Report Overview and 2014 Highlights
UNRWA's Family Health Team (FHT) is now implemented in 99 of 115 health centres, excluding Syria, where the transition is scheduled to be made in six health centres during 2015. e-Health, the UNRWA's in-house electronic medical record system was developed in 2011 to address the administrative burden of millions of patient files. At the close of 2014, 54 health centres were implementing the traditional e-Health system, while 18 health centres were implementing the new FHT e-Health system, tailored to allow for seamless integration with the FHT approach.
Highlights from two diabetes campaigns, implemented in 2013 and 2014 are also featured in this report. A total of 1,300 patients with diabetes participated in each round of the campaign, during which they were provided with a number of educational materials and sessions, healthy cooking materials and classes and group exercise activities. In both rounds of the campaign, participants had significant reductions in body measurements, as well as improved blood pressure readings. Additionally, the comradery and sense of community ownership that developed as a result of the campaigns has inspired the Department of Health to expand the activities in the campaign to all health centres, integrating the health education and lifestyle support into regular activities.
A study assessing the infant and neonatal mortality rates (IMR, NMR) across Four Fields (Jordan, Lebanon, West Bank and Gaza) was conducted in 2013, and analysis completed in 2014. The results show that while Lebanon and the West Bank's rates declined in accordance with Millennium Development Goal (MDG) 4, Jordan's rates declined only marginally, and Gaza's IMR actually rose slightly, while NMR rose significantly. These results are troubling to the Department of Health, and plans are in place for 2015 to further supplement these findings.
Emergency response continued to be a pillar of the Department of Health's service delivery in 2014. Gaza experienced a 50 day conflict during July and August, 2014, which resulted in 1,450 civilian deaths. Despite challenging and often dangerous circumstances, UNRWA was able to provide lifesaving and essential care to all residents of the Gaza Strip and health centres suffered no stock ruptures. Shelters, which reached a peak of more than 290,000 Internally Displaced Persons (IDPs), were able to contain communicable disease, and no significant outbreaks were reported. The crisis in Syria entered its fifth year, internally displacing over 280,000 Palestine refugees from Syria (PRS), and causing more than 80,000 to flee to neighbouring countries, including Jordan and Lebanon. Nine health centres have been forced to close due to security concerns or damage; however, with the establishment of 12 health points, the number of consultations are back to 92.7% of pre-crisis levels. A focus on improving the quality of these consultations will be a priority for 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.
While the Department of Health has made significant strides over the past 65 years, new challenges have emerged as priorities for 2015 and beyond. This year will bring an increased focus on improving the quality of health care delivered through the FHT model, which includes improving the quality of medical consultations, improving diabetes care quality and continuing to train staff on family health. Additionally, the Department of Health will focus on integrating health issues that have previously been unaddressed in a systematic fashion, including Mental Health and Psychosocial Support (MHPSS) and protection, and engaging the community in health prevention and promotion activities. Plans for 2015 include focusing on the improvement of hospitalization support in order to ensure financial protection is available for the most impoverished Palestine refugees, as well as fostering a better understanding of how UNRWA can prevent catastrophic health expenditure for families on the brink of poverty.
Section 1 - Introduction and Progress Date
This section includes an introduction to UNRWA as an Agency, and the Department of Health's activities over the past 65 years. It highlights the traditional model of health service delivery that has been provided in UNRWA's 137 health centres, and examines the demographic and epidemiological shifts in the served population that served as the reasoning behind reforming this model. It also gives an overview of the state of emergency response in each field, as well as priorities for 2015.
Section 2 - Maintaining Quality Health Services Across the Life Cycle
The performance of UNRWA's health services in 2014 towards the 2010-2015 Medium Term Strategy (MTS), as well as for the priorities identified in the biennium Field Implementation Plan (FIP) is presented in this section. The UNRWA Department of Health measures its performance on three strategic outcomes: ensure universal access to quality and comprehensive primary health care, protect and promote family health and prevent and control disease. A chapter highlighting cross cutting issues is also included in this section. Highlights from each of the Agency's Five Fields - Jordan, Lebanon, Syria, Gaza and the West Bank - are also featured throughout the report.
Section 3 - Data
Of note this year, for the first time since 2011, Syria Field is included in recorded indicators wherever possible. Such inclusions for 2012 and 2013 were not possible due to incomplete and inconsistent data collection and reporting as a result of the ongoing conflict. However, a focus on improved data collection techniques was emphasized in 2014, leading to this year's data.
Part One: Agency-wide trends (in graphic form) for selected indicators for overall programme performance from 2007 to 2014
Part Two: Field Implementation Plan (FIP) indicator trends by Field, and Agency-wide, sorted by Strategic Objective.
Part Three:2014 data tables by Field and Agency-wide on more general details, including demographic information, health infrastructure, Strategic Outcomes one, two and three and cross-cutting indicators.
Part Four: Includes selected survey indicators, including the DMFS Survey (2010), current practices of contraceptive use among mothers and prevalence of anaemia.
Part Five:Includes a list of donors who provided health-specific (earmarked) support to UNRWA. Many donors supported UNRWA with non-earmarked, General Fund contributions, however this table only highlights those who supported the health department specifically with ear-marked funds.