MIDDLE EAST - The total healthcare market expenditure for the Middle East and North Africa (MENA) region is estimated at $241.13 billion.
Driven by demographic growth, infrastructure booms, and a sharp rise in chronic illnesses, this regional spending is projected to grow to $412.25 billion by 2032. Yet an important question remains: how effective are these health systems?
A successful health system is an equitable one, where everyone can access essential care before illness becomes a crisis, regardless of their income, location, or social circumstances.
This means ensuring that vulnerable populations can receive vaccinations, screenings, and regular management of conditions such as diabetes and hypertension close to where they live. Yet across much of the MENA region, healthcare continues to be a burden on many families.
In the Arab region, households pay an average of 30% to 40% of their total health expenditures directly out of pocket. This is significantly higher than the 14% average seen in OECD nations
This imbalance is increasingly difficult to afford. Noncommunicable diseases, including cardiovascular disease, diabetes and cancer, accounted for an estimated 78% of deaths in MENA in 2019.
As populations age, the demand for long-term monitoring, treatment, and care will continue to grow. The region therefore faces a basic development question: Should limited health budgets continue to prioritize treating complications, or invest earlier in preventing diseases?
Why Treatment in MENA Often Wins?
The bias toward treatment over prevention is clear. Hospitals are visible and essential during emergencies, and their needs are simple: beds, equipment, operations, and medicines. The results of prevention often take years to materialize, well beyond a government’s budget cycle.
Payment systems also shape behavior. When providers are reimbursed for each consultation, test, or procedure, more activity produces more revenue.
Regular counselling, follow-up calls, and coordinated management of chronic disease are harder to bill. A WHO regional review found that private providers, which deliver the major share of care in the Eastern Mediterranean, are generally more focused on curative services for commercial reasons.
Patients’ choices matter, but “trust” should not be treated as a cultural problem. If a primary healthcare center has irregular hours, medicine shortages, limited diagnostics, or weak referral links, going directly to a specialist may be a rational decision. Trust follows reliability.
Primary care cannot become the preferred entry point merely through awareness campaigns; it must consistently provide qualified staff, essential medicines, and clear routes to higher-level care.
A Regional Pattern With National Differences
Both Tunisia and Morocco serve as excellent examples of why preventive medicine is a core aspect of a health policy especially when implementing the shift towards Universal Health Coverage.
Tunisia illustrates the gap between having an extensive public system and financing it effectively. A 2026 World Bank assessment, using 2021 expenditure data, found that more than 80% of government health spending went to curative services, while only around 5% supported preventive and public-health functions.
Spending on primary facilities remained so low that centers struggled to provide routine services. Tunisia has expanded its National Health Policy, a government-led reform strategy centered on improving equitable access to care and prioritizing preventive and protective health services.
This comes after the World Bank approved a US$125.16 million loan to improve pandemic preparedness and emergency care, modernize primary healthcare services, and strengthen governance and digitalization across the public health system.
Morocco is advancing towards Universal Health Coverage by implementing reforms to improve health risk protection through increased health insurance coverage, modernizing health service provision, and ensuring equitable distribution of healthcare workers. However, Morocco shows why expanding insurance alone is insufficient. By June 2023, health insurance coverage had expanded to 80% of Morocco’s population.
However, accessibility remained an issue, particularly in rural and remote areas, where communities faced long distances to health facilities and shortages of healthcare workers. Between 2024 and 2025, a World Bank-supported programme rehabilitated 200 primary healthcare facilities as part of broader efforts to improve staffing, service quality and access for underserved communities.
In Lebanon, the imbalance is especially sharp. A 2025 UNICEF-supported financing analysis reported that 64% of the 2024 public health budget was spent on hospital bills and 22% on medicines.
Meanwhile, the country’s network of primary healthcare centers operates under severe financial pressure and remains highly dependent on donors and non-governmental providers. Lebanon’s National Health Strategy: Vision 2030 explicitly identifies the predominance of tertiary care over preventive and primary care as a longstanding weakness.
Would Prevention Really Cost Less?
The World Bank’s 2025 regional analysis notes that preventive primary care and behavior-change interventions can reduce future health costs. Vaccination, tobacco control, blood-pressure management and targeted screening can prevent expensive complications.
However, not every screening program saves money, and poorly designed prevention can generate unnecessary tests and treatment. The objective should be to fund interventions shown to be effective for each country’s disease burden, not simply label more spending as “preventive.”
An effective healthcare reform would guarantee a defined primary-care package; pay providers partly for continuity and outcomes, such as controlled blood pressure and completed vaccinations; integrate patient records and referrals; and require contracted private providers to deliver and report preventive services.
Primary centers also need predictable, long-term operating budgets, not just investments in infrastructure and short-term projects.
This is ultimately an equity reform. Out-of-pocket payments average 38.8% of health expenditure across MENA, placing the greatest burden on families least able to absorb an unexpected diagnosis. Accessible primary care brings early support closer to rural, low-income, and displaced communities.
While prevention may be less visible than a new hospital wing, when it works, fewer families need to visit the hospital in the first place.
