Annual report of the UNRWA Department of Health – Executive summary

UNITED NATIONS RELIEF AND WORKS AGENCY

FOR PALESTINE REFUGEES IN THE NEAR EAST

ANNUAL REPORT OF THE

DEPARTMENT OF HEALTH

2011

EXECUTIVE SUMMARY

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) is the main comprehensive Primary Health Care provider for Palestine refugees in the Near East and has been the largest humanitarian operation in the region for over 60 years. UNRWA’s mandate on health is to protect and promote the health of Palestine refugees registered in the Agency’s five Fields of operation (Jordan, Lebanon, Syria, Gaza and the West Bank). It aims for them to achieve the highest attainable level of health as indicated in the first Human Development Goal, “A Long and Healthy Life”, of the UNRWA Medium Term Strategy 2010-2015. Under this goal UNRWA has three strategic objectives: to ensure universal access to quality, comprehensive primary health care; to protect and promote family health and to prevent and control diseases.

UNRWA works toward achieving these objectives through a range of services that address the needs of refugees across the lifecycle phases of an individual. A healthy life is a continuum of phases from infancy to old age. Each one of these phases has specific needs for the maintenance of good health. UNRWA therefore adopts a Life Cycle Approach to health care, providing packages of prevention and care that are best suited to each phase of an individual’s life. In 2011, the UNRWA Health Department was confronted with a situation of changing health care needs, increasing demand for services and rising health care costs, while at the same time facing a stagnating resource base. New approaches to health services provision had to be found to meet the needs of Palestine refugees in the 21st century. This report summarizes the main achievements of UNRWA’s Health Programme in 2011 and is structured in three sections: Section 1 reports on the innovation strategies being implemented to provide quality health services to Palestine refugees in a changing environment, Section 2 provides information on the performance of health service delivery programmes and activities in 2011 and Section 3 contains self-explanatory data tables and trends on major indicators for each service delivery area.

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THE GAZA STRIP: preparing the community for the family health team approach

Introduction of the Family Health Team approach represents a substantial change for both staff and patients. Gaining community support is essential. In the Gaza Strip, three FHT pilot health centres (Beit Hanoun, Sabra and Beach) used a range of communication methods to reach the community. Achieving the buy-in of health centre staff was the first step. All staff members were engaged in the FHT preparations from the beginning and encouraged to contribute to innovation and problem solving. Staff that actively supported the introduction of the FHT approach from the start were key in helping to prepare the community. Community preparation activities were conducted both within the health centre and in the community. Clear, positive messages were used, for example, “FHT is not for reduction of services, but for improvement of care”; “Each family will have their own doctor”; “FHT is a global modern approach to improve health services”.

Inside the health centre, staff conducted individual and group discussion sessions with patients; brochures about FHT and its benefits were distributed; wall paintings were made to illustrate the team approach and posters were placed throughout the facility to attract the clients’ attention. Efforts were made to help patients locate their team easily. Teams were represented by different colours; walls and guiding arrows were painted according to team colours; a map of the health centre showing the location of each team was placed near the entrance. Posters showing the names and job titles of team members were produced, and nametags were made for all staff members. All family files were marked according to the team colour. At the community level, the Friendship Committees played a key role in advocating for the new approach. In addition, health centre staff conducted community outreach activities in places such as mosques, kindergartens and Women’s Centres. Meetings were held with local non-governmental organizations and with teachers, pupils and parents. Teachers were very supportive of the FHT initiative and instrumental in increasing awareness. Health centre staff used every available opportunity to distribute brochures and to talk about the FHT at community events, such as during the ceremonies for World Diabetes Day. As a result of the communication efforts of the health centre teams, the Family Health Team approach was successfully introduced into all three pilot health centres.

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THE WEST BANK: NCD care and family and child protection

Promoting Healthy Food in UNRWA’s Schools: development of poor eating habits and consumption of low quality foods at a young age are risk factors for the future development of NCDs. During 2011, the West Bank Field office (WBFO) piloted a Healthy Food Initiative (HFI) in Shufat Refugee Camp Elementary School. The school canteen was renovated both in its infrastructure and in the type of food served to children.

Chips, sweets and soda were replaced with healthy foods such as vegetables, fruit, muajanat and sandwiches. The innovation of the HFI lies in the partnerships among different UNRWA departments and the community to achieve healthier food options at schools. For example, Women’s Programme Centres, after being trained on healthy food preparation and food handling, now sell their healthy food products at the canteen, stimulating income generation for them and their families. WBFO seeks to expand the HFI in all West Bank schools.

Shams Centre for NCD Prevention and Management: as part of the WBFO’s longer-term strategy against NCDs, the Shams Centre for Prevention and Management of Non-Communicable Diseases (“Shams”) was established in Dheisheh Refugee Camp. Shams is the 1st referral centre for NCDs, complementing the work of UNRWA’s primary health care clinics. It provides intermediary care for patients who would otherwise directly access tertiary services and is the result of an effective partnership between health service providers and the community. The USD 500,000 building was donated by the Dheisheh community, refurbishing resulted from collaboration between UNRWA and the community, and strategic partners (Augusta Victoria Hospital and St. Johns Eye Hospital) provide specialized equipment and technical support. During 2012, high impact health and psychosocial teams will promote NCD prevention in the centre and in the community, providing refugees with information and tools to maintain a healthy lifestyle.

Family and Child Protection: recognizing family violence and child abuse and neglect as a public health issue, WBFO implements a cross-sectorial, multidisciplinary, community-based family and child protection programme, to slot in with the emerging national system for family and child protection. The programme, currently implemented in 15 refugee camps and one village, integrates family and child protection within UNRWA’s health services. It also mobilizes the community as a primary prevention and response mechanism. Initial findings suggest that this integration is improving the effectiveness of prevention and response measures thanks to the strengthening of trust between health care providers, victims of abuse and their communities. Sexual and reproductive health and rights promotion is also changing attitudes about family and child violence by sensitizing the community.

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Emergency preparedness and response

The Occupied Palestinian Territory

The humanitarian crisis continues in the occupied Palestinian territories, with intermittent violence, displacement, movement restrictions and intimidation.

West Bank

In 2011, UNRWA reported a total of 280 access incidents involving its staff, including doctors and nurses. Of the 271 communities in Area C, 22% faced difficulties in accessing health services due to road detours, road barriers and costs of transportation. Obstacles to obtaining building permits hindered appropriate maintenance and expansion of the health infrastructure. Movement restrictions also prevented Palestinians from accessing six Palestinian NGO hospitals in East Jerusalem. The hospitals are the main providers of specialized care for the occupied Palestinian territory. In the face of these challenges, UNRWA continued to provide health services to marginalized communities through five mobile health clinics, a community mental health program, and provided financial support to enable access to hospital care.

Gaza Strip

The blockade on the Gaza Strip continues to erode the quality of medical services in the area. Electricity cuts restrict medical treatment and construction and rehabilitation of health infrastructure is limited. There are on-going shortages of medicines in Palestinian Authority health facilities, for example, a cancer patient in the Gaza Strip can only expect to find half of the drugs required by chemotherapy protocols7. Patients referred for treatment abroad experience delays in obtaining permits to exit the Gaza Strip and this can at times result in death. As a result of their living conditions, Gazans experience significant mental stress. Almost a quarter of the patients assisted through UNRWA’s community mental health services in the Gaza Strip during 2011 were children with bedwetting, a frequent symptom of psychological trauma. UNRWA provides Primary Health Care to over 85% of the population of the Gaza Strip through 21 health centres, while also ensuring emergency preparedness through training of staff and prepositioning of essential medical supplies.