Joint efforts to avert collapse of health services

Thu, September 07, 2006

Responding to the crisis: Joint efforts to avert collapse of health services

Monitoring the impact of the crisis on health services:

In light of the current crisis in OPT, UNFPA revised its programs within the Consolidated Appeal Process (CAP) and added a number of new programs that respond to the ensuing situation. A major new program is seeking to monitor the impact of the current crisis on the health situation in terms of availability and accessibility of health services. This is a joint program with other UN agencies working in the health field, including UNICEF, WHO, UNRWA and OCHA. Each of these agencies identified appropriate indicators for monitoring the health situation in their respective field of mandate and a monitoring mechanism wasset up for measuring these indicators and updating the data on monthly basisrather than waiting for quarterly or annual reports by MoH. The indicators measure the impact of the crisis on MoH functions both financially and administratively, particularly in terms of the impact of the prolonged delay in paying staff salaries, inability to cover the running costs, the impact on service quality, etc.


In anticipation of such situation, UN agencies already made an examination of the different possible scenarios that can ensue from the current crisis and possible ways to respond, which proved useful for taking the necessary measures, modifying work priorities and expediting response to the emerging needs.


Responding to the emerging needs of the health sector:

In response to MoH appeal issued in February, UNFPA and UNICEF coordinated their efforts for assisting MoH in addressing the new needs ensuing from thecurrent crisis. This assistance is regulated by a memorandum of understanding signed with UNICEF and another with MoH. UNFPA major interventions in this regard include:


· Provision of a USD 250,000 value of drugs and medical equipment

and supplies to MoH. Lists of needs were agreed upon with MoH, which included medical equipment of USD 100,000 value, medical supplies and disposables of USD 100,000 value and drugs of USD 50,000 value. The procurement process was completed and the materials are being supplied to the MoH.


· Support to transportation running costs. A mechanism was set up with MoH to enable UNFPA to cover the running costs of MoH ambulances (fuel and maintenance) related to UNFPA mandate, namely reproductive health services and emergency obstetric care in particular.

Additionally, UNFPA is covering the costs for transporting cancer patients to specialized treatment centres in Jerusalem and Beit Jala. Initially, this support is agreed to last for three months, after which the situation will be assessed and a decision will be made in regard to the need for extension. At the primary health care level, division of roles between UNFPA and UNICEF was agreed upon in coordination with MoH, whereby UNFPA would cover 50% of the costs for transporting medical teams and UNICEF would cover the remaining part of transportation costs, in addition to vehicle maintenance and rental for the purpose of transporting health staff, vaccines and other supplies.


· Support to MoH in logistics management. Coordination has been made with UNICEF to support MoH with a logistics team, which will include an international consultant recruited by UNICEF and two national staff members, one in the West Bank and one in Gaza, recruited by UNFPA. This team will provide the following support:

1. Provision of technical assistance to MoH in developing the logistics management of drugs and supplies.

2. Coordination with donors that do not work directly with MoH.

3. Logistical coordination with other health providers, mainly NGOs. This effort is expected to assist MoH in upgrading the system of logistics management in order to control the flow of supplies and drugs from MoH central warehouses to district warehouses and then to peripheral health centres in need for such items. This is envisaged to contribute to sustaining service provision at MoH facilities.


In addition to above, UNFPA headquarters approved the provision of additional support of USD 200,000 to MoH to meet other needs as identified by MoH with focus on medical supplies and disposables.


Rehabilitation of maternity wards in hospitals:

In any situation, approximately 15% of deliveries will be complicated and require medical intervention. High risk management in pregnancy requires a mechanism that can respond effectively and immediately to emergency obstetric situation if maternal death and morbidity are to be avoided. The crisis created by closures and other measures imposed under Israeli occupation have led to fragmentation of the health system and inability to effectively respond to emergency obstetric cases. In recent months, the Ministry of Health has been further incapacitated due to the lack of funds for running costs, pharmaceuticals and supplies to effectively and efficiently run the maternity wards and operating theatres for emergency cases such as caesarean sections and postpartum complications.


Moreover, many of the maternity wards require rehabilitation, renovation and

equipping to ensure safe delivery. To respond to these needs, UNFPA added a new program to its CAP projects seeking to upgrade maternity wards, operating theatres and referral mechanisms in six hospitals in the West Bank and Gaza that account for more than 60% of deliveries and represent the major referral centres in six governorates (Jenin, Nablus, Ramallah, Hebron, Gaza and Khan Younes). The project will provide these hospitals with the minimum requirements in terms of equipment, renovation of maternity wards and operating theatres, and a covering a proportion of the operating costs (maintenance, fuel, utilities) for the six hospitals that are related to the provision of obstetric care and referral.


The project will help reduce the number of maternal deaths and morbidity by improving emergency obstetric care response and introducing live-saving measures.