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Syrian Refugee Health Access Survey in Jordan - December 2014

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Executive Summary

The objective of this national assessment of access to health care by Syrian refugees in Jordan was to characterize the health status and care-seeking behaviors of Syrian refugees living outside of camps and to inform issues related to their access to health care. The survey sample was nationally representative of Syrians in Jordan. A summary of key findings is as follows:

• Demographics: The survey population was young, 53.8% of household members reported were age 17 or under and only 3.9% were over 60 years old. The average household size was 6.2. Educational attainment among household heads and respondents was low, with less than a quarter having completed secondary school.

• Living Conditions and Household Economy: The majority of households (87.1%) lived in apartments or houses, with most (96.1%) renting their accommodations. Households reported an average of 1.8 rooms for sleeping and 3.75 people per sleeping room. Crowding, defined as five or more people per sleeping room, was observed in 25.1% of households. The mean monthly household expenditure was 472 JD per month (median= 416 JD). Expenditures were primarily for housing (30.9%), food (29.4%), health (9.7%), and transportation (7.4%). Mean and median monthly household incomes, excluding humanitarian assistance, were 228 JD and 100 JD, respectively. Asset sales or borrowing in the three months preceding the survey were reported by 68.8% of households.

• UNHCR Registration and Receipt of Humanitarian Assistance: A substantial portion (95.0%) of households reported registration of all members with UNHCR. Most households also received assistance: 93.7% reported receiving cash or vouchers from the UN or an NGO in the month preceding the survey, with an average value of 201 JD.

• Household Health Care Access and Utilization: In general, most households (84.5%) reported receiving care at a public health facility since arriving in Jordan, averaging 6 visits to public health facilities in the six months preceding the survey. Conversely, less than half of households (45.7%) reported seeking care at private sector facilities since arriving in Jordan, averaging 4.4 private facility visits in the six months preceding the survey. Mean household spending on health in the month preceding the survey was 57 JD, with an average of 32.1 JD spent on consultation and diagnostic fees and 24.9 JD spent on medications.

• Adult Health: The majority of households (86.1%) reported they last time an adult household member was ill they were able to receive needed medical care. Adult health care was most often sought at public facilities (52.9%), with 33.4% seeking care in private facilities, and 9.8% in charity/NGO facilities. Cost was the greatest barrier to care, reported by 64.5% of households; however, among the adult care seekers, 60.4% reported accessing medical care without an out-of-pocket payment. The average out-of-pocket cost to the household for the most recent adult care-seeking visit for those paying was 24.4 JD. Prescriptions were given to 87.4% of adult health care seekers and 89.8% of those patients were able to obtain all of the prescribed medication. Of those receiving medication, 58.5% reported paying and the average out-of-pocket medication cost following the most recent health care visit was 14.2 JD.

• Hospitalizations: In the year preceding the survey, 21.2% of households reported one or more hospitalizations of a household member in Jordan for reasons other than childbirth, the most common being injury (20.7%). The average number of hospitalizations in the preceding year per household was 2.1, with an average length of stay of 5.9 days. A large portion of hospitalizations were in public sector facilities (68%), due to affordability (reported by 41.8% of households seeking care). The major reason for choosing a public facility was affordability 41.8%). Out-of-pocket payments were reported by 22.3% of households for the most recent hospitalization, with an average cost of 146.3 JD.

• Chronic Health Conditions: The presence of hypertension, cardiovascular disease, diabetes, chronic respiratory disease, or arthritis in one or more household members was reported by 43.4% of households. Of 1363 index cases with a chronic health condition diagnosis, 84.7% had received care in Jordan, most commonly at public facilities (53.9% of care seekers). Among those receiving care for a chronic condition in Jordan, 31.6% had an out-of-pocket payment for the most recent care received. The average cost for patients receiving care was 13.3 JD (median= 0 JD). Medications were prescribed for 88.9% of chronic health condition cases, and 85.5% reported currently taking medication. In Medication use stopped, or medication ran out, for longer than two weeks in the past year by 26.5% of cases, most commonly due to high cost as reported by 59.1% of those stopping medication.

• Children’s Health: The majority of households (90.9%) reported that medical attention was sought the last time a child household member needed medical care. Child health care was most often sought at public facilities (54.6%), with 24.6% seeking care in private facilities and 8.9% in charity/NGO facilities. Cost was the greatest barrier to care, reported by 68% of households. However, among the child care seekers, most (70.7%) reported accessing medical care without an out-of-pocket payment. The average out-of-pocket cost to the household for the most recent child care-seeking visit for all patients was 13.4 JD. Prescriptions were written for 88.6% of child health care seekers, and 90.6% of those patients were able to obtain all of the prescribed medication. Of those receiving medication, 57% reported paying for it. The average out-of-pocket medication cost for all prescriptions was 8.8 JD.

• Antenatal Care and Deliveries: Among respondents, 20.3% reported that a woman in the household gave birth in the past year, 87.9% of whom delivered in Jordan. Antenatal care (ANC) was sought by 82.2% of women who were pregnant in Jordan, with an average of 6.2 antenatal visits among women receiving ANC. Cost was the most common barrier to antenatal care-seeking, and was reported by 32.6% of women not receiving antenatal care during pregnancy in Jordan. The most common location for ANC was a private Jordanian clinic or doctor (30.4%). The majority of deliveries took place in a public hospital (51.8%), primarily for reasons related to cost (54.8%). The majority of households did not pay any out-of-pocket payment for the delivery (67.4%). The average out-of-pocket payment was 70.1 JD among all deliveries and 217.6 JD among households paying for the delivery.