Can the Integration of Artificial Intelligence Systems Contribute to the Improvement of Iraqi Healthcare System?  

Executive Summary

1. This commentary focuses on unraveling Iraqi public health crisis, underlining the gaps of the low number of staff, hospital beds, and shortage of medicine.  
2. highlights three Artificial Intelligence (AI) enabled tools, and explains how each one can improve the healthcare system: (a) Computerized Clinical Decision Support System (CDSS) for faster and more accurate diagnostics, (b) Surgical robotics for better surgical treatment, and (c) AI tools as Corruption Indicators as well as management of extensive amounts of data that are beyond human capabilities available in the healthcare sector.
3. It explains the importance of providing fertile ecosystem for better implementation of AI-enabled tools by identifying two main challenges that can hinder the benefits of AI in healthcare: the neglect of reforming healthcare system by the Iraqi government and; second, the organized corruption that plagues the healthcare sector. The third part also discusses encouraging receptivity towards international cooperation, to better understand the standards and norms of the AI technologies.  

Unraveling Iraq’s Public Health Crisis  

The technological revolution of Artificial Intelligence (AI) has been playing a significant role in improving services to humans, especially health services. These technologies have the potential to transform various aspects of healthcare systems and strengthen human security. At a time when in most developing countries it is at stake. That is why using the potential of AI-enabled tools to provide health services in a country like Iraq is essential. Decades of conflict, namely the Iran-Iraq war in 1980–1988, the fall of Saddam Hussein’s regime in 2003, and the war with the Islamic State (ISIS) in 2014; coupled with international sanctions and a lack of attention to the health sector, have harshly damaged Iraq’s healthcare system. This created an environment that led to the migration of many doctors and other medical professionals. The ensuing political landscape offered an environment susceptible and accepting of corruption amongst politicians, which further deteriorated the sector. Eventually, this led to a low doctor to patient ratio; 9.7 doctors per 10,000 individuals; while the recommended number by the World Health Organization (WHO) is one doctor per 1000 individuals¹.  

Compared to other countries in the region, Iraq allocates a smaller portion of its budget to the health sector. In 2019, the country had an annual budget of 133 trillion Iraqi dinars (ID), of which only 4.5 per cent (six trillion ID) went to both the health and environmental sectors². Leading to a low number of hospital beds; according to the World Bank, for every 1000 Iraqis, there are 1.3 hospital beds, a drop from 1.9 in 1980. At the same time, Iraq faces shortage of medicine, especially, the crucial types such as cancer treatment, forcing cancer patients to seek treatment abroad: in Jordan, Iran, Turkey, Lebanon, and India³. The issue is rooted in the high rate of corruption that exists within the system, as the medicines intended for the public use is often sold for private profit. Some companies were sued in United States courts for bribing the Iraqi Health Ministry to win contracts. On top of that both the Iraqi government and the Health Ministry were accused of selling medicines on the black market that were meant for the Ministry⁴. 

AI-Enabled Tools for Iraq’s Healthcare System  

AI in healthcare describes the application of machine learning (ML) algorithms and other cognitive technologies in medical settings. In other words, AI in healthcare is when computers and other machines such as robotics, mimic human intelligence. AI can assist doctors, nurses, and other healthcare workers in their work by producing accurate diagnosis, treatment plans, and surgical treatments. Especially, in cases where there is a shortage of doctors, such as in Iraq, in which patients may be left with inaccurate diagnosis or untreated conditions, AI has the potential to address these issues. AI enabled tools function as checks and balances on governments as well. In this sense, given the wide-range corruption cases in the Iraqi Health Ministry, by monitoring the government and its relevant ministries, AI helps with tracking the government’s corruption in the sector. All in all, AI enabled tools lead to a better patient experience and an improved health sector. Considering the challenges, such as dwindling number of doctors and hospital beds, as well as shortage of medicine, the Computerized Clinical Decision Support System (CDSS), Surgical Robotics, and AI-enabled tools for detecting signs of corruption, are all potential viable options for enhancing the healthcare system in Iraq.  

Better Medical Diagnostic and Surgical Treatment  

The CDSS is comprised of software designed to assist clinical decision making, by comparing the characteristics of the patient with the computerized knowledge base; consists of clinical information and guidelines. Through which provides the required clinical information and recommendations for the sake of optimal patient care. The system allows the clinician to receive evidence-based support that is customized to each individual patient, in shorter period, without compromising their outcomes. It is worth mentioning that CDSS is not intended to replace the clinicians but to assist them. A study presented the case of a doctor named Jacinta-radiologist at a public hospital in the city of Quito, Ecuador. Dr. Jacinta attended to hundreds of women every day at her clinic and wished to assist them all, but the hospital did not have enough staff to support her. However, as she received an AI-enabled radiology tool from her hospital, she was able to examine images of potential lumps and identify potential tumors more quickly and accurately. She still checked each result and followed the clinical protocols, but she could review three to five more samples per day.⁵ 

Surgical Robotics are fed with large sets of data, through which they can highlight tools, monitor operations, and send alerts to surgeons. This way, surgical robots help by mapping out the best steps according to the patients’ needs for better surgical treatment. All of this reduces the stress level of surgeons, which helps them to save significant operating time, perform a larger volume of procedures with better outcomes, not to mention the advantage of shorter the recovery time of patients. Hence, surgical robots enable the reduction of costs for hospitals and patients, and inpatient stays. For instance, Neil Thomas, the former tech entrepreneur who had a tumor in his colon removed in June 2022, left the hospital only two days after his surgery. After three months, he was able to return to his training for an Ironman triathlon.⁶ 

AI as Corruption Indicator in the Health Sector  

To tackle the issue of shortage of medicine, which is mainly caused by corrupt officials, there is a need for supervising the financial processes in the Health Ministry. This can be done through managing enormous amounts of undocumented data. should the Health Ministry's database become digital, it would directly open space for AI enabled tools to analyze the data and potentially monitor corruption activities. Amongst the variety of AI systems, a system that is developed by Riigikontroll (The National Audit Office), an independent institution that audits and reports on the government’s use of taxpayers’ money in the Northern European country Estonia, is a potential system to alter and adopt in the Iraqi Health sector. The Estonian National Audit Office collaborates with MindTitan to improve the analysis of all public information sources for misuse of public funds and is funded by the European Regional Development Fund. The system highlights and visualizes the misuse of public money, using election dates, selected candidates, and various sources of data that the system manually collects from publicly available sources.  

It Filters the candidates of interest, and identifies their past and future claims of achievements through which it detects suspicious contract or misuse of public money. The data from the AI algorithm is stored in the database, until the National Audit Office (NAO) auditors determine its usefulness, with periodic deletion cycles planned⁷. Estonia is a good example for Iraq to follow in terms of AI adoption. Part of the success of the Estonian NAO centers around adopting a suitable AI system. Equally important, this initiative by the NAO sheds light on the significance of creating a fertile ecosystem for it, such as by passing legislation by the Estonian Parliament in 2000 declaring internet access a fundamental Human Right principle in the country. In addition, it led to the introduction of electronic ID cards in 2002, and enacting several laws and regulations to combat the abuse of public funds. Which helped the country rise to the 13^th place on Transparency International’s Corruption Perceptions Index 2021; amongst the least corrupt countries.  

Creating a Fertile Ecosystem for AI Solutions 

For Iraq to achieve a higher level of technological integration, it requires to adopt a process-oriented approach to AI implementation. Instead of a project-based one. Otherwise, the unresolved challenges in its healthcare system, as well as lack of receptive mentality towards international cooperation, will prevent it from attaining the benefits that developed nations experience and quickly adapt to AI.  

The Challenges Hindering AI Adoption in Iraq  

one of the failures of the Iraqi government to date was its response to the Covid-19 pandemic when it was first detected in March 2020. The Health Ministry was fragile and as a result of many years of neglect, the pandemic shock crippled the health sector altogether⁸. Thus, it is likely that the implementation of AI may also be subject to neglect, or intentionally taken for granted. All the same, it is important to note that the accuracy of implementing AI enabled tools in the health sector depends on sufficient data, a qualified staff to feed it, and monitor its outputs. Therefore, even if the developed countries such as US develops and exports advanced AI-enabled tools to Iraq, they will provide inaccurate outputs if implemented without taking into account the abovementioned factors. In other words, this means the Iraqi Ministry of Health must begin serious work on the digitization process that started on February 9, 2023, partnering with the World Health Organization (WHO) and United Nations Children's Fund (UNICEF)⁹. Also, allocating money for the local staff training to regularly feed the system and monitor its outputs, to enable the use of AI to its full potential.

On the other hand, the high level of corruption that pervades the Iraqi Healthcare system since 2003 and ranks the country amongst the most corrupt ones on the list of the agency Transparency International, indicates the fragility of healthcare governance. Regardless of what percentage of Iraq’s GDP is allocated to the health sector, the result will be futile, as the allocated funds are often misplaced, misused, or appropriated for personal use. This may also infect the AI-system that works as the indicator of corruption. Hence, hindering its positive impacts by corrupting the design of the AI system, as the codes and the available data can be manipulated to achieve corrupt objectives. However, the case of Estonia provides some tried methods for Iraq to follow by enacting law and regulations concerning corruption and digitization for better outcomes.  

Receptivity Towards International Cooperation 

The two objectives mentioned previously requires international cooperation to share expertise, as well as, offering support through investing a part of its resources, to provide consulting services and training for the local staff to better understand the standards and norms of the AI technologies. At the same time, it helps the government produce effective strategies and identification of crucial areas for investment and intervention.

Without adopting the process-based approach to AI implementation, through which a fertile ecosystem could be created to encourage technological flourishment, the full benefits from implementing AI-based technologies may not be realized.

Conclusion 

Artificial Intelligence-enabled tools such as computerized clinical support (CDSS) that feeds the medical staff with fast and accurate diagnostics, surgical robotics that help surgeons to perform a larger volume of procedures with better outcomes, and AI-enabled tools for detecting indicators of corruption that paralyze the healthcare system are all viable options that may contribute to the improvement of Iraq’s healthcare sector.  

However, it is crucial to recognize that without adopting the process-based approach to AI implementation, through which a fertile ecosystem could be created to encourage technological flourishment, the full benefits from implementing AI-based technologies may not be realized. Promoting international cooperation, to benefit from expertise and experience of developed nations, is another crucial component that would have positive impact on the integration of AI-based technologies in the healthcare sector. As a cautionary note, there will be a temporary hype around the idea of the AI-integration due to its reputation as a miracle tool. Expectations could be managed through proper introduction to the new technology, its limits and future promises.   

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