Attachments
Executive Summary
Household demographics
A total of 566 non-Syrian households in Jordan were interviewed about their health access and utilization practices in 2023. The non-Syrian household’s members were almost equally divided between males and females (52 vs. 48 per cent, respectively). As for age and gender distribution, 30 per cent of household members were under 18 years of age, 24 per cent of non-Syrian household heads were females, 49 per cent of household heads were between 35 and 59 years old, and 22 per cent were older than 60 years. The majority of non-Syrian households were living in Amman (82%) and almost all (99%) were in the Country of Asylum (CoA) for more than 2 years.
Non-Syrian household average size was 3.7 per household, similar to 2021 study while the average monthly income for a non-Syrian refugee household was 198.5 JOD. Iraq was the highest listed country of origin at 55 per cent, followed by Yemen at 25 per cent and Sudan with 17 per cent, similar to the trends observed in the 2021 HAUS survey.
General Awareness on health care access
An increase was witnessed with regards to the awareness of UNHCR supported facilities since 2021 by 9 per cent (62 in 2023 vs. 53 per cent in 2021), while the awareness of access to MOH facilities at subsidized costs decreased by 2 per cent (48 vs. 50 per cent in 2021). Furthermore, 69 per cent of heads of household reported they understood information regarding subsidized health care access, yet awareness of issuing a white card at MOH facilities was only 43 per cent. Only 27 per cent reported to possessing a white card issued by the MoH facilities.
Health service and health seeking behaviour
The need to access a health-care facility decreased to 24 per cent in 2023, compared to 37 per cent in 2021 survey results. For those who accessed health-care services in 2023, 48 per cent chose to seek care at private clinic or hospital, 28 per cent sought care at a governmental health facility, and 13 per cent went to private pharmacies. It is important to mention that access to pharmacies dropped by 17 per cent, access to private hospitals or clinics increased by 10 per cent, and access to government hospitals increased by 6 per cent as compared to the 2021 survey results. With regards to the first health-care facility accessed, 90 per cent of non-Syrian household members reported that they received the needed health-care service at the first facility, compared to 81 per cent in 2021. While most household members could access the health-care facilities, 10 per cent could not access the needed services, mainly due to the costs of services. Furthermore, the average paid amount at the first health-care facility accessed was 81 JOD in 2023, and the vast majority of non-Syrians (90 per cent) were satisfied with the services provided by the first health-care facility accessed. Also, 11 per cent of non-Syrians who needed health-care services were referred to a second health-care facility, versus 17 per cent in 2021.
Finally, with regards to the most preferred source of communication to receive information about health care, phone was the most preferred means of communication, followed by text messages, the internet (UNHCR website and Facebook), and WhatsApp.
Expenditure on health care and impact Non-Syrian households noticing an increase in health-care costs increased by 10 per cent compared to 2021 survey results. Seventy per cent were unable to afford the necessary medications, and 60 per cent stated they were unable to visit doctors or medical facilities if they needed health care. Furthermore, a significant decrease of 26 per cent was observed in non-Syrians in 2023 who reported that the health cost increase made them unable to afford necessary medical procedures. To cope with the health-care cost increase, 62 per cent of non-Syrians adopted a number of strategies, as follows: 48 per cent resorted to reducing visits to health-care providers, 46 per cent spent savings or borrowed money, 35 per cent stopped or reduced medication use, and 28 per cent reached NGO’s clinics for free health-care service (15 per cent increase compared the to 2021 study). The top preferred sources for medical information for non-Syrian heads of household were phone, followed by text messages, the internet (UNHCR website and Facebook), and WhatsApp, respectively.
Childhood vaccinations (not including COVID-19)
Awareness of free children’s vaccinations offered by MOH facilities was at 79 per cent in 2023 among non-Syrians who have a child between 9-59 months while 99 per cent of infants between 9-59 months were in possession of a vaccination card. Over 97 per cent of non-Syrian children (0-5 years old) took the MMR and polio vaccination (mostly taken at governmental health centres), similar to the 2021 survey.
Sexual & Reproductive Health
Out of all non-single women in reproductive age (15-49 years old) in 2023, 26 per cent were mothers of children younger than 2 years old, of which 85 per cent stated they received antenatal care. Around 70 per cent of mothers visited health-care centres more than four times for antenatal care. Twenty-seven per cent of mothers who received antenatal care reported they faced difficulties when receiving the service, mainly due to their inability to afford service fees.
In 2023, almost half of mothers (49 per cent) gave birth through normal vaginal delivery, and 50 per cent delivered through a caesarean section (29 per cent unplanned caesarean section, 21 per cent planned caesarean section). The average amount spent on delivery was 370 JODs, with the highest reported delivery place was in governmental hospitals (51 per cent) and 46 per cent in private hospitals. Fifty-two per cent of females who paid for delivery fees did not get any financial assistance for the delivery, while 24 per cent received full financial support and 24 per cent received partial financial support.
With regards to family planning, 37 per cent of mothers were aware of services available in Jordan to prevent unwanted pregnancies. Furthermore, 26 per cent of mothers said that they heard information about family planning in the past year. While 37 per cent of nonsingle Women at Reproductive Age (WRA) were aware of available services in Jordan to prevent unplanned pregnancy, only 17 per cent in 2023 tried to obtain contraceptive methods. Among the non-single WRA, 30 per cent sought services at MOH health facilities to receive contraceptives, 38 per cent visited a private doctor, and 9 per cent sought services at NGO’s clinics.
Nutrition including Infant and Young Child Feeding “IYCF”
Out of children between 0-59 months old, 20 per cent had nutritional and growth difficulties in 2023, of which 54 per cent requested assistance and only 3 per cent were included in professional assistance program. With regards to breastfeeding practices for infants, 79 per cent were ever breastfed and 41 per cent of those were breastfed during the first hour.
Chronic Diseases
Chronic diseases prevalence among non-Syrian households’ members surveyed was at 23 per cent in 2023, compared to 26 per cent in 2021 with the top recorded chronic cases of hypertension (44 per cent in 2023, 41 per cent in 2021), and diabetes (30 per cent in 2023, 27 per cent in 2021), followed by asthma or COPD and ischaemic heart disease.
In the past 3 months prior to data collection of the 2023 study, 76 per cent of non-Syrian household members suffering from chronic disease were able to receive health care for their chronic condition with the average amount of 69 JOD spent on treatment Twenty-four per cent of household members with chronic diseases reported that they could not access medical care for their condition, largely due to their inability to afford the service fees.
Disability
The reported disability cases among non-Syrian household members decreased from 11 per cent in 2021 to 9 per cent in 2023. The highest reported disability was physical impairment at 51 per cent compared to 57 per cent in 2021, followed by sensory disability and mental disability (28 and 13 per cent in 2023 vs. 24 and 10 per cent in 2021, respectively). The leading disability cause for 36 per cent of household members living with disability was “natural/at birth”, followed by accidents (26 per cent) and war (23 per cent).
These causes in the 2021 survey were at 54, 16, 23 per cent respectively. With regards to receiving support for disability, 64 per cent did not receive any support due to unaffordability, and 19 per cent reported not receiving the needed support due to the unavailability of service for their condition.
COVID-19
Ninety-two per cent of surveyed household members over the age of 18 years received COVID-19 vaccinations, out of which 4 per cent received a single shot, 81 per cent stated they received 2 shots, and 14 per cent reported receiving the third booster shot of the vaccine. Household members who did not receive the COVID-19 vaccine referred to reasons related to: “lack of trust in vaccinations” (44 per cent), “was not advised by friends and family” (16 per cent), and due to pregnancy (14 per cent).