UNRWA has been operational since 1950. UNRWA provides assistance and protection for approximately 5.8 million Palestine refugees in the five Fields of operations today — Jordan, Lebanon, Syria, West Bank and Gaza. 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 PHC facilities, and supports patients to access secondary and tertiary health care services. Currentlly, around 3.5 million Plaestine refugees receive health care at UNRWA health centres. During 2016, our Fields of operation continued to suffer the effects of instability in the region. In Lebanon and Jordan, refugees from Syria (PRS) have been straining the system for years, while the occupation by Israel and the on-going conflict continues to challenge Palestine refugees' access to deliver of health care by UNRWA in the West Bank, Gaza and Syria.
The Palestine refugee population is predominantly young. Population ageing, however, is advancing with longer life expectancy. The demographic shift has resulted in changes in disease burden, particularly increased prevalence of non-communicable diseases (NCDs) which accounts for approximately three fourths of mortality today. In response to this, UNRWA has established health reform strategies which marked a significant milestone in 2016. Family Health Team (FHT) Approach is a new, person-centred approach, devoted to improving the quality and delivery of public primary health care for Palestine refugees. Now FHT approach is being implemented in 135 health centers: operational in all health centres in Jordan, Lebanon, West Bank and Gaza with exceptional on-going effort to expand the approach in Syria.
Introduced with the FHT approach is an electronic patient health-record system referred to as e-health. As a complement to the FHT approach, e-health ensures that family health teams can readily follow up and/or offer health services as result of having consolidated information about the patient's health. Being introduced to 114 health centers, e-Health FHT version is now operational across all health centres in Gaza, and Lebanon, and the system is expected to be fully operational in both Jordan and West Bank and by mid-2017. An important dimension of the FHT approach in 2016 also involved Family Medicine Diploma Programme which trained 15 UNRWA doctors in Gaza.
The Medium Term Strategy (MTS) presents the Agency's strategic vision and objectives for its programmes and operations for the period 2016-2021, with the aim of maximizing its use of resources and the impact of its operations in serving Plaestine refugees. The Department of Health is primarily responsible for its Strategic Outcome 2: Refugees' health is protected and the disease burden is reduced, which includes the implementation of people-centred primary health care system using the FHT model. In Gaza, pilot project to integrate Mental Health and Psychoso-cial Support (MHPSS) was launched at Saftawi health centre. The integration of MHPSS within its primary health care is a turning point for the Agency, enabling the provision of more comprehensive services to Palestine refugees. In January 2016, Saftawi health centre in North Gaza became the first MHPSS pilot health centre, integrating the full package of services. In response to the increasing incidence of NCDs among the Palestine refugee population, UNRWA has introduced new tests, medicines and public awareness campaigns to promote NCD prevention and condition management.
In addition to passive case detection, screening for diabetes among high-risk groups were continued to be provided. In 2016, the prevention and control of communicable diseases was successful, as no cases of outbreaks were reported among Palestine refugees. Maternal and child health outcomes, including immunisation rates, remain strong. In 2017, UNRWA will continue to partner with domestic and international agencies to maintain such strong health outcomes, and to investigate areas where services can be further improved Another health-related outcome of MTS is the provision of efficient hospital support services. In January 2016, UNRWA introduced adjustments to its hospitalisation policy in Lebanon to achieve greater sustainability in the Agency's support for the Palestine refugees. This was a reflection to the voices of the Palestine refugee population who had concerns with the cost-sharing element previously introduced for secondary hospitalization support. The Agency took these concerns very seriously and as a result, developed and implemented a refined hospitalization policy. UNRWA will continue to focus on the most life-threatening illnesses and on those who lack the necessary financial resources to attain life-saving/life-supporting treatment.
Finally, this Annual Report is thus organized in the following manner:
Section 1 — Introduction and Progress to Date
This section includes an introduction to UNRWA and to the activities of the Department of Health over the past seven decades, introducing the population and examining its demographics. It highlights progress in the health reform process, namely FHT approach and e-Health system, which respond to the changing disease burden and increasing health demands of Palestine refugees. 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 2016 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
This section outlines outcomes based on one of the MTS 2016-2021 set by UNRWA. The activities and achievements of all sub-programmes by the Department of Health are presented. Those include outpatient care, community mental health, non-communicable diseases (NCDs), communicable diseases, maternal health services, child health services, school health, oral health, physical rehabilitation and radiology services, disability care and pharmaceutical services. It also outlines information and data about inpatient care, outsourced hospital services, and crosscutting issues.
Section 3 — Data
Under this section, major indicators are presented in four parts followed by annexes. Part 1: Agency-wide trends for selected indicators, presented in figures. The 24 selected indicators show the overall health programme performance Agency-wide from 2009 to 2016. Part 2: Common Monitoring Matric (CMM) indicators (2016-2021). Trends in selected 27 indicators under strategic objectives 1-3, for the years 2016-2021, per Field and Agency-wide, are presented in tables. Part 3: 2065 data Tables, presenting aggregated 2016 data and details on all relevant information and indicators per Field and Agency-wide. Part 4: Selected survey indicators, presenting results of surveys conducted at the Health Department. Part 5: Health Department Research Activities and Published Papers Part 6: Director of health and senior staff of department of health participated in the Meeting/ Conference and Part 7: Donor support to UNRWA health program me. Additionally, annexes include list of strategic outcomes, health maps, contacts of senior staff of the UNRWA Health Department and finally, the list of abbreviations.