 36 percent of all hospital beds, distributed among 56 hospitals. In June 2007,JordanHospital(as the biggest private hospital) was the first general specialty hospital who gets the international accreditation (JCI).

The complexity of the healthcare delivery system and the increasing role of the private sector require careful planning and management of human resources to achieve equitableprovision of health care. While no absolute ideal ratios exist, the physician-to-population ratio is high. However, the nurse-to-physician ratio is low, which may have implications for the cost and quality of care.

Six out of 10 physicians inJordan work in the private sector, and about one half of the registered nurses are similarly employed. Theproportion of dentists and pharmacists, who work privately is 79% and 89% respectively. Hospital utilization ratios are medium to low in general, but are very low for private hospitals, in which the length of stay is 3–4 days on average. Hence, potential exists to improve the efficiency of human resources use and reducing the cost of hospital care.

[1].    Public Health Law, Law No. 47/2008, repealing the Law No.21/1971, was published in the Official Gazette, Volume 4924 dated 17.08.2008.

[2].    General Association for Food and Medicine, Law No. 31/2003 was published in the Official Gazette, Volume 4592 dated 16.04.2003.

[3].    Jordanian Labour Law, Law No. 8/1996; dated 02.03.1996 amended by Jordanian Law No. 56/2001.

[4].    Jordanian Social Security Law, Law No. 19/2001 was published in the Official Gazette, issue No. 4489, dated 8 Rabi’l/1422H; Corr. to 31 May 2001.

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