Jordan has one of the most modern health care infrastructures in the Middle East. Jordan’s health system is a mixture of public and private. The public sector consists of two major public programs that finance as well as deliver care: the Ministry of Health (MOH) and Royal Medical Services (RMS). Other smaller public programs include several university-based programs, such as Jordan University Hospital (JUH) in Amman and King Abdullah Hospital (KAH) in Irbid. Each of the health care subsectors has its own financing and delivery system that reflects directly on the delivery of services among these sectors.

The main challenges facing all providers of health care in Jordan include problems related to accessibility, equity, duplication of services, poor coordination among major providers, unregulated private sector, low utilization rates in the private sector, limited quality improvement programs, inefficient use of available resources, poor management and inappropriate health information systems.

For diabetics we have the National Center for Diabetes, Endocrinology and Genetics (NCDEG) which is an independent non-profit organization. It is a fully integrated organization of specialized health care for diseases of diabetes, endocrine glands and genetics in both the public and private sectors in cooperation with the public and private medical institutions.

What happens if you need to see a doctor?
It depends in which sector you get your healthcare. If you have public insurance you register and follow up with one of the public-affiliated centers (usually the nearest to where you live). There you get your prescription from the doctor for a minimal amount of money.

Private patients go to private based clinics where they register, follow up, and get prescription from the doctor, paying cash from pocket for prescriptions. For example, a 10 year old girl gets diagnosed with type 1 diabetes and her father works for the government, so his insurance covers all public hospitals. The government pays for her therapy unless her father decides to treat her at a private clinic. If he chooses private, he has to pay for her therapy from his own pocket, rather than the free care at the public clinics.

Who decides what medicines a doctor can prescribe?
The Jordan Food & Drug Administration (JFDA) is an independent public sector institution that is the sole national competent authority for ensuring drug safety and efficacy in addition to food safety and quality.

Practically, what is it like to live with type 1 diabetes in Jordan?
It can be very hard or it can very easy; it all depends on which coverage you have. Public insurance covers insulin up to a certain age and it does not cover all types of insulin. It also does not cover the needed amount of strips to fully manage diabetes. On the other hand there are people who can afford private care who have the most updated insulin pump with all things they might need to manage their diabetes.

What about getting admitted to hospital?
If you are admitted to a public hospital you would pay a minimal amount of money for the therapy you received. If you are admitted to a private hospital you would pay from your own pocket.

How does diabetes care vary throughout Jordan?
Diabetes care can vary dramatically across Jordan. As explained above, you can be a type 1 patient with no full coverage of all types of insulin and you can be an insulin pump user with personal continuous glucose monitoring. It all depends on your financial status.

To address this inequality I founded Your Device is My Life (YDIML), a Jordanian youth initiative for diabetics in need. We support 45 patients who get their supply of test strips of one box per month from YDIML along with hope, support and awareness sessions for them and their families.

Thank you so much to Yassmin Al-Shalabi in Jordan for providing this information.