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.

Finally, in this annual report, we have followed a structure that reflects the structure of the new UNRWA Medium Term Strategy for 2016-2021. Therefore, it is organized in the following manner:

Section 1 – Introduction and Progress to Date

This section includes an introduction to UNRWA and to the Department of Health's activities over the past seven decades. It highlights progress in the reform process, particularly the implementation of the FHT approach and the e-health system. In addition, this section examines the demographics of an aging refugee population, and the epide­miological shifts towards NCDs, that evoked the introduction of the reform model. Moreover, this section presents the way forward regarding the implementation of the MHPSS model, improved hospitalization support, and a new innovative approach to medicine and medical supplies procurement. Lastly, it introduces some of the innovations implemented during 2015 by the health programmes both at HQ and Fields' levels.

Section 2 – Strategic Outcome 2:

Refugees' health is protected and the disease burden is reduced

Under this section, there are two outputs: Under the first output, "people centred primary health care system using FHT model: the activities and achievements of all sub-programmes are presented. They include outpatient care, non-communicable diseases (NCDs), communicable diseases, maternal health services, child health services, school health, oral health, community mental health, physical rehabilitation and radiology services, disability care and pharmaceutical services. Under the second outpueefficient hospital support services," information and data about in-patient care, outsourced hospital services, and crosscutting issues are presented. Crosscutting issues include nutrition, laboratory services, health communication, human resources and gender mainstreaming.

Section 3 – Data

Under this section, data major indicators are presented in four parts followed by annexes.

Part 1: Agency-wide trends for selected indicators, presented in graphical form.The 24 selected indicators show the overall health programme performance Agency-wide from 2008 to 2015.

Part 2: Trends in selected 27 indicators under strategic objectives 1-3, for the years 2010-2015, per Field and Agency-wide, in table format.

Part 3:2015 data tables by Field and Agency-wide presenting details on all relevant information and indicators per Field and Agency-wide.

Part 4: Includes selected survey indicators.

Annexes: Include Annex 1 that represents Health Department research activities published papers, oral presenta­tions and poster presentations during 2015, Annex 2 that includes the Health Department Field Implementation Plan for 2014/2015, Annex 3 that presents updated health maps, Annex 4 which presents names and contact info of senior staff at both HQ and Fields, and lastly, Annex 5 includes a list of abbreviations used in this document.