Health access and utilization survey among Syrian refugees in Lebanon - November 2017
Lebanon currently hosts over 1 million Syrian registered refugees who live outside of camps in urban centers and informal settlements. UNHCR is providing assistance and support to the refugees through a variety of programs covering basic assistance, protection, shelter, WASH, education and health. UNHCR plays an overall coordination role for several actors involved in providing healthcare assistance to Syrian refugees in Lebanon. These health programmes aim to enhance refugee access to comprehensive health services within Lebanon. Primary health care (PHC) is the core of all health interventions and in partnership with local and international implementing partners, UNHCR is supporting 30 PHC facilities where a minimum package of health care services is provided at subsidized prices. In total there are approximately 100 PHCs countrywide supported by partners where subsidized care is available for refugees. Healthcare services include, medical consultations, laboratory tests, pharmacy prescriptions, free vaccinations. Referral care is an essential component of access to comprehensive health services for refugees. UNHCR supports deliveries and life-saving emergency care by paying 75–90% of hospital fees depending on the socio-economic vulnerability of the individual refugee and the cost of the admission.
To facilitate the administration of referral care support UNHCR contracts a Third Party Administrator (TPA) and since January 2017 the TPA is NEXtCARE.
It is challenging to collect reliable routine data on the health service needs of non-camp refugees when compared to those residing in traditional camps. For this reason, Household Access and Utilization Surveys (HAUS) allow UNHCR to monitor trends in how refugees access and utilize health services over time. The proportion of registered Syrian refugee households with telephone numbers in Lebanon is 98%. Since 2014, UNHCR Lebanon has conducted annual telephone HAUS surveys which have provided important information on the challenges faced by refuges in accessing health care services. The survey results guide program delivery by providing timely and regular information in a cost-efficient manner on key variables relating to access and utilization.
This cross-sectional follow-up survey was conducted among refugees living in Lebanon, to monitor their access to and utilization of available health care services. The survey will aim to assess significant changes, if any that have occurred since the last survey which was conducted in 2016.
The survey was conducted through telephone interviews from the 5th to 8th of September 2017.
Eight surveyors were recruited and underwent 1.5 days of training.
Survey households were selected using random sampling, from a master list provided by UNHCR registration unit containing all registered refugees in Lebanon (as of August 2017), with a valid telephone number in the database.
The WHO STEP sample size calculator was used to obtain a representative sample.
Sample size was determined based on a desired confidence level between 3 and 5% for key indicators, baseline levels of indicators of 50%, design effect of 1, and accounted for a non-response rate of 50%.
Selected HHs were contacted and interviewed over the phone by the interviewers.
Participation was fully voluntary and everyone was informed that participating or not would not have any consequences in regards to UNHCR support and assistance to the household.
The head of household, or an adult (aged ≥18) who could respond on his/her behalf, was interviewed.
The specific inclusion and exclusion criteria for individuals within a selected household are as follows:
Inclusion o In case of absence, adult who can provide response on behalf of the household Exclusion o Not providing informed consent o Under 17 years of age o Not registered in the database
Attempts were made to contact all the selected households. Households that for some reason did not respond to the survey were not replaced.
Costs were asked for in Lebanese Pounds and converted to USD (1 USD=1500 LBP).
Data were entered using mobile tablets in real time, and analyzed using Microsoft Excel 2011.