Fatima, Mohamed & their children

1

Health of Fatima and her familyHow they enjoy their health status?

What are their health concerns?

Fatima has no worry about babies’ lives UNRWA Health Progress

2

3

Pakistan Sudan Jordan Lebanon Syria USA UK0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NCD account for 70-80% of deaths in Near East(Estimated proportional mortality: both sexes

2004)

InjuriesCDNCD

Ref: WHO World Statistics Report

Fatima may worry about life-style illness UNRWA Health Problem (1)

CD: Communicable DiseaseNCD: Non-Communicable Disease

Ref: UNRWA Health Report 2010 4

Fatima may not get proper care UNRWA Health Problem (2)

Health Center

When Fatima, Mohamed & their children go to the health center

5

`

`

Pharmacy

Clerk room

LaboratoryPre & Post natal care

General clinic (Dr’s office)

Growth monitoring & Immunization

NCD clinic

Present: When Fatima, Mohamed & their children go to the health center

Oral health (dental)`

` `

Family planning

Dre

ssin

g

6

UNRWA Health Reform

• Family Health Team

7

`

`

Pharmacy

Clerk room

LaboratoryPre & Post natal care

General clinic (Dr’s office)

Growth monitoring & Immunization

NCD clinic

Pre-Reform: When Fatima, Mohamed & their children go to the health center

Oral health (dental)`

` `

Family planning

Dre

ssin

g

8

`

`

Pharmacy

Clerk room

Laboratory

Post Reform: When Fatima, Mohamed & their children go to the health center

Oral health (dental)`

` `

Family planningFamily Health Team

“Comprehensive, Continuity of care”

`` `

9

UNRWA Health Reform: Vision

• Family Health Team approach– Primary health care delivery through health team to

address health needs of families holistically.• Person-centered, not disease centered• Comprehensive, not disease specific• Continuity of care• Community-oriented

– Globally accepted approach in primary health care• UK (GP), Canada (FHT), and many developed countries• Adopted in many countries in Middle East

– Jordan (Family physician), Palestine (PHC vision)– Extensive experience in Egypt & GCC countries

10

Family Health Team and Fatima’s Family UNRWA Health Reform Vision

11

Strong bond FHT & Family- Address all health needs of family-Help family to stay healthy - Effective appointment system

Education- Early detection of

education problems

- School health

Relief & Social Serv. - Care for gender-

based violence- Care for poverty

(assistive devices)

Referral- Effective referral to specialized care Host countries

- Improvement of care

- Alignment of health policy

Family Value

“Arab Spring”- UNRWA value on stability, youth, human rights etc.

Donor & Partners- Health reform based on modern universal value & standards

All other services - Family protection- Empowerment

with microfinancing

UNRWA Partners

Community

Limited in new areas, vertical, overcrowded, quality compromised

Poor knowledge on refugees’ conditions

Command-control sysImproper appraisal

Un-updated structure

Fragmented health information system

Very low health expenditure per capita

UNRWA closed in itself with others

From Reviews to Reform document

Family health team

Family Health Team approach

UNRWA Health: From Review to Reform

-Person-centered, continuity of care

-Team work by health professionals

-Revised structure to support FHT

-e-Health & health information system

- Platform for synergy with other UNRWA programs, and collaboration with partners

Appointment system

Operational research & surveys

Hospitalization arrangement support

“Raising fund with FHT Health Reform”

UNRWA Health Expenditures

13

2004 2005 2006 2007 2008 2009 -

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

70,000,000

80,000,000

90,000,000

100,000,000

Total GF health expenditure by expense groupAll others

Hospital

Medicine & equipment

Salaries

UNRWA Health Reform: Steps

14

2011 2012 2013 2014 2015 2020

Preparation

UNRWA Pilot

Field PilotsExpansion

Extensive preparation-technical-teamwork-e-Health & HIS- re-

organization- communicatio

n

-1st pilot in 1-2 health center-Learning & assessment

- Pilots in all fields

- Expansion to all health centers

0 1-2(1st pilot)

6(Field pilots)

63

(those in camps)

137

(All)

Family Health Team health centers

UNRWA Health Reform: Resources

• Family Health Team– In principle, no additional resources required eventually

• Optimal ways to utilize existing resources– Staff, health centers, and funds

– Still, additional resources are needed to bring changes• Preparation for pilot phases

– E-health including information systems– Training– Communication– Technical assistance

• Once changes are in place, GF will absorb changes

15