Ministry of Health State of Palestine Public Health Policy for ......Mamdouh Nujoum, Ms. Taghrid...

December 2012

Public Health Policy for Palestinian ChildrenPalestinian Child Health Priorities Based on the Child’s Rights to Health

Ministry of HealthState of Palestine

Public Health Policy for Palestinian Children

Palestinian Child Health Priorities Based on the Child’s Rights to Health

December 2012

Ministry of HealthState of Palestine

Education

Protection

Disability

Child Participation

Health

Note: Data included in this report is primarily based on statistics available in 2011 when this work was initiated

Participants in the Preparation of the Policy:From the MOH:• Committee Coordinator: Dr. Waleed Al-Khateeb• Ms. Ilham Shamasnah• Ms. Taghreed Hijaz• Dr. Jawad Al-Bitar• Dr. Bassem Naji• Dr. Mamdouh Njoom• Dr. Ghada Khoury• Eng. Ala’ Abu Rub• Ms. Lubna Sader• Ms. Lina Bahar• Dr. Abdullah Zahran• Ms. Taghreed Yaseen• Ms. Jameeleh Dababneh• Ms. Majida Saeedi• Ms. Amal Al-Haj

From Save the Children• Ms. Lubna Iskander

Final Editing and General Supervision:• Dr. Asaad Ramlawi• Dr. Waleed Al-Khateeb

This document was produced with the technical and financial support of Save the Children International

All rights are preserved – In case of quotation please refer to the document as:

MOH-Palestinian Child Public Health Policy- Palestinian Child Health Priorities Based on the Child’s Rights to Health – Palestine 2012

Acknowledgment

This policy is the result of national consultations based on the report by the Palestinian National Authority (PNA) on the implementation of the Convention on the Rights of the Child (CRC), seeking to make the rights and health of Palestinian children a fundamental pillar of our national plans for a healthy society.

We would like to express our deep appreciation to all those who contributed to the development of this document, from inside and outside the Ministry, and to the efforts of the Palestinian civil society organizations, and all departments and directorates of the Palestinian Ministry of Health (MOH). Special thanks are due to Dr. Walid Al-Khatib – coordinator of MOH internal committee on the rights of the child, Dr. Jawad Bitar, Dr. Bassem Naji, Mr. Alaa Abul-Rub, Ms. Ilham Shamasneh, Ms. Lubna As-Sadr, Ms. Lina Bahr, Dr. Abdulla Zahran, , Dr. Mamdouh Nujoum, Ms. Taghrid Hijaz, Ms. Jameeleh Dababneh, Ms. Taghreed Yaseen, Ms. Majida Saeedi, and to Ms. Hanan Abed and Mr. Ihab Shukri from the Ministry of Education. (MOE)

We would like to thank UNICEF and Save the Children for their technical and financial support in the production of this document, and to the Palestinian Central Bureau of Statistics (PCBS).

Dr. Asaad Ramlawi

Director General of Primary Health Care, MOH

Table of Contents

Introduction .................................................................................................7

Executive Summary .....................................................................................8

Problem Statement ......................................................................................11

Situation Analysis ........................................................................................13

Major Health Indicators in Palestine ..........................................................14• Child Mortality• Social Practices• Nutrition and Physical Activity• Non-Communicable Diseases (Chronic Diseases) – NCDs• Mental Health• School Counselling• Health Education and Adolescents Health• Availability of Services and Infrastructure• Early Detection and Disability

Policy Framework ........................................................................................22• Vision• Mission• Policy’s Ultimate Goal• Intervention Levels• Policy Rationale• Policy priorities according to Consultations with the Partners• Partners• Marginalized Groups/ Marginalized Children

Strategies of the Palestinian Public Health Policy .....................................27Obstacles......................................................................................................49

Risks.............................................................................................................49

Strengths ......................................................................................................50

Weaknesses ..................................................................................................50

Needed Supportive Studies and Protocols ..................................................51

Child Rights to Health Indicators ...............................................................52

Annexes:Annex 1: Palestinian Health Strategies – Prevention and Healthy Life Styles ...... 58

Annex 2: Suggested Roles and Needs for Early Detection and Referral .............. 62

Annex 3: Influence of the Political Situation on the Socio-Economic Life of the Palestinian People ...................................................................................... 64

Annex 4: The Health Situation in Palestine ............................................................... 68• Health Legal and Legislative Framework• Policy and Strategic Framework• Partnership with UNRWA• Health Centres and Personnel

Annex 5: Summary of Some Health Indicators ........................................................ 69• Nutrition• Health Education and Adolescent’s Health• Inappropriate Preventable Social Practices that can Affect Child’s Health • Early Marriage and Consanguinity• Smoking and Substance/Drug Abuse• Non-Communicable Diseases (NCDs)• Mental Health• Affordability

Annex 6: Best Practices ................................................................................................. 83• Combating Smoking and Pollution• Accident Prevention• School Health• Prevention of Nutrition Related Problems• Health Education and Awareness Raising• Systems, Services and Monitoring• Partnership, Coordination and Role Distribution• Protecting Mother and Child’s Health

Annex 7: General National Health Rights Based Indicators ................................... 88

7Public Health Policy for Palestinian Children/Right to Health Priorities

IntroductionThrough our continuous and diligent efforts to develop and improve qualitative, affordable and accessible health services in Palestine to match the level of sacrifices of our people under these difficult circumstances, this policy will add to our national achievements to build our Palestinian State on a sound footing. It represents a good example of partnership and cooperation within the different departments of the ministry itself, and with partners from other governmental and non-governmental organizations.

We worked together to ensure the best interests of the Palestinian children, without discrimination, and to ensure their survival and development, and to create an enabling environment for them. We, at the Ministry of Health have prioritized Palestinian children since our inception. Furthermore, we are one of the leading countries in the field of primary health care and maternal and child care in the region. However, this achievement is a first steps towards the institutionalization of children’s rights within our priorities and programs. It puts us among the few countries that have a national policy based on the rights of the child. What is special about this document is that it was built not only on the basis of well-being and needs of the child, but was based on their rights. It puts the Palestinian child in the center of attention, commensurate with his/her status as the foundation and future of the Palestinian society. They are half of the present and all of the future.

This policy paper focused on the child’s individual rights and not only the right of the family. Children deserve special attention and positive discrimination. It puts the best interest of the child above all other considerations. Children are the most vulnerable group and are at risk of marginalization due to the economic, political and social factors. Considering the current circumstances, and the fact that Palestinian children have not yet reached the stage where they are represented within society. Moreover, this policy targets the children from marginalized groups and marginalized areas and gives them more attention to reduce the socioeconomic gap as much as possible, and to achieve justice, equity and equality in access to services.

This may not be a perfect policy from the point of view of some, but it reflects the reality and what we can realistically accomplish in the coming years. It also sets an example and model for future formulation of health policies and plans. This document is “house grown” and is a national Palestinian effort, and is in harmony with the Palestinian Child Law and amendments, and in accordance with international standards of human and child rights; to plan according to our national priorities and our local capacity and identify the way for the realization of the rights of Palestinian children, and make human and child rights the pillars and building blocks of the Palestinian society. And, as they say “It is better to light a candle rather than to curse the darkness.”

Dr. Hani Abdeen

Minister of Health

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Executive SummaryThe occupied Palestinian territory (OPT) is a unique situation of fragility because of the Israeli occupation. There is no single expression to describe the conditions in the OPT starting from the establishment of the Palestinian National Authority (PNA), until now. During this period, the early years of development were followed by a terrible humanitarian situation which has endangered, and in some cases reversed, much of what has been achieved during the years before; (de-development). Achievements made by the MOH and partners are clear and proven at the level of policies, plans, programs and services, particularly in primary health care programs, which have surpassed those in some neighbouring countries. This includes, but not limited to the protection of Palestinian children from communicable diseases, screening and surveillance programs in nutrition and school health, as well as health education programs. All of this has been accomplished under challenging conditions; imposing difficult choices on the MOH.

Nevertheless, there have been obvious negative effects resulting from the geographic division (lack of contiguity) of the Palestinian territories due to military checkpoints and Israeli security zones on the one hand, and the internal Palestinian division on the other hand, which together undermine the State’s control over a large part of its territory, preventing it from implementing its policies and development plans in most cases, and even imposing unstable humanitarian situations, leading to a discrepancy in access to services. As a result, the social and economic conditions are unstable, impeding the achievement of the expected significant progress following this period of hard work. To the contrary, in certain sectors the situation became comparable to what had been prevalent prior to Al-Aqsa Intifada in 2000.

The above situation has had negative effects on the health status of children, especially in marginalized areas and marginalized groups. This situation has also led to a health system with multiple service providers, who are not sufficiently coordinating and sharing information among themselves. Effective participation in the process of national planning, policy development and decision-making is also inadequate. Instead, competition for limited resources sometimes led to the duplication of some services in some areas at the expense of other services and areas. Please see Annex 3 for more information on the impact of the political situation on the social and economic life in the OPT.

Taking into account the PNA expenditure on the treatment of non-communicable diseases (NCDs) (reaching about 48% of its health budget), and the inability to estimate the expenditure on persons with disabilities and children in general, and given the large number of interventions in the field of nutrition over the past years, the continued suffering by Palestinian children from nutrition-related problems to date, and the fact that many health programs and interventions have not been evaluated, it becomes necessary to take decisive and proactive steps to evaluate the previous interventions. This should help identify reasons for achieved successes in


order to expand and scale them up, as well as draw lessons learned and end the ineffective programs, or at least change their course. In addition, focus should be made on prevention programs targeting children and their lifestyles in parallel with the curative interventions; to ensure a healthy and productive generation and society. Furthermore, early and proper detection /diagnosis and intervention will help alleviate the suffering of many children and their families in the future, and will constitute a cost-effective strategy for the government in economic and social terms.

Children constitute around half of Palestinian society and the child mortality rate is relatively low (compared to regional and other developing countries). Nevertheless, given the importance of Palestinian children’s lives and health, and since some of the mortality, disability and morbidity cases were due to preventable causes, and also because of the wide range of marginalization in the OPT, policy focus on children in general, with affirmative action for marginalized groups, would help protect their future and that of future generations.

Given the prevalence of some negative social norms and phenomena, whether due to the Israeli military occupation or due to ignorance, and the negative effects of some external habits to the Palestinian society, considering the overall vulnerability and susceptibility of children, it is necessary to promote prevention through education and counselling, and allow a chance for children and especially adolescents to obtain reliable and safe information in relation to their physical and mental health. It is equally important to respond to their specific needs and ensure their development as effective and proactive members of society.

It is not enough to deliver information using traditional methods. Rather, interactive education and learning methods should be used in conveying messages in accordance with modern directions in health education and promotion. This requires enhancing the natural and social environment of children and their families, and equipping them with life skills that they will need to make the right decisions, and adopt healthy lifestyles and behaviours in order to enhance their health and the health of their families and society; as active members, rather than being passive recipients of information only.

Hence it is necessary to develop comprehensive preventive programs at all levels, and with the involvement of all stakeholders, as well as to strengthen the positive existing programs, build on previous successes, and prevent duplication while closing the gaps in programs and ensuring sustainability. It should be noted that change does not occur spontaneously but needs time, concerted effort and the necessary capacities, since:

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• Focus on addressing the problem when it occurs is usually less cost effective in economic terms in the long run, will need a lenghty period of time to yield results, and will require larger financial and human resources.

• Focus on prevention may be costly in economic terms at the beginning, but the long-term results will be productive, and cost less in comparison to dealing with a problem once it has occurred.

Based on the vision of MOH of creating a comprehensive and integrated health system that contributes to sustainable improvement and enhancement in the health status of the Palestinian population; through its mission of working together with all partners to improve performance and upgrade the health sector, to ensure professionally sound management of the health sector, and create an empowered leadership with the capacity to set policies, regulate the work and ensure quality services in the public and private sectors, and be based on MOH recognition of the right to health and to access equitable quality services, with a special focus on marginalized groups, and seeking to achieve the MOH’s strategic goal of promoting healthy lifestyles and implementing public health programs, the Ministry decided to develop a national policy focusing on children as the future of a healthy and productive society, and as a special group with specific rights and needs, and promoting affirmative action in favour of children in marginalized areas.

As part of its commitment to implementing the UN Covention on the Rights of the Child (CRC), the PNA issued in December 2010 its report on the implementation of the CRC in the OPT. This policy has been created based on the recommendations and findings presented in that report through a participatory process involving government institutions, civil society organizations, international organizations and UN agencies.

Schools and kindergartens (KGs) are a suitable place to target a large segment of children, parents and the community, and to start changing some negative habits and practices.


Problem Statement• Numerous health education, screening and surveillance programs exist.

However, due to limited financial and human resources, and due to an often unpredictable context, these programs are not usually scaled up or extended to the adequate level, and sometimes they are not mainstreamed or provided with the required human resources.

• The Palestinian health system is often forced to provide an immediate response to certain emergency situations (reaction), the expenditure on these interventions tends to exceed the costs of a preventative approach. This is primarily due to the prevailing political, economic and social conditions.

• Some child mortality, disability and morbidity are caused by preventable factors.

• Statistics indicate an increase in the prevalence of chronic diseases in Palestinian society and among young groups. These diseases can be reduced and their complications mitigated by early detection, proper intervention and adoption of healthy lifestyles. Comparison is difficult when it comes to disability, but it is expected that the last wars on Gaza Strip, military incursions, complications of some chronic diseases and traffic accidents contribute to increasing disability rates.

• Palestinian society is known to have cohesive families, and the child is seen as a member of a family. Despite this positive attitude towards child protection, family’s priorities and interests may dominate and prevail over those of the child, who is not seen as a member with specific personality and character, capable of protecting his/her own health and making responsible choices. Furthermore, systems specifically dealing with and targeting the child are lacking.

• A specific strategy for children is lacking, and they are not seen as partners in the planning process.

Hence this policy seeks to promote the principle of health responsibility of Palestinian children and those around them, by equipping them with the necessary skills and knowledge on the one hand, and creating an enabling environment on the other. Many families lack adequate awareness on health issues and rights in general, the importance of early detection, service delivery points, the concept of primary mental health, among others. The PNA report on the implementation of the CRC stated that “there is still fairly low pre and post-natal follow up by mothers, even though services are available and free of charge. Health awareness on issues of early marriage, maternal age, and consanguinity as risk factors for congenital malformation and risks the child and mother’s well being are available, yet many mothers still support negative behaviours”. Furthermore, families are subjected to pressures from society and the extended family. Therefore, focus on children without taking their surrounding environment into consideration will only put them in a swirl of dilemmas between school, home, community and family.

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Correlation is noticed between health indicators and a mother’s educational level and family income. Hence focus on education, incorporation of health messages and awareness at the school age, reduction of school dropout and improved access to information would improve numerous health indicators while also contributing to improving family income in the future. Change takes time. Hence focus on children in various age groups and according to each group’s needs, and the use of school curricula, extracurricular activities and media channels to instil these messages from an early age would help create awareness on children’s health rights, and will consequently ensure children’s rights for future generations.

Children in marginalized areas are more vulnerable to the deteriorated economic, political and social conditions than children in other areas. Overlooking this group may have consequences with the potential of negatively affecting other children and achievements in other areas. Moreover, this would be a violation of the rights of this group of children. Therefore, efforts should seek to include these areas and groups and reduce the gap.

Children with a disability, poor nutritional status, NCDs and other forms of chronic illnesses tend to live in poverty. Families with children constitute around 80.1-82.8% of all Palestinian families, and the proportion of poor families among them may reach 59.3%. The Palestinian child statistics 2011 indicate that 27.2% of children live in poverty (with 13.9% living in abject poverty). The family poverty rate, according to consumption patterns, is 13.2% among families without children and 22.7% among families with children, proportionally increasing with the increase in the number of children. There are limited numbers of Palestinian studies that have examined the relationship between poverty and illness, but it is well known that the costs of dealing with long term health problems is a financial burden that depletes family resources. Furthermore, chronic illnesses, accidents and poverty may cause secondary disabilities, thus increasing the economic and social burden on the family and the State. This situation is exacerbated for families that live in remote and/or isolated communities or those affected directly or specifically by the Israeli occupation and its measures, as they have to pay high transportation costs and other indirect costs in addition to treatment costs. In 2009, MOSA was providing assistance for 6124 poor children with chronic diseases. There are children who are not currently receiving assistance and are unaware that social assistance is available to support them and their families. Based on the right of the child to enjoy a healthy life, and taking into consideration the fact that most these diseases are preventable through a comprehensive long-term approach at all levels, with specific roles and responsibilities, the government and its partners can save children and their families the suffering, or at least mitigate its adverse influences.


Situation AnalysisChildren in the age group 0-17 years constitute 49% of the population. In 2011, there were around 1,450,000 children enrolled in schools. Using the 2007 population figures as a reference point (4,016,416), the percentage of children enrolled in primary and secondary education is 36% of the total population. Since 40% of children aged 3-6 years are enrolled in KGs, and there are more children attending day care centres, especially children of working mothers, and also since many under fives have siblings in schools or KGs, the targeting of schools, KGs, day care centres and clinics would reach the larger proportion of society.

As stated above, the separation of the different areas within the OPT by checkpoints, the apartheid Wall, closures and barriers is fragmenting the territory and creating discrepancy in access to services, especially affecting the population of rural and remote areas, as well as Bedouin communities, who have to bear additional indirect costs. Access remains a problem, whether in financial terms or in terms of infrastructure and transport. The marginalized groups are usually the most affected, enduring more severe negative effects. A 100% increase in the number of households experiencing “catastrophic” health care costs occurred between the years 1998-2007 (due to Intifada related injuries and continuing Israeli invasions and attacks on civilian populations). This also correlates with increasing numbers of families living in poverty and in need of receiving free national health insurance, which is directly increasing health spending costs for the MOH. In 2008, families had to spend 36.7% of their non-food expenditure on purchasing health care services.1 Around 53% of the expenditure is allocated for food (a higher percentage in Gaza and for food-insecure families). Strategies to cope with poverty and food insecurity include families’ reduction of consumption of nutritional foods in terms of quantity and quality, and a reduction of expenditure on health and education.2 Please, see Annexes 3 and 4 for more information on the health situation in Palestine.

1 Palestinian health accounts, PCBS, 2011.2 Socio-economic and food security survey in the West Bank and Gaza Strip, occupied Palestinian territory. PCBS, WFP

and FAO 2010.

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Major Health Indicators in PalestineChild mortality: The family survey (2010) results indicate a decline in infant mortality to 20.6 per 1000 live births. However the rate varies between the West Bank (18.8) and Gaza (23.0). Under five mortality was 25.1 per 1000 live births (22.1 in the West Bank and 29.2 in Gaza). These indicators suggest an improvement in child health conditions, but do not indicate the conditions that affect children’s rights, and do not always reflect the unstable state of health conditions and violations of children’s rights. The marginalized groups are the most vulnerable to threats and risks.3 The following table summarizes the most common causes of mortality in the age group 0-19 in the West Bank in 2011 according to the annual health report:

Most common causesAge group

Most common causesAge group

0-4 5-19 0-4 5-19Congenital malformations 175 6 Traffic accidents 21 24

Infectious diseases (sepsis) 161 5 Heart disease 1 13

Respiratory illnesses 43 18 Other accidents 17 18

Sudden death 46 - Malignancy 12 30

Malnutrition and metabolic disorders 21 2 Cerebral palsy 7 18

For children 0-4 years of age, the main causes of death are usually congenital malformation, respiratory disorders, low birth weight (LBW), sudden infant death (SID) and heart diseases. Higher rates of LBW are reported in rural areas and refugee camps, which are attributed to poverty, mother’s age and educational level, rather than the type of locality. Other factors that may affect mother and child’s health is poor nutrition during pregnancy, early marriage and active and passive smoking of cigarettes or water pipes.4 For older ages (5-19) the main causes of death include traffic accidents and other accidents, respiratory disorders, malformations, cerebral palsy and malignant neoplasm. Child statistics (2011) indicate that respiratory diseases are the main cause of infant mortality in the West Bank. For children under five, antenatal-related diseases were the main cause of death. Therefore, it is necessary to focus on the surrounding environment and promote and monitor maternal health during pregnancy.

3 Palestinian National Authority Report on the Implementation of the Convention on the Rights of the Child (CRC) in the Occupied Palestinian Territory (Dec. 2010). PCBS (2011)

4 Women’s Health Surveillance Report: A Multi-Dimensional View to Palestinian Women’s Health, Juzoor for Health and Social Development, 20 May 2009.


Accidents are a main preventable killer of children

• During 2011, in the age group 5-19, the mortality rate due to traffic accidents was 12.1% - the second highest among all causes of death, after malignant neoplasm. In the age group 1-4, traffic accidents were recorded as the second cause of death in that year, following respiratory diseases. Other accidents were reported as the fourth cause of death in this age group, following congenital malformations.5

• During 2011, 106 deaths and 8132 injuries, including 74 disabilities (at least 20 of them among children), were reported as resulting from traffic accidents. The highest percentage of moderate and severe injuries was among children under one year of age.

• For children aged 1-4 years, accidents were the major cause of death for 27.7% of the total deaths in that age group with traffic accidents accounting for 11.7% of young children’s death. For children 5 to 18 years of age, the main cause of death was also due to accidents which accounted for 46% of total deaths (5.5% of which were due to traffic accidents.)6

• Although studies are not available on the economic costs of traffic accidents, the cost is estimated to be in millions of dollars annually.

Social practices: The deteriorating political and economic conditions, and the resulting social pressures and harassments at military checkpoints and barriers and by settlers have led to a state of general frustration, and the revival of some negative social practices that have been reduced for some time, such as early marriage, school dropout, violence, child labour, drug abuse, and smoking especially among children and girls. Therefore, raising awareness and equipping children with the tools and skills to resist the negative influences in the surrounding environment will help protect them from various adverse social and health practices that will have a negative impact on their health in the future. For further information, please see Annex 5.5 6

Nutrition and physical exercise: Malnutrition is a serious problem affecting mental development and contributing to obesity and adult diseases in the future, especially when associated with little physical exercise. The OPT combines nutrition problems for both developed and developing countries, including stunting, wasting (hunger), anaemia, overweight and obesity. This situation poses a double burden on strategy development. It should also be noted that the deteriorating economic situation in Palestine has left around 40% of the population dependent on food assistance, and reduced the consumption of nutritious foods such as meat, vegetables and fruits (Please see Annex 5 for further information).

5 Annual Health Report. Ministry of Health. 20116 Palestinian National Authority report on the implementation of the Convention on the Rights of the Child (CRC) in

the Occupied Palestinian Territory (Dec. 2010). PCBS (2011)

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Non-communicable (chronic) diseases:7 According to MOH data, the prevalence of NCDs is increasing, with 48% of MOH budget spent on the treatment of these diseases8. There is a need to adopt a comprehensive approach and early intervention in this regard. There is a gap in the health care services for children between the ages of 3-18 years. Admission and treatment costs are not free of charge for children above the age of three, and sometimes medications are not available. Some chronic/non-communicable diseases require using medical equipments which are not always available. Needy patients should receive assistance to purchase the necessary medical equipments. Moreover, patients with NCDs, especially children, females and teenagers suffer from resistance and denial, so they need special support and counselling from family, peers, community and school. Some might try to hide it. However, families with NCD children are usually under huge psychological and economic pressure. Some families cannot afford transportation to the hospitals and clinics and cost of stay. In cases where a special nutrition regime is required, it is usually problematic due to the poor economic situation. During the National NCD Conference, it was agreed that more efforts need to be exerted in combating smoking, encouraging physical exercise, reducing obesity and using healthy nutritional habits. For more information, please see Annex 5.

Mental health: Currently, mental health units are integrated into primary health care (PHC) centres. Intervention is primarily focused on the provision of medicines rather than community PHC, that gives priority to prevention and detection of at risk children; to protect them from various life pressures and adverse impacts of changes in their environment. In addition, there is a shortage in terms of early detection of psychological and behavioural disorders within high risk groups, and in life skills-based mental health awareness that is aimed at reducing the risk of psychological problems among children and ensuring the active participation of families.

There is no legal mechanism to enforce guardians to bring their children for follow up sessions and treatment. Transportation and the need to be accompanied by an adult sometimes prevent guardians from bringing the children to the centre, especially the girls. This situation results in children not receiving timely and consistent treatment. According to the Annual Health Report of 2011, during 2010 new cases registered by MOH were 129 in the age group 0-9 years, increasing with age to reach 246 cases in the age group 10-19 years. Major causes of mental health problems mentioned are epilepsy, schizophrenia, neurosis and mental retardation. Epilepsy is still classified as a mental health illness rather than a chronic disease. In addition, indicators suggest that suicide attempts are increasing. All this indicates the importance of early detection, diagnosis and intervention. For more information, please see Annex 5.


8 Dr. Asaad Ramlawi. On the international day to combat smoking. MOH website , May 2011.


Early diagnosis and intervention have great importance in reducing the duration and severity of mental health diseases. Early screening is recommended to be conducted in health clinics and schools to detect at risk children, and provide them with the required assistance. Counselling and support networks should be offered to children living in families with one or more members with a mental disorder. Training courses were offered to counsellors and there is still a need to offer specialized training by qualified trainers in order to enhance the quality of programs targeting children.

School counselling: The Ministry of Education (MOE) runs a school counselling program in 68% of public schools. The school counselling program works in synergy with the school health program in both MOH and MOE, dealing with students in need of professional counselling, and addressing anxiety, fears, problems related to stress, family support, and referrals. The program is specifically sensitive to targeting children at risk of school dropout and those with low attainment and performance at school, offering guidance to students on the advantages of staying in school and avoiding early marriage and dropout. The program also identifies those who may have been exposed to violence, abuse and/or exploitation. The program is part of the national child protection network; it refers children in need of more intensive treatment, or for certain treatments by more competent professionals at MOH or in the NGO sector. However, there is a need for more counsellors, especially in high risk areas; Jerusalem suburbs, East Jerusalem, Hebron, South Hebron, Jordan Valley, areas adjacent to the Wall, or areas close to settlements and military camps, among others.

Health education and adolescents health:9 There are many services, activities and policies addressing the issues of health education, school health, nutrition, adolescent health, counselling, environment and others. However, they are not institutionalized and thus not sustainable. They are rarely evaluated and lack the required material and financial resources to scale them up, either because they are not included in regular budgets or because they lack financial support and/or qualified human resources in the field. Expansion of these efforts is impeded by the absence of a comprehensive vision that sees the school as part of the family and community environment surrounding the child. The condensed school curriculum often hinders the implementation of activities and limits opportunities for follow up and discussion with parents, because teachers are overwhelmed with teaching tasks, and because there are limited initiatives for community-based activities during after school hours. MOH produces a large number of educational materials and carries out field work despite the inadequate number of health educators. In addition, there is a need to depart from traditional education styles towards interactive methods, and to invest in the pre-school level in health education as indicated by various research studies. For more information, please see Annex 5.


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Reaching out to parents and children while they are in PHC waiting areas offers a good opportunity to increase their awareness about health related topics; like early intervention, parenting skills, and basic best health practices, in addition to specific topics like nutrition, mental health, chronic illnesses, and other types of health issues relevant to children. These messages should be short, focused, and appeal to both mothers and fathers in a manner that can be easily understood and remembered. This can be achieved by expanding the production and dissemination of educational and learning materials via the use of television, and closed circuit TVs within the PHC waiting areas and for broadcasting on local TV stations.

Availability of services and infrastructure: In 2011 there were 748 PHC centres in the OPT. There are 669 (81%) and 147 (19%) centres in the West Bank and Gaza, respectively. Governmental PHC centres constitute 458 (61.2%) of the total PHC centres (404 (60.4%) in the West Bank and 54 (36.7%) in Gaza). MOH uses mobile clinics to reach communities in remote areas. These centres would be more than sufficient to meet local needs in normal conditions. However, in view of the Israeli closure policy and procedures, MOH continues to expand services in clinics based on constant demands by the local communities for greater health service availability. Usually this expansion may affect the quality of services, reduce the availability of specialized care and professionals, and increase the cost.

Wide variations exist between the different geographic areas. The situation is not encouraging for health practitioners to work in marginalized and hard to reach areas. In some instances, mothers have reported that they delay pregnancy testing and visits until they have access to a female doctor.10 This has an impact on women’s motivation and access to pre and post-natal services, and consequently may affect the right of the child to life even before it is born. Higher rates of postnatal care visits were mainly associated with increased income, caesarean delivery, and receiving health education on postnatal care during prenatal care. The most reported reasons for not receiving postnatal care were no presenting symptoms of a health problem, checkpoints, high cost and lack of money, the woman’s reluctance to seek care alone, the lack of female staff to offer the services, difficult transportation, and distant service delivery point, and not knowing where to receive the service. However, there is improvement in this regard compared to previous years. Recently, some medical schools and physician training programs in some hospitals instituted a quota for equal enrolment between males and females.11 For more information, please refer to Annex 5.

10 Only 13% of the general physicians and 6% of the specialized physicians are females. Among the specialists, only 44% are gynaecologists. Female nurses and midwives are also under the recommended level.

11 The PCBS Population, Housing and Establishment Census of 2007 and Women’s Health Surveillance Report- Juzoor- May 2009.


Early detection and disability:12 Based on the disability survey 2011, child statistics indicate that children with disability constitute 1.5% of children in the OPT. Congenital causes constitute 29.6% of the cases, followed by acquired illnesses in 24% of the cases. Other major causes of disability include accidents, heredity, problems during pregnancy and child birth, physical and psychological abuse, stress and Israeli measures. The acquired illnesses were the most common causes of visual and hearing impairments, remembering/memory and concentration, slow learning and mental disability. Congenital cases were more related to communication problems. However, the issue should be linked to the mother’s educational level and age.

MOH is committed by the Basic Law and the Public Health Law (article 2) to provide the necessary services related to early intervention and prevention of diseases as mentioned earlier. The Phenyl Ketone Urea (PKU) and the Thyroid Stimulating Hormone (TSH) tests are free and compulsory at PHC centres. Positive cases of PKU receive free special milk for children, and parents are informed on how to provide the child with a special diet.

Physical checkups for babies are performed on a regular basis before vaccination. Early screening is done through the Integrated Management of Childhood Illnesses (IMCI) program and the well-baby clinics. Child development is monitored through the ‘mother and child health handbook’. Early screening for developmental disorders, illnesses and other medical conditions is provided at all PHC centres of MOH, UNRWA and NGOs. The Ministry also adopts the Integrated Management of Childhood Illnesses Initiative (IMCI) in association with UNICEF to reduce mortality, build capacity of health professionals and case management skills, but the IMCI includes the psycho-social aspect rather than Malaria component to adapt to the Palestinian context. An IMCI national plan was implemented covering the period 2006-2008, but difficulties are encountered due to lack of institutional capacity.13 Premarital testing is obligatory for certifying the marriage certificate in court.

During 2010, according to the Annual Health Report, 150 cases of disability (mostly visual and physical) and 1147 congenital diseases were detected in the age group 1-3 years in MCH centres. Yet there is a problem in referral, and procedures to assist the nursing and medical staff to decide on the follow up steps once the case is detected, and where to refer the child for follow up, and how to ensure appropriate and affordable treatment or rehabilitative interventions for the referred children.

12 Palestinian National Authority report on the implementation of the Convention on the Rights of the Child (CRC) in the Occupied Palestinian Territory (Dec. 2010). PCBS (2011)

13 UNICEF Situation Analysis Report – Draft of February 2009 and MOH sources.

20

School health services include programs conducted by MOH; as medical screening to students (physical exam, oral and dental screening and psychological tests), referral to relevant professional services and follow up,14 provision of vaccination, first aid and emergency services, surveillance of communicable diseases, surveillance of death cases among students, water testing and treatment, monitoring environmental health in schools and KGs, and conducting physical and mental health education activities. This is in addition to programs conducted by MOE which include the provision of supporting devices, such as wheelchairs, glasses, hearing aids, etc, mental health through school counselling, awareness raising, screening for mental, emotional or psychological problems, referral and follow up, meetings with teachers and parents, dealing with special needs and school violence. However, this area is under-covered due to the lack of psychological specialists. Unfortunately, the majority of schools still lack a nurse’s room. School health programs are not adequately institutionalized and there is a shortage in human resources.

14 In the first grade in terms of migrant testicles, throat, abdomen, thyroid, weight and height, heart exam, and dental and ophthalmic exams for grades 7 and 10, examination of girls in the sixth grade for back problems. For dental health there is a gargling project in pilot schools for one year, a fluoride sealant project, a fluoride gel project and 5 mobile dental clinics.

Updates: Summary of the results of the survey conducted by the PCBS in cooperation with the MOH and the UNFPA, on evaluating the youth needs ( 15-24 years old) of youth friendly health services in the West Bank (2011):

The primary results of this survey were announced on 25 July 2012. Despite the fact that the targeted group in this survey is the youth in the age group 15-24, yet the results give an indication of the most important services and things to consider when developing the national policies and plans for the youth and children (tomorrow’s youth). The results also support this policy paper.

• There is a gap between health knowledge and practices.

• The youth considered that the most prominent health problems/issues are the ones due to unhealthy practices such as smoking, drug addiction, etc, followed by psychological problems and non-communicable chronic diseases.

• Private clinics were used by youth more than governmental clinics to seek health services.

• One fifth of the youth who needed medical services did not seek it. Half of the surveyed youth thought that the available health services did not meet their needs, either due to lack of availability, lack of understanding and care about youth needs, negligence and medical errors, and in some cases the high cost.


• Most prefer to have the health center close to their residence, and to be integrated.

• Privacy was considered a major issue for them when seeking the health service.

• The health system in its current shape requires serious investment in medical staff to establish a new practical model of youth friendly health services, and attract them to get safe and correct information.

• Mental health, physical health and reproductive health constitute their main concern, in addition to prevention in terms of healthy life styles, availability of information, availability of means of prevention and reproductive health in its wider sense.

• The role of the local community, and raising awareness at all levels including youth, family and community were highlighted as a main focus of attention.

• The study showed that only one third of the surveyed youth practiced sport. That youth resort to other means than the health clinic; as the internet, TV among others to get information. Some of these means might not be monitored or safe. The curriculum sometimes does not provide the required information due to lengthy materials, shortness of time or lack of expertise. Lack of confidence between the students and counsellors or teachers increases the gap further.

• The youth have lots of free un-invested time, which leads to harmful health and social practices.

• The study recommended piloting youth friendly health centres in marginalized areas in the first phase, and later expand this experience based on the lessons learned.

22

Policy Framework

Vision:

Promote the general health of children in the Palestinian society, through investing in children as a basis for a healthy society, by providing them with the necessary tools and an enabling environment to enhance a healthy and productive future society, reduce the health-related discrepancy among children, and address the rights and needs of children, especially the marginalized ones, according to the specific needs of the different age groups, thus reducing the health and financial burden associated with health problems that can be controlled in the long term, and mitigating their complications and negative effects, and ensuring that the available resources are geared towards other health priorities.

Mission:

Advance and promote a healthy society by controlling preventable diseases, accidents and mortality, reducing complications and mitigating their adverse effects whenever they occur. This is to be achieved through the provision of quality preventive health services to the community and children by qualified human resources; through prevention and healthy lifestyles; changing the culture regarding health, nutrition and environment; raising health awareness at all levels; controlling communicable and non-communicable diseases, especially those occurring at an early age; combating accidents; reducing complications of diseases and accidents; reducing infant and maternal mortality; and mitigating the impact of stress on children and families, in a way that ensures equitable access to all social segments and different geographic areas while focusing on marginalized groups.

Policy’s Ultimate Goal:

Reduce the prevalence of non-communicable diseases and disabilities and their complications in children through prevention and early detection targeting all children, and through detecting and protecting at risk children, and providing remedies to vulnerable children and protecting them from complications at an early age. Children, according to their age, should have control and responsibility towards what they intake, and towards external factors around them. They should be responsible for their bodies and for their own protection and development. The government should provide the conducive enabling environment by giving consideration to the following:

• Performing screening tests on all children, while considering that some hereditary diseases occur at a later age.

• Adopting the principle of rights rather than needs, especially with regard to marginalized children.15

15 Marginalization could be due to individual, social or geographic factors.


• Drawing on and upgrading the existing institutions and initiatives.

• Considering children as essential partners and not just as recipients of services.

• Adopting long-term, sustainable, cost efficient and effective programs.

• Developing the existing capacity with regard to policy making, services, attitudes, knowledge and skills.

Intervention levels:

The child (the focus of the intervention), family, KG, school, care centres, community, institutions and the government, taking into consideration the varying degrees of effects the prevailing political, economic, social, cultural and environmental conditions may have on each of the above elements.16

Remedy

Prevention

Protection

Vulnerable/ marginalized children

At risk children

All children

Policy rationale: Why do we need this policy?1. Children are the basis for a healthy, sound and productive society.

2. Children comprise 50% of Palestinian society, but they do not possess the needed tools and skills that would encourage them to practice healthy lifestyles, and cope with the adverse life changes affecting their mental and physical health.

3. Children are a special group with special needs that are different from adults’. They require more focus and allocation of financial and human resources.

16 For example, the prevailing culture and socio-economic conditions greatly affect the child and his/her immediate environment (family, school and community), whereas the political conditions have a higher impact on the indirect environment (institutions and the government), which will reflect on the direct environment of the child. Nevertheless, at a certain point, children will need to be equipped with the necessary tools to have a say in governmental policies and influence their peers and the surrounding environment.

24

4. There are no national policies and long-term strategies that target child’s health in Palestine in general, although there are several general national policies and strategies for nutrition and control of communicable and non-communicable diseases. Yet these policies are often needs-based rather than rights-based.

5. There is a general deficiency in well-defined and endorsed protocols and procedures reflecting the best practices.

6. Communicable disease control programs and immunization programs in Palestine have a high success rate and are supported by several laws and national and regional policies.

7. Policies related to health sector governance, human resource development, information systems at MOH and mental health are developed through donor support.

8. Different statistics suggest that many of the injuries, accidents, disabilities and chronic diseases are preventable17, and they consume a large proportion of the government and individual’s budget. Some of the preventive interventions are affordable and do not require large budgets, and when implemented, they will save the state from the need for secondary and tertiary-level services.

9. Preventive programs cannot be addressed at a single level, in isolation from the surrounding environment and without proper coordination among all stakeholders.

10. Children and especially adolescents have the right to obtain health advice and accurate information from reliable sources, while maintaining their privacy.18

11. Statistics indicate that the Palestinian society suffers from a double burden of both malnutrition and obesity/overweight at the same time.

12. There is a need to reduce the financial, economic and social burden on the government, families and individuals, particularly the marginalized and at risk groups through prevention and early detection and intervention. However, it is not possible to focus on early detection in schools and clinics without ensuring follow up by the family and competent bodies, and without ensuring financial ability to cover direct and indirect costs.

13. Nutrition-related diseases and NCDs affect the marginalized groups disproportionally, and have higher economic and social consequences for them as compared to other groups. They also affect the child’s intellectual capacity and future productivity.

Policy priorities according to national consultations:• Promote and mainstream healthy lifestyles (nutrition, physical exercise,

combating smoking and substance abuse, prevention of home and road accidents, preservation of the environment) at the state, community, school, family and child levels, through health education, awareness raising, advocacy and lobbying for health rights of children at all levels.

17 Please see the results of the disability survey 2011.18 Please see the results of the survey on evaluating the youth needs for youth friendly health services (2011).


• Include community mental health as a first line of defence to protect children’s mental health, and equip children with protective mechanisms to increase their ability to deal with life’s pressures through schools, PHC clinics, the family and community.

• Establish procedures, protocols and mechanisms for early detection and intervention; ensure follow up and prevention of complications by parents, the school and health teams; provide the required resources and establish child and adolescent-friendly clinics to ensure provision of health advice from reliable sources.

Partners:The public sector (MOH, its directorates and departments, the Medical Council, MOE, Ministry of Transport, Environment Quality Authority, Consumer Protection Society and the Palestinian Standards Institution – PSI, the media (TV and radio)), Palestinian Medical Association, Association of Health Professions, UNRWA, the private sector, health NGOs, especially the Medical Relief Society, Health Work Committees, Health Care Committees, Palestinian Red Crescent Society, Arab Society for Rehabilitation, Palestinian Counselling Centre, Defence for Children International, General Union of the Persons with Disability, Palestinian universities and colleges.

The Media

MOH, MOE,

EQA, Ministry of Economy/Consumer

Protection, Civil Defence, The Police, PSI, MOSA, MOLG,

MOF

Decision-makers

Marginalized groups/children:

Poor children, children with disability, orphans, children in conflict with the law (juveniles), children in marginalized areas such as East Jerusalem, areas close to the Wall, settlements and military camps, Seam Zone, the Old City of Hebron, South Hebron, Jordan Valley, etc.

Civil Societyand

Community-based Organizations

26

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Strategies of the Policy

During the next 5-10 years, national level work should seek to:1. Develop a work plan for child health in the coming 10 years, outlining health needs,

the required competencies and resources to be invested by MOH, the concerned civil society organizations and the private sector.

2. Develop a sector-wide approach with detailed budget allocations, monitoring and accountability.

3. Develop a comprehensive national database, disaggregated indicators, and a case management and follow up system for marginalized children in cooperation with the relevant ministries and agencies, including MOH, MOSA, MOE and PCBS.

4. Mitigate the adverse effects of poverty and deteriorated living standards through an effective health insurance system and food security strategies in cooperation with Ministry of Finance (MOF), MOSA, Ministry of Agriculture, Ministry of Economy and MOE.

5. Establish special funds or adopt unified funding for marginalized children or those with NCDs or disabilities in order to ensure they access their rights under all circumstances.

6. Review the Public Health Law and relevant laws to secure children’s rights in general, and those of marginalized children in particular, and to ensure harmonization with other laws, through a national legal committee, in addition to developing and endorsing the executive bylaws.

7. Increase health sector allocations for children from the general budget.

8. Develop systems to handle medical malpractice and negligence.

9. Develop a code of conduct on the responsibility of health teams towards children and their rights.

10. Provide specialists in planning, evaluation and monitoring (at least two per directorate) and health and educational supervisors (at least 4-5 per directorate).

11. Develop a comprehensive system for early detection/diagnosis, follow up, monitoring and accountability.

12. Computerize the child’s file.

During the next 5 years, work should seek to:1. Develop comprehensive programs to protect children from diseases,19 disabilities and

complications that would affect children’s health and future productivity, and thus alleviate their health, economic and social burden, through:

19 A NCD control centre and policy exist. Therefore, we will not focus here on the issue of NCDs to avoid duplication, focus will be made on disability in terms of prevention and integration with the Disability Card, as well as on primary mental health rather than treatment.

28

• Focusing on proper nutrition and healthy lifestyles from an early age and targeting children with family history.

• Regular checkups for early detection.• Raising awareness on the hazards of consanguinity, smoking, accidents,

pollution and others, and the importance of women’s health and continuing follow up during pregnancy.

• Equipping children with the knowledge and skills to cope with the negative changes in their environment, including health, social, political or economic changes and peer pressure.

For more information, please see the section on best practices in Annex 6.

2. Develop mechanisms and programs for early intervention in order to reduce complications and adverse effects by:

• Providing and monitoring the provision of nutritional items and supplements to children in MCH clinics, KGs and schools.

• Increasing the number of and access to child-friendly specialized clinics.• Increasing the number of qualified specialized health personnel with the

competence to work with children, especially those with disability or chronic diseases.

• Activating home visits, raising awareness level of children and families and equipping them with the skills to cope and make sound decisions regarding their bodies, health and other issues.

• Providing treatment, rehabilitation and compensation for physical and psychological consequences of road accidents.

• Training health teams on immediate management of accidents to prevent complications, ensure early intervention and reduce losses.

• Managing the consequences of medical malpractice and the associated issues.

EarlyDetection Referral

Early Intervention and Follow

up

• Awareness raising

• Trainnig

• A specializeed center

• Different specializations to confirm or rule out the diagnosis

• Individual work plans

• Adaptations and tools• Policies• Personnel recruitment,

capacity building and retention

General determinants/influencing factors:• The political situation and access• Mother’s educational level• Family income/poverty• The social situation


Proposed activities:20 21 22 23

Results Activities Estimated yearly budget

Target 1:Prevent (physical and mental) diseases, disabilities and their complications

Goal 1.1: Early detection, screening / surveillance, early interventionPartners: MOSA, MOH, MOE, in cooperation with civil society organizations and UNRWA20

Objective 1.1.1: Provide adolescents with reliable health and psychological advice21

Establish and develop child and adolescent-friendly clinics (including children with a disability and who suffer from a chronic non-communicable disease or psychological problems) for obtaining counselling and health services and advice from reliable sources.

$100,000 (including training, simple equipments, means for health education).

Objective 1.1.2:Develop mechanisms, procedures and protocols for early detection

• Develop procedures and follow up manual for screening of diseases22 and disabilities for all age stages (MCH, KGs, school), based on what exists, and institutionalize it, and distribute it to public and non-governmental hospitals, PHC centres, schools and preschools, in cooperation with all stakeholders- Form a committee of 10 persons/$300

per person: $3000- Logistical support for the committee

meetings including hospitality costs ($200) and stationary ($500)/ 10 meetings: $700

- Coordinator: $1000- Piloting: $1000 (5 districts, 10 areas/$100

for each area)- Linguistic review: $500- Design: $1000- Printing/ 3 levels /1500 copies/$10 for

each: $45,000. Other expenses: $2800

• Develop a referral system within the manual in cooperation with the concerned health institutions23 ($5000).

• Train medical teams on the manual and referral system according to a unified training program (1000 persons): $40,000

Manual, referring system and training: $100,000

A list of all possible diseases and disabilities, needs assessment for possible available interventions as support tools according to resources available is to be prepared. The cost to be determined at a later stage.

20 Detailed roles and responsibilities will be added in the work plan.21 Please see the results of the study on evaluating the youth needs of youth friendly health services in the West Bank, 2011.22 This applies to mental and behavioural disorders and learning difficulties, so it should be distributed to counsellors and teachers.23 There is a manual prepared by the MOE in cooperation with the MOH, UNRWA, PRCS, UNICEF, UNFPA on

dealing with health conditions, to train school health teams, teachers and counsellors in the field. It will be piloted in 10 schools . The cost for training and piloting to include 200 schools/ 5000 teachers is $100,000 per year.

Total: $100,000

30


• Develop skills of the medical teams to communicate with children, especially those with chronic diseases or special needs, and on children’s rights in general.

• Train nurses and doctors in clinics on the importance of early detection, using proper tools, the importance of initiation of antenatal care, and raising awareness of pregnant women on the importance of health care and periodic visits during pregnancy irrespective of whether she has or does not have any complaints or complications, proper nutrition and supplementation prior to and during pregnancy, and avoidance of types of certain medicines that may cause congenital malformations in the foetus.

$30,000

This requires the expansion of some programs as:

• school health program to include early childhood/preschool stage.

• nutritional surveillance program to include children 3-5 years24

• school health programs to include additional classes in basic education stage

$30,000

$30,000

$30,000

24 This might not be possible in the near future, since it is related to endorsing the early childhood development strategy in Palestine, and including a compulsory preschool class within the basic education. It also requires enforcing the concept of well-baby clinic through awareness raising on the importance of regular check-ups for the child. One of the amendments to the Palestinian Child Law that has been endorsed recently by the President states that free medical services to be provided up to the age of 6 . Besides, this requires increase in the number of staff and capabilities and resources at the MOH to cover this additional stage, in addition to encouraging parents to follow up, and obligate medical check-ups at the ages of 3 and 4 (after the obligatory vaccination period is over).



Establish a diagnostic centre with all the required specializations, such as paediatricians, neurologists, orthopaedists, psychiatrists, education specialists and social workers, nutrition specialists, among others, within the Directorates of Health premises or separately, in three central areas; in the north, south and centre. Provide equipments for investigation and diagnosis, especially for hearing, visual, neurological and intellectual disabilities and learning difficulties; and ensure equipments maintenance; and train the staff on their use and maintenance. Please, see Annex 2 for further information on the perceived roles and needs with regard to early detection and referral.

• Screening and diagnostic tools ($120,000 for each centre): $360,000

• Training of staff on using the equipments: $5000

• Upgrade the teams’ skills to deal with referred cases (100 persons): $5000

$370,000

Develop a child file form that can be kept with the child since birth in the hospital, through MCH centres and throughout school, to record the child’s health status, piloting and printing samples. Review the Mother and Child Handbook.

$5000

Total: $595,000

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Objective 1.1.3:Improve access to health services, especially in marginalized areas for early detection, follow up and prevention of complications.

Partners: MOH, Ministry of Local Government (MOLG), municipalities, local councils, MOE, civil society organizations, UNRWA

Increase the number of trained field teams and equipped mobile clinics, adopt home visits in marginalized areas/marginalized groups and provide the needed transportation.

Needs assessment of the mobile clinics and evaluating the experience through completing formats by health district directorates on what is available and what is needed, conducting field visits and others: $2000

The exact number needed will be determined later and included within the work plan.

Provide and retain human resources and reduce the problem of staff shortages in marginalized areas.25 Mobilize support and advocate for this purpose.

Coordinate with Palestinian and Arab universities regarding the required specializations in the coming years (special education, learning difficulties, speech therapy, occupational therapy, audiology, etc).

Renovate medical clinics in remote areas and provide them with medical equipments, heating, cooling, infrastructure, waiting areas and education materials.

Needs assessment in clinics. Details to be included later in the work plan.

As a start: 40 centres/ $60,000 for each:$ 2,400,000

25 For example, by giving incentives to staff working in marginalized and at risk areas and develop a program requiring new graduates to spend an internship year in marginalized areas as civil service. However, these steps will require discussion with the Ministry of Finance, the General Personnel Council, and the Association of Medical Professions and an official ministerial decision.



Train qualified personnel on first aid, management of injuries and home accidents before and after reaching the hospital, to reduce the complications and the possibility of disability, through a unified training program, and adopt and scale up protocols and specific procedures for injury management, and train the personnel on their use.

• Train medical teams on first aid/1000 persons: $40,000

• Develop procedures and protocols on managing injury and training: $100,000

• Train child caregivers and teachers on first aid, accident prevention, nutrition, management and monitoring of children, especially those with chronic illnesses and set regular monitoring, by linking accreditation to periodical training, and by conducting periodical site visits by the inspection and monitoring committee for monitoring and health education.

• Train 300 teachers and 3000 students in 150 schools: $80,000 per year/$240,000 in 3 years.

• Develop a manual for mothers and caregivers in day care centers on dealing with domestic accidents: $2000 (please see goal 2.1 and sub objective 1.3.3)

• 500 institutions per year/$500 : $250,000

$632,000

Total: $3,034,000

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Goal 1.2: Develop procedures to control infections in schools, KGs, day care centres, hospitals and clinicsPartners: MOH, MOE, municipalities, local councils, etc

Develop a manual for preventing and combating communicable diseases among students, training on it (in the future it can further be expanded to include KGs and day care centers), through many activities, among which:

• Scale up the hand washing policy26 through activities, and developing means, brochures and lectures.

• Ensure proper waste disposal*.• Rehabilitate and ensure clean facilities and

sanitary units, and provide clean drinking water**.

• Raise awareness among students and workers in care centres and KGs.

• Encourage competition and cooperation between schools, KGs and care centres through conducting health competitions in certain areas.

Developing the manual: $20,000

Implementation and training on the manual: to be determined later.

Note: The MOH already has a policy for combating nosocomial infections.

26 There are guidelines and manuals available from MOE on this topic, these were disseminated to all schools and training was conducted. The problem is that the implementation is restricted to some schools only, due to lack of resources and support. To expand and generalize the hand washing policy in 200 schools in one year, MOE needs $40,000.

* For proper disposal of waste in 200 schools, it takes $50,000 yearly.** Rehabilitation and building of facilities and health units is within the mandate of MOE. In 3 years, to build 100 units

and maintain 300 units, it takes $200,000 and $300,000 respectively.



Goal 1.3: Protect children from accidentsPartners: MOH, MOE, MOLG, Ministry of Public Works, Ministry of Information, PSI, Civil Defence, MOSA, Consumer Protection Association, Ministry of Interior/the Police, Ministry of Transport

Objective 1.3.1:Prevent traffic accidents by inspecting and testing the drivers

Develop a protocol to include psychological and behavioural testing in licensing of drivers and renewal of licenses, for those with a record of 5-10 violations and accidents, by:

• Amending the existing protocol and developing forms and criteria.

• Designating a seconded psychological counsellor in each directorate.

• Providing an assessment committee.• Training the staff of the Medical Institute to

Prevent Road Accidents.- Forming a committee of 7 persons ($300 for each): $2100- Linguistic review: $500- Design and printing 1000 copies: $3000- Other expenses: $100

• Training of staff in the medical institute for road accidents (25 persons for 2 days): $1300

$7000

Provide at least one refractometer, one ergometer and one audiometer in north, south and central areas. The cost of one device is over $10,000.Designate an ophthalmologist and an optometrist in each centre and train them on the use of the equipments. Ensure budget for maintenance.

3 devices cost $1500027 for one area/$60,000 for the 4 areas

Study causes of traffic accidents especially among public taxis (in coordination with universities and reviewing what exists at the ministry of transport, MOI/ police and other institutions).

Total: $67,000

27 At the current stage, MOH will start with simple equipments that cost each $5000. When the situation is better and resources are available it is better to purchase the suggested equipments in the activity.

36


Objective 1.3.2:Protect children in residential areas and schools from traffic accidents

• Raise awareness (please, see strategy 3) and create lobbying pressure groups from school children to prevent traffic accidents through awareness raising and lobbying with parents and local community with regard to causes of traffic accidents, such as using seat belts, refraining from using mobile phones while driving, refraining from speeding, respecting others, respecting traffic rules, using child car seats and not letting children sit in the front seat, etc.

• Scale up the Young Policeman program and road safety teams.28

• Provide sidewalks for students on the roads to school, especially in dangerous/at risk, unsafe and marginalized areas29.

• Deploy traffic police in highly populated areas and by schools. Protect children in remote and marginalized areas.

• Coordinate with municipalities and village councils to improve roads and sidewalks, and provide the necessary road signs.

Train teachers and students on road safety/50 schools per year: $100,000 ($300,000 in 3 years)

Total: $300,000

28 There are programs for road safety at the MOE (to train students and rehabilitate the surrounding of the schools, putting signs) that target and focus schools in dangerous/at risk and unsafe areas, and the ones close to cross roads. There is also a database of the targeted areas.

29 The estimated cost is about $5000,000, and the activity is not under the mandate of MOH.



Objective 1.3.3:Prevent home /domestic accidents

• Raise public awareness among families, day care centres, schools and KGs in relation to safety, such as suffocation, toy specifications, storage of medicines, detergents and other chemicals, and how to act and provide first aid in case of an accident or poisoning.

• Link the licensing procedure to attendance of regular training courses by the staff, especially in KGs and day care centres in particular.

Campaigns: $40,000

Educational materials for general safety: $10,000 per year ($30,000 in 3 years)

• Specify safety requirements for all age groups (safety protocols and booklets) in day care centres and KGs30, child/supervisor ratio, the surrounding environment, provision of safety measures for children at home and in the KG/school, and ensure accountability of supervisors accordingly.

• Institutionalize periodical inspection of day care centres and KGs (every 4 months) in terms of physical structure and environment, staff conduct, etc, and provide the required transport, by forming inspection committees from the relevant bodies.

• Monitor toys specifications and raise awareness among dealers, chambers of commerce and families.

Form a committee of different concerned institutions; MOH, MOE, MOSA, PSI, to review what exists and what can be done. The details will be added later in the work plan. The initial expected cost is $20,000

• Training on evacuation and fire fighting in 20 schools each year31.

• Provide 200 fire extinguishers each year.

30 There is a manual for school environment health, that was produced by MOH. But there is not one for KGs and day care centres.

31 This item is under the mandate of the MOE. The estimated yearly cost is $50,000 for training and $100,000 for the extinguishers.

38


Goal 1.4: Protect Children from PollutionPartners: EQA, MOH, Ministry of Information, municipalities and local councils, MOLG, MOE, civil society, etc

Ensure that landfills are away from residential areas, schools and day care centres, and impose fines for garbage burning, smoking in public places, and vehicles with emission problems by enforcing the 1999 Environment Law and developing executive bylaws, activating and enforcing the Antismoking Law (2005) and policy, and the new bylaws that were prepared in 2012, and endorsing them.

Conduct awareness raising campaigns to reduce the use of plastic bottles and plastic bags in schools, community, shops, etc, and encourage the use/distribution of daily-use plastic containers and bottles for school children and cloth shopping bags with support from the local community or the private sector, especially in marginalized and poor areas.

$2000 for each area32/ 13 governorate: $26,000

Raise awareness of students and teaching staff on the proper ways of solid waste disposal in schools and KGs, including batteries and electronic wastes and others.

$2000 for each governorate/ 13: $26,000

Scale up the creation of environmental clubs33.

Develop a protocol on the disposal of chemical waste and materials and expired medicines, raise public awareness and set clear responsibilities with this regard.

$15,000

Promote local recycling and sorting of waste (plastic, paper, glass, metal) starting with local initiatives, and educate people on reducing the production of waste. Hold competitions between neighbourhoods at the district level and between districts and replicate successful initiatives.

$3000 for each locality. Piloting on 9 localities in the first phase ($27,000)

Lobby and advocate with regard to smoking, pollution and settlements’ waste.

Campaigns: $40,000

Total: $134,000

32 East Jerusalem and suburbs is considered as the 13th governorate. Work in East Jerusalem is usually done through, and in coordination with, the civil society.

33 Under the mandate of the MOE. The estimated cost of training on environmental clubs (30 clubs per year) is $150,000, provision of materials for the clubs: $50,000



Goal: 1.5: Primary Community Mental Health CarePartners: MOH, MOE, Ministry of Information, UNRWA, civil society, etc

Develop mechanisms and national tests for the screening, diagnosis and early detection of mental disorders, learning difficulties and behavioural disorders among children (tests from neighbouring countries can be adapted to the Palestinian context and used), especially for marginalized children.

$100,000 to develop an electronic form$100,000 for tools

Provide psychological support, life skills and defence mechanisms to enhance children’s immunity against adverse influences and life pressures through the school, KG, PHC clinics, family and community.

Train medical staff working with children to deal with marginalized groups

50 workshops for 5 days/ $500: $125,000

Raise awareness on the concept of primary mental health.

Educate and provide children with the tools to express their fears, solve their problems, resist negative changes in their environment and body, and manage peer pressure, through school counselling and focus on at risk groups.

Use the existing manuals and develop new manuals on topics not addressed before, while ensuring staff training on these manuals.

$100,000

40


Enhance the role of health and psychological counselling in schools, KGs and clinics by:• Developing a strategy for health and

psychological counselling in schools, KGs and clinics and making use of UNRWA model: Mental Health Tool Kit, Prevention and Coping Mechanisms.

• Increasing the number of qualified personnel, taking into account the need for:- School-based primary mental health

workers (12-15 per directorate).- School counsellors: 300-600.- Mental health counsellors for children (2-5

per governorate).- Child psychiatrists (2-3 per governorate).- Social workers.- Specialists in special education and

learning difficulties (as per the need in each governorate).

• Increase the number of counselling sessions in schools.

• Task shifting, i.e., making use of teachers and nurses in schools in counselling.

• Provide designated rooms for counsellors and specialists in schools and clinics to ensure privacy.

• Provide resource rooms equipped with the needed games and tools.

• Child-friendly clinics (please, see 1.1).• Promote extracurricular activities in after

school hours and refresher courses in the summer. Volunteers can be used and the local community can help in covering the salary of a guard/janitor, under internal instructions or formal decision34.

$ 5000 for the strategy

Total: $430,000

34 Under the mandate of the MOE. The estimated cost to open schools after formal school time for extracurricular activities in 150 schools in one year is $45,000 ($1,350,000 in 3 years)



Target 2: Raise awareness and promote healthy lifestyles through health education at the level of the family, school and child, and through lobbying and advocacyPartners: MOH, MOE, Ministry of Information, civil society organizations, municipalities and local councils, mosques, churches, youth clubs and forums, etc

Goal 2.1: Produce, review and present educational materials (Please see page 46 for more details).

• Develop an integrated package of school and community health education (educational field visits, especially in marginalized areas) for the different age groups, starting with early childhood and through grade 12, gradually increasing the scope and intensity with age (3-5 years, grade 1-3, 4-6, 7-9 and 10-12). The package will contain activity forms and worksheets, applied activities, videos and others, on issues that have not been addressed before such as proper nutrition, unhealthy nutritional habits, physical exercise, oral and dental care, eye (ophthalmic)care, smoking, substance abuse, environmental health, chronic diseases, communicable diseases, mental health, early marriage, and traffic accidents, in the form of life skills. The package can be distributed to clinics, KGs and schools and can be uploaded to a safe website under MOH and MOE administration, and training should be given to relevant personnel on its use. Implement activities in the existing manuals, review and update them if necessary, and distribute them to clinics and schools while avoiding duplication.

• Produce and disseminate educational booklets and posters in clinics, mosques, churches, and community-based organizations. Review and update the available ones by the Health Education Committee. Use these forums to raise awareness and promote positive behaviours.

• Show health education videos for mothers and children during waiting time in clinics. There is a need for 129 TV sets and 178 DVD players for all districts.

• Coordinate with Palestine TV and local radio channels to screen films or health education spots, and to allocate one hour per week regularly, to address different health topics and discuss the right to health (TV talk shows) and publish regular newspaper articles.

• Increase the number of health and field medical staff working in health education and promotion

• Get out of the usual patterns to present the health topics, through developing a cartoon character, set competitions, develop activities and educational tools (Please see pages 46-47).

$50,000 per year ($150,000 in 3years)

$20,000 to establish and develop electronic means and a safe website for awareness raising

$52,000

$243,680

Total: $465,680

42


Goal 2.2: Changes at the school, university and community level.

• Designate more than one lesson per week for school health and focus on practical applications and practices (reconsider the practice of ending the school day at 12:00 pm, and consider extending it, starting with schools that do not run double shifts).

• Allocate part of the morning period and school broadcast for the discussion of health issues, and assist students in preparing and presenting materials and practice physical exercise.

• Revise school curriculum by a committee of education and health specialists to fit with healthy lifestyles and learning for life rather than just academic achievement.

• Use schools as social centres after school hours and promote volunteering activities by university students (community service program) and local community, through internal instructions or a national strategy, and encourage the local community to cover the salary of a guard/janitor to be available in the school during this period.

• Form mothers’ groups to act as health promoters and activate, scale up and expand parents’ councils.

• Conduct competitions between schools in the production of health education posters by students on issues like combating smoking and substance abuse, accidents, nutrition, physical exercise, etc.

• Provide the students with a cup of milk or a meal in the morning on daily basis, especially in poor and marginalized areas, in cooperation with the private sector and local community, and develop a program to ensure the practicing of physical exercise in the morning and that children eat breakfast every day. Monitor what children eat by using special forms that can be monitored by teachers and parents35.

MOE mandate

35 Mandate of the MOE. The cost of providing a meal for 100,000 students in the most marginalized and poorest areas is about $300,000 per day ($450000,000 in one year).

12 competitions/ $1000 as awards: $12,000



• Coordinate with universities on; - The provision of new specializations and

on the training of personnel on health education, nutrition, nutrition surveillance and dental health. Make use of the existing personnel (teachers and health staff) and train them, in a way that is appropriate with the students age and level, to support students’ active learning.

- Study the impact of audiovisual media on the promotion of positive behaviours and reconsider the current health education methods (through universities).

Specify a budget for direct community activities with parents and community, to enhance positive behaviour, through diverse training activities with the target groups at the level of the local community.

$50,000

Total: $62,000

Note: Hiring of new staff and any internal process within the mandate and internal budgeting of the ministries were excluded from budgeting. There are many activities that can be implemented by the MOE, these can be included within the policy of the MOE for safe and fair access to quality education.

44

A list of activities that enhance the Palestinian child’s health and do not lie under the mandate of the MoH during 3 years

Activity Estimated budget Responsibility

Training on the referral manual in schools, by the educational system, and implementing it in 200 schools, targeting 500 teachers

Training on the system (school health teams and counsellors): $100,000 in one year ($300,000 in 3 years)

Rehabilitate and clean health and sanitary facilities and units, and provide clean drinking water

Building of 100 health units in 3 years: $200,000Maintenance of 300 units in 3 years: $300,000

Expand the hand washing policy

Proper waste disposal

Targeting 200 schools in a year ($40,000): $120,000 in 3 years

200 schools/$50,000 per year: $150,000 in 3 years

Training on fire fighting and evacuation in 20 schools per year

$50,000 per year/$150,000 in 3 years

Provision of 200 fire extinguishers per year

$100,000 in one year/$300,000 in 3 years

Expand the environmental clubs

Training on environmental clubs: 30 clubs in one year/ $150,000, $450,000 in 3 years

Materials for the clubs: $50,000

Enhance extracurricular activities after formal school hours, and summer programs. Volunteers and the local community can be used to cover the salary of a janitor, supported by internal regulations or a formal decree.

In 150 schools per year: $450,000. $1,350,000 in 3 years

MOE


Provide a cup of milk or a meal for the most needy and marginalized areas, in cooperation with the private sector or local community. Set a program to ensure students practice daily morning physical activity, eat breakfast, and monitor what students eat through forms, by parents and teachers

Provision of a meal for 100,000 students in the most marginalized areas: $300,000 per day. $45,000,000 per year

Total of MOE programs: $47,920,000

Build sidewalks in fast main roads close to schools, especially in marginalized areas

$5,000,000 MOLG

Grand Total: $52,920,000

46

The main point for raising awareness is to go beyond the typical approaches and use of booklets and brochures, and move towards interactive methods.

Activity 1:• Develop one or two cartoon characters (age-appropriate) to provide a

model for children in healthy lifestyles. Use these characters in preparing short TV episodes (5 minutes) ($2,000 per topic) and brochures on various health issues, including proper nutrition, obesity, energy drinks, sweets, fast food, potato chips, smoking, substance abuse, sports, environment, road accidents, domestic accidents and safety, personal hygiene, dental health, eye/ophthalmic health, mental health, medicines and chemicals, healthy habits, reproductive health, blood donation, communicable diseases, chronic diseases (NCDs), disability, negative attitudes, and others.

• For 60 episodes and a contest in drawing, design, animation, review, production of CDs and printing of 5000 copies, the cost could reach $20,000). Puppet representing the characters can be designed to visit schools and make shows on the previously mentioned topics.- Hold a contest to develop the character for a symbolic monetary award

($200).- Write the episodes and review the content from health and educational

perspective with MOE ($50-100 per episode).

• Distribute CDs to schools, KGs, local radio channels, You Tube (Palestine TV charges $70 per minute) ($21,000).

• Design, print and publish brochures, booklets and stories in a non-traditional way, with activities for children ($30,000).

• Promote child-to-child programs in health education programs at the school, community and family levels.

Estimated cost of activity 1: ($111,300)Activity 2:1. Design and print colouring and activity books on various health topics ($70-1000 for

design and 60,000NIS/$16,000 for printing 200,000 copies).

2. Design local educational games and distribute them to schools and KGs (the cost of the game with the design and 5000 copies for distribution to schools and KGs may reach $65,000). Two games can be produced (a puzzle and a game similar to snakes and ladders addressing health topics).

3. Develop a model for children to help them make calculations by themselves for obesity and overweight in order to monitor their own weight, and perhaps going further to include the family ($30,000).


4. Distribution of health messages through SMS and electricity, phone and water bills ($10,000).

5. There is a need to train trainers, school counsellors, teachers and educators (3 workshops).

6. Train teachers to link the curriculum to lifestyles.

7. Promote volunteerism. Sign MOUs with colleges and universities, conduct advocacy activities and train volunteers through workshops with focus on marginalized areas.

8. Develop a training manual for volunteers (a package of different age-appropriate topics) either through MOH departments or by hiring a consultant ($2,500 per topic). Focus will be made on common issues such as healthy lifestyles (nutrition, smoking, substance abuse, hygiene, physical exercise), accidents and safety ($2500x3: $7,500). Make use of the existing educational manuals. The proposed target groups:

• Day Care centres – not available

• KGs (3-5 years) – not available

• Local community and marginalized areas – not available

Estimated cost of activity 2: ($128,500)

Activity 3:1. Train teachers in KGs and day care centres in cooperation with MOE (one workshop

per year for each district (13), workshop costs: NIS 5,000/$1200, trainers’ fees: $2,000).

2. Increase the number of health educators in clinics, schools, media and local councils in each district (around 4 persons per district for a salary of NIS 2,500 per month ($600)).

3. Designate a display area with shelves for brochures and booklets in each MCH or PHC clinic (NIS 300 per shelf/$80).

Estimated cost of activity 3: ($3880)24 25 26 27 28 29 30 31 32 33 34

Total estimated cost of the previous activities: $243,680

٢٤

٢٥

٢٦

٢٧

٢٨

٢٩

٣٠

٣١

٣٢

٣٣

٣٤

48

• Provide qualified teams and train them on diagnosis, use of equipments and how to deal with children and parents and develop follow up plans.

• Provide equipments and ensure maintenance.

• Raise awareness of medical staff in clinics and centres on indications and mechanisms for referral.

• Map all potential referral sites for follow up once the diagnosis is confirmed, depending on specialization, type of case and need, and develop mechanisms for referral based on MOUs. This requires building partnerships and advocacy to ensure the work complements each other.

Illustration for the suggested diagnostic centre (see Annex 2 for more information)

Diagnostic Center

Tools

Monitoring and Accountability

Individual plans and follow up

Referral System

Specialized team

Intervention mechanisms/levels to protect children’s right to health and prevention of disease and disability

Advocacy and Monitoring• Enforce and amend Public Health Law, Environment Law, Antismoking Law, Child Law, Traffic Law, etc.• Monitoring toys specifications, labels of chemical materials, licensing of drivers, particularly public and

commercial transpot drivers, and moninitor imports• Develop policies to protect children from pollution and traffic accidents• Link licensing of care centers and KGs with conditions of public safety training• Regularly inspect schools, care centers, KGs, playgrounds and parks, in terms of staff and physical environment• Develop protocols to specify safety requirements as per stage• Scale up the young policeman program, road safety teams and environmental clubs• Develop and scale up local initiatives for recycling and sorting of waste and to reduce the use of plastic bags, etc

Enhance Capacity of Staff Working with Children

• Train staff on safety, First Aid, and how to deal with children according to age group and health condition• Develop staff capacity in policy development and planning for child protection• Develop staff capacity in monitoring and inspection, and provide them with transportation means• Make use of university and college students to conduct awareness raising campaigns at all levels

• Awareness raising campaigns through media, in schools, and through curriculum on pollution• Use public forums, churches and mosques• Involve local community, municipalities, local councils and merchants• Encourage children and families to report any violations of children’s rights to clean and safe environment• Form lobbying groups by children with regard to pollution and traffic accidents

Awareness Raising

Standards


Obstacles• Lack of complete Palestinian control and sovereignty, leaving some areas

beyond SP control, such as Area C, areas adjacent to the Wall, Gaza, and East Jerusalem. This puts these areas at risk of marginalization and creates discrepancies in services received by children in these areas compared to those in areas under the control of SP. The risk will be increased if coordination is not maintained with civil society institutions and UNRWA to ensure coverage and access to these areas, and use of unified systems.

• The prevailing culture, social pressures and individual interests may lead in other undesired direction.

• Lack of a national and comprehensive case management system, detailed information and adequate trained human resources to follow up with marginalized children and ensure they are receiving the needed health and educational services.

• Increased poverty and unemployment rates, and continuing deterioration in the socio-economic conditions.

• Lack of studies to assess the effectiveness of the existing programs over the past years in combating poverty, and controlling chronic non-communicable diseases and nutrition-related diseases.

• Lack of a rights-based approach in the prevailing culture, policies, strategies and plans, and lack of a vision of the importance of equipping children with the appropriate tools to control and manage their own health and bodies. Effecting the desired change and obtaining results will take time.

• Failure to mainstream interventions and policies and base them on national human and financial resources, leaving them unsustainable and exposed to funding uncertainty.

• Absence of an active participatory role by civil society organizations.

• Lack of sources for continuing financial and material support to implement the different health programs and plans, and dependency on international donors.

Risks:• Lack of an adequate political will and resistance by stakeholders with personal

interests.

• Volatile political conditions and separation between Gaza and the West Bank.

• Lack of adequate support/funding from the local community, international partners, the private sector and Ministry of Finance.

• Continuity and sustainability of programs.

• Centralization.

50

• Cultural resistance and norms.

• Inability to hire staff.

• The increasing burden on existing personnel.

• Low level of training.

• Discrepancy between the different Palestinian settings and areas, making it difficult to generalize experiences.

• Poverty.

Strengths• SP commitment to the CRC and support to efforts aimed at developing health

and other programs for children.

• Existence of national health legislations and policies.

• A strong civil society.

• Existence of PHC centres all around the country.

• Existence of a child file.

• Existence of several laws and health policies and strategies.

• Existence of many motivated health, social and educational workers.

• Wide use of technology.

• Availability of several manuals on health education for grades 1-9, reproductive health and adolescent’s health.

• Existence of several national committees and programs.

• Strong Palestinian media, such as Palestine TV, Mix, Maan, Al-Quds Educational TV and local radio stations such as Raya, Ajyal, Watan, etc.

• Investment in the existing personnel and competencies.

Weaknesses• Reliance on external funding.

• Lack of adequate coordination among partners and competition over resources.

• Shortage in various fields of specialization.

• Poor diagnostic capacity.

• Lack of adequate incentives and follow up.

• Duplication in programs and unequal distribution.


• Poor evaluation, monitoring and follow up.

• Failure to enforce some laws, policies and programs.

• Inability to equitably reach all areas and groups.

Needed Supporting Studies and Protocols

• A study on economic costs of traffic accidents.

• A Study on the reasons behind the increase in traffic accidents and nutrition-related diseases in some areas more than in others.

• A study to investigate causes of anaemia in Palestine.

• A study on health workforce and their needs.

• A study on distribution of health centres and how this links to marginalized and rural areas.

• A study on effectiveness and impact of health programs during the past 20 years, as well as lessons learned.

• A study on the impact of media on behavioural change.

• A protocol for management of accidents on the spot and in the hospital by medical teams.

• Clear protocols on management of emergency and high risk pregnancy and the associated procedures for monitoring and accountability.

• A protocol on early detection and follow up, outlining responsibilities and accountability.

• Development of procedures to identify and manage cases of medical malpractice and negligence.

• Development of procedures for disposal of chemical and plastic waste and expired medicines.

• Development of a strategy for school counselling

52

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nd st

udies

3-5

year

s

% o

f ch

ildre

n us

ing

drug

s with

in a

spec

ific

perio

d by

regi

on, r

easo

n an

d ag

e.

• Su

rvey

s•

Stud

ies•

Min

istry

of

Inte

rior,

the

Polic

e, M

OH

, M

OSA

, UN

RWA

3 ye

ars

39

Indi

cato

rs o

n an

aem

ia, w

astin

g, u

nder

weig

ht, s

tunt

ing,

ove

rweig

ht, o

besit

y, pe

rcen

tage

of

thos

e ea

ting

pota

to c

hips

and

swee

ts, a

nd p

erce

ntag

e of

thos

e ea

ting

brea

kfas

t and

nut

ritio

nal m

eals.

54

Qua

ntita

tive

indi

cato

rsSo

urce

(cur

rent

ly)Fr

eque

ncy

Det

ails

% o

f sc

hool

s and

KG

s with

clea

n dr

inki

ng

wat

er, s

anita

tion

syst

ems a

nd sa

nita

ry fa

ciliti

es

by re

gion

, sch

ool t

ype

and

gend

er, w

ithin

a

spec

ific

perio

d of

tim

e.

• PC

BS, s

urve

ys•

Wat

er A

utho

rity

• M

OH

, MO

E•

UN

RWA

3 ye

ars

% o

f sc

hool

s and

KG

s abi

ding

by

corr

ect

met

hods

of

solid

was

te d

ispos

al.M

OE

, MO

H, P

alest

inian

Env

ironm

ent

Qua

lity

Aut

horit

y, U

NRW

A

% o

f in

jurie

s and

disa

bilit

ies a

mon

g ch

ildre

n du

e to

traffic

acc

iden

ts.

• M

inist

ry o

f Tr

ansp

ort

• M

OH

• U

NRW

AA

nnua

lly

% o

f ch

ildre

n w

ith p

sych

olog

ical a

nd

beha

viou

ral d

isord

ers w

ithin

a sp

ecifi

c pe

riod

of ti

me

disa

ggre

gate

d by

age

, cau

se, r

egio

n,

gend

er, e

tc.

• M

OH

, MO

E•

UN

RWA

• Ci

vil s

ociet

y or

gani

zatio

ns•

Surv

eys

3 ye

ars

% o

f ch

ildre

n in

clude

d in

food

dist

ribut

ion

prog

ram

s by

stag

e an

d re

gion

with

in a

spec

ific

perio

d of

tim

e.

• M

OH

• M

OE

• U

NRW

AA

nnua

llyFo

r disc

ussio

n.

Num

ber o

f re

porte

d co

mpl

aints

of

viol

atio

ns

again

st c

hild

ren

in te

rms o

f no

t rec

eivin

g th

e pr

oper

hea

lth se

rvice

s ent

itled

to th

em d

ue to

ne

glig

ence

by

healt

h se

rvice

pro

vide

rs w

ithin

a

spec

ific

perio

d of

tim

e.

• In

depe

nden

t Com

miss

ion

for H

uman

Ri

ghts

(ICH

R)•

MO

H, C

ompl

aints

Box

• U

NRW

A

Ann

ually


Qua

ntita

tive

indi

cato

rsSo

urce

(cur

rent

ly)Fr

eque

ncy

Det

ails

Num

ber o

f re

porte

d co

mpl

aints

of

viol

atio

ns

again

st c

hild

ren

in te

rms o

f no

t rec

eivin

g th

e pr

oper

hea

lth se

rvice

s the

y ar

e en

titled

to, t

hat

have

bee

n ad

dres

sed

with

in a

spec

ific

perio

d of

tim

e.

• M

OH

• U

NRW

A

% o

f di

sabi

lities

det

ecte

d at

an

early

age

am

ong

child

ren

by a

ge g

roup

and

type

of

disa

bilit

y.

• M

OH

• U

NRW

A•

Civi

l soc

iety

orga

niza

tions

1-3

year

s

% o

f ca

ses w

ith c

onge

nita

l dise

ases

det

ecte

d at

an

ear

ly ag

e am

ong

child

ren

by a

ge g

roup

and

ty

pe o

f co

nditi

on.

• M

OH

• U

NRW

A•

Civi

l soc

iety

orga

niza

tions

1-3

year

s

Qua

litat

ive

indi

cato

rsSo

urce

(cur

rent

ly)Fr

eque

ncy

Det

ails

Avail

abili

ty o

f rig

hts-

base

d he

alth

laws,

polic

ies

and

prog

ram

s.

• M

OH

• U

NRW

A•

Pales

tinian

Leg

islat

ive

Coun

cil (P

LC)

• H

ighe

r Cou

ncil

for N

atio

nal H

ealth

Po

licies

and

Plan

ning

Avail

abili

ty o

f m

easu

res t

o re

duce

phy

sical

and

men

tal d

isabi

lity,

com

plica

tions

and

dep

ende

nce

thro

ugh

prev

entio

n, e

arly

dete

ctio

n, re

ferr

al,

awar

enes

s rais

ing

and

early

inte

rven

tion.

• M

OH

• Ci

vil s

ociet

y or

gani

zatio

ns•

The

priv

ate

sect

or•

UN

RWA

56

Qua

ntita

tive

indi

cato

rsSo

urce

(cur

rent

ly)Fr

eque

ncy

Det

ails

Avail

abili

ty o

f m

easu

res t

o re

duce

and

pre

vent

bo

th ro

ad a

nd h

ome

accid

ents.

• M

OH

, UN

RWA

• M

inist

ry o

f Tr

ansp

ort

• M

inist

ry o

f In

terio

r, th

e Po

lice

Avail

abili

ty o

f pr

oced

ures

for m

onito

ring

and

acco

unta

bilit

y.

• M

OH

, UN

RWA

• IC

HR

• G

ener

al A

ttorn

ey O

ffice

• H

ealth

pro

fess

iona

l ass

ociat

ions

Avail

abili

ty o

f na

tiona

l pol

icies

on

adol

esce

nt

healt

h an

d sa

fe a

cces

s to

info

rmat

ion

• M

OH

• U

NRW

A•

MO

EAv

ailab

ility

of

polic

ies a

nd p

rogr

ams t

o ad

dres

s po

llutio

n an

d its

impa

ct o

n ch

ild h

ealth

, an

d av

ailab

ility

of

proc

edur

es to

add

ress

en

viro

nmen

tal h

ealth

risk

s.

• M

OH

• U

NRW

A•

EQ

A

Avail

abili

ty o

f pr

oced

ures

to p

rom

ote

healt

hy

nutri

tiona

l pra

ctice

s and

pre

vent

maln

utrit

ion

and

over

weig

ht.

• M

OH

• M

OE

• U

NRW

A

Avail

abili

ty o

f ps

ycho

socia

l sup

port

to c

hild

ren

by a

ge, d

evelo

pmen

tal n

eeds

and

vul

nera

bilit

y.

• M

OH

• M

OE

• Ci

vil s

ociet

y or

gani

zatio

ns•

UN

RWA

Allo

catio

n of

reso

urce

s to

deve

lop

adol

esce

nt-

frien

dly

coun

selli

ng a

nd re

habi

litat

ion

serv

ices

that

do

not r

equi

re p

aren

tal c

onse

nt.

• M

OH

• Ci

vil s

ociet

y or

gani

zatio

ns•

UN

RWA

Avail

abili

ty o

f m

easu

res t

o im

prov

e nu

tritio

n in

dica

tors

and

hea

lthy

lifes

tyles

am

ong

child

ren

and

adol

esce

nts.

• M

OH

• U

NRW

A•

MO

E

Qua

litat

ive


Annexes:

Annex 1: Palestinian Health Strategies – Prevention and Healthy Life Styles

Annex 2: Suggested Roles and Needs for Early Detection and Referral

Annex 3: Influence of the Political Situation on the Socio-economic Life of the Palestinian People

Annex 4: The Health Situation in Palestine

Annex 5: Summary of Some Health Indicators

Annex 6: Best Practices

Annex 7: General National Health Rights-Based Indicators

58

Ann

ex 1

: Pal

esti

nian

Pub

lic H

ealt

h St

rate

gies

for P

reve

ntio

n an

d H

ealt

hy L

ifest

yles

–In

itia

l

dra

ft fo

r dis

cuss

ion

1. E

arly

det

ectio

n, s

cree

ning

/sur

veill

ance

, ear

ly in

terv

entio

n an

d pr

even

tion

of d

isea

ses

and

com

plic

atio

ns39

Prio

rity:

Est

ablis

h pr

oced

ures

, pro

toco

ls an

d m

echa

nism

s for

ear

ly de

tect

ion

and

inte

rven

tion,

and

pre

vent

ion

of c

ompl

icatio

ns b

y pa

rent

s, sc

hool

s and

hea

lth

team

s, an

d pr

ovid

e th

e re

quire

d fin

ancia

l and

hum

an re

sour

ces;

esta

blish

and

upg

rade

chi

ld a

nd a

doles

cent

-frien

dly

clini

cs to

ens

ure

prov

ision

of

healt

h ad

vice

fr

om re

liabl

e so

urce

s.

Ratio

nale:

Ear

ly de

tect

ion

help

s red

uce

suffe

ring

and

save

s tim

e, ef

fort

and

mon

ey.

Impr

oved

acc

ess t

o he

alth

and

coun

selli

ng se

rvice

s.

Inte

rven

tion

(how

?)Ta

rget

gro

up

(whe

re?)

Roles

and

re

spon

sibili

ties

(who

?)Re

quire

d bu

dget

Situ

atio

n

1.1.

Dev

elop,

main

stre

am

and

dist

ribut

e pr

oced

ures

an

d fo

llow

up

man

ual

for s

cree

ning

of

dise

ases

an

d di

sabi

lities

for a

ll ag

e st

ages

, in

orde

r to

ensu

re

expa

nsio

n of

the

scho

ol

healt

h pr

ogra

m to

inclu

de

early

chi

ldho

od/p

resc

hool

st

age,

expa

nsio

n of

nu

tritio

nal s

urve

illan

ce to

in

clude

chi

ldre

n 3-

5 ye

ars,

skill

s to

com

mun

icate

w

ith c

hild

ren,

and

ch

ildre

n’s ri

ghts.

• Id

entif

y pa

rtner

s and

re

quire

d wo

rksh

ops.

• Id

entif

y re

sour

ces

need

ed fo

r im

plem

enta

tion.

MO

H a

nd

partn

ers i

n civ

il so

ciety,

priv

ate

sect

or a

nd

UN

RWA

The

Mot

her a

nd C

hild

H

andb

ook

is av

ailab

le.

Scho

ol h

ealth

pro

toco

ls ar

e av

ailab

le.

Ther

e is

a defic

iency

with

re

gard

to th

e ag

e ab

ove

3 ye

ars.

Ther

e is

wea

knes

s in

the

scre

enin

g fo

r neu

rolo

gica

l di

sabi

lity.

39

We

will

focu

s on

prev

entio

n of

disa

bilit

y on

ly sin

ce th

ere

is a

natio

nal s

trate

gy d

ealin

g w

ith c

hron

ic an

d co

mm

unica

ble

dise

ases

.


Inte

rven

tion

(how

?)Ta

rget

gro

up

(whe

re?)

Roles

and

re

spon

sibili

ties

(who

?)Re

quire

d bu

dget

Situ

atio

n

1.2.

Pro

vide

equ

ipm

ents

for

inve

stig

atio

n an

d di

agno

sis,

espe

cially

of

hear

ing,

visu

al,

neur

olog

ical a

nd in

telle

ctua

l di

sabi

lities

.

Spec

ify ty

pes a

nd

num

bers

of

equi

pmen

ts

need

ed a

nd tr

ain st

aff

on

their

use

.

Mob

ile c

linics

, M

CH c

entre

s, ho

spita

ls an

d sc

hool

hea

lth

MO

H, M

OF

and

dono

r cou

ntrie

s an

d ag

encie

sN

ot av

ailab

le.

1.3.

Tra

in m

edica

l tea

ms o

n ac

cura

te d

iagno

sis th

roug

h a

unifi

ed tr

ainin

g pr

ogra

m.

Dev

elop

a tra

inin

g pr

ogra

m b

y ag

e gr

oup.

Mob

ile c

linics

, M

CH c

entre

s, ho

spita

ls an

d sc

hool

hea

lth

MO

H an

d pa

rtner

s in

civi

l soc

iety,

priva

te se

ctor

and

UN

RWA

1.4.

Im

prov

e ac

cess

to h

ealth

se

rvice

s, es

pecia

lly in

m

argi

naliz

ed a

reas

by:

• In

crea

sing t

he n

umbe

r of

train

ed fi

eld te

ams a

nd

equi

pped

mob

ile cl

inics

.•

Adop

ting h

ome v

isitat

ion

in m

argin

alize

d ar

eas/

m

argin

alize

d gr

oups

.•

Prov

idin

g and

retai

ning

hum

an

reso

urce

s and

redu

cing t

he

prob

lem o

f staf

f sho

rtage

s in

mar

ginali

zed

area

s.41

• Re

habi

litati

ng cl

inics

in re

mot

e ar

eas a

nd su

pplyi

ng th

em w

ith

med

ical e

quip

men

ts, h

eatin

g, co

olin

g, in

frastr

uctu

re ,

waiti

ng

area

s and

educ

ation

al m

ateria

ls.

Spec

ify th

e nu

mbe

r, sit

es,

targ

et c

omm

uniti

es a

nd

finan

cial r

esou

rces

and

pr

ovid

e tra

nspo

rtatio

n m

eans

.

Clin

ics in

m

argi

naliz

ed

area

s

MO

H, M

OF,

pa

rtner

s in

civil

socie

ty, p

rivat

e se

ctor

and

U

NRW

A, d

onor

co

untri

es a

nd

orga

niza

tions

41

For e

xam

ple,

by g

ivin

g in

cent

ives

to st

aff

work

ing

in m

argi

naliz

ed a

nd a

t risk

are

as a

nd d

evelo

p a

prog

ram

requ

iring

new

gra

duat

es to

spen

d an

inte

rnsh

ip y

ear i

n m

argi

naliz

ed a

reas

as c

ivil

and

com

mun

ity

serv

ice. H

owev

er, t

hese

step

s will

requ

ire d

iscus

sion

with

the

Min

istry

of

Fina

nce,

the

Gen

eral

Pers

onne

l Cou

ncil,

and

the

Ass

ociat

ion

of M

edica

l Pro

fess

ions

and

an

offic

ial m

inist

erial

dec

ision

.

60

Inte

rven

tion

(how

?)Ta

rget

gro

up

(whe

re?)

Roles

and

re

spon

sibili

ties

(who

?)Re

quire

d bu

dget

Situ

atio

n

1.5.

Tra

in q

ualifi

ed p

erso

nnel

on fi

rst a

id, m

anag

emen

t of

inju

ries a

nd h

ome

accid

ents

bef

ore

and

afte

r re

achi

ng th

e ho

spita

l in

ord

er to

redu

ce

com

plica

tions

and

the

poss

ibili

ty o

f su

fferin

g a

disa

bilit

y.

• D

evelo

p a

train

ing

prog

ram

an

d pr

otoc

ols

for a

ccid

ent

man

agem

ent.

• Sp

ecify

the

targ

eted

nu

mbe

r.

Med

ical

pers

onne

l

MO

H, N

GO

s an

d th

e pr

ivat

e se

ctor

1.6.

Dev

elop

proc

edur

es

to c

ontro

l inf

ectio

ns in

sc

hool

s, K

Gs,

day

care

ce

ntre

s, ho

spita

ls an

d cli

nics

thro

ugh

a ha

nd

was

hing

pol

icy, p

rope

r w

aste

disp

osal

and

clean

lines

s of

facil

ities

.42

• D

evelo

p an

d di

ssem

inat

e a

prot

ocol

with

pa

rtner

s.•

Prov

ide

soap

for

hand

was

hing

and

ed

ucat

e st

uden

ts o

n pr

oper

and

ratio

nal

use

of w

ater

and

sp

ecify

the

num

ber.

Scho

ol st

uden

tsM

OH

, MO

E,

UN

RWA

and

the

priv

ate

sect

or

A p

olicy

on

infe

ctio

n co

ntro

l in

hosp

itals

is av

ailab

le.

42

It is

also

poss

ible

to a

men

d an

d pr

omul

gate

the

civil

serv

ice la

w b

y all

owin

g m

othe

rs to

take

sick

leav

e su

ppor

ted

by a

med

ical r

epor

t in

case

of

child

illn

ess i

n or

der t

o pr

otec

t the

chi

ld a

nd p

reve

nt

trans

miss

ion

of in

fect

ion

to o

ther

chi

ldre

n (a

s app

lied

in M

OE

), an

d ra

ise aw

aren

ess t

o pr

even

t ina

ppro

priat

e us

e of

this

prov

ision

. How

ever

, thi

s req

uire

s coo

rdin

atio

n an

d ad

voca

cy w

ith th

e Le

gisla

tive

Coun

cil, t

he G

ener

al Pe

rson

nel C

ounc

il, a

nd M

inist

ry o

f La

bour

.


Inte

rven

tion

(how

?)Ta

rget

gro

up

(whe

re?)

Roles

and

re

spon

sibili

ties

(who

?)Re

quire

d bu

dget

Situ

atio

n

1.7.

Tra

in c

hild

care

giv

ers

and

teac

hers

on fir

st

aid, a

ccid

ent p

reve

ntio

n,

nutri

tion,

man

agem

ent

and

mon

itorin

g of

ch

ildre

n, e

spec

ially

thos

e w

ith c

hron

ic ill

ness

es,

and

prov

ide

cont

inuo

us

mon

itorin

g.

• In

clude

relev

ant

cond

ition

s for

lic

ensin

g.•

Dev

elop

a tra

inin

g m

anua

l on

deali

ng

with

chi

ldre

n w

ith

chro

nic

dise

ases

or

disa

bilit

y.

MO

E, M

OH

, M

OSA

1.8.

Est

ablis

h ch

ild a

nd

adol

esce

nt fr

iendl

y cli

nics

th

at re

spon

d to

the

need

s of

child

ren

with

a d

isabi

lity

or

chro

nic

dise

ases

to o

btain

co

unse

lling

and

hea

lth

serv

ices.

• Sp

ecify

num

ber,

sites

an

d pl

ans o

n se

tting

up

the

clini

cs.

• Tr

ain m

edica

l st

aff

on d

ealin

g w

ith c

hild

ren

and

adol

esce

nts.

MO

HD

onor

s

62

Inte

rven

tion

(how

?)Ta

rget

gro

up

(whe

re?)

Roles

and

re

spon

sibili

ties

(who

?)Re

quire

d bu

dget

Situ

atio

n

2.1

Dev

elop

mec

hani

sms f

or

the

scre

enin

g, d

iagno

sis

and

early

det

ectio

n of

m

enta

l diso

rder

s, lea

rnin

g di

fficu

lties

and

beh

avio

ural

diso

rder

s am

ong

child

ren,

es

pecia

lly fo

r mar

gina

lized

ch

ildre

n, a

nd p

rovi

de

psyc

holo

gica

l sup

port

and

life

skill

s to

resis

t adv

erse

influ

ence

s .

- H

ealth

edu

catio

n.-

Train

hea

lth a

nd

scho

ol p

erso

nnel

work

ing

with

ch

ildre

n.-

Dev

elop

diag

nost

ic pr

ogra

ms a

nd te

sts.

- Ch

ildre

n in

confl

ict

with

the l

aw,

disin

tegr

ated

fa

milie

s, or

phan

s-

Scho

ol an

d K

G ch

ildre

n

MO

H, M

OSA

, M

OE

2.2

Act

ivat

e th

e ro

le of

he

alth

and

psyc

holo

gica

l co

unse

lling

in sc

hool

s, K

Gs a

nd c

linics

.

• In

crea

se a

nd tr

ain

pers

onne

l and

de

velo

p a

stra

tegy

to

this

effe

ct.

• Ra

ise aw

aren

ess o

n m

enta

l hea

lth a

nd

prev

entio

n.

• Sc

hool

st

uden

ts•

KG

s•

Clin

ics•

Hea

lth

and

scho

ol

pers

onne

l

MO

H, M

OE

, U

NRW

A

2.

Prim

ary

Com

mun

ity M

enta

l Hea

lth C

are

Prio

rity:

Inclu

de p

rimar

y co

mm

unity

men

tal h

ealth

car

e as

a fi

rst l

ine

of d

efen

ce to

pro

tect

chi

ldre

n’s m

enta

l hea

lth a

nd e

quip

chi

ldre

n w

ith p

rote

ctiv

e m

echa

nism

s to

raise

their

abi

lity

to d

eal w

ith li

fe’s

pres

sure

s thr

ough

scho

ols,

PHC

clini

cs, t

he fa

mily

and

com

mun

ity.

Ratio

nale:

Ear

ly de

tect

ion,

awar

enes

s rais

ing

prog

ram

s, ps

ycho

logi

cal s

uppo

rt an

d ac

cess

ibili

ty o

f he

alth

serv

ices a

nd c

ouns

ellin

g he

lp re

duce

risk

of

men

tal

diso

rder

s and

suffe

ring,

and

save

tim

e, ef

fort

and

mon

ey.


Inte

rven

tion

(how

?)Ta

rget

gro

up

(whe

re?)

Roles

and

re

spon

sibili

ties

(who

?)Re

quire

d bu

dget

Situ

atio

n

2.3

Dev

elop

a st

rate

gy fo

r he

alth

and

psyc

holo

gica

l co

unse

lling

in sc

hool

s, K

Gs

and

clini

cs.

Scho

ol st

uden

ts,

KG

chi

ldre

n an

d he

alth

and

scho

ol

pers

onne

l

MO

H, M

OE

, U

NRW

A,

acad

emics

and

N

GO

sect

or

2.4

Edu

cate

and

pro

vide

ch

ildre

n w

ith th

e to

ols t

o ex

pres

s the

ir fe

ars,

resis

t ne

gativ

e ch

ange

s in

their

en

viro

nmen

t and

bod

y, an

d m

anag

e pe

er p

ress

ure.

• M

ake

use

of p

eer

pres

sure

in e

ffect

ing

posit

ive

chan

ges.

• M

ake

use

of th

e cu

rricu

lum

, sch

ool

coun

selli

ng a

nd

extra

curr

icular

ac

tiviti

es.

• D

esig

nate

a le

sson

pe

r wee

k to

teac

h ch

ildre

n pr

oblem

so

lvin

g an

d in

terp

erso

nal s

kills

.

Scho

ol a

nd K

G

child

ren

MO

E, c

linics

, M

OH

64

Inte

rven

tion

(how

?)Ta

rget

gro

up

(whe

re?)

Roles

and

re

spon

sibili

ties

(who

?)Re

quire

d bu

dget

Situ

atio

n

3.1.

Dev

elop

an in

tegr

ated

pa

ckag

e of

scho

ol h

ealth

ed

ucat

ion

for t

he d

iffer

ent

age

grou

ps st

artin

g w

ith e

arly

child

hood

th

roug

h gr

ade

12, w

hich

co

ntain

s act

ivity

form

s an

d wo

rksh

eets,

app

lied

activ

ities

, vid

eos a

nd o

ther

s, on

issu

es re

lated

to:

• Pr

oper

nut

ritio

n,•

Phys

ical e

xerc

ise,

• O

ral a

nd d

enta

l car

e, ey

e ca

re,…

• Su

bsta

nce

abus

e,•

Env

ironm

enta

l hea

lth,

• Ch

roni

c di

seas

es,

• Co

mm

unica

ble

dise

ases

,•

Men

tal h

ealth

,•

Traffic

acc

iden

ts.

• D

evelo

p fo

rms f

or a

ll ag

e gr

oups

:1.

E

arly

child

hood

(3

-5 y

ears

)2.

G

rade

s 1-3

3.

Gra

des 4

-64.

G

rade

s 7-9

5.

Gra

des 1

0-12

• Sp

ecify

requ

ired

num

ber o

f wo

rksh

ops

and

partn

ers.

• M

ake

use

of st

uden

ts’

com

mitt

ees.

• Pr

ovid

e sa

fe a

nd

inte

ract

ive

web

sites

for

child

ren’s

use

to a

cces

s re

liabl

e in

form

atio

n an

d to

train

them

on

pro

per d

ecisi

on-

mak

ing.

Prac

tical

appl

icatio

n wo

rksh

eets

ca

n be

prin

ted.

• Re

view

and

upd

ate

the

avail

able

man

uals.

• K

Gs

• Sc

hool

s

MO

H, M

OE

, ac

adem

ics,

educ

atio

nal a

nd

healt

h sp

ecial

ists

A m

anua

l for

ado

lesce

nt

healt

h gr

ades

6-1

2 is

avail

able.

A m

anua

l on

healt

h ed

ucat

ion

for g

rade

s 1-9

is

avail

able.

Wor

k is

unde

rway

on

a re

gion

al m

anua

l on

nutri

tion

and

phys

ical

exer

cise.

Ther

e ar

e se

vera

l man

uals

and

effo

rts a

ddre

ssin

g th

e fo

llow

ing

topi

cs:

• Ph

ysica

l hea

lth a

nd

hygi

ene,

• H

ealth

y ha

bits,

• Sm

okin

g,•

Repr

oduc

tive

healt

h,•

Safe

ty.

3.

Rai

se a

war

enes

s an

d pr

omot

e he

alth

y lif

esty

les

thro

ugh

heal

th e

duca

tion

at th

e le

vel o

f fa

mily

, sch

ool a

nd c

hild

Prio

rity:

• Pr

omot

e an

d m

ainst

ream

hea

lthy

lifes

tyles

(nu

tritio

n, p

hysic

al ex

ercis

e, co

mba

ting

smok

ing

and

subs

tanc

e ab

use,

repr

oduc

tive

healt

h,

prev

entio

n of

hom

e an

d ro

ad a

ccid

ents,

.....

) at t

he st

ate,

com

mun

ity, s

choo

l, fa

mily

and

chi

ld le

vels.

• H

ealth

edu

catio

n, aw

aren

ess r

aisin

g, a

dvoc

acy

and

lobb

ying

for h

ealth

righ

ts o

f ch

ildre

n at

all

levels

.

Ratio

nale:

To

prot

ect c

hild

ren’s

hea

lth in

ear

ly ag

e an

d ad

ult y

ears

by

prov

idin

g th

e ch

ild an

d fa

mily

with

the

requ

ired

know

ledge

and

info

rmat

ion,

an

d eq

uip

them

with

life

skill

s to

prom

ote

the

adop

tion

of h

ealth

y lif

esty

les a

nd b

ehav

iour

s.


Inte

rven

tion

(how

?)Ta

rget

gro

up

(whe

re?)

Roles

and

re

spon

sibili

ties

(who

?)Re

quire

d bu

dget

Situ

atio

n

3.2.

Pro

duce

and

diss

emin

ate

educ

atio

nal b

ookl

ets a

nd

post

ers i

n cli

nics

, mos

ques

, ch

urch

es a

nd c

omm

unity

-ba

sed

orga

niza

tions

; re

view

and

upd

ate

the

avail

able

ones

by

the

Hea

lth

Edu

catio

n Co

mm

ittee

.

• U

pdat

e/re

view

ed

ucat

iona

l m

ater

ials,

spec

ify

num

ber,

topi

cs a

nd

dist

ribut

ion.

• Bo

oklet

s, CD

s, ed

ucat

iona

l br

ochu

res f

or

pare

nts o

n dr

ug

addi

ctio

n, sy

mpt

oms

and

prev

entio

n m

eans

.

Clin

ics,

chur

ches

, m

osqu

es, s

ocial

fo

rum

s, th

e m

edia,

Min

istry

of

You

th a

nd

Spor

ts (M

OY

S),

clubs

, MO

SA,

child

ren

in

confl

ict w

ith th

e law

, orp

hans

- M

OH

, civ

il so

ciety

or

gani

zatio

ns,

dono

rs

3.3.

Scr

een

healt

h ed

ucat

ion

vide

os fo

r mot

hers

and

ch

ildre

n du

ring

wait

ing

time

in c

linics

.

• D

evelo

p ed

ucat

iona

l m

ater

ials,

spec

ify

num

ber a

nd

dist

ribut

ion.

• Sp

ecify

the

requ

ired

num

ber o

f TV

sets

an

d D

VD

play

ers

and

loca

tions

.

MCH

cen

tres

MO

H, c

ivil

socie

ty

orga

niza

tions

, M

OF,

don

ors

66

Inte

rven

tion

(how

?)Ta

rget

gro

up

(whe

re?)

Roles

and

re

spon

sibili

ties

(who

?)Re

quire

d bu

dget

Situ

atio

n

3.4.

Des

igna

te a

less

on p

er w

eek

for s

choo

l hea

lth a

nd fo

cus

on p

ract

ical a

pplic

atio

ns

and

prac

tices

. Allo

cate

par

t of

the

mor

ning

que

uing

pe

riod

and

scho

ol b

road

cast

fo

r the

disc

ussio

n of

hea

lth

issue

s and

ass

ist st

uden

ts in

pr

epar

ing

the

educ

atio

nal

mat

erial

s

• U

se th

e he

alth

educ

atio

n pa

ckag

e.•

Revi

ew le

sson

s’ sc

hedu

le an

d us

e Th

ursd

ay a

fter

scho

ol h

ours

.•

Train

teac

hers

, co

unse

llors

and

he

alth

com

mitt

ee

coor

dina

tors

in

scho

ols.

• U

se th

e cu

rricu

lum

.

• K

Gs

• Sc

hool

sM

OE

, MO

H

3.5.

Coo

rdin

ate

with

Pale

stin

e TV

and

loca

l rad

io c

hann

els

to sh

ow fi

lms o

r hea

lth

educ

atio

n sp

ots,

and

to

alloc

ate

one

hour

per

wee

k,

perio

dica

lly, t

o ad

dres

s di

ffere

nt h

ealth

topi

cs a

nd

disc

uss t

he ri

ght t

o he

alth

(TV

talk

show

) and

pub

lish

regu

lar n

ewsp

aper

arti

cles.

• Co

ordi

nate

with

ac

adem

ics a

nd

educ

atio

nalis

ts o

r he

alth

spec

ialist

s to

talk

on

a sp

ecifi

c iss

ue e

very

wee

k.•

Mak

e th

e re

quire

d ar

rang

emen

ts

with

radi

o an

d TV

st

atio

ns.

MO

H, M

OE

, the

m

edia


Inte

rven

tion

(how

?)Ta

rget

gro

up

(whe

re?)

Roles

and

re

spon

sibili

ties

(who

?)Re

quire

d bu

dget

Situ

atio

n

3.6.

Pro

vide

stud

ents

with

a

daily

cup

of

milk

or m

eal i

n th

e m

orni

ng, e

spec

ially

in

poor

and

mar

gina

lized

are

as

in c

oope

ratio

n w

ith th

e pr

ivat

e se

ctor

and

dev

elop

a pr

ogra

m to

ens

ure

the

prac

ticin

g of

phy

sical

exer

cise

in th

e m

orni

ng a

nd

that

chi

ldre

n ea

t bre

akfa

st

ever

y da

y. M

onito

r wha

t ch

ildre

n ea

t by

usin

g sp

ecial

form

s tha

t can

be

mon

itore

d by

teac

hers

and

pa

rent

s.

• Co

oper

ate

with

the

priv

ate

sect

or•

Spec

ify n

umbe

r, lo

catio

ns a

nd c

ost.

• D

evelo

p a

form

and

pr

int i

t in

the

scho

ol.

Child

ren

in

poor

and

m

argi

naliz

ed

area

s

• M

OE

, the

pr

ivat

e se

ctor

• M

OE

in

coop

erat

ion

with

MO

H

MO

E ru

ns su

ch a

pr

ogra

m.

68

Inte

rven

tion

(how

?)Ta

rget

gro

up

(whe

re?)

Roles

and

re

spon

sibili

ties

(who

?)Re

quire

d bu

dget

Situ

atio

n

4.1.

Ens

ure

that

landfil

ls ar

e aw

ay fr

om re

siden

tial

area

s, sc

hool

s and

day

car

e ce

ntre

s and

impo

se fi

nes f

or

garb

age

burn

ing.

Enf

orce

the

law a

nd

impo

se fi

nes.

EQ

AM

unici

palit

ies a

nd

loca

l cou

ncils

MO

H

4.2.

Ra

ise aw

aren

ess o

n di

spos

al of

che

mica

l was

te

and

mat

erial

s and

exp

ired

med

icine

s

Revi

ew st

rate

gy 2

.

Com

mun

ity,

teac

hers

, st

uden

ts,

hosp

itals,

clin

ics

MO

H, E

QA

, m

unici

palit

ies a

nd

loca

l cou

ncils

4.3.

Aw

aren

ess r

aisin

g ca

mpa

igns

to re

duce

the

use

of p

lastic

bot

tles a

nd

plas

tic b

ags.

• Pr

actic

al ca

mpa

igns

such

as u

sing

spec

ific

cont

ainer

s for

food

or

wat

er, u

sing

cloth

ba

gs w

hen

shop

ping

.•

Use

the m

edia

and

scho

ol cu

rricu

lum

an

d co

ordi

nate

wi

th en

viro

nmen

tal

clubs

and

stude

nts

com

mitt

ees.

• Cr

eate

lobb

ying

grou

ps fr

om ch

ildre

n.

Com

mun

ity,

scho

ols a

nd

KG

s

• E

QA

• M

inist

ry o

f In

form

atio

n•

Mun

icipa

lities

an

d lo

cal

coun

cils

• M

OH

• M

OE

4.

Prot

ect c

hild

ren

from

pol

lutio

nPr

iorit

y: Pr

omot

e an

d m

ainst

ream

hea

lthy

lifes

tyles

(nut

ritio

n, p

hysic

al ex

ercis

e, co

mba

ting

smok

ing

and

subs

tanc

e ab

use,

prev

entio

n of

hom

e an

d ro

ad a

ccid

ents,

....)

at t

he st

ate,

com

mun

ity, s

choo

l, fa

mily

and

chi

ld le

vels.

Ratio

nale:

Pro

tect

chi

ldre

n fr

om h

ealth

haz

ards

; sho

rt an

d lo

ng-te

rm n

egat

ive

effe

cts.


Inte

rven

tion

(how

?)Ta

rget

gro

up

(whe

re?)

Roles

and

re

spon

sibili

ties

(who

?)Re

quire

d bu

dget

Situ

atio

n

5.1.

Ra

ise aw

aren

ess.

• Pl

ease

, see

stra

tegy

2.

• Cr

eate

lobb

ying

grou

ps o

f ch

ildre

n to

com

bat t

raffi

c ac

ciden

ts.

5.2.

D

evelo

p a

prot

ocol

to

inclu

de p

sych

olog

ical

and

beha

viou

ral t

estin

g in

lice

nsin

g dr

iver

s and

re

new

al of

lice

nses

for

thos

e w

ith a

reco

rd o

f 5-

10

viol

atio

ns a

nd a

ccid

ents.

- Co

ordi

nate

with

M

inist

ry o

f In

terio

r (th

e Po

lice)

.

MO

H, M

inist

ry

of T

rans

port,

M

inist

ry o

f In

terio

r

Curr

ently

, tes

ting

inclu

des

bloo

d te

st, d

iabet

es a

nd

hype

rtens

ion,

esp

ecial

ly fo

r th

e eld

erly

and

driv

ers o

f pu

blic

trans

port.

5.

Prev

ent t

raffi

c an

d ho

me

acci

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Annex 2: Primary Illustration of Roles and Needs for Early Detection and Referral

40 41

٤٠

٤١

Advocacy and lobbying with decision-makers in cooperation with civil society organizations.

Development of systems and training of personnel.

Raising awareness of:• Families /

community• Staff working

with children

In cooperation with civil society organizations and the media.

Health • Defining treatments and making them available

• Aid devices and health service provision• Follow up

• Adaptation of school environment, curriculum and tools

• Provision of tools, resource rooms and trained staff

• Case report, issuing the disability card and health insurance

• Provision of required aid devices

Early detection

and diagnosis

Referral

Early intervention

and individual plan

Monitoring and

evaluation

• Hospitals (at birth): nurse and pediatrician• MCH center: one week - 1.5 years and at any visit by the child for what so ever reason up to age 3 years

• KG: at the age 3-5 years• School: teachers and counselors: all grades, MOH through school health: grades 1,7 and 10

• Needs: Trainnig, awareness raising, development of standards and indicators

• Referral to a specialized diagnostic centre to confirm the preliminary diagnosis (could be in 3 central locations in north, south and central area or in each directorate

• Needs: paediatricians, neurologists, psychologists, special educators, representative from MOSA, MOH and MOE/ infrastructure

• Setting up an individual work plan incorporating the case management system • Needs: Policies, adaptation, aid devices, referral to institutions, provision of staff, training or buying the service

• Follow up with the case every 3 months, reporting and re-evaluation• Needs: Follow up team and transportation means

72

Annex 3: Effect of the Political Situation on the Social and Economic Life of the Palestinian People

Facts on the ground demonstrate that the situation has had detrimental consequences on the socio-economic conditions of the Palestinian people. At the economic level, the closure policy, fragmentation and SP lack of control over borders have led to a decline in economic activity and left the Palestinian market largely dependent on imports and the Israeli market. In addition, both direct and indirect costs have increased as a result of an increase in transportation costs due to the need to use bypass roads and other transport means to overcome the Israeli occupation’s policies. This has raised the costs of living to a level beyond the income levels of most Palestinians, decreased job opportunities in the Palestinian labour market, and increased overall unemployment and poverty, disproportionately affecting certain areas and social groups.42

Real GDP growth has declined from 11% in 2010/2011 to 6% in 201243. According to PCBS, 2011 poverty rates reached 25.8% (abject poverty: 12.9%), and unemployment reached 23% in 2012 44. These rates were higher in Gaza than in the West Bank. Yet there have been geographic variations within the West Bank, with northern and southern areas, particularly South Hebron and some areas of the so called Area C, suffering from worse conditions in comparison to central areas. This situation has made 40% of the OPT population and 85% of the Gazan population dependent on food aid45. The figures have been higher in households with children, proportional to the number of children in the family. As a result, large numbers of children have been forced to drop out from schools to seek jobs or for early marriage.

At the social level, the closure policy and territorial fragmentation have caused social divisions between the populations of the West Bank and Gaza, as well as between the West Bank, Gaza and East Jerusalem. This is exacerbated by the Israeli occupation’s policy of transfer and forced displacement; through the demolition of homes and structures, the creation of isolated and marginalized communities separated from services, denial of building and development activities in these areas, as well as violence and attacks by settlers and the Israeli army, and imposition of military barriers and checkpoints, all of which are depriving many children of their right to safe access to health services.

43 IMF (2013) report to the Ad Hoc Liaison Committee in March 2013 44 PCBS (March 2013), Palestine in Figures. www.pcbs.gov.ps45 Ministry of Social Affairs Strategy (2011-2013).


Annex 4: The Health Status in Palestine

Health Legal and Legislative Framework46

There are many laws which address the rights of children to health and well being. The most important laws addressing these rights include: the Amended Basic Law of 2003, the Public Health Law No. 20 of 2005, the Palestinian Child Law No. 7 of 2004, the draft Health Insurance Law,47 the Anti-Smoking Law, the Palestinian Standards Law, the Palestinian Disability Law No. 4 of 1999, the Palestinian Labour Law No. 7 of 2000, the Environment Law No. 7 of 1999, and the Palestinian Medical Council Law No. 1 of 2006.

In many of the laws, child and maternal health have been addressed jointly. This is evident in the Basic Law, the Education Law, the Palestinian Child Law and the Public Health Law. All of these laws have clear articles which prevent discrimination, and uphold equality, and they particularly emphasize the right of all people to enjoy good health and access to health services. They also take into consideration the best interests of the child and the right to life, survival and development as the key factor when taking any actions related to child health. These laws are supported by the Penal Code No. 16 of 1960 (article 290) which specifies penalties for not caring for, neglecting, or failure/refusal to provide food, clothing, furniture, or basic needs to guarantee the health and well being of a child.

The Public Health Law regulates the work of MOH, and in addition to basic health service provision, requires MOH to provide assistance in supervising and monitoring public health and ensuring food, water and environmental safety and protection. This also encompasses the Ministry’s role in educating and raising awareness on health issues related to children. The law has emphasized the reproductive role of women but it failed to include special provisions for the protection of the health rights for marginalized groups such as the poor, elderly, and persons with special needs.

Despite the absence of bylaws for the Public Health Law, MOH has been proactive and has fulfilled many of its responsibilities by delivering necessary programs and services that fall within its mandate and obligations. Efforts are underway to overcome some gaps in the current laws and legislations. For example, the Palestinian Child Law* is currently being amended to raise the age of free medical services for children from 3 to 6 years, and for the age of marriage to be set at 18 years. A draft Health Insurance Law was endorsed by the Cabinet which seeks to ensure health insurance coverage for all children through a compulsory state program. However, there are certain provisions which are under review by different sectors.

46 The Palestinian National Authority Report on the Implementation of the Convention on the Rights of the Child in the Occupied Palestinian Territory, PCBS, December 2010. Most the information on the background situation is derived from the above report, unless indicated otherwise.

47 Endorsed by the Cabinet and raised to the President for endorsement. It still faces some opposition from some civil society organizations and PLC members

* In December 2012, some of the suggested amendments to the PCL were endorsed by the President including the provision of free medical services to children up to the age of 6.

74

Currently, the Ministry is concluding draft bylaws for the Public Health Law, and the Palestinian Medical Council Law. The importance of making sure that children receive basic school health programs that include direct delivery of health care, emergency first aid, and educational and awareness raising on health concerns facing children is addressed in article 6 of the Public Health Law, and article 96 of the Education Law. The Jordanian Penal Code No. 16 of 1960, in article 343, defined what constitutes medical errors.

Cabinet decision No. 113 for the year 2004 also specifies the services to be provided by the Ministry to all citizens, whether covered by government health insurance or not. This includes vaccination, primary health care services, services in cases of contagious/epidemic diseases, health services to children under the age of three, services to cover chronic mental health conditions, and disaster services. For issues not regulated by laws, the Ministry issues internal regulations such as the child health card. Furthermore, the Presidential Decree No. 16 of 2009 endorsed the establishment of the Palestine Medical Complex in Ramallah/Al-Bireh Governorate, and a ministerial decree to give haemophilia and thalassemia patients free medical insurance was issued in March 2009.

Policy and Strategy FrameworkThe government has developed a number of different and complementary plans and policy documents that support health development. This includes, inter alia: the Palestinian Reform and Development Plan (PRDP 2008-2010), the National Health Strategy (2011-2013), the National Nutrition Policy and Strategy, a Strategy for Infant and Young Child Feeding, a Legal Policy and Strategy for Prevention and Management of Non-Communicable Diseases (NCD), a program for combating nosocomial infections, a Palestinian National Plan for Pandemic Influenza A (H1N1) 2009 – Preparedness and Response, a National Nutrition Surveillance System, a surveillance system for epidemic diseases, a strategy for mental health, a strategy for combating cancer, a National Strategy for HIV/AIDS (2010-2015), the National Plan of Action for Palestinian Children (NPA) 2009-2011, a School Nutrition Policy, a strategy to combat substance abuse, a manual for school safety and a manual for adolescent health.

MOH has completed and adopted the National Health Strategy (2011-2013), where the Ministry focuses on its role in policy development and ensuring balance between prevention, treatment of diseases and health promotion. The Strategy includes the following programs:

• Quality sustainable primary, secondary and tertiary health services• Public health program, including healthy lifestyles• Human resource development and education in health program• Good governance program (health management, financial management,

public-private partnership, aid effectiveness and inter-sectoral cooperation)


The MOH has also drafted a health education policy, a draft strategy for prophylaxis and management of diabetes, a training plan for residency in hospitals, national programs to combat thalassemia, regulations on organizing and licensing medical professions, and a Geographic Information System (GIS) for health facilities. There is also a national record/database for cancer.

However, the problem is not in the availability or absence of policies and strategies or in their quality, but rather in their implementation, awareness of their provisions, monitoring their impact and effectiveness and drawing lessons from them. Most of these strategies and policies have remained on the shelves, while those put in implementation have never been evaluated to assess their impact on the health status of the child. Another problem is the lack of a strategy, policy or even a long-term vision focused on a child’s health and their related needs (financial, human and physical) during the next 10 years.

The MOH has established a number of multi-stakeholder, multidisciplinary committees to support health related issues. This includes the National Committee for Mental Health, the National Committee for Maternal Mortality, the National Committee for AIDS, the National Committee for Pandemic Influenza, the Technical Committee for Nutrition, the Technical Committee for Food Fortification and Monitoring, the National Council for Planning and Health Policies, and participated in the Higher Council for Motherhood and Childhood, and the Higher Council for Traffic among others. There are a number of aid related coordination forums like the Social Strategy Group, and the Health Sector Working Group, along with thematic groups such as nutrition, NCDs and MCH.

Partnership with UNRWAUNRWA is responsible for the provision of health care services to the refugee population, which represents a majority of the population in Gaza. But this does not prevent MOH from offering health services and medicines to refugees on some occasions. This may allow for the duplication of services in favour of some groups at the expense of others. To avoid this, MOH and UNRWA have recently started coordination through sharing of beneficiary lists. There is also coordination between MOH and UNRWA programs with regard to surveillance of communicable diseases and immunization. However, there is a need to harmonize the systems in other aspects and expand some programs with proven effectiveness, such as managing and reporting abuse, in order to ensure equality and non-discrimination among children.

76

Health Centres and Health PersonnelComplete family planning services are provided in 187 centres (167 in the West Bank, and 20 centres in Gaza). Specialized services exist in 310 centres, oral health clinics in 30 centres, and laboratory testing in 152 centres in the West Bank.

MOH health personnel information48

MOH GPs Specialists Dentists Pharmacists Nurses Paramedics Admin.

2011 2141 938 291 421Nurses 3621Midwives 321*

32421670 5318

Number Per

10,0005.5 2.2 0.7 1 8.6* 4 12.7*

% of MOH staff*

15% 6% 1.9% 2.8% 26.7% 11% 36%

2010 2220 904 285 412Nurses 3572Midwives 284*

38561511 5431

Number Per

10,0005.5 2.2 0.7 1 8.8* 3.7* 13.4*

2009 2226 941 300 421 3403 / 279 midwives 1512 5444

Number per

10,0005.7 2.4 0.8 1.1 9 / 0.7* 3.8 14.5

% of MOH staff

15%* 6%* 2%* 3%* 23% / 2%* 10%* 38%*

* calculated48

48 Health annual reports 2009 (2010), 2010 (2011), 2011 (2012).


Annex 5: Summary of Some Health Indicators

Nutrition• The findings of the 2010 Family Survey revealed that 20% of children 6-59

months are anaemic, with the percentage in Gaza double that in the West Bank. Furthermore, 1% of children under five suffer from chronic malnutrition, which represents a 41% increase from the year 2000 rate, while 10.6% suffer from stunting (with a higher percentage in the West Bank than in Gaza). Findings from the Nutrition Surveillance 2008-2010 suggest a slight increase in the percentage of children 5-10 years suffering from underweight, and an increase in the percentage of those with overweight (more in the West Bank than in Gaza), which indicates a change in lifestyle, nutrition and physical exercise patterns. However, stunting in this age group is more prevalent in Gaza compared to the West Bank. Wasting does not constitute a problem in Palestine.

• Statistics show that higher rates of stunting are associated with low levels of maternal education, family income, and living within poorer localities. For example, a one year increase in a mother’s schooling reduces stunting by 4%. Children in Gaza are more likely to be stunted. The higher the family income, the less likely stunting will occur. Wasting is more likely to be found in children living in Gaza, older children, and children living in rural areas or urban areas compared to camps. This needs further investigation. Underweight children are correlated with low family income and lower levels of maternal education. With every year increase in a mother’s schooling, underweight decreases by 5%. Children in Gaza are more likely to be underweight, and the higher the family income, there is less likelihood of underweight children (Juzoor study).

• Poverty is a major cause of malnutrition, according to a study conducted by FAO, UNRWA and WFP. Some families are decreasing their food intake, especially of fresh vegetables and meat and allotting their share for their children. The risk of food insecurity is increasing, especially among refugees and in rural areas and northern and southern parts of the West Bank compared to the centre of the country. In Gaza, the risk of malnutrition in non-refugees was higher.

• Studies showed that 10% of schools lack canteens and 47.2% of the existing canteens lack sanitation. MOE has worked to implement a policy of healthy foods within schools. A MOU was signed by MOH, Ministry of National Economy and MOE, stipulating that only certain kinds of healthy foods could be served in the canteen. However, the policy is not in operation and requires lobbying and advocacy with the private sector and decision-makers, as well as awareness raising among the students and their families. Currently, MOE has initiated a pilot project in which the canteen’s management will be turned over to women projects supported by micro-finance, under the condition that they provide high quality, healthy food only.

78

• Studies indicate that 25% of students skip breakfast and that this type of behaviour is more common in adolescents and girls. Studies also reveal that girls are more knowledgeable about health facts and habits compared to boys, although this does not have an impact on their behaviour. Four out of ten students showed resistance in changing their eating habits and other health practices, and this resistance increased with age. Girls and children at a younger age were more anaemic than boys and older aged students. Factors that tend to influence children’s eating patterns include peer pressure, mother and family educational level, family lifestyle, and getting up late for school; all factors that impact on whether or not children ate breakfast before going to school. Nevertheless, an improvement has been noted in eating patterns in 200849 in both the West Bank and Gaza, although consumption of sweets has almost doubled.

• The Global School Health Survey 2010 targeting children 13-15 years old indicated that 37.3% of students spend three or more hours per day in activities that do not require any physical effort (in a sitting position). In addition, 32.8% have not practiced walking or riding a bike during the seven days preceding the survey. Around 21.4% of the students reported practicing physical exercise for one or more hours per day during the week preceding the survey, with a higher rate among boys compared to girls.

Health Education and Adolescents’ HealthMOE prepared guidelines on adolescent health that provide comprehensive information on adolescent physical, social and mental health issues. These guidelines target students 12-14 years old (grades 7-10). Topics discussed include life skills, changes during puberty, healthy lifestyle, career counselling, social and family relations, sex education (to a limited extent) and AIDS. MOE adopted the guidelines and the counsellors assisted in training staff on it. MOE is working currently on an annual plan for adolescents’ health. MOE also conducted an analysis of the educational content of the curricula and found that sex education, reproductive health, harassment concepts, family planning/family planning devices and gender issues are being discussed in the curricula for grades 7-10. Introducing sexual and reproductive health starts at a relatively early stage. Interventions target students in grades 7-10 as a vulnerable transitional stage.

The MOH produces health related awareness and educational materials on various topics that address children through active learning tools like activity sheets, colouring books, and stories. Activities also include free medical campaigns that include physical exams. Volunteers are also trained to be focal points and

49 The Nutrition Surveillance System 2008 revealed that 65.4% of children eat breakfast at home (59% in the West Bank and 75% in Gaza). The lowest percentage of students eating breakfast was in Nablus, Hebron and Jerusalem districts. Furthermore, 75% stated they eat food in school (80.3% in the West Bank and 67.4% in Gaza). The lowest percentage was in Gaza, Bethlehem and Hebron. On the other hand, 10.42% stated they do not eat breakfast at all (10.9% in the West Bank and 9.8% in Gaza). The highest percentage was in Hebron, Nablus and Jerusalem. About 24% of students reported eating sweets in school, while 76.88% eat potato chips, with the highest percentage in Gaza, 12.68% eat fruits in school and 11% eat fortified biscuits in school.


coordinators within their local community. Campaigns target remote areas or areas with reported health problems. There is also coordination with the National Committee for Summer Camps. Success of these activities in the field usually depends on the cooperation of the health director in the district. Health education in Bedouin and very remote areas is done through female health workers or trained volunteers. MOH and other agencies ensure that children in marginalized communities are included in all interventions. In addition, a National Committee for Health Education and Promotion exists, with members representing civil society organizations and relevant institutions.

Inappropriate Preventable Social Practices that can Affect Child’s Health50

1. Early Marriage and Consanguinity Twenty percent (20%) of Palestinians marry between the ages of 15-19 years. Child statistics of 2010 indicate that the percentage of marriage under the age of 18 years in the West Bank was 21.8% among females and 0.9% among males who married in that year. The median age at marriage for women in urban areas is lower than that for women in rural areas and the camps by one year, which may be due to more concentration of some educational and awareness raising programs on the risks associated with early marriage in rural areas and camps, which may suggest that these educational and awareness raising programs have an impact. Taking into consideration the negative effects on the health of both mother and child, encouraging more awareness on the hazards of early marriage can reduce child and maternal mortality, improve child nutrition and health, improve economic productivity and growth and protect girls from abuse, exploitation and risk of dying while giving birth.

Studies and statistics indicate that consanguinity increases the risk of disability and hereditary diseases. In 2006, 28.1% of all married persons had married a first degree cousin. For the age group, 15-19 years, 32.4% reported marrying a first degree cousin. In the last five years there has been a return to this practice after a decline for some period of time. This may be due to the deteriorating economic situation, closures, and lack of alternatives.

2. Smoking and Substance AbuseYouth and children in the age groups 10-22 years old are the most vulnerable. Up to 130 death cases due to drugs were reported in the West Bank alone, including Jerusalem, during the years 2005/2006. The percentage of deaths amongst children is not available. The social and political pressure and situation are contributing factors due to increasing levels of frustration and the eventual use of drugs.

50 Palestinian National Authority report on the implementation of the Convention on the Rights of the Child (CRC) in the Occupied Palestinian Territory (Dec. 2010). PCBS (2011)

80

Males working in Israel have higher rates of drug use. There are few Palestinian organizations working with drug users and addressing addiction. It is important to raise awareness in schools, community centres, and child and youth organizations on ways and means to prevent and combat drug abuse. Teachers and parents need to be educated on how to identify and deal with children using drugs or those at risk of drug use.

As for smoking, a study done recently by the Institute of Community and Public Health in cooperation with the MOE showed that 25% of students in grades 7 through 10 smoke. Over half of the students (52%) who were questioned reported that buying cigarettes at stores was easy. Higher rates of smoking were correlated with greater exposure to violence either by the Israeli army or through domestic violence. Increased rates of smoking were found in children who had friends (85%), parents (63%), or brothers/sisters (44%) who smoke. Smoking in the Palestinian society is around 26%, while passive smoking reaches 68%, according to a study conducted by the anti-smoking committee in Tulkarem (2010). Recent data from MOE in its strategy revealed that 23.5% of students smoke, and that the majority lack awareness on the dangers of smoking.51

It is noteworthy to note that:51

• The Palestinian average monthly expenditure on tobacco and cigarettes per capita is around 5.4 Jordanian Dinars (JDs), which exceeds expenditure on education (4.5 JDs), and is slightly lower than expenditure on health care (6.9 JDs).

• Up to $180,000,000 are spent annually on smoking in Palestine.• About 25% of smokers are 18 years of age or younger.

Non-Communicable (Chronic) Diseases Cancer and diabetes are among the major NCDs affecting children’s lives, growth and development. NCDs are increasing among this age group and are causing a double economic (direct and indirect) and social burden on the child, family and the State. Poor families and those living in remote areas find great difficulty when they try to handle the financial burden associated with these diseases.

In Gaza, children with chronic diseases endure much higher suffering due to the closures and blockade, the lack of medicines and equipments and the shortage of fuel and electricity. In 2010, three children died in Gaza while waiting to access specialized medical treatment abroad. In the two previous years, 19 children died (10 in 2008 and 9 in 2009) because of being prevented to exit Gaza for treatment. There are currently 340 children suffering from cancer and blood related diseases that are in need of exit permits to receive treatment abroad.

51 MOH website


As for Thalassemia (a hereditary disease), there is national strategy for the treatment and prevention. The disease incidence is decreasing due to better awareness and obligatory free pre-marital testing which started in May 2000. However, there is a need to continue to better target health awareness activities to eliminate this disease, and to emphasize the possible negative impact of consanguinity. Pre-marital testing can prevent the incidence of thalassemia and should be enforced. Haemophilia patients also suffer from psychological, physical and material burdens associated to the complications of this illness.

Mental HealthIt is likely that political, social, economic and cultural pressures are effecting an increased rate of suicide attempts, especially among the vulnerable groups who lack the appropriate mechanisms and tools to resist pressures of the surrounding environment in a positive way. Although there is a lack of adequate statistics showing the number of suicide attempts among children, there are indications that more people are doing so, especially among women. In 2009, there were 213 suicide attempts and 8 cases resulting in death. About 61% of cases among women were in the age group 16-45 years.52

There is still a shortage of specialized doctors for mental health; and in MOH in particular. There are no specialized mental health services for children except in Hebron, where services are based on a curative approach, and none are equipped to support children with mental retardation. New cases are still registered at PHC centres. Data is not disaggregated by age so the percentage of children in this group is not known. Professionals report that the deteriorating socio-economic and political situation is contributing to the incidence and severity of cases they are handling53.

A database should be established for mental health case management, and information should be disaggregated by age, sex and locality, and should focus on prevalence and causes of mental health disorders in children. In addition, support should be offered to raise the ability to cope with changes in the surrounding environment, raise awareness on better parenting skills, protection from poverty, protection from abuse, neglect and harm of children, early intervention and early diagnosis. This includes raising awareness on mental health disorders, and to de-stigmatize and not label individuals as permanently sick and non-functional54.

52 The Palestinian National Authority Report on the Implementation of the Convention on the Rights of the Child in the Occupied Palestinian Territory, PCBS, December 2010.

53 Ibid.54 Ibid.

82

AffordabilityThe existing General Health Insurance covers services for the enrolee, spouse and children (for girls till they get married, and for boys till they finish their university education). MOH covers the costs of treatment in the cases of cancer, blood diseases, dialysis and kidney transplantation. During periods of epidemics/contagious diseases, donor assistance is typically made available to cover prevention and treatment costs for the general population. Early screening for breast cancer and cervical cancer is free, as well as health care to children under three years of age and to pregnant women till 42 days after birth (except for high risk pregnancies), drug addiction and mental health disorders. Nevertheless, indirect costs like transportation, or even lack of awareness about such services prevent access to such services by needy populations.

In 2009, the General Health Insurance covered 60.4% of the Palestinian population and 29.9% paid premiums,55 while the rest received health services free of charge. Compared to 2000, there has been a decrease in private contributions from workers in Israel, individuals, companies and private institutions, while MOSA contributions to cover health care for the poor and needy groups has almost doubled in 2006. The Ministry of Detainees and Ex-Detainees, Ministry of Interior and Ministry of Labour also pay to cover health costs for the unemployed, detainees and ex-detainees, and the military services. However, many families do not use health insurance services, which could indicate a lack of confidence or dissatisfaction in the services covered by the General Health Insurance, or difficulty in accessing listed service providers. According to the 2007 Health Sector Review, “patient satisfaction with Palestinian health care system is low. Patients generally regard health care services in Palestine as inferior and seek care in Jordan, Israel, and elsewhere.”

55 MOH Achievements 2010, National Strategic Health Plan 2011-2013.


Annex 6: Best Practices

Combating Smoking and Pollution• Enforcing and implementing the law, allocating budget, conduct lobbying,

advocacy and public awareness raising at all levels, starting from the child and family, increasing taxes on cigarettes and tobacco products, banning their promotion and advertising, banning the distribution of fruit-flavoured tobacco, banning smoking in public places, restaurants, stations and workplaces and imposing fines on violators.

• Establishing public transportation stations outside urban centres to reduce traffic jams and pollution, and to be situated away from schools where possible, day care centres and KGs.

• Ensuring that landfills are far from residential areas, schools and day care centres, and imposing fines for garbage burning within cities and inside residential areas.

• Developing a program with Civil Defence to inspect schools, public places and childcare centres to ensure that safety procedures are available and observed. Train teachers on first aid, and monitor the school environment to ensure that children are not exposed to pollution.

• Conducting advocacy and lobbying at the national level, and forming lobbying groups from children to prevent smoking in public places, buildings, transport means and places where children are present, and impose monetary fines.

• Working with local councils and municipalities to ensure proper waste disposal, and raise awareness on the proper disposal of chemical waste and expired medicines, on the adverse effects of burning garbage, ways to reduce the use of plastic bags and cooperating with the private sector to distribute healthy containers and water bottles, with a focus on marginalized areas.

Accident Prevention• Prevention of traffic accidents and complications by focusing on infrastructure

and roads, and ensuring that they comply with general safety standards; setting technical standards and specifications for design; reviewing the Traffic Law and setting strict fines for speeding, use of mobile phone and/or eating while driving, and failure to abide by traffic lights and traffic rules; developing a national strategy for road safety, focusing on the medical, behavioural and psychological elements of drivers, and on vehicle compliance with general safety specifications; and increasing awareness of children, families and the community on how to prevent traffic accidents. With regard to traffic accidents that do occur, qualified personnel should be trained on the management of injuries before and after reaching the hospital in order to reduce complications and the possibility of suffering a disability.

84

• Prevention of home (domestic) accidents by raising public awareness among families, day care centres, schools and KGs in relation to safety, such as suffocation, toy specifications, storage of medicines, detergents and other chemicals, and how to act and provide first aid in case of an accident or poisoning; and specifying general safety requirements for all age groups in day care centres and KGs, child/supervisor ratio, the surrounding environment, provision of safety measures for children at home and in the KG/school, and ensure accountability of supervisors accordingly.

School HealthThe school is an appropriate place for the provision of preventive services and early detection of physical and psychological problems for the age groups 6-18 years. Through school, programs can indirectly reach the early childhood stage and a wide segment of society to offer health awareness activities on the importance of proper nutrition, hazards of smoking and substance abuse, road safety (by including it in the school curriculum), eliminating violence, promoting the presence of traffic police around schools, expanding the school health and school counselling program to include KGs, reaching children with health problems to prevent complications, and ensuring safe and clean water, sanitary units and sanitation facilities according to the standards.

Ensuring a nurse present in the school or a nearby health centre close to each school, and developing protocols and procedures on school responsibility in ensuring children’s safety and managing any emergency situation.

Prevention of Nutrition-Related Problems • Focusing on healthy nutritional patterns and awareness raising; providing

vitamin and iron supplements to children, pregnant and lactating mothers and ensuring mother’s compliance with regular administration of supplements for herself or for her child; examining and controlling the unconventional reasons for anaemia, such as worm infestation, especially in schools.

• Including children 2-6 years in the nutrition surveillance system.

• Advocating for limiting the selling of materials with food colouring agents and of food with a high content of saturated fats and preservatives to children, and creating lobbying groups of children to act at the level of private sector to improve the quality of food products targeted at children, and ensure monitoring of the specifications of these materials by MOH and PSI.

• Partnership with the private sector and civil society organizations to fund the provision of nutritional meals, whole cereals, fortified milk and nutrient supplements in public schools, especially in marginalized areas, and the provision of supporting medical instruments. The provision of tax reductions/ exemptions to these institutions as incentives for their commitment, and the promotion of a sense of national duty among all social segments may help ensure sustainability of these initiatives.


• Developing initiatives for hand washing and teeth brushing in schools, especially after play, and before and after eating.

• Focusing on the importance of getting up early and eating breakfast.

• Establishing a national body for food security.

Health Education and Awareness Raising• Designate the World Health Day or Environment Day to conduct awareness

raising campaigns by schoolchildren for the surrounding communities to preserve the environment, or collect donations to cover the expenses of school health initiatives and allocate part of the funds raised to schools in marginalized areas.

• Use mosques, churches and public forums, water, electricity and telephone bills and media outlets to disseminate messages and use parents’ meetings in schools to emphasize the importance of healthy practices.

• Work with the Palestinian Curriculum Centre to include health education topics in a systematic, practical and age-appropriate way, and ensure involvement of parents and community in the activities. The activities should be related to practical behaviours and a child’s life at home and in the community.

• Ensure dissemination of policies, procedures and any documents developed by any governmental or non-governmental institution with regard to general health and wellbeing; in order to be used at a national level and stop duplication and wasting of national resources in the production of already existing materials.

• Make use of the waiting time spent by mothers in the clinics to show short educational films, and raise awareness of mothers by direct communication with the health staff. Involve husbands in this process.

• Enhance the social status and respect of teachers and physicians. Increase counselling sessions and use the schools in after school hours as youth and social centres, and the clinics as health education centres. Train students on health education and designate 15 minutes in the morning for physical exercise and health awareness. Focus on practical application and real life practices.

Systems, Services and Monitoring• Allocate (by using the existing information systems) or establish health and social

databases for children up to the age of 18 to identify children in marginalized areas, through clinics and schools in order to ensure they are offered follow up care and attention, and providing detailed computerized information on each child and their social and health status.

• Create a documentation centre for cases of violence against children in school and at home, and adopt a written policy to end violence in school and home, and a clear strategy for counselling and school health, road safety, prevention of school dropout and child labour, which is exposing children to health hazards and accidents.

86

• Define and document medical malpractice and negligence cases and develop standardized procedures to address them. Evaluate internship students and graduates from Palestinian universities by external examiners and focus on the issue of continuing education.

• Allocate a share of the budget to support the implementation of the Traffic Law, the Antismoking Law and the different health policies and strategies and ensure they are monitored, and ensure accountability in cases of non-compliance within a specific period of time.

• Monitor the implementation of laws and policies, promote individual and community responsibility and impose fines for noncompliance. Develop a mandatory community service program for law violations. Teach children the importance of respecting and complying with the law.

• The Higher Council for Health Policies and Planning should ensure that a national comprehensive work plan for prevention, monitoring and accountability is in place.

• Concentrate subsidized public centres and NGO centres in marginalized and poor areas, and encourage private centres in areas with better-off social and economic level.

Partnership, Coordination and Role Distribution• Active role of the local community: Develop mechanisms to enable the

community and families to report children who are experiencing health negligence or cannot access health services through SMS or hotline.

• Involve the municipalities and local community in assuming responsibilities towards roads, health, education and disability.

• Ensure the provision of a school clinic and nurse, especially in schools in marginalized areas within the next 10-15 years.

• National and international non-governmental organizations and UN agencies should coordinate with MOH on what studies are needed for the development of policies and plans, to avoid duplication of work and ensure optimal use of resources, with focus on using and training local personnel.

• Continue to expand the harmonization of health systems with UNRWA in order to ensure equality and reduce discrepancies.


Protect Mother and Child’s Health1. Health care for mothers and children, especially in the first month of life,

focus on high risk pregnancies and educating pregnant women and mothers on conditions that require immediate medical attention, while also training physicians on handling these conditions.

2. Focus on quality of services and availability of transport to ensure access, or use of mobile clinics and training of paramedics and midwives in marginalized areas.

3. Advocacy and awareness raising on the importance of creating a conducive environment to promote breastfeeding and protect child health, especially targeting working mothers by:

• Providing reliable day care centres close to areas where institutions are concentrated, or within institutions with 20 lactating women or more.

• Allowing the mother to take sick leave when her child is sick according to a medical report by an accredited doctor; in order to prevent transmission of diseases and development of complications.

4. Follow up by social workers with families subjected to accidents, especially those resulting from malpractice, negligence and neglect.

5. An enhanced role of school counselling by increasing the number and competence of personnel, and developing a strategy for school counselling to ensure problems are anticipated and addressed before they occur.

88

Ann

ex 7

: Gen

eral

Nat

iona

l Rig

hts

Base

d H

ealt

h In

dica

tors

The

right

of

child

to h

ealth

and

surv

ival

(Arti

cles 6

, 18,

24)

Indi

cato

rSo

urce

Freq

uenc

y*D

etail

s

Avail

abilit

y of s

pecifi

c law

s, ex

ecut

ive re

gulat

ions,

and a

utho

rities

base

d on t

he ri

ghts

of th

e chil

d an

d ens

ure t

heir

parti

cipati

on, a

ccou

ntab

ility,

trans

paren

cy, eq

uality

, non

-disc

rimina

tion,

and t

he

child

’s bes

t int

erest

• M

inist

ry o

f H

ealth

• U

NRW

A•

PLC

• N

atio

nal C

ounc

il of

Hea

lth P

olicy

and

St

rate

gic

Plan

ning

Avail

abilit

y of

healt

h po

lices

, plan

s, pr

ogra

ms,

budg

ets,

and

com

plain

t mec

hani

sms b

ased

on

the r

ights

of th

e chi

ld an

d en

sure

s his/

her p

artic

ipati

on, a

ccou

ntab

ility,

trans

pare

ncy,

equa

lity,

non-

disc

rimin

ation

and

the c

hild

’s be

st in

tere

sts

• M

inist

ry o

f H

ealth

• U

NRW

A•

PLC

• N

atio

nal C

ounc

il of

Hea

lth P

olicy

and

Stra

tegic

Pl

anni

ng•

Inde

pend

ent C

omm

issio

n of

Hum

an R

ights

(ICH

R)

Avail

abili

ty o

f m

echa

nism

s mon

itorin

g an

d ev

aluat

ion

of th

e law

s, po

licies

, plan

s and

pr

ogra

ms

• M

inist

ry o

f H

ealth

• N

atio

nal C

ounc

il of

Hea

lth P

olicy

and

St

rate

gic

Plan

ning

• U

NRW

A

56

structural indicators

* Ava

ilabl

e or u

nava

ilabl

e, de

gree

of i

mpl

emen

tatio

n, d

egre

e of s

atisfa

ction

on

impl

emen

tatio

n an

d qu

ality


Indi

cato

rSo

urce

Freq

uenc

y*D

etail

s

Avail

abilit

y of m

echa

nism

s to

mob

ilize s

uppo

rt,

partn

ersh

ip b

uild

ing,

and

raise

the l

evel

of

awar

enes

s on

the c

hild

’s rig

hts i

n he

alth

• M

inist

ry o

f H

ealth

• N

atio

nal C

ounc

il of

Hea

lth P

olicy

and

St

rate

gic

Plan

ning

• Ci

vil s

ociet

y in

stitu

tions

• U

NRW

A

Avail

abili

ty o

f pr

otoc

ols a

nd p

roce

dure

s of

mon

itorin

g, e

valu

atio

n, a

ccou

ntab

ility

and

m

echa

nism

s of

com

plain

t

• M

inist

ry o

f H

ealth

, UN

RWA

• N

atio

nal C

ounc

il of

Hea

lth P

olicy

and

St

rate

gic

Plan

ning

• In

depe

nden

t Com

miss

ion

of H

uman

Rig

hts

• A

ttorn

ey G

ener

al’s O

ffice

• H

ealth

Uni

ons

Avail

abili

ty o

f cle

ar p

roto

cols

to d

eal w

ith

emer

genc

y ca

ses,

med

ical n

eglig

ence

, and

ab

use

• M

inist

ry o

f H

ealth

• U

NRW

A•

Hea

lth U

nion

s

Avail

abilit

y of l

aws a

nd m

easu

res f

or th

e pr

ovisi

on o

f fre

e bas

ic m

edica

l car

e for

child

ren

unde

r 18

year

s of a

ge

• M

inist

ry o

f H

ealth

• U

NRW

A•

Min

istry

of

Fina

nce

Avail

abili

ty o

f th

e nee

ded,

syste

mat

ic an

d un

ified

train

ing

fram

ewor

k in

the fi

eld o

f he

alth

educ

atio

n an

d rig

hts a

nd h

ealth

of

the

child

• M

inist

ry o

f H

ealth

• Ci

vil s

ociet

y in

stitu

tions

• Pr

ivat

e Se

ctor

• U

NRW

A


90

Indi

cato

rSo

urce

Freq

uenc

y*D

etail

s

Avail

abilit

y of p

roce

dure

s to

prev

ent d

isabi

lity,

com

plica

tions

and

depe

nden

ce th

roug

h ea

rly

detec

tion,

pre

vent

ion,

raisi

ng th

e lev

el of

aw

aren

ess a

nd ea

rly in

terve

ntio

n

• M

inist

ry o

f H

ealth

• Ci

vil s

ociet

y in

stitu

tions

• Pr

ivat

e Se

ctor

• U

NRW

A

Avail

abili

ty o

f pr

oced

ures

to re

duce

and

co

mba

t acc

iden

ts•

Mini

stry o

f Hea

lth –

Med

ical I

nstit

ution

to P

reven

t Ro

ad A

ccide

nts,

UN

RWA

• M

inistr

y of T

ransp

ortat

ion•

Mini

stry o

f Int

erior

- Po

lice

Avail

abilit

y of

proc

edur

es to

com

bat

com

mun

icabl

e and

non

-com

mun

icabl

e dise

ases

• M

inist

ry o

f H

ealth

• U

NRW

A

Avail

abili

ty o

f m

easu

res56

to re

duce

mor

talit

y ra

te o

f in

fant

s, ch

ildre

n be

low

five

yea

rs o

f ag

e, an

d m

othe

rs

• M

inist

ry o

f H

ealth

• U

NRW

A

Avail

abili

ty o

f na

tiona

l pol

icies

on

the

healt

h of

ado

lesce

nts a

nd sa

fe a

cces

s to

info

rmat

ion

• M

inist

ry o

f H

ealth

• U

NRW

A•

Min

istry

of

Edu

catio

n

Avail

abili

ty o

f ps

ycho

logi

cal a

ssist

ance

for

child

ren

by a

ge, d

evelo

pmen

tal n

eeds

and

lik

eliho

od o

f ex

posu

re to

dan

ger

• M

inist

ry o

f H

ealth

• Ci

vil s

ociet

y in

stitu

tions

• U

NRW

A


56

Proc

edur

es a

nd m

easu

re in

clude

wha

t the

Sta

te p

ossib

ly co

nduc

ts in

term

s of

revi

ews,

mon

itorin

g, e

stab

lishi

ng o

f sp

ecial

fund

s or n

atio

nal b

odies

, aw

aren

ess c

ampa

igns

; pro

vide

pol

icies

, leg

islat

ion,

law

s, st

rate

gies

and

tran

spor

tatio

n su

ppor

t


Indi

cato

rSo

urce

Freq

uenc

y*D

etail

s

Avail

abili

ty o

f re

sour

ces a

lloca

ted

to d

evelo

p co

nsul

tatio

n an

d re

habi

litat

ion

serv

ices

frien

dly

to y

oung

ado

lesce

nts a

nd av

ailab

le w

ithou

t the

con

sent

of

pare

nts

• M

inist

ry o

f H

ealth

• Ci

vil s

ociet

y in

stitu

tions

• U

NRW

A

Avail

abili

ty o

f m

easu

res t

o im

prov

e th

e nu

tritio

nal i

ndica

tors

and

hea

lthy

life

patte

rns a

mon

g ch

ildre

n an

d ad

oles

cent

s

• M

inist

ry o

f H

ealth

• Ci

vil s

ociet

y in

stitu

tions

• U

NRW

A

92

Base

Yea

r 201

1

Indi

cato

rSo

urce

(Cur

rent

ly)Fr

eque

ncy

Defi

nitio

nCo

mm

ents

Indi

cato

rs o

f th

e qu

ality

of

healt

h se

rvice

s pro

vide

d:

Num

ber o

f qu

alifie

d an

d lic

ense

d m

edica

l tea

ms;

their

cla

ssifi

catio

n, d

istrib

utio

n,

sex,

inco

me

level

(Phy

sician

s, sp

ecial

ists,

dent

ists,

nurs

es,

phar

mac

ists,

mid

wiv

es,

nutri

tioni

sts,

psyc

hiat

rists,

ps

ycho

logi

sts,

etc.)

Min

istry

of

Hea

lth /

Hea

lth

Info

rmat

ion

Cent

reAnnual

For e

very

10,

000

of th

e po

pulat

ion

durin

g th

e sa

me

year

Det

ails /

clas

sifica

tion

in

term

s of

phys

ician

s, sp

ecial

ists,

dent

ists,

nurs

es, p

harm

acist

s, an

d m

idw

ives

are

avail

able

at

Hea

lth In

form

atio

n Ce

ntre

. A

s for

the

class

ifica

tion

by

licen

se, s

ex, l

evel

of in

com

e an

d nu

mbe

r of

nutri

tioni

sts,

psyc

hiat

rists,

and

psy

chol

ogist

s; it

is cu

rren

tly u

nava

ilabl

e.

Num

ber o

f ca

mpa

igns

and

pr

ogra

ms t

hat t

arge

t chi

ldre

n,

driv

ers,

traffi

c po

lice,

teac

hers

an

d pa

rent

s on

traffi

c sa

fety

du

ring

the

year

and

the

resp

onsib

le pa

rty.

• M

inistr

y of T

ransp

ortat

ion•

Mini

stry o

f Hea

lth –

the M

edica

l In

stitut

ion to

Prev

ent R

oad

Accid

ents

and D

epart

ment

of H

ealth

Ed

ucati

on•

Mini

stry o

f Edu

catio

n•

Pales

tine B

road

casti

ng C

orpo

ration

• Ci

vil So

ciety

Insti

tution

s•

UNRW

A•

Natio

nal C

ommi

ssion

of H

ealth

Pr

omot

ion an

d Edu

catio

n.

Annual

Nee

d to

dev

elop

a m

echa

nism

to

col

lect t

his i

nfor

mat

ion

Process Indicators


Num

ber o

f aw

aren

ess

cam

paig

ns a

nd p

rogr

ams

to c

omba

t unh

ealth

y so

cial

habi

ts su

ch a

s ear

ly m

arria

ge,

cons

angu

inity

, sm

okin

g, e

tc.

durin

g th

e ye

ar a

nd to

be

dire

cted

at t

he re

spon

sible

parti

es.

• M

inist

ry o

f H

ealth

–D

epar

tmen

t of

Hea

lth E

duca

tion

• Ci

vil So

ciety

Insti

tutio

ns•

Pales

tine B

road

casti

ng C

orpo

ratio

n•

Min

istry

of E

duca

tion

• UN

RWA

• N

ation

al Co

mm

issio

n of

Hea

lth

Educ

ation

Annual

Dev

elop

an in

form

atio

n ga

ther

ing

mec

hani

sm

Num

ber o

f m

edica

l ce

ntre

s and

hos

pita

ls an

d th

eir d

istrib

utio

n by

are

a, go

vern

orat

e, po

pulat

ion

and

num

ber o

f ch

ildre

n, a

nd

qualifie

d an

d sp

ecial

ized

pe

rson

nel i

n a

certa

in ti

me

perio

d an

d as

per

the

serv

ice

prov

idin

g pa

rty.

Min

istry

of

H

ealth

–

Hea

lth

Info

rmat

ion

Cent

reAnnual

• Pe

rson

nel a

vaila

ble

for t

he

facil

ities

of

the

MO

H o

nly.

• D

evelo

p an

info

rmat

ion

gath

erin

g m

echa

nism

.•

A su

rvey

of

healt

h fa

ciliti

es

(per

sonn

el, c

entre

s and

nu

mbe

r of

patie

nts)

on

the

natio

nal l

evel

is av

ailab

le.

Ano

ther

surv

ey w

ill b

e co

nduc

ted

on th

e he

alth

facil

ities

dur

ing

2012

.

Process Indicators

94

Mor

talit

y ra

te o

f in

fant

s, ch

ildre

n un

der fi

ve y

ears

of

age

, chi

ldre

n be

twee

n 5-

less

than

18

year

s of

age57

by

caus

es, t

ime

perio

d,

geog

raph

ical d

istrib

utio

n by

(g

over

nora

te, s

ex, a

ge g

roup

, so

cio-e

cono

mic

situa

tion,

an

d th

e lev

el of

edu

catio

n of

th

e m

othe

r).

• M

inist

ry o

f H

ealth

– H

ealth

In

form

atio

n Ce

ntre

• PC

BS

• A

nnua

l

• E

very

four

ye

ars

• (M

ortal

ity o

f inf

ants)

: N

umbe

r of d

ecea

sed

child

ren

for e

very

1000

ne

wbor

n in

the s

ame y

ear.

• (M

ortal

ity o

f chi

ldren

un

der fi

ve ye

ars o

f age

): N

umbe

r of d

ecea

sed

child

ren

for e

very

1000

ne

wbor

n in

the s

ame y

ear.

• (M

ortal

ity o

f chi

ldren

be

twee

n 5-

less

than

18

year

s of a

ge):

Num

ber

of d

ecea

sed

child

ren

for

ever

y 100

0 chi

ld fro

m th

e sa

me a

ge gr

oup

in th

e sa

me y

ear.

Inclu

ded

in th

e A

nnua

l Hea

lth

Repo

rt (th

e ca

uses

by

reas

on,

age

grou

p, se

x an

d ge

ogra

phica

l lo

catio

n). A

que

stio

nnair

e on

de

ceas

ed in

fant

s up

to o

ne y

ear

of a

ge is

avail

able,

but

doe

sn’t

inclu

de c

lassifi

catio

n by

the

socio

-eco

nom

ic sit

uatio

n an

d th

e lev

el of

edu

catio

n of

the

mot

her.

Outcome Indicators

57

Ther

e is

a ne

ed to

dev

elop

and

expa

nd th

e qu

estio

nnair

e of

dec

ease

d ch

ildre

n to

inclu

de c

hild

ren

1- le

ss th

an 1

8 ye

ars,

and

to a

dd th

e so

cio-e

cono

mic

situa

tion

of th

e fa

mily

and

the

level

of

educ

atio

n of

the

mot

her a

nd c

ondu

ct a

train

ing

on it

. It i

s pos

sible

that

this

will

not

take

plac

e so

on, a

s it n

eeds

gre

at su

ppor

t to

mak

e it

happ

en.


Perc

enta

ge o

f ch

ildre

n w

ho

suffe

r fro

m m

alnut

ritio

n58

inclu

ding

thos

e w

ho su

ffer

chro

nic

maln

utrit

ion

(Ane

mia,

was

ting,

low

w

eight

, stu

ntin

g, v

itam

in A

defic

iency

, iod

ine

defic

iency

, ov

erw

eight

, obe

sity)

or a

cute

on

e by

age

, are

a, se

x, so

cio-

econ

omic

situa

tion

and

the

level

of e

duca

tion

of th

e m

othe

r, an

d tim

e pe

riod.

Perc

enta

ge o

f th

ose

eatin

g sw

eets,

pot

ato

chip

s, an

d w

ho re

gular

ly ha

ve b

reak

fast

(a

t sch

ool/

hom

e).

• M

inist

ry o

f H

ealth

– H

ealth

In

form

atio

n Ce

ntre

thro

ugh

Nut

ritio

n Su

rveil

lance

, and

ad

min

istra

tive

reco

rds

• PC

BS•

UN

RWA

- Re

cord

s

• 1-

3 ye

ars

or e

very

4

year

s•

1-3

year

s

Num

ber o

f ch

ildre

n su

fferin

g fr

om th

e pr

oblem

with

a c

erta

in a

ge

grou

p /

the

tota

l num

ber

of c

hild

ren

with

in th

at a

ge

grou

p) x

100

Was

ting

: -2

Stan

dard

D

eviat

ion

> w

eight

/heig

ht

Low

Wei

ght:

Low

w

eight

vs.

age

-2 S

tand

ard

Dev

iatio

n >

weig

ht/a

ge

Ove

rwei

ght:

+3

Stan

dard

Dev

iatio

n ≥

w

eight

/age

> S

tand

ard

Dev

iatio

n

Obe

sity

: +3

Stan

dard

D

eviat

ion

> w

eight

/age

Stun

ting

: sho

rtnes

s vs.

age

and

refle

cts t

he h

ealth

or

nut

ritio

nal s

ituat

ion

-2

Sta

ndar

d D

eviat

ion

>

weig

ht/h

eight

Ane

mia

: Les

s tha

n 11

gm/

decil

iter S

ever

e: les

s tha

n 7g

m/d

ecili

ter A

vera

ge:

7-10

gm/d

ecili

ter

Exp

and

the

Nut

ritio

n Su

rveil

lance

pro

gram

and

sc

hool

hea

lth to

inclu

de ch

ildre

n fr

om 3

-5 y

ears

of

age.

Outcome Indicators

58

Ther

e ar

e di

ffere

nt re

ason

s for

all

the

diso

rder

s, st

artin

g fr

om la

ck o

f pr

ecise

and

spec

ific

nutri

tiona

l elem

ents

such

as v

itam

ins,

min

erals

or p

rote

ins.

Any

dec

reas

e or

incr

ease

in th

e ca

lorie

s mig

ht

caus

e hu

nger

or o

besit

y or

oth

er p

robl

ems.

96

Num

ber/

perc

enta

ge o

f ch

ildre

n (0

- les

s tha

n 18

ye

ars)

that

wer

e di

agno

sed

with

non

-com

mun

icabl

e ch

roni

c di

seas

e by

ag

e, ge

ogra

phica

l are

a (G

over

nora

te),

sex,

and

tim

e pe

riod.

• M

inist

ry o

f H

ealth

– H

ealth

In

form

atio

n Ce

ntre

• PC

BS

• A

nnua

l

• 4

year

s

Canc

er, d

iabet

es a

nd e

very

no

n-co

mm

unica

ble

chro

nic

dise

ase

bein

g di

agno

sed

in th

e fu

ture

Mor

talit

y ra

te o

f m

othe

rs

by a

ge d

etail

s, ca

uses

, di

strib

utio

n, so

cio-e

cono

mic

situa

tion

durin

g a

certa

in

time

perio

d (o

ne y

ear)

Min

istry

of

Hea

lth –

Hea

lth

Info

rmat

ion

Cent

reA

nnua

lFo

r eve

ry 1

00,0

00 o

f liv

e bi

rths d

urin

g th

e sa

me

year

Perc

enta

ge o

f fu

ll na

tura

l br

east

feed

ing

with

in th

e fir

st h

our o

f bi

rth, a

nd in

th

e fir

st si

x m

onth

s; by

are

a (g

over

nora

te),

sex,

wor

k of

mot

her,

socio

-eco

nom

ic sit

uatio

n, a

ge o

f m

othe

r, ed

ucat

ion

of m

othe

r dur

ing

a tim

e pe

riod

• M

inist

ry o

f H

ealth

– H

ealth

In

form

atio

n Ce

ntre

thro

ugh

Nut

ritio

n Su

rveil

lance

and

he

alth

situa

tion

of m

othe

r and

ch

ild•

Surv

eys -

PCB

S

• An

nual

• 3-

4 yea

rs

Child

ren

from

0 to

the

end

of th

e fif

th m

onth

of

their

ag

e w

ho a

re st

ill b

reas

tfed

by th

eir m

othe

r and

who

di

dn’t

eat a

ny a

rtific

ial

milk

, foo

d or

drin

k.

Vita

min

s and

med

icine

are

ex

clude

d.

• W

ork

of m

othe

r, so

cio-

econ

omic

situa

tion,

age

of

mot

her,

educ

atio

n of

m

othe

r dur

ing

a tim

e pe

riod

(una

vaila

ble

at th

e m

omen

t)•

Full

brea

stfe

edin

g: b

reas

tfed

by th

eir m

othe

r and

did

n’t

cons

ume

any

artifi

cial m

ilk,

food

or d

rink.

Vita

min

s and

m

edici

ne a

re e

xclu

ded.

Outcome Indicators


Perc

enta

ge o

f wo

men

eig

htee

n ye

ars o

r les

s or >

35

year

s upo

n gi

ving

birt

h in

a

certa

in ti

me

perio

d

• M

inist

ry o

f H

ealth

–

Adm

inist

rativ

e re

cord

s•

PCBS

1-3

Year

sFo

r 100

0 ch

ildre

nD

evelo

p liv

e bi

rth re

port

form

an

d ad

d th

e ki

nshi

p ty

pe a

nd

degr

ee

Perc

enta

ge o

f di

sabi

lity

case

s due

to tr

affic

acc

iden

ts

durin

g a

certa

in ti

me

perio

d

• M

inist

ry o

f H

ealth

• M

inist

ry o

f So

cial A

ffairs

• PC

BS

Ann

ual

(Num

ber o

f di

sabi

lity

case

s due

to tr

affic

ac

ciden

ts /

tota

l num

ber

of d

isabi

lity

case

s) x

100

Num

ber o

f re

porte

d co

mpl

aints

rega

rdin

g ch

ildre

n no

t rec

eivin

g ne

eded

hea

lth

serv

ices a

nd n

eglig

ence

by

healt

h se

rvice

pro

vide

rs

durin

g a

certa

in ti

me

perio

d

• IC

HR

• M

inist

ry o

f H

ealth

–

Com

plain

ts b

ox

Ann

ual

Show

s the

incr

ease

in th

e lev

el of

peo

ple’s

awar

enes

s of

their

rig

hts

Num

ber o

f co

mpl

aints

re

gard

ing

deni

al ch

ildre

n’s

right

s tha

t wer

e pr

oces

sed

durin

g a

certa

in ti

me

perio

d

• IC

HR

• M

inist

ry o

f H

ealth

–

Com

plain

ts b

ox

Ann

ual

Show

s how

com

mitt

ed is

the

Min

istry

in fo

llow

ing

up ri

ghts

of

pat

ients

Outcome Indicators

Date post:	08-Mar-2021
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Ministry of Health State of Palestine Public Health Policy for ......Mamdouh Nujoum, Ms. Taghrid...

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