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Source: World Health Organization (WHO)
1 March 2005




Health Inforum News
Volume 4, No.58, 1 March, 2005
__________________________________________________________________________________________________
Welcome to the fifty-eighth issue of the Health Inforum Newsletter.
Quote of the month
    Health is a state of complete physical, mental, and social well-being and not
    merely the absence of disease or infirmity. World Health Organization
CONTENTS

Health News
• World Health Day 2005
• WFP delivers food to Al Mawasi
• WHO mission to investigate mumps outbreak in WB
• B'Tselem’s updated map of the Separation Barrier
• Jerusalem resident delivers at Kalandia checkpoint
• 2nd issue of “Bridges” Magazine
• WHO/ Health Inforum Coordination activities in oPt
• National Plan for Nutrition in oPt.

Reports
UNRWA Medium Term Plan

Projects
Maternal, Child Health And Nutrition Project (HANAN).

Casualties & access incidents
During 28/1-27/2, 2005 , 20 deaths according to the Palestinian Ministry of Health.

During February, there were 14 episodes of ambulance delay and 4 cases of denied access.


HEALTH NEWS

World Health Day 2005
WHO announced healthy mothers and children as the theme for World Health Day 2005. This is also the subject of the World Health Report 2005, which will be launched on World Health Day, on 7 April 2005.

The slogan for World Health Day 2005 is "Make every mother and child count", which reflects the reality that today, the health of women and children is not a high enough priority for many governments and the international community. For more information please click www.who.int/world-health-day/2005/en/

WFP Delivers Food to Al-Mawasi
On February 20th, WFP succeeded, for the first time in four years, in delivering food aid to Al-Mawasi area, in the Gaza strip. A two month ration was distributed amongst families of fishermen, farmers, Bedouins and hardship
social cases. Since the outbreak of the second Intifada, Al-Mawasi has been under strict IDF control and was totally disconnected from the rest of the Gaza strip.

Al-Mawasi is located in the southwest of the Gaza Strip. About 7,000 Palestinians live, completely isolated from the rest of Gaza, between the settlement of Gush Katif and the sea. Palestinians are allowed out during the day only if they obtain an IDF permit and they must return home within the same day, before sunset. Al-Mawasi was once an agricultural and fishing community located near the seashore, but, since the outbreak of the second Intifada, the area has been strangled.

WHO mission to assist in the investigation on mumps outbreak in the West Bank
In a follow up for the WHO response to Mumps outbreak in West Bank, A special mission of WHO-headquarter will visit the West Bank and Gaza on March 10-19, 2005. Several meetings will take place with the Ministry of Health
(MOH) and other health agencies.

The objectives of the mission are the following:

. Review the MOH program for prevention and control of measles, mumps and rubella.
. Assist MOH officials in characterizing the mumps outbreak
. Characterize the clinical distribution of the disease.
. Review laboratory investigations of the outbreak with MOH officials.
. Make recommendations for outbreak control and use of mumps vaccine in the Expanded Program of Immunization schedule.

B'Tselem publishes an updated map of the Separation Barrier
On February 20 2005, the Israeli government approved an updated route for the Separation Barrier. According to the map published by the Ministry of Defense, sections of the revised route will run close to or along the Green Line, thus reducing the harm caused to the daily life of Palestinians living in proximity to the route.

Despite these improvements, the new route does not eliminate the “fingers” which reach deep into the West Bank to surround the Ariel and Qedumim settlements. In addition, a new section of the Barrier has been added around Ma'ale Adumim and the settlements near it. In these locations, the government approved the route. For more information and to download the updated Separation Barrier map, please visit www.btselem.org/English/

Jerusalem resident delivers at Kalandia checkpoint
15 February 2005 around 9:00 am – A woman in labor - with Jerusalem ID - was denied to cross Kalandia checkpoint by the Israeli soldiers, on her route to a Palestinian hospital in Jerusalem. The soldiers claimed that her husband had no permission to enter Jerusalem. At the checkpoint, a PRCS ambulance team was asked to assist the woman who delivered in the ambulance. Both the mother and the baby are in good health and were transferred to Al-Muhtadi hospital in Kufr Aqab, near Ramallah.

The 2nd issue of “Bridges” Magazine
The second issue of Bridges, the Israeli-Palestinian public health magazine, was published and distributed in West Bank, Gaza and Israel. This issue focuses on the subject of disabilities. The full copy of the magazine is available on www.healthinforum.org

WHO/ Health Inforum Coordination activities in oPt
On 9 February 2005, a district meeting was held in Tulkarem. MoH and UNRWA presented an overview of the current health situation in the district, including available services and needs. The main constraints are closures affecting the access to health services, shortages of medicine, shortages of staff, lack of financial resources, lack of coordination between MoH and other health providers.

On 8 February, a Health Emergency Coordination Meeting in Gaza addressed the topic of solid waste management. The Chairman of the Environmental Quality Authority presented the critical issues in Gaza Strip, including the consequences of the closure of the roads leading to the landfill in the mid-zone. The GTZ also presented their activities and projects on the same subject. For more details, please see the minutes of the meetings at www.healthinforum.org

National Plan for Nutrition in oPt.
In March 20 – 22 2005, MoH and WHO will conduct a 3 day workshop on the Operational Plan for National Nutrition Strategies in oPt. The workshop aims to develop a comprehensive operational plan of action for 2005 - 2008 based on the existing National Nutrition Strategies for the oPt.

Among the specific objectives there are: To present the key findings and conclusions of the “State of Nutrition” document and agree on the main nutrition problems in the OPT; to present and ratify a National Nutrition Policy Statement; to review the existing Nutrition Strategies and develop them into an operational plan.



REPORTS

UNRWA Medium Term Plan (MTP) 2005 - 2009

The United Nations Relief and Works Agency for Palestine Refugees (UNRWA) presented their MTP 2005-2009 to the international donor community in Geneva, with a request of US$1.1 billion for the next five years.

On the Health sector, the plan objectives include:

1. To achieve parity of UNRWA services with host authority and international standards:
a) Reducing excessive workloads. Exceptionally high workloads at primary health care facilities would be reduced by reinforcing staffing of the existing facilities and by establishing additional facilities that are adequately staffed and equipped;
b) Improvement of refugee access to basic primary health care services. This requires investments in expanding, renovating and upgrading the Agency's primary health care facilities and medical equipment; and improving out-reach services with special emphasis on un-served and under-served communities. Duplication and overlap with the services of other providers would be minimized.
c) Introducing equitable and sustainable hospitalization policies. The Agency would reduce the current disparities in resource allocations between Fields while increasing the allocations for Jordan, Gaza and Syria Fields. Referral policies/practices will be rationalized in Lebanon and the West Bank Fields.

2. To address the needs of vulnerable refugees
Addressing priority unmet needs. Special emphasis will be placed on:
a) developing a program of psychosocial counseling and support, and initiating the phased implementation of community mental health programs in Fields beyond the oPt;
b) establishing programs for early detection and management of disabilities among children, with special emphasis on disabilities which affect the learning abilities of children, such as vision and hearing defects;
c) introducing screening and control of cancers among women by targeted screening of women at least once in the life cycle.

Improving environmental conditions in refugee camps. Special attention is required to address the primary health needs of camp residents who are made vulnerable to disease by unhygienic environmental conditions. This objective should be pursued in close co-ordination with local municipalities and with special emphasis on wastewater disposal and solid waste management.

4. To build capacity within UNRWA
Institutional capacity building and staff development in the health department. This is essential in order to improve system performance, and to meet future replacement needs, especially at the senior professional level. The use of ICT would be expanded and effective systems introduced for improving surveillance, monitoring and management of services at the delivery level. The Agency will also strive to improve planning, monitoring and evaluation of the program at all levels, utilizing whenever appropriate the results of the IUED-UCL/UNRWA partnership.

Expected results and indicators:
• Doctor consultations are reduced to no more than 70 per day; there are 30 or more nurses for every 100,000 of the agency's beneficiary population.
• Further reduction in infant, child and maternal mortality by improving the coverage and quality of ante-natal, intra-partum and post-natal care, further enhancement of the at-risk strategy, and expanding the use of modern contraceptive technology.
• Improved management of child disabilities by integrating with school health services programs for screening, early detection and management of physical impairments such as hearing and vision defects.
• Reduction of morbidity and mortality from communicable diseases by achieving the WHO targets for eradication of poliomyelitis, elimination of measles and control of tuberculosis; and by strengthening surveillance of other communicable diseases of public health importance.
• Reduction of morbidity from micronutrient deficiencies such as iron deficiency anemia and other vitamin deficiencies among children and women of reproductive age by sustaining, expanding and supplementing food fortification programs;
• Reduction of morbidity, disability and mortality from non-communicable diseases by mobilizing additional resources to strengthen strategies that address risk factors and that help to prevent complications;
• Reduction in the burden of mental and psychological problems among vulnerable population groups especially women and children by implementing a community-based, multidisciplinary program within a preventive-based approach to psychosocial well being;
• Reduction of morbidity and mortality from cancers of the breast and the uterus by implementing programs fully integrated within the Agency's primary health activities for targeted screening, early detection and management of these conditions;
• Reduction of morbidity from sexually transmitted diseases by implementing the WHO recommended approach within the framework of the Agency's maternal health and disease control strategies;
• Reduction of disability and premature death from acute and other life-threatening conditions by improving Agency assistance towards outsourced hospital treatment, especially in Fields where alternative facilities are not readily accessible to refugees at affordable cost;
• Reduction in environmental hazards and contributing to sustainable development I refugee camps by upgrading camp water and sanitation infrastructure in close cooperation with local municipalities;
• Enhanced capacity of the health care system in the areas of program analysis, monitoring and evaluation by upgrading the skills and capabilities of health professionals through in-service and post-graduate training, expanding the use of information technology and forging partnerships with local, regional and international research institutions.
For more information ,please visit the UNRWA site www.UNRWA.org


PROJECTS

Project Title: Maternal, Child Health and Nutrition Project (HANAN).
Location: Gaza Strip and West Bank
Project duration:3 years.
Donor: US Agency for International Development (USAID)
Starting Date: first of January, 2005
Project Budget: US$ 21,000,000
Implementing agency: John Snow Institute and others

The Maternal, Child Health and Nutrition Project (MCHNP) began on 1 January 2005 and will continue for 36 months. The goal of this project is to bring a basic package of top quality maternal, child health, and nutrition services to Palestinians as close to their homes as possible. The project has offices in Ramallah and Gaza, and will have satellite offices in Hebron, Nablus, and Khan Younis.

Project Goals & Targets
MCHN will seek to expand the public health advances made by USAID through the Maram Project, including:
• Upgrading essential skills of health care providers;
• Enhancing the management skills of clinic managers;
• Working with Palestinian communities to enlist their support for the program;
• Introducing effective health education messages and interventions to promote healthy lifestyles.

The project’s targets will be to:
• Improve the availability of essential services and counseling for women of reproductive age;
• Upgrade well-baby care and infant and child nutrition;
• Improve the management of common childhood illnesses.
Project interventions will focus simultaneously on the service delivery level as well as at the community level. Clinic capacity building and community mobilization will improve access to and quality of MCHN services.

In addition to field implementation of services and information, the Hanan Project will also seek to identify policy needs which—if effected—could further improve access to and quality of services for the most vulnerable Palestinians.

Project Start-Up
During its first four months, the project staff will carry out a series of assessments and will conduct fact finding. These assessments will include the Maram Maternity Homes, and will seek to identify the most vulnerable communities from the maternal and child health perspective. Following data collection and analysis, vulnerable communities will be rank-ordered to select the communities where Hanan will work. We will also conduct a siting analysis to identify potential services provider opportunities in proximity to the MV communities; will assess the interests of communities and providers to become a part of the Hanan-assisted network; will conduct an assessment of the needs of communities and providers to play this role and of training capacity in WB and Gaza.

At the end of this start up period, Hanan will have identified the initial cohort of communities and service providers with whom it will work during the initial year of implementation; will have developed its comprehensive strategic framework, and will have completed a Performance Monitoring Plan, a first year work plan, and the budget. We expect to initiate full implementation by mid 2005.

Coordination with Stakeholders
The project will work in close coordination with the Palestinian Ministry of Health, and other key stakeholders, seeking to achieve measurable improvements in women’s and children’s health and nutritional status.

We are aware that many groups—external and local—are working in the areas of MCHN, and wish to ensure that our efforts are fully complementary and cumulative with these. Two initial coordination mechanisms we envision include:

• Establishing a Project Steering Committee, which will facilitate our ability to know what others are doing, and to get feedback on the appropriateness of Hanan objectives, strategies, priorities, and activities, and coordinate Hanan activities with those of other stakeholders. Membership of the PSC will include the MOH, USAID, one or more representative of NGOs, plus several UN agencies.
• Appointing a senior member of the Hanan technical team to work with a counterpart inside each major stakeholder as a way to ensure close liaison.
• Creating an active program of dissemination of project designs, plans, tools and methods, lessons learned, and
results.

End of Project Vision
Our vision is—by the end of the project--to have:
• Provided access to an essential package of quality MCHN services and information to 60% of the most vulnerable
women of reproductive age and children under 5 (in non-refugee communities).
• Significantly improved the understanding among Palestinian communities about their health needs,
• Helped to improve the capability of the health system to provide quality services available to mothers and
children.
The HQ of Hanan is in the Masrouji Building, 3 Mada’en Street, Suit 200, Al Bireh/Ramallah, Tel: 02 240 7021/2, Fax: 02 240 7490



CASUALTIES AND HEALTH INCIDENTS

According to the Palestinian Health Information Center (MOH), during the period 28/1 - 27/2, 2005, the number of casualties reported in the West Bank and Gaza Strip was 20 deaths (including 10 children) and 104 injuries (including 31 children).

During February 2005, there were 14 episodes of ambulance delay (for a total delay of 15 hrs). In 4 cases the access was totally denied, according to PRCS, including a delivery at a checkpoint (see news), and the case of a 15 years old boy who was injured in Al Salah area in Hebron, and only after 2 hours the soldiers allow the ambulance to transfer the boy to hospital, where he was declared dead.

The following diagram shows the total number of ambulance incidents by area, the time of delay and the episodes of denied access (D/A) at the checkpoints:



FOR MORE INFORMATION

Please feel free to contact us at:

Health Inforum, c/o Italian Cooperation/ Sheikh Jarrah, East Jerusalem, Tel: 02 532 7447, Fax: 02 532 2904

Health Inforum, c/o WHO Jerusalem office/ Sheikh Jarrah, East Jerusalem, Tel: 02 5400 595, Fax: 02 581 0193

Health Inforum, c/o WHO, Gaza office, Al-Bayed building, Al-Halbi Str. Tel: 08-2822033, Fax: 02-2845409
Email: info@healthinforum.org

Health Inforum posts daily news and announcements concerning health issues on its website: www.healthinforum.org.

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