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Source: World Health Organization (WHO)
23 April 1987



Provisional agenda item 29


WHO Collaborating Centers in Primary Health Care Research
In the Occupied Arab Territories

Progress report by the Director-General

Following requests contained in World Health resolution WHA35.15 (1982) and WHA36.27 (1983) the D1rector-General designated three institutions, two in the West Bank and one in Gaza, as WHO collaborating centers in primary health care research.

The institutions concerned, are described and an outline of their activities during the period May 1986 to April 1987, is given. This progress report is a follow-up to one provided by the Director-General to the Thirty-ninth World Health Assembly (document A39/24 of 7 May 1986).


1. All three WHO centers have now been designated. Financial support has been provided to them by WHO, through the UNDP Program of Assistance to the Palestinian People, and they have been operative since the dates shown below:

Ramallah Health Services Research Center - June 1985

Gaza Health Services Research Center - January 1986

Health Manpower Development Working Group of
the Health Services of the West Bank - June 1986

2. In the case of each center the objectives are the same, i.e., "to support the undertaking of health systems research aimed at ensuring total coverage of the local population with primary health care, using the most appropriate technology".

3. Hence the work of the centers is closely connected with all health service work in the area and with that of all educational institutions preparing health workers, whether in the public or the private sector, as well as with many private-sector health service, activities and private voluntary organizations.

4. The day-to-day implementation of the project activities are carried out on WHO's behalf by the UNDP Program of Assistance to the Palestinian People; the technical supervision rests with the Director-General of WHO.

5. The largely successful activities so far achieved have thus been the result of carefully established relations between WHO, UNDP and the health services in each territory. WHO fully acknowledges the contribution of its respective official partners in the enterprise. The costs of the total enterprise, as is the case in any situation where health systems research is the subject, are to a very large extent borne by those who operate the particular health system On which research is being carried out, and this is usually as in the West Bank and Gaza, the civil administration concerned.

6. WHO's financial contribution, a substantial one by usual standards, is directed only to the funding required to launch and stimulate the research and development being undertaken.

7. The actual day-to-day research - surveys, health examinations, interviews, questionnaires, etc. – has of course been mostly the responsibility of the Palestinian staff of the centers themselves. It has involved very large numbers of other health professionals in the wide range of subjects covered, as in essential in research of this kind, and in both territories have collaborated. The remarkable dedication and enthusiasm of the health professionals and the amount of hard work done in this period are cause for gratification, as are the good response rates in the populations studied.

8. Full participation by all involved in the day-to-day work of a health system, as well as by those for whom the system operates, is as fundamental for good health systems research as it is for primary health care itself.

9. Besides its financial input, WHO's technical cooperation has been provided in the usual way by members of the Secretariat and local and international consultants. The Director-General, as was reported in his last progress report (document A39/24), appointed in 1983 a Personal Representative who carried through on his behalf the negotiations leading up to the designation of the centers and to the establishment of appropriate working methods through UNDP. The Representative visits the area for several weeks each year and maintains contact through the appropriate channels to ensure continuous technical supervision of the work as it develops. During the period under review he has been assisted in certain activities by one senior staff member and by some five consultants, all selected by WHO in the usual manner.

10. All of the developments reported on are taking place at a time of change both in the special circumstances of the area and in the health services themselves. There have been substantial increases both in the funds made available locally and in the health manpower available in the public and private sectors.


Ramallah Health Services Research Center

11. This Center is in its second year of full operation and progress has been made in several of the planned research projects. Prominent amongst these have been the studies on infant mortality and a serological survey designed to provide better measurements of the immunization status of the young population. The latter survey has reached the stage of a draft final report and is the first study by any of the centers to reach this stage. It is anticipated that the final report will be ready for approval by the Chief Medical Officer soon. An early beginning has been made to the evaluation of the expanded primary health care project in the Hebron area. Studies of a number of subjects, e.g., evaluation of the work of traditional birth attendants (dayas), and analysis of factors promoting or constraining utilization of prenatal care and hospital delivery, has been much speeded up as one outcome of the health services research training workshop mentioned below (paragraph 14). New research topics also include the prevalence of cardiovascular risk factor, a subject of considerable importance in view of the changing epidemiological patterns among the population. It is anticipated that support requested from UNFPA will be particularly helpful in promoting activities in maternal and child health that have been timed to match the establishment of a service of special care, with built-in evaluation, for women with high-risk pregnancies.

Gaza Health Services Research Center

12. Work at the Gaza Center has made remarkable progress. In particular, the priority activity of the Center, which relates to the computerization of vital health statistical data, is considerably much further ahead than was envisaged a year ago. Computerization of the data appearing in Gaza, which will ultimately cover the entire population, is a noteworthy development - as it would be in any country. Staff of the Gaza Center have also been extremely active in pursuing the work arising from the health services research training workshop (paragraph-14).

Health Manpower Development Working Group of the Health Services of the West Bank

13. The-newest of the centers, whose scientific and professional activities got under way much later, has nevertheless made an important beginning on the scientific side in attempting to review all existing data concerning the health manpower available in the West Bank, beginning with physicians and nurses. By its very nature health manpower research, leading to medium-term and long-term planning, is a slow process; but with the goodwill of all concerned and the hard work of the staff, a promising beginning can be recorded. A higher proportion of training is planned than in the other two centers. An impressive beginning can be recorded here, too, especially in regard to local continuing education programs.


Health Services Research Training Workshop

14. A training exercise in health services research is currently being undertaken in the territories with the objective of increasing the skills of the staff of the centers, and of those who work closely with them, in carrying out health services research. The Workshop has provided encouragement and technical guidance to the participants in formulating and implementing a selection of relatively small yet relevant research projects, each being undertaken as a practical learning experience by all participants during a period of approximately six months. Part I of the Workshop took place from 7 to 11 December 1986. Part II will take place in June 1987. There were 26 participants in Part I, assisted by a faculty of five, all of them WHO consultants or staff. In April 1987 one WHO consultant and one staff member met with all of the participants for a two-day interim review meeting. Progress between December and April was found to have been very satisfactory, and the enthusiasm and dedication of the research workers concerned and the quality of their work were very favorably commented on.

Individual training

15. The Director of the Gaza Center took part in an advanced epidemiology course (University of Minnesota, USA). The Director of the Ramallah Center and one colleague took part in the "international track" of the Epidemic Intelligence Service Course (Centers for Disease Control, Atlanta, Georgia, USA). The Director of the Health Manpower Development Working Group of the Health Services of the West Bank paid a technical visit to WHO headquarters in October 1986 as his colleagues had done, in order to familiarize himself with related work and technical resources in WHO. Apart from periodical local courses, training abroad is currently in the planning stage for the two research officers of that Center and for two physicians, one each from Ramallah and Gaza. The latter will combine attendance at the forthcoming triennial scientific meeting of the International Epidemiological Association in Finland in August 1987, and visits to primary health care projects in the vicinity. Three further fellowships for training for masters of public health at the international level have been awarded to candidates from the West Bank and the fellowship awarded last year to a Gaza candidate has had a successful outcome.


16. Each center is an integral part of the health services of the area concerned. The Government Health Services of the West Bank and Gaza have been operated since 1967 under the auspices of the Government of Israel through its Civil Administration and in association with the Ministry of Health. These services are headed in each case by a Chief Medical Officer who comes under the Civil Administration. The various operating divisions are headed by Palestinian physicians, and the substantial number of operating staff in each area are all Palestinian. The three institutions designated by WHO are also each headed by and staffed by Palestinians. The support staff provided to assist the work, funded by WHO through UNDP contracts, are likewise Palestinians.


17. These aspects were reported on at some length in document A39/24. The financial requirements to maintain the centers in operation at the same level and to respond to their manifestly substantial capacity remain of the same order, and the Director-General has made a number of approaches in order to seek extra-budgetary funding. A distinct likelihood of support for one small-part of the needs, especially relating to research in maternal and child health including family planning, has been indicated by ONFPA Approaches to specific bilateral agencies are still under way. WHO funding has thus come so far exclusively from the Director-General’s Development Program.

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