This report represents the first output of a tool designed to describe the changes occurring in the health status, health service delivery and health system performance of the Palestinian health sector. Specific efforts are deemed necessary to follow the current situation of growing shortage of resources as a result of the blockage of international financial assistance to the Palestinian Authority (PA). The aim of this tool is to monitor trends over time in the short and mid term by using a set of selected indicators which are sufficiently sensitive and relatively easy to access.
The tool includes two sets of indicators (see annex):
- The first set (general health indicators) monitors health status, health services and system and includes central level sources of data.
- The second set (sentinel indicators) monitors health services and includes data collected at district (for the PHC) and hospital level.
SET N. 1: GENERAL HEALTH INDICATORS
The first set includes indicators collected at central level. According to the type of indicator, data will be analyzed on monthly or quarterly basis. The figures, so far collected, relate to a baseline (Dec 2005 and Jan 2006) and to March and April 2006 (table 1). Data are also available by district.
- The Neonatal and Infant Mortality Rates and the Low Birth Weight(1) are not expected to show any possible trend in a short term. Data will be analyzed next month, according to a quarterly frequency.
- Underweight continues to be very low in the West Bank according to available data(2).
- Anemia3 remains at a level of a public health problem in the oPt as it affects around a half of 9 - month- children in the West Bank and about a quarter of pregnant women who attended the MoH health facilities in the West Bank(4).
- The incidence of Diarrhea is low, in children 0-3 years who attended UNRWA health facilities. Data from Gaza Strip show only a modest trend, probably due to seasonal variations(5). Diarrhea cases should indicate - among others - problems in access to clean water.
- A mild increase in deliveries at MoH hospitals and decrease at NGOs and private facilities seems to emerge from preliminary data. Normally about two thirds of women deliver in MoH, while about one third deliver in NGOs or private facilities. Shifting from NGO/private to MoH facilities, if the trend will be confirmed, could be explained by economic reasons. In fact, women do not pay any fee in MoH facilities (covered by governmental insurance), whilst there is an average fee in both NGOs and private for profit sector of about 200 NIS in Gaza and 400-800 NIS in the West Bank.
- The admissions(6) to the MoH hospitals in the oPt slightly increased from January 2006 to March and April 2006. Also for PHC services, there has been an increase in number of consultations in the public sector in Gaza, in both MoH and UNRWA. (data on the WB will be available soon)
- The number of patients referred abroad has decreased, as expected from the MoH new policy that limits the criteria for referral. This is true particularly in the Gaza Strip where there has been a sharp reduction from March to April.
- Fuel consumption for transportation has only mildly decreased. In January 2006, Gaza figures show that the cost for fuel was double compared to that in the West Bank and has significantly diminished in March and April 2006, reaching the same levels of the West Bank.
(1) Data on live births and on their weight at birth are collected from the Immunization unit in the MOH, through the birth certificate showed during the BCG vaccination, (coverage is around 100%). The data on deaths are collected from the Ministry of interior.
(2) The 5th percentile has been used as cut off point instead of -2SD; these results are not comparable with other figures from different surveys. Also, the limit of this data is that they are clinic based and it may not give a representative picture for all the children 0-2 years. From June, appropriate data on wasting and underweight in both west Bank and Gaza should start to be available from the newly established nutrition surveillance system, in the MoH. These data will use internationally agreed standards, and will be representative, although limited to a narrow age group. Current WHO calculation is based on data collected from Palestinian Health Information Center (PHIC) through the Maternal and Child Health (MCH) department in the West Bank. No data is currently available for Gaza.
(3) Hemoglobin level <11Hg/dl. WHO calculations, based on data collected from PHIC in the West Bank for the MoH health facilities. Hemoglobin tests were done during the measles vaccination. Data for children at 9 months is not available for MoH health facilities in Gaza Strip.
(4) WHO calculations, based on data from the PHIC in the West Bank. Data is not available for Gaza.
(5) WHO calculations based on data collected by UNRWA field offices in Gaza strip and the West Bank 6 WHO calculations based on data collected from the Hospital directorate, MoH, in GS and PHIC in GS and the West Bank.