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HEALTH CARE SYSTEM IN PALESTINE

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Title: HEALTH CARE SYSTEM IN PALESTINE


1
HEALTH CARE SYSTEM IN PALESTINE
2
Definition
  • A health system is the combined entity of all
    resources, actors and institutions related to the
    financing, regulation and provision of all
    activities whose primary intent is to improve or
    maintain health (WHO, 2000).

A health care system is an arrangement in which
health care is delivered. There are many
variations of health care systems around the
world.
3
Goals
  • The goals for health systems according to the
    World Health Report 2000 - Health systems
  • improving performance (WHO, 2000)
  • responsiveness to the expectations of the
    population and fair financial contribution.

4
  • Duckett (2004) proposed a two dimensional
    approach to evaluation of health care systems
    quality, efficiency and acceptability on one
    dimension and equity on another.

5
Why is it important to observe the health care
system in Palestine ?
  • 1. To provide up to date quality information on
    the health system, its performance and reforms to
    be used by policy makers.
  • 2. To provide a sound foundation for comparative
    analytical work on specific health system issues.

6
What is a successful health system ?
  • A "successful" Palestinian health system should
    at a minimum
  • Maintain an effective and well regulated public
    health system.
  • Provide reasonable access to high quality
    preventive and curative services for all
    Palestinians.
  • Maintain high quality programs for training
    health professionals.

7
  • Achieve health outcomes at the population level
    that meet or exceed international guidelines such
    as those recommended by the WHO.
  • Be effective , efficient and financially viable.
  • Encompass the possibility of cooperation with
    neighboring countries on issues of common
    interest .

8
Financing
  1. direct or out-of-pocket payments.
  2. general taxation.
  3. social health insurance.
  4. voluntary or private health insurance.
  5. donations or community health insurance.

9
Health care has the following characteristics
  • The provision of critical health care treatment
    is often regarded as a basic human right
    regardless of whether the individual has the
    means to pay some treatments cost more than a
    typical family's life savings.
  • Health care professionals are bound by law and
    their oaths of service to provide lifesaving
    treatment.
  • Asymmetric information.
  • High risk level.

10
Models
  • Purely private enterprise health care systems are
    comparatively rare.
  • The other major models are public insurance
    systems.

11
Public insurance systems
  • Social security health care model where workers
    and their families are insured by the state.
  • Publicly funded health care model where the
    residents of the country are insured by the state
    and health care workers are employed by the
    state.

12
  • Publicly funded health care model where the
    residents of the country are insured by the state
    and those who provide health care work in private
    enterprises.
  • Social health insurance where the whole
    population or most of the population is a member
    of a sickness insurance company.

13
HEALTH CARE SYSTEM IN PALESTINE
  • A Health Care System Still Fragmented and
    Increasingly Unaffordable.

14
HEALTH CARE SYSTEM IN PALESTINE
  • Socio Economic Geopolitical Mapping.
  • Health status and demographics.
  • Health System organization governance.
  • Health System Finance Expenditure.
  • Human Resources.
  • Health service delivery.
  • Health System Reforms.

15
Indicators of Health status
2004 2000 1995 Indicators
M/F 71.1 / 74.1 M/F 71.8/ 73.5 - Life Expectancy at Birth
20.5 22 25 Infant Mortality Rate
25.4 27.3 - Probability of dying before 5th birthday/1000
10.0 37.3 - Maternal Mortality Rate
98.8 95.9 - Percent Normal birth weight babies
9.4-1.9 9-2.5(2002) - Prevalence of stunting/wasting
underestimated
16
Top 10 causes of Mortality/Morbidity
  • Rank Mortality (2003) Morbidity
  • Heart diseases.
  • Cerebro-vascular.
  • Peri-natal death.
  • Malignancy.
  • Accidents.
  • Senility.
  • Hypertension.
  • Pneumonia and other respiratory.
  • Diabetes mellitus.
  • Renal failure.

17
Age and Sex Composition of the Palestinian
Population in Gaza Strip and the West Bank
(including East Jerusalem) 2005
18
Demographic Indicators
2004 2000 1995 Indicators
28.6 33.2 46.5 Crude Birth Rate
2.8 3.2 4.1 Crude Death Rate
2.5 - - Population Growth Rate
97.5 100.6 102.5 Dependency Ratio
46.3 46.9 49.7 Population lt15 years
4.1 4.31 6.7 Total Fertility Rate
19
Providers of health care in Palestine
  • MOH (Main) provides primary, secondary and
    tertiary health services and purchase the
    unavailable tertiary health services from
    domestic and abroad providers.
  • UNRWA provides primary care services only for
    refugee and purchase secondary care services for
    the hardship cases.

20
  • Non governmental organizations (NGOs) provide
    primary, secondary and some tertiary
    services.
  • Private Sector (for profit provider) provides
    the three level of care through a variety
    of specialized hospitals and investigation
    centers.

21
Health Expenditure Data and Trends
2004 1995 Indicators
138.4 122 Total health expenditure /capital.
13 8.6 Total health expenditure as of GDP.
- - Investment Expenditure on Health.
33.3 - Public sector of total health expenditure.
22
Sources of finance by percent
2002 2000 1995 1990 Source
General Government
15 Central
7 (Premium) Social Security
- Private
2 Private Social Insurance
- Insurance
2 (Co-payment) Out of Pocket
11 Non profit Institutions
15 Private firms and corporations
48 External resources
23
  • The external source is distributed among
    supporting the MOH recurrent budget (8),
    MOH investments (16), UNRWA (10), and NGOs
    (14).

24
Health Expenditures by Category
 2004 2000 Expenditure 
126.475 M 95.72 M Total expenditure 
39/Capita - Capital expenditure
- - by item
56.1 47.5 Staff costs
18.6 20.9 Drugs and supplies
14.9 6.5 Medical referral
25
INSURANCE SYSTEM
  • Public health insurance covers worker employees
    and their families who pays the fees of medical
    insurance and children below 3 years of age.
  • Private medical insurance companies.

26
HUMAN RESOURCES
  • 57 of health human resources in Palestine are
    employed by MOH, There are 9.73 physicians,16
    nurses, 1.43 pharmacists, 7.43 paramedics and
    17.5 administrators and workers per 10.000
    populations in Palestine in 2004.
  • There are 0.47 physicians and 0.74 nurses per
    hospital bed in Palestine. There is one
    physician for 3.000 populations and one nurse
    for 2,265 populations in PHC clinics in
    Palestine.

27
Health care personnel
2004 2000 Personnel per 100,000 Population
150.9 75.2 Physicians
9.2 6.9 Dentists
14.3 7.4 Pharmacists
144.9 122.9 Nurses
74.3 47.7 Paramedical staff
14.9 12.3 Midwives
7.4 22.2 Community Health Workers
175.0 108.8 Others
Includes physicians and specialists.
Underestimated, the private sector is not
included.
28
Primary Health Care
Package of Services for Health Care
  • Health Post covers less than 1,000 populations.
  • Health Clinic covers 1000-3000 populations.
  • Health centre covers 3000-1000 populations.
  • Comprehensive Health Centre covers 10,000-25,000
    populations.

29
Non personal Services Preventive/Promotive
Care
  • Availability and accessibility.
  • Environmental health.
  • Health education/promotion.

30
Secondary/Tertiary Care
2004 2000 1995
1.3 1.4 - Hospital Beds/1,000
8.6 5.9 - Admissions/100
2.6 2.8 3.2 Average LOS (days)
81.1 72.4 68.5 Occupancy Rate ()
31
Public/private distribution of hospital beds
  • Ministry of Health owned and operates 22
    hospitals with total capacity of 2,735 beds. 17
    hospitals provide general hospital services, two
    psychiatric hospitals with 319 beds, two
    pediatric hospitals in Gaza Strip with 222
    beds and one ophthalmic hospital with 31
    beds.

32
Public/private distribution of hospital beds
  • There are 31 hospitals with a capacity of 1,565
    beds owned and operated by NGOs in Palestine in
    2004.
  • NGOs hospitals provide secondary, maternity,
    geriatric and rehabilitation services. There are
    no geriatric or rehabilitation hospitals in
    public or private sectors.

33
Public/private distribution of hospital beds
  • Private sector has 23 hospitals with total
    capacity of 461 beds. Private hospitals provide
    special types of health service such as
    Intra Vitro Fertilization (IVF), Ophthalmic,
    maternity and surgical services.

34
Pharmaceuticals
  • Essential drugs list by level of care.
  • Manufacture of Medicines and Vaccines.
  • Regulatory Authority Systems for Registration,
    Licensing, Surveillance, quality control,
    pricing.
  • Systems for procurement, supply, distribution.

35
Health System Reforms
  • A National Strategic Health Plan was prepared in
    1998 to cover five years 1999-2003.
  • It was partially implemented and affected by
    the Intifada events from September 2000.
    There is a current evaluation to this plan for
    preparation for a Health system reform.
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