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UN Tourism Launches the Tourism Investment Guidelines for Jordan

• Middle East
• 23 May 2024

UN Tourism has presented a new volume of its “Tourism Doing Business: Investment Guidelines”, this time with a focus on the investment potential of the Hashemite Kingdom of Jordan.

The report was launched at the Conference " Investing in Tourism: Opportunities and Challenges for Sustainable Financing ", part of the 50th UN Tourism Regional Commission for the Middle East. Elaborated in collaboration with the Ministry of Tourism and Antiquities of Jordan, the guide provides a comprehensive overview of the socioeconomic reality of the Kingdom, its tourism performance, and investment opportunities.

In front of an audience composed of high-level officials, investors, and experts from across the region, UN Tourism highlighted the appealing value proposal of the country, which counts with globally recognized UNESCO World Heritage sites, a New Wonder of the World, Petra, and unique natural attractions with celebrated therapeutic benefits.  

H.E. Mr. Makram Queisi, Minister of Tourism and Antiquities of the Hashemite Kingdom of Jordan, affirmed: "One of Jordan's driving forces of recovery is the active and solid partnership we have with the private sector. The government of the Hashemite Kingdom of Jordan has embarked on legislative reforms targeting investment as a whole by introducing a new investment law and also significant reforms in the tourism law. These reforms are the result of direct and continuous dialogue with the private sector. We are taking solid steps into transforming Jordan into a haven for investors, and with the help of our formidable partnership with UN Tourism and the introduction of the UN Tourism investment guide of the Hashemite Kingdom of Jordan we are on the right track".

Natalia Bayona, UN Tourism Executive Director, who presented the report's content at the conference, stated: "Jordan offers a one-of-a-kind tourism proposition with a rich umbrella of options that include seven subsectors such as medical and wellness tourism, film tourism, business or agritourism. This diverse offer is paired with institutional stability, strategic policymaking, and a robust recovery of post-pandemic tourism figures."

Jordan's Remarkable Post-Pandemic Growth

Jordan is a global destination that has shown its tourism resilience through its outstanding performance during 2023. 

Some key insights in the " Tourism Doing Business – Investing in Jordan " report include:

• By 2023, Jordan fully recovered from the pandemic with 6.3 million international visitors (including overnight and same-day travelers), an 18.5% increase over the 2019 record.
• Between January and September 2023, trade, restaurants, and hotels have increased their weight in the economy, reaching 12.5% of GDP compared to 11.4% in 2019.
• Tourism employed 54,856 people in 2023, a slight increase from 2019 and representing 4 to 5% of Jordan's total employed population.
• Jordan's air travel sector has rebounded, maintaining connections to 43 countries through 54 airlines by 2023.

Economic Performance and Growth Potential

The Jordanian economy has experienced a steady growth rate of 2.2% and has kept inflation stable at an average rate of 2.1% over the past decade. IMF projections suggest that Jordan's GDP recorded a 2.6% increase in 2023, and it is expected to grow by 2.6% in 2024 and 3.0% in 2025.

In 2023, tourism generated USD 7.4 billion of foreign inflows, surpassing pre-pandemic levels by 28%, and confirmed its role as one of the main sources of income to the economy and motor for the country's GDP growth.

The guidelines also provide a detailed analysis of the investment outlook and greenfield investment dynamics. When it comes to Foreign Direct Investment (FDI), FDI inflows surged by 83% in 2022, reaching the mark of USD 1.1 billion, which nearly matches the country's 10-year average inflow. A trend that seems to have continued into 2023.

The country is also implementing a series of strategies to strengthen its competitiveness and investment frameworks and to support the growing innovative entrepreneurial ecosystem: the Economic Modernization Vision (2023 – 2030), the Investment Promotion Strategy (2023 – 2026), and the Jordan National Tourism Strategy (2021 – 2025). These initiatives are projected to attract additional investments of around USD 3.8 billion in the tourism sector by 2033.

Basmah Al-Mayman, Regional Director for the Middle East, said: "Supported by sizeable investments, tourism diverse products and Jordan's natural beauty, tourism can be an engine of job creation and growth in the country. Tourism investment offers opportunities for economic diversification and market-creation when effectively managed".

Related links:

• Download News Release on PDF
• Tourism Doing Business Investing in Jordan
• UN Tourism Connects Leaders for Investment Conference Focused on Middle East Opportunities

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World Travel & Tourism Council Declares Jordan a Safe Destination

(Jordan - Sunday, July 5th The Ministry of Tourism and Antiquities announced today that the World Travel and Tourism Council (WTTC) has awarded Jordan the “Safe Travels Stamp” thanks to Jordan’s health safety protocols that were deemed to be in line with the Council’s standards, which makes Jordan a safe destination for Travel & Tourism. The Ministry stated in a statement published today that WTTC approved the Ministry’s health safety measures, which were also documented and distributed to all tourism sectors and facilities. The Ministry also ensured the proper application of these measures, in addition to training the sectors’ employees on how to abide by them through inspection visits by the Ministry’s monitoring and inspection teams along with other concerned entities. The statement also stated that Gloria Guevara, CEO of WTTC, informed Her Excellency the Minister of Tourism and Antiquities, Majd Shweikeh of the Council’s decision to award Jordan the “Safe Travels Stamp” through a conference call that took place on Wednesday 1st July between the Minister and the President & CEO of WTTC, congratulating both her and Jordan for this achievement. Her Excellency, the Minister of Tourism and Antiquities, Majd Shweikeh, expressed her satisfaction at Jordan being awarded the “Safe Travels Stamp” by WTTC, a step that recognizes the country’s efforts for dealing with the Coronavirus pandemic and thus enabling it to offer Safe Travel & Tourism. In return, Her Excellency thanked the President and CEO of WTTC for their tremendous efforts in championing the initiatives of safety and security of tourism sector. The Ministry had also stated that the decision issued today by WTTC to award Jordan the “Safe Travels Stamp” reflects Jordan’s commitment to safely resume safe travel and tourism that is supported by a comprehensive set health safety measures. Her Excellency further elaborated that the series of procedures applied by the Government of Jordan in dealing with coronavirus pandemic, especially those related to the tourism sector through the Ministry of Tourism and Antiquities, had a tremendous effect on WTTC’s decision to award Jordan the “Safe Travels Stamp.” Her Excellency explained that the Ministry’s health & safety protocols related to all tourist establishments such as hotels, restaurants, airports, transport, tour guides, camp sites, diving centers etc. were provided to the WTTC and were found to be compatible with those espoused by the WTTC, hence the awarding of the “Safe Travel Stamp” to Jordan.

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UNDP Jordan supports the Ministry of tourism & Antiquities to take the first step towards tourism transition into green economy

June 10, 2018.

--- Image caption ---

In order to continue its development vision in protecting the environment and climate change in Jordan; UNDP is taking the lead to sustain environmental practices especially in the tourism sector.

• The establishment of the new green unit will encourage actions, behaviors, and work practices that are in sync with environment and natural assets

One of the new initiatives UNDP Jordan will implement is establishing a Tourism Green Unit (TGU) in the Ministry of Tourism and Antiquity (MOTA), which will be done through “Mainstreaming Biodiversity Conservation in Tourism Sector Development in Jordan (BITS) project”, supported by Global Environment Facility (GEF).

The innovative idea was developed by UNDP and MOTA. UNDP is supporting the ministry to establish the unit through technical and financial assistance which will enhance the adoption of environmental good practices in the tourism sector in Jordan. The mandate of the unit will focus on achieving the following:

·         Enhance environmental protection and to set the tourism policy towards mainstreaming biodiversity protection in the process of tourism development within MoTA and the tourism Sector especially in the new national tourism strategy 2016-2020.

·         Enhance the coordination and networking through the formation of a national committee for tourism and biodiversity conservation from different key stakeholders in tourism and environmental sectors.

·         Encourage more eco-friendly practices within the tourism sector through incentive schemes and certification and eco-labeling programs.

·         Conduct a strategic environmental assessment for the tourism sector in Jordan.

This innovative activity comes to address the development of the organizational and administrative framework of a specific unit at MoTA (Tourism Green Unit) which would be mandated to lead the integration of natural heritage and biodiversity into MoTA’s institutional and legal frameworks and to mainstream biodiversity conservation within the tourism sector in Jordan, including the integration of biodiversity concerns within the licensing system. The TGU is envisaged to be a technical unit that will act as a liaison body with all related main stakeholders in issues related to biodiversity and tourism, the unit will be governed by a management team from MoTA and a Steering Committee.

One of the main key advantages for Jordan is the natural assets, according to this MoTA has to adapt new culture that focus more on this asset and develop new ways and initiatives to protect and maintain those assets.

The establishment of the new green unit will encourage actions, behaviors, and work practices that are in sync with environment and natural assets.  It will also be matched to the requirements of the tourism new trends, and to dedicate considerable effort to establishing MoTA’s culture that encourages behaviors and work good practices conducive to promote and protect the natural assets.

It is worth mentioning that The GEF-UNDP “Mainstreaming Biodiversity Conservation in the Tourism Sector Development in Jordan (BITS)” Project aims at making the consideration of biodiversity a fundamental part of everyday planning and development for tourism in Jordan. The project is implemented jointly by a number of national institutions namely, the Ministry of Tourism and Antiquities (MoTA), the Ministry of Municipal Affairs (MoMA), the Petra Development and Tourism Region Authority (PDTRA), and the Aqaba Special Economic Zone Authority (ASEZA). The project is further coordinated with the Ministry of Planning and International Cooperation (MoPIC) and the Ministry of Environment (MoEnv).

UNDP Jordan will continue its support to the government of Jordan by providing innovative policy advice and sharing environmental best practices. UNDP remains focused on some environmental issues: Energy Efficiency, Biodiversity Conservation in Tourism sector, Marine Coastal Biodiversity Conservation, Electronic E-Waste Management, Migratory Soaring Birds and Climate Change.

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‘ambitious, but realistic’ national tourism strategy 2021-2025 launched.

By Batool Ghaith - Dec 28,2021 - Last updated at Dec 28,2021

Tourism Minister Nayef Al Fayez speaks during a ceremony to launch the National Tourism Strategy for the years 2021-2025 on Tuesday (Photo courtesy of Tourism Ministry)

AMMAN — The Ministry of Tourism and Antiquities on Tuesday launched the National Tourism Strategy for the years 2021-2025. 

The strategy is in line with the government’s economic priorities programme, which included the tourism sector, according to the ministry.

Tourism Minister Nayef Al Fayez presented the strategy in the presence of ministers of Transport, Labour, directors of the Jordan Tourism Board, dean of the Mosaic Institute, and a number of stakeholders.

According to Fayez, the Cabinet recently approved the 2021-2025 National Tourism Strategy. 

“The strategy seeks to surpass tourism figures recorded in 2019 through the next years,” he said during the launch event.

Fayez noted that the strategy, focuses on five main aspects: Tourism product development, human resources, marketing, heritage management and protection.

“We are aiming to double the number of tourists as well as tourism revenues by 2025,” Fayez added, noting that this strategy is a continuation of previous strategies and it is in line with the sustainable development goals.

“We consider it a golden opportunity for the tourism sector to achieve better numbers in the coming years. They are ambitious, but realistic and applicable numbers,” the minister continued.

Approximately 5.3 million tourists visited the Kingdom in 2019, and the tourism revenues amounted to JD4.1 billion, Fayez said.

The minister indicated that the Kingdom’s tourism income recorded an increase during the first 11 months of 2021, to reach JD1.692 billion, compared with JD1 billion in 2020, citing data from the Central Bank of Jordan.

“The first two months of 2020 before the COVID-19 crisis and the airport closures, tourism revenues and numbers were way better than 2019 already, until the middle of March,” he added.

Fayez mentioned that the total number of tourists coming to the Kingdom in 2021 exceeded 2.1 million, while the number of overnight tourists reached 1.8 million.

The strategy will mainly work on raising the number of tourists to how it was in 2019 by 2025, and to increase the total revenues as in 2019 by 2024, and increasing direct employment in tourism to exceed 2019 figures by 2023, Fayez noted.

According to the minister, transit tourism has a positive impact on the sector and its supporting sectors, such as restaurants and transport.

“In a period of four months, we received 200,000 visitors in Jordan for 14 days, which had a significant impact,” he said.

“The ministry seeks to create comprehensive economic growth through real and sustainable tourism products and experiences, in addition to taking all measures to recover the tourism sector from the impact of the pandemic,” Fayez noted.

The minister highlighted that the tourism sector was the first sector to vaccinate 90 per cent of its staff.

“The development of the strategy seeks to enable the tourism sector overcome the damage resulted from the pandemic, which were represented in four stages: Response, recovery, restart and reforms,” Fayez said.

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• Open access
• Published: 06 September 2024

The transformation of Jordan’s healthcare system in an area of conflict

• Ahmad Tamimi 1 ,
• Mousa Al-Abbadi 2 ,
• Iskandar Tamimi 3 ,
• Malik Juweid 4 ,
• Muayyad Ahmad 5 &
• Faleh Tamimi 6  

BMC Health Services Research volume  24 , Article number:  1033 ( 2024 ) Cite this article

Metrics details

The Jordanian healthcare system has evolved over the past decades expanding its services, technological, and educational resources. A comprehensive view of this system is lacking. The objective of this report is to describe the structure of the Jordanian healthcare system, the challenges facing it, and the current and recommended health policies.

Materials and methods

This study reviewed the current status of the Jordanian healthcare system. The following parameters were analyzed: health indicators, infrastructure, human resources, insurance system, pharmaceutical expense, health education system, and medical tourism. Data were collected from various relevant official institutions and related published literature.

Jordan has a young population with a median age of 23.8 years. Life expectancy is 78.8 years for females and 77.0 years for males. The Jordanian healthcare system is divided into three major categories: (1) Governmental Insurance (i.e., the Ministry of Health (MOH), the Royal Medical Services (RMS) and semi-governmental insurance); (2) Private Insurance; and (3) Refugee Insurance, including the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the United Nations High Commissioner for Refugees (NHUR). The Governmental Insurance covers 64.30% of the total population. Health expenditure is 6.37% of the gross domestic product (GDP). Pharmaceutical expenses make up 26.6% of the total national healthcare budget. Human resource assessment shows a high ratio of medical staff per 10.000 inhabitants, especially concerning physicians (31.7), dentists (7.9), and pharmacists (15.1). However, the ratio of nursing staff per 10.000 inhabitants is considered low (37.5). The Hospital bed/1000 population ratio is also relatively low (1.4). Healthcare accreditation is implemented through the Joint Commission International (JCI) accreditation which was achieved by 7 hospitals and by the National Health Care Accreditation Certificate (HCAC) achieved by 17 hospitals and 42 primary healthcare centers. Postgraduate medical education covers almost all medical and surgical fields. Medical tourism is currently well-established.

Conclusions

Assessment of the Jordanian healthcare system shows high ratios of physicians, dentists, and pharmacists but a low ratio of nursing staff per 10.000 inhabitants. The hospital bed/1000 population ratio is also relatively low. Pharmaceutical expenses are significantly high and medical tourism is well-developed.

Peer Review reports

Introduction

Jordan is a Middle Eastern Arabic country covering an area of 89,342 km with a total population of 11.517.887 inhabitants [ 1 ]. Jordan is considered a low-middle-income country with a gross domestic product (GDP) of 48.65B USD/year [ 1 ] and a GDP per Capita of 4.255.00 USD/year [ 2 ]. In addition, Jordan hosts the second-highest share of refugees per capita worldwide [ 3 ].

The Jordanian healthcare system has evolved over the past decades transforming into a generally well-developed service despite being in an area of constant conflicts and volatility, particularly in neighboring countries, such as Palestine, Syria, and Iraq.

During the last three decades, the health status of the Jordanian population has significantly improved. For example, since 1990, life expectancy has increased from 69.85 to currently 77 years for males and 78.8 years for females [ 4 ]. Infant mortality has decreased from 32.0 to 12.8 per 1,000 live births in 2024(6). In addition, Jordan has become a popular destination for medical tourism in the region.

The country has one of the most modern health systems in the region and the total health expenditure was estimated at 6.73% of the GDP [ 5 ]. The national policies in Jordan have been oriented towards expanding the health care umbrella to cover all Jordanian citizens.

The Jordanian healthcare system provides wide public healthcare services with a relatively low budget and is divided into a public system, private sector, and refugee insurance system. The public system is subdivided into the Ministry of Health (MOH), the Royal Medical Services (RMS), and semi-governmental insurance, such as the Jordan University Hospital and King Abdallah the First Hospital. The refugee insurance system is subdivided into the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the United Nations High Commissioner for Refugees (NHUR) (Fig.  1 ). The governmental and semi-governmental insurances cover approximately 64.3% of the Jordanian population [ 6 , 7 ].

Structure of the Healthcare System in Jordan

A comprehensive assessment of the Jordanian healthcare system is currently lacking.

In this article, we describe the structure of the Jordanian healthcare system, the challenges facing it, current and recommended health policies.

In this study, we analyzed the following parameters of the healthcare system: infrastructure (hospitals, number of beds, primary healthcare centers), human resources (physicians, dentists, pharmacists, nurses), insurance system (variety of insurance systems), pharmaceutical expenses, healthcare educational teaching system (undergraduate and postgraduate) and medical tourism.

Data were obtained from various relevant official resources and institutions, such as the MOH, Jordan High Council for Health (JHCH), National Statistics Department (NSD), Ministry of Higher Education (MOHE), Jordanian Universities, Royal Court (RC), National Department of Civil Status (NDCS), health care teaching, World Health Organization (WHO), the UNRWA and World Bank. We also utilized up-to-date related published data. We excluded any data that was not officially published in PubMed nor reported by the official Jordanian organizations in order to avoid inaccurate data. This research project was sponsored by the University of Jordan (R.1511/2023/19). It did not require approval by our institutional ethical committee.

Jordanian Administration System

Jordan is a constitutional monarchy in which the king is the head of state. He exercises his executive power through the Prime Minister and the Council of Ministers. The House of Representatives is democratically elected by Jordanians and the members of the Senate are appointed by the king. In addition, there is an independent judiciary system. Jordan is divided into 12 Governorates subdivided into 54 municipalities [ 8 ].

The Jordanian economy is classified as an emerging market with a mixed economic system, including a private economy combined with centralized economic planning and governmental regulation [ 9 ].

Demography and health indicators

According to the national official statistics from 2023, the total population of Jordan was 11.517.887 [8.514069 (73.92%) Jordanians and 3.003818 (26.08%) non-Jordanians], including 5.344299 (46.4%) females and 6.173588 (53.6%) males [ 10 ].

The age range of 0–14 years constitutes 30.7% of the population, and individuals between 15 and 65 years and over 65 years constitute 65.9% and 3.7% of the population, respectively (Table  1 ) [ 9 ]. The median population age is 24 years [ 11 ].

The unemployment rate is still above the pre-pandemic levels (22.6%), especially among women (29.4%) and the young (46.1% among those under 25 years). The female labor force is particularly small, being one of the smallest in the world [ 12 ]. Life expectancy for females and males was 78.8 and 77.0 years, respectively. The infantile mortality below the age of 5 years was 12.8 /1000 live births whilst the fertility rate was 2.22 children per woman [ 9 , 13 ]. (Table  1 ).

Disease patterns have also changed in Jordan, alongside the economic development, from predominantly acute to chronic diseases. Today the leading causes of death per 100.000 inhabitants are ischemic heart disease (48.08), cerebrovascular accidents (28.8), road traffic accidents (RTA) (17.0), diabetes mellitus (16.7), and lung cancer (10.84) (Fig.  2 ) [ 14 ]. Two important burdens on the health system are smoking and obesity. The prevalence of smoking among Jordanians is very high, with a prevalence of smokers under the age of 45 years of 85% [ 15 ] with a male-to-female ratio is 53.6%, to 46.4%. Obesity, a global public health problem in terms of morbidity and mortality is prevalent in the country. According to the waist-to-height ratio (WHtR) measurement, 44.2% of Jordanian men and 47.8% of Jordanian women are considered obese [ 16 ].

Top causes of death/100.000 population in Jordan(WHO)

Health Insurance System

Overall, 76.80% of the Jordanian population is covered by some healthcare insurance system (Table  2 ). Among non-Jordanians who are not considered refugees, this figure is 25.3% [ 17 ]. The Jordanian health insurance system can be divided into three different categories (Table  2 ):

Governmental insurance, which is subdivided into the MOH, the RMS, and semi-governmental insurance. A total of 65.59% of Jordanian citizens are covered by governmental insurance. The MOH insurance covers governmental employees and their dependent family members (i.e.,40.99%) [ 6 ]. In addition, all children less than 6 years old and citizens aged above 60 years are freely covered by the MOH. The RMS covers military members and their dependents (i.e., 23.31%) [ 7 ], and the semi-governmental services cover university employees, their dependents as well as university students (i.e., 1.29%) [ 17 ].

Private insurance: it includes private institutions that are responsible for the health insurance of their personnel and independent individuals who purchase private insurance (i.e., 12.5%) [ 18 ].

Refugee insurance: It includes mainly primary healthcare. The UNRWA is responsible for the healthcare of Palestinian refugees (i.e., 6.8%) [ 17 ] while NHUR covers Syrian refugees (Table  2 ).

Primary healthcare clinics in Jordan provide quick access to medical care, vaccination schedules, maternity, childcare, and chronic disease management services. They operate in urban as well as rural areas and range in size from small individual clinics to comprehensive multi-clinic centers, depending on the area and its population.

Health Expenditure

The national expenditure on public health arises from services provided by the MOH, RMC, and semi-governmental agencies and represents 6.4% of the GDP. This expenditure covers 65.6% of the Jordanian population (Table  3 ). The costs of governmental and private sector services constitute 64.3%, and 31.75% of the total healthcare expenditure, respectively [ 18 ].

The in-hospital services represent 69.55% of the national health expenditure, whereas 21% is spent on primary care, 7.17% on administrative activities, 1.62% on training, and less than 1% on miscellaneous activities [ 19 ] (Table  4 ).

The MOH insurance also covers the dependent family members of contributing individuals. Affiliated subjects pay 3% of their gross salaries per month, with an upper limit of 30 JD/month. Coverage includes all potential health conditions and their respective treatments [ 20 ] (Table  4 ).

In 2022, the average cost per patient admission was 782.3 JD regardless of the length of hospitalization. Moreover, the mean inpatient day cost was 236.6 JD, and the bed day cost (i.e. without additional medical procedures) was 172.9 JD.

The average operation cost was 449.6 JD and the per emergency room visit cost was 31.8 JD [ 21 ].

The outpatient clinic expenditures (out of pocket) were 28.8 JD and 6.8 JD at private and public facilities, respectively [ 22 ] (Table  4 ).

The pharmaceutical and disposable expenditures accounted for 15.15% of the total health expenditure budget of the MOH whilst 26.6% of the total health expenditure was attributed to just the pharmaceutical expenses [ 18 ]. However, medication fees for the insured are symbolic, ranging from 0.25 to 10 JD per drug. Other types of insurance have followed similar payment criteria [ 6 , 7 ].

Syrian refugees place an important burden on the healthcare system in Jordan. The cost of healthcare for Syrians in Jordan is 271 million JD/year [ 23 ]. The Government’s policy on Syrian refugees’ access to healthcare services has changed over the last 10 years. At the beginning of the Syrian crisis, the government granted free of charge access to the Jordanian public health system. However, by 2015 Syrian refugees followed the same insurance criteria as Jordanians. In 2018, the policy was reversed with Syrian refugees having to pay 80% of the established fees for foreigners in Jordan at the MOH facilities. However, Syrian refugees were still exempt from fees for maternity and childhood services [ 18 ].

Hospital beds and primary health care

Tertiary health care in Jordan includes 120 hospitals [i.e., 31 MOH hospitals with 5884 beds, 17 RMS hospitals with 3350 beds, 2 university hospitals with 1236 beds and 70 private hospitals with a total of 5529 beds]. Accordingly, the total number of hospital beds in Jordan is 15.999 (1.45/1000 population). (Table  5 )

There are a total of 832 primary healthcare clinics and 440 dental clinics [ 9 ].

Human resources

The ratio of healthcare professionals in Jordan per 10.0000 population is 31.7 for physicians [ 4 ], 9 for dentists, 15.1 for pharmacists, and 37.5 for nursing staff (Table  6 ) [ 9 ].

Accreditation and healthcare

During the last decade, there has been an increasing awareness of the importance of accreditation in healthcare activities. Accordingly, 7 hospitals were accredited by the Joint Commission International (JCI) [i.e., 2 university hospitals, and 5 private hospitals] as well as a private laboratory [ 24 ].

The National Health Care Accreditation Council (HCAC) also accredited 17 hospitals from the public, private, and academic sectors and 42 public primary health care centers. In addition, it also certified two diagnostic imaging centers [ 25 ]. This has led to a significant improvement in the overall quality of the Jordanian healthcare system.

Medical education

Undergraduate medical education.

Jordan’s undergraduate medical education started in the 1970s with the establishment of the first medical school at the University of Jordan [ 24 ]. There is a relatively large number of medical and dentistry schools in the country (i.e., 8 and 6, respectively).

Admission to medical schools depends exclusively on grades obtained in the Jordanian General Secondary Certificate exam (JGSC) or equivalent. The students who meet the minimum requirements in the science JGSC track (i.e., a score of 85%) or equivalent are eligible to apply for medical schools in Jordan. No additional cognitive or non-cognitive tests are required for this purpose.

The admission system to Jordanian medical schools includes multiple tracks [ 26 , 27 ]: (a) The open National Unified Admission (NUA) track; (b) a track for underprivileged students; (c) for the children of university employees (UES); (d) the parallel track (i.e. this is a track for students with lower scores that are required to pay higher registration university fees) and (e) The international track for foreign students.

The curriculum is divided into an initial 3-year pre-clinical or basic medical science stage (integrated system) followed by 3 clinical years (traditional). At the end of the sixth year, students undergo a written theoretical assessment as well as a supervised clinical assessment. The students who successfully pass the exams are awarded a medical doctor degree provided they also complete a research project, which is evaluated by a faculty committee during the last semester of the program [ 26 , 28 ].

There are currently approximately 20,609 medical students at Jordanian universities with a similar number studying abroad [ 29 ]. However, there is a relatively low number of nursing students and a high number of dentistry and pharmacy students (Table  7 ). Approximately, 3,000 students graduate from Jordanian medical schools annually, whilst another 1000 students graduate from countries abroad [ 30 ].

Postgraduate medical education

A partial postgraduate specialty medical training program (i.e. 2–3 years of training) was established in 1968 at the RMS and some MOH hospitals. This resulted in residents having to complete their training in centers abroad to obtain their official specialty degree. In 1982, the Jordan Medical Council (JMC) was established to control the practice of medical specialties in the country, and the first complete residency programs were established at Jordan University Hospital. This was followed by similar programs at other MOH and RMS hospitals as well as the Jordan University of Science and Technology Hospital and, more recently in some private hospitals and the King Hussein Cancer Center [ 31 ]. The approximate number of the offered medical training positions is 1200 posts/year nationwide.

Postgraduate medical education in Jordan is oriented towards the acquisition of specialty degrees in all the major clinical specialties and some subspecialties. The admission criteria to postgraduate medical and surgical training programs are based on a theoretical exam and an interview, both performed by each training center and accredited by the JMC. The duration of the training period varies between specialties, ranging between 4 and 6 years, and the trainees are evaluated each year [ 26 ]. To qualify as specialists, the trainees must pass the JMC competency assessment at the end of the program. This assessment is supervised by a select committee of senior qualified specialists and is divided into two parts: (a) Part 1; a multiple-choice questions (MCQ) exam that includes basic medical and clinical sciences related to the specialty and (b) Part 2 comprised of a comprehensive assessment that includes specialty-specific MCQs, oral and clinical exams. After passing these final exams, the residents are qualified to practice as specialists throughout the country. Specialists trained in other countries must also pass these exams to be eligible to practice in Jordan. In 2023, new legislation exempted from the JMC exams postgraduates from countries abroad who hold a foreign board certificate and have 3 years of experience as specialists in the country they graduated from [ 31 ].

Regarding the postgraduate academic track, there are currently variable tracts of master’s degree programs in basic medical sciences and only one PhD program in medical statistics.

Medical health tourism

The tourist industry’s contribution to the global GDP reached 10.3% in 2019 and was responsible for the creation of one out of every four new employments worldwide [ 32 ]. In Jordan, there are approximately 55,000 jobs directly related to tourism with an additional 125,000 jobs indirectly related [ 28 ]. The state of the tourism sector is widely regarded as ¨below potential¨, especially given the country’s rich history, ancient ruins, Mediterranean climate, and diverse geography.

Medical tourism in Jordan has progressively become more relevant as a result of the good reputation of the Jordanian healthcare system regionally. Medical tourism constitutes 3.5% of the country’s GDP [ 33 ]. This sector, which has a high added value and creates employment in many areas is supported by the government with investments and incentives [ 32 , 34 ].

The competitive edge of medical tourism arises from its cost-effective health services, its renowned healthcare reputation, and the diversity of its touristic attractions. In addition, the majority of the medical tourists who visit Jordan come from other Arab countries, as Jordan offers a similar culture and no language barrier.

The Kingdom of Jordan is a low to middle-income country, with a population having a median age of 24 years [ 9 ], which is below the average world age (i.e. 30.5 years) [ 11 ]. However, with the continuous increase in life expectancy and decrease in the fertility rate [ 8 ], the average age of the Jordanian population is expected to increase in the coming years.

Jordan is in an area of constant conflicts and volatility, particularly in neighboring countries, such as Palestine, Syria, and Iraq, affecting its economy and constituting a significant burden on its healthcare system. The country has a high percentage of immigrants (i.e. 33.89%) compared with other countries that are traditional receivers of immigrants (i.e. Australia 30.14%; Canada 21.33%; Germany 18.81%; the USA 15.28% and the UK 13.79%) [ 35 ]. Syrian refugees have placed significant challenges on the Jordanian healthcare system, especially because of the high prevalence of women and children, wounded patients, individuals suffering from mental health conditions, and elderly patients. These vulnerable groups require a wide range of expensive services [ 34 ]. In addition to affecting the healthcare system, the high number of immigrants and refugees has a significant impact on the country´s infrastructure, security, social structure, financial sector, and education.

The kingdom has a high unemployment rate (i.e.,23.5%), that is particularly high among the female population [ 36 ]. Accordingly, only 14.7% of women within the working age contribute to the country’s workforce [ 36 ] compared with 39.49% worldwide [ 37 ]. Nevertheless, there is a high percentage of female undergraduate students in Jordan (i.e. 55%) and this number increases to 65% among healthcare students (Table  7 ) [ 8 ]. However, many of these female students decide not to work after concluding their studies attributed to multiple factors. We, therefore, believe that there is a need to readjust the current legislation to encourage women to participate in the national labor market.

On the other hand, the different causes of death and morbidity also have an additional burden on the health care system. The leading causes of death are similar to those in lower-middle-income countries. However, the incidence of road traffic accidents (RTA) is particularly high (i.e. 18/100,000 inhabitants) when compared with lower-middle-income and other countries (i.e. the UK, Spain, Germany, and Australia where the death ratio due to RTA is less than 5/100.000 population) [ 11 , 38 ]. The morbidities and disabilities caused by RTAs, constitute an additional burden on the Jordanian healthcare system with an estimated cost of RTAs of 324 million JD/year, according to the Jordan Traffic Institute [ 39 ].

The smoking rate in Jordan is one of the highest in the world, with a prevalence of 70.2% among adults [ 40 ]. The male/female ratio is 53.6% /46.4% [ 9 ]. Moreover, the prevalence of smokers below the age of 45 is 85% [ 15 ], making it the highest among eastern Mediterranean countries and the second highest worldwide after Indonesia [ 31 , 40 ]. Smoking is associated either directly or indirectly with approximately one in every 8 deaths in the country. It also has an estimated cost of $2.67 billion annually because of healthcare expenditures and loss of productivity [ 41 ]. Therefore, stricter implementation of the law by the different national institutions should be a national priority to reduce the burden of smoking on society.

Obesity is another burden on the economy and healthcare system in Jordan due to associated morbidity and mortality. According to the WHtR measurement, the prevalence of obesity in the Jordanian population is 44.2% in men and 47.8% in women [ 14 ]. The prevalence of obesity is alarmingly high and increasing in many countries in the Eastern Mediterranean region due to changes in food consumption, reduced physical activity, and an increasingly sedentary lifestyle [ 42 , 43 ]. However, obesity in Jordan is also among the highest in the region and higher than in Western countries, such as the USA and UK (i.e. 34% and 24%, respectively) [ 44 ]. Consequently, obesity in Jordan results in an estimated cost of 650 M JD annually [ 45 ].

The number of hospital beds in Jordan (i.e. 4.4/1000 inhabitants) is relatively low compared with other countries (i.e., 12.65/1000 inhabitants in South Korea) [ 46 ]. Moreover, the bed occupancy rate is also low at 58% compared to the Organization for Economic Co-operation and Development (OECD)countries (i.e., 75%). Therefore, there is a need to increase the number of hospital beds and bed occupation efficiency [ 47 ], which requires further reinvestment in the infrastructure and a better management of resources.

Jordan has a high number of physicians, dentists, and pharmacists per 10.000 inhabitants [ 19 ] and a relatively low number of nurses. These figures require future adjustments to adapt the number of health professionals to the demands of the labor market. Moreover, the number of unemployed physicians is currently approximately 2500 (unpublished data from the records of the Jordan Medical Association).

Public health insurances cover 64.30% of the Jordanian population [ 17 ]. However, the government is considering a potential expansion of the public insurance system to include all Jordanians. This step would require an important additional investment increasing the health care expenditure to 9% of the GDP. Nevertheless, the size of the public healthcare insurance is one of the best in the region (e.g., in Egypt, the public health insurance covers 60% of the population) [ 48 ] but it is still limited compared with other countries, such as Turkey (90%) [ 49 ] and Spain (99%) [ 50 ].

The total health expenditure in Jordan was estimated to be 3.17 billion USD (i.e., 6.37% of the GDP), which is similar [ 20 , 21 ] to other countries such as Greece (8.6%), Israel (7.4%) and Turkey (4.3%) [ 50 ]. Expenditure on pharmaceutical products is relatively high in Jordan reaching up to 25.9% of the total health expenditure [ 22 ]. This number is higher than the majority of the OCED countries and similar to Greece (27%) and Romania (23.9%) [ 51 ].

Global Healthcare Accreditation (GHA) is one of the major players in the global medical travel industry, which identifies and compares medical travel programs and destinations against global standards and international best practices. There has been an early awareness of the importance of the quality of the health system in Jordan. The country involved national and international organizations, to achieve quality certificates, such as those from JCI, JCI-academic centers, and Health Care Accreditation Council (HCAC) [ 25 ]. This awareness has had a positive impact on medical tourism, making Jordan a regional leader in this sector. As mentioned above, the number of healthcare graduates should be adjusted to the requirements of the labor market [ 9 ]. Moreover, postgraduate medical education has a limited number of training residency programs and infrastructure; and there should be a close supervision of the quality of training programs, by JMC and the Jordan Medical Association (JMA).

Finally, the medical tourism sector in Jordan is highly competitive compared to other countries in the region [ 34 ], not just for the competitive costs of treatment but also for the additional services that support health tourism in general.

Strengths of the study

This is a comprehensive updated study of the healthcare system in Jordan. It includes information on the national health system, infrastructure, human resources, medical education, and health tourism. It also includes updated figures, which can be valuable for experts, stakeholders, and healthcare researchers.

The weak points

Due to the insufficient data in PubMed, we had to use information from different national institutions and annual reports. Moreover, there was some variation in several estimates depending on the sources (i.e. governmental reports or international organizations).

Conclusion and recommendations for future research and policy actions

The Jordanian health system is divided into public and private sectors and United Nations refugee services. The healthcare infrastructure needs a larger number of hospitals and a more efficient administration regarding bed occupancy and pharmaceutical expenses. Moreover, Jordan needs the effective support of the international community to cover the health needs of the Syrian and Palestinian refugees. The country also needs to address significant social health problems, such as the high number of road traffic accidents, the prevalence of smoking, and obesity. Moreover, the number of human resources should be altered to increase the number of nursing staff and control the number of graduating physicians and pharmacists. More attention should be paid to postgraduate medical education, including the academic track of PhD programs, especially in our medical schools. Finally, medical tourism should be further developed as the country has multiple assets making it an attractive destination.

Data availability

The data are available in the annual reports of the different institutions (MOH, RMS, (JHCH), (NSD), (MOHE), (NDCS), (WHO), the UNRWA, and World Bank).

Abbreviations

Global Healthcare Accreditation

Gross Domestic Products

Health Care Accreditation Certificate

Joint Commission International

Jordan Dinar (1 dollar = 0.71JD)

General Secondary Certificate exam

Jordan High Council for Health

Jordan Medical Association

Jordan Medical Council

Multiple-Choice Questions

Ministry of Health

Royal Medical Services

United Nations Relief and Works Agency

United Nations High Commissioner for Refugees

National Statistics Department

Ministry of Higher Education

National Department of Civil Status

National Unified Admission

Organization for Economic Co-operation and Development

Philosophy Doctor

Road Traffic Accidents

Royal Court

University Employees

United Kingdom

United States of America

United States Dolar

World Health Organization

Waist-to-height ratio

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Acknowledgements

We would like to acknowledge the Research Deanship at Jordan University who provided us with the support to develop the project, and The Research assistants in the project Dr. A. Obeidat and Mr. M. Abdelaziz for their effort in data collection.

This study was sponsored by the University of Jordan.

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Orthopedic Surgery Department; Regional University Hospital of Malaga, Malaga University, Malaga, Spain

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Department of Radiology and Nuclear Medicine, Faculty of Medicine, University Hospital, University of Jordan, Amman, Jordan

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A.T., M.AL., and M.A. We’re responsible for the study conception and the development of the protocol A.T., Wrote the manuscript, ran the research, and coordinated the review. A.T., M.AL, Conception, design of work, acquisition, analysis, interpretation of data. I.T., Acquisition analysis, wrote the first draft, preparing Figs. 1 and 2, interpretation of data, M.J., Interpretation of data. F.T., Acquisition analysis, interpretation of data, and preparing Fig. 1. All authors revised the manuscript critically and approved the final manuscript.

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Tamimi, A., Al-Abbadi, M., Tamimi, I. et al. The transformation of Jordan’s healthcare system in an area of conflict. BMC Health Serv Res 24 , 1033 (2024). https://doi.org/10.1186/s12913-024-11467-1

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DOI : https://doi.org/10.1186/s12913-024-11467-1

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