Issue No.
150, October 2010 Latest update 8 2011f January 2011, at 3.56 am
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Photo courtesy of Lutheran World Federation.
Children’s wing patient registration area at the Palestine Medical Complex.

Health Reform A summary of the health reform initiatives under way in Palestine
By Aisha Mansour
The Ministry of Health (MoH) believes that every Palestinian has the right to health. During the last several years, the MoH has worked to improve the health system in order to better serve the Palestinian people. The priority areas for health reform in the Palestinian health system focus on state building and improved governance, health promotion, accessible and quality service delivery, and sustainability through appropriate health-financing mechanisms and a competent workforce.

The MoH recently published the 2011-2013 National Health Strategy. The strategy serves to highlight the reform priorities of the Palestinian health sector - governance and institutional development, human resource development, healthy lifestyles, and access to quality health services.

Governance/Institutional Development
Policy and Planning: The MoH has institutionalised the planning process during the past few years. The planning team within the MoH has been established and formalised. Under the direction of the policy and planning director and the office of the minister of health, the planning team facilitates the planning process through all phases involving the stakeholders from inside and outside the MoH. This ensures a rational process where the health system is assessed and problems are identified, with priorities and actions set to address the issues. In the development of the 2011-2013 National Health Strategy, stakeholders within the Palestinian health sector were included in the process as well as other governmental bodies, local NGOs, the private sector, and the international community.

Health Financing: In order to ensure a future mechanism for sustainable health financing, the MoH has developed a new mandatory national health insurance system that has been approved by the ministerial cabinet and awaits the president’s decree. A health financing committee has been established that has been tasked with undergoing a thorough study of the costs within the Palestinian service delivery system. This will provide a base for a pricing scheme.

Health Information: In order to ensure evidence-based decision making, there has been a major focus on improving the health information system. Currently, health information in Palestine is incomplete, fragmented, unreliable, and outdated. Last month, a national workshop was held to conduct a comprehensive assessment of the current health information system using the WHO Health Metrics Network assessment tool. The results of the assessment will serve as the base to develop a national health information strategy. In addition, USAID through the Flagship project is funding a health-information-system project that will provide an electronic clinical information system in governmental hospitals and clinics.

Human Resource Development: The MoH, in collaboration with the relevant stakeholders, has begun to develop continuing education requirements for the re-licensure of physicians and dentists. The MoH plans to develop similar requirements for the other health-related disciplines. In addition, the MoH has started to develop the terms of reference for a national human resource development thematic group which will be charged with developing a national strategy for human resources development. Most recently, the MoH has initiated an emergency medicine residency programme. At this time, there are no emergency medicine physicians in Palestine.

Healthy Lifestyles: The rise of non-communicable diseases (NCD) continues to burden the health system. The MoH is constructing a national NCD centre that will be responsible for conducting health education and health promotion campaigns, and maintaining a surveillance system. Further, the MoH NCD department, in collaboration with WHO technical assistance, has developed a national strategy for the prevention and management of NCDs.

Access to Quality Health Services: During the last year, the MoH has renovated and expanded several of its secondary care facilities. And to ensure access to primary health care services, the MoH has initiated the establishment of several primary health care centres and clinics. The MoH serves as the main health care provider in Palestine. As such, the ministry is working to complete its service delivery network to ensure that every Palestinian has access to health services, especially primary health care. In the next year the ministry, in collaboration with the relevant stakeholders, will develop a comprehensive service coverage plan that will map existing services and highlight the gaps in the service delivery system.

Some progressive steps have been initiated to improve the hospital infrastructure of the MoH, including the establishment of the Palestine Medical Complex (PMC) in Ramallah. This consists of two newly established hospitals and two existing facilities. The consolidation of these facilities into one entity aims to serve as a national centre of excellence and is a pilot approach to decentralised hospital management. The PMC will serve as a pilot for improving the quality of the services and meeting the patient-safety standards set by international organisations, the Joint Commission International, and the World Health Organization.

Further, in order to improve the quality of the service delivery system, the quality improvement department within the MoH has been revitalised and staffed. To date, four of the governmental hospitals have established quality improvement committees. Also, a quality improvement coordinator has been appointed within the primary health care directorate. In addition, the theme of the second national health conference held on 13 May 2010, was “Our Goal: Patient Safety.” The national health conference kick-started the MoH’s patient-safety initiative.

Gaza: As a result of the Israeli closure and the abnormal situation resulting from the coup d’état, the MoH is not able to manage the health system in the Gaza Strip. At this time, the ministry is sending the needed drugs and equipment, and continuing to pay the salaries of its employees. The number of referrals abroad has increased due to the lack of capacities. According to recent data, Gaza has received over 10,000 tons of drugs through Rafah and other donor support. However, the health system in Gaza has only been able to benefit from 30 percent of these drugs. Unfortunately, most of the drugs brought into Gaza were expired or not needed. The ministry has stressed on multiple occasions the need for the donor community to coordinate with the ministry in order to ensure that items sent to Gaza are those that are needed.

Challenges: The main challenge to the sustainability of the Palestinian health system is the Israeli occupation. Importing medical equipment and supplies is often subject to delays by the Israeli authorities. Furthermore, the Israeli authorities have recently prohibited the entry of medical devices, drugs, and consumables from the West Bank into Jerusalem. This has had a detrimental impact on the operations and fiscal status of the East Jerusalem hospitals. In addition, health workers and patients from the West Bank and Gaza continue to face difficulty accessing the health facilities in East Jerusalem.

Another challenge that faces the Palestinian health system is the rapid rise of non-communicable diseases. During the last several years, there has been a shift to urbanisation that leads to unhealthy lifestyles - poor diet, smoking, and lack of physical activity.

Aisha Mansour serves as the assistant to the minister of health and health reform coordinator with the World Health Organization. Ms. Mansour can be contacted at aisha_1975@hotmail.com and 059-894-9101.
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