Executive Summary
For the seventh decade, UNRWA Health programme continues to deliver comprehensive preventive and curative primary health care (PHC) services to Palestine refugees through a network of 143 primary health care facilities, and helps them access secondary and tertiary health care services. The total number of registered Palestine refugees has reached some 5.7 million, out of whom; about 3.5 million are served at our health centres.
During 2015, Lebanon, Jordan and the West Bank continued to suffer the effects of instability in the region this year. In Lebanon and Jordan, PRS have been straining the system for years, competing for scarce resources in camps, schools and health centres, while in the West Bank; the occupation by Israel creates its own set of challenges in accessing health services. In addition, the blockade in Gaza and the ongoing conflict in Syria, seriously affected the proper delivery of health services to Palestine refugees during 2015.
By the end of its 5th year, the health reform has reached an advanced stage of implementation in the Fields. The Family Health Team (FHT) approach was implemented in 119 health centres, excluding Syria, covering about 90.0% of the served population. In Syria, only 4 health centres rolled out the FHT model. Moreover, the other reform pillar, the e-health system, was introduced to 104 health centres in the five Fields, which implement either the classical or the FHT-e-health versions, fully or partially.
The changing disease burden among Palestine refugees is still challenging. An ageing refugee population will continually lead to an intensification of existing health trends, with increasing numbers of older refugees at risk of non-communicable diseases (NCDs), which cause more than 70 per cent of refugee deaths. The number of patients with NCDs is increasing consistently by approximately 5.0% per year. This has resulted in both: a greater workload for health centre staff and a financial challenge for the Agency.
The second diabetes care clinical audit, conducted in 2015, followed the same methodology of the first one conducted in 2012. The second audit showed some improvements and maintenance of good diabetes care at UNRWA health centres. Health education was provided more frequently to patients, and the technical instructions on treatment and monitoring of diabetes patients were regularly followed. The problems identified in the first audit, namely low control rates and poor health lifestyle remained the major problem facing diabetes care in UNRWA. Control rates were only around 25%. Obesity and overweight remained prevalent among 90.9%. In 2015, it was decided to introduce HbA1c testing widely and to update the NCD technical instructions accordingly.
A joint project between UNRWA Health Programme and Microclinic International (MCI) was launched in 2015, with the financial support by World Diabetes Foundation (WDF). The project aims to scale up diabetes prevention at UNRWA health centres, basically through training of all nursing staff and recruiting patients and their social network in health education interactive sessions aiming at helping them to follow a healthy life style.
A follow up survey was conducted on infant and neonatal mortality rates (IMR and NMR consequently) among Palestine refugees in Gaza. The IMR was found to be 22.7 per 1000 live births, while the NMR was 18.3 per 1000 live births. This survey confirmed that for the first time in decades, mortality rates among Palestine refugee new-borns in Gaza seems to increase.
In 2015, the integration of Mental Health and Psychosocial Support services (MHPSS) into primary health care was designated as an Agency-wide priority, and WHO’s mental health Global Action Programme (mhGAP) was adopted to use with patients who need additional mental health care for depression, unexplained medical complaints (including anxiety), grief, and epilepsy. On 31 January, 2016 Saftawi Health Centre in North Gaza became the first pilot MHPSS health centre, integrating the full package of services developed in 2015.
A pilot survey was conducted in November 2015 to collect more data on the effectiveness of the current hospitalization strategy. An Agency wide hospitalization policy revision and development of a hospitalisation database are still under development.
In 2015, and in cooperation with the Procurement and Logistics Division at HQA, the Health Department introduced UNRWA Pharmaceutical Quality Assurance policy and Strategic Sourcing for qualified pharmaceutical manufacturers, a sizable procurement efficiency gain was achieved. The unit price difference for some products ranged between 25 – 40%, thereby enabling access to high quality and lower cost medicines.
One milestone that UNRWA has achieved in 2015 was the decision to go 100% smoke free in all UNRWA premises and vehicles, and the launching of a new no-smoking Policy that went into effect on 11 November 2015.
During 2015, UNRWA Health Programme in Gaza, in cooperation with the Health Department at HQA, launched the Family Medicine Diploma Programme (FMDP). This programme aims at developing the competencies of UNRWA doctors in Family Medicine as an essential component of the FHT model.
Based on WHO’s Community Based Initiatives, in particular, the Healthy Cities programme, the West Bank Field implemented a Healthy Camp Initiative (HCI) as a pilot in 2015, in both Shu’fat and Aida Camps, and it is anticipated as a model to be expanded to other health centres in the Field and to the other Fields.
In 2015, the prevention and control of communicable diseases did not face big challenges, as no cases of polio or other emerging diseases were reported among Palestine refugees. UNRWA continued its cooperation with host authorities and WHO, and participated in immunisation campaigns for polio in all Fields.