Jordan is a small Arab country with a limited supply of natural resources such as oil and water (Abu-Jaber 1991). Furthermore, the conflicts and crises in the region have affected Jordan badly. Jordan was at war with Israel between 1948 and 1994, as a result of which Jordan's population has been increased by successive waves of Palestinian refugees seeking shelter. Refugees from the 1948 and 1967 Arab-Israeli wars account for a considerable part of Jordan's population and there are currently about one million registered Palestinian refugees in Jordan (Abu-Jaber 1994). The Gulf crisis in 1991 brought a new wave of homeless people. The Ministry of PlanningEconomic and Social Development Plan(1993) suggested that around 300,000 Jordanians who been working in Gulf countries returned to Jordan and another 500,000 people found refuge in Jordan. The inflow of these refugees aggravated Jordanian's already serious economic problems. In 1994 Jordan signed a peace treaty with Israel to end the state of war. One implication of the treaty has been to allow Jordan to decrease its annual expenditure on defence and to increase expenditure on health, social and educational services, although the amount spent is still minimal compared to that of developed countries.
Health care services
In this section indicators of health and the provision and spread of health services in Jordan are briefly presented.
Health indicators in Jordan
Despite the lack of natural resources and the continued conflicts in the area, health indicators show that Jordan ranks well when compared with other countries in the region (MoH [Jordan] 2000).
The total cost of health care in 1990 represented 4.8 per cent of government expenditure, increasing to 5.9 per cent in 2000. This increase in health expenditure may have been the result of either a reduced need for expenditure on defence or an increase in population size.
The annual population growth rate in Jordan has been higher than in other countries in the region and much higher than in developed countries (Janson, 1993). For example, the annual population growth rate is 2.8 per cent in Jordan compared to 2 per cent in Egypt and 1.7 percent in Lebanon. In developing countries the average rate of population growth is 2 per cent, whereas in developed countries the figures range between 0.4 and 0.7 per cent. This could be explained by the greater family size in developing countries: the average family in Jordan has six children (Suhimat 2001).
Islamic religious leaders and teachings play an important role in decision-making about family size, since Islam encourages large families (Farsoun and Khoury 1996). Farsoun and Khoury found that Jordanian married couples identified three basic types of pressure leading to large families: traditional, familial, and religious. On the traditional level, respondents cited the long-held tradition of having many children to help work in the fields and provide care for their parents in old age. Often in combination with traditional pressures, couples felt pressure from other family members to have many children, especially boys, to continue the family line.
In terms of care for stroke patients, larger family size may influence the level of care since carers may have difficulties to taking care of big families as well as stroke patients. On the other hand, the more family members the more people to share the care.
In Jordan, the population is also very young. According to MoH [Jordan] (1998) figures, the median age is 19.3 years and the infant mortality rate is 31.3 deaths per 100,000 births, which is much lower than the average (57 per 100.000 births) in the Middle East. The birth rate is 34.3 births per 1000 population and life expectancy at birth increased from 65 in 1991 to 73.06 (71.15 for men and 75.08 for women) in 1999 (Department of Statistics [Jordan] 1999).
According to Jordanian MoH figures (1998) the average life expectancy in the Middle East was lower than that in developed countries: 65 for men and 69 for women. Jordan's dramatic improvements in child survival and life expectancy, combined with continued high fertility, are the major reasons for the high natural growth rate.
Hospitals
Over the past four years the total number of hospitals has increased from 75 to 86 and the number of hospitals beds has increased from 7969 to 8120. The increased number of hospitals beds is directly attributable to the increased number of hospitals.
Health professionals
Jordan has a high proportion of physicians compared to other countries in the region and the population per physician has decreased from 607 to 506 (Suhimat 2001). However, there are shortages of health professionals including as physiotherapists, occupational therapists and speech therapists working with PWD. One possible explanation for the large number of physicians in Jordan is that culturally the medical profession is highly respected in the Arab community. Families are proud to have one of their members gain a medical qualification, so the whole family (hamula) will financially support their members who study medicine.
