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Fatima, Mohamed & their children
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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”
`` `
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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
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Family Health Team and Fatima’s Family UNRWA Health Reform Vision
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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
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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
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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
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