Annual Report of the Department of Health 2010 - Unrwa

FOREWORD
FOREWORD OF THE DIRECTOR OF HEALTH
Health services of UNRWA are at the critical juncture. After the decades of remarkable progresses in improving
the health status of the Palestine refugees that UNRWA serves, particularly mothers and children, challenges
are paramount and overwhelming. There are serious concerns about a possible shrinkage of UNRWA health
services in light of the financial constraints facing the Agency.
As a new director of health programme, I would like to emphasize how this report is a reflection of the continued
commitment of the UNRWA health programmes, in the midst of a health reform, to improve our health
services for the Palestine refugees we serve. For this reason, particularly this year the Annual Report of the
Department of Health is very important.
The health status of Palestine refugees has shown sizable improvement. Deaths of mothers and children have
been considerably decreased. Progress in the Millennium Development Goals 4 and 5, namely to reduce child
and mother deaths, respectively, is on track. Immunization coverage has always been close to 100%, much
higher than the WHO Target of 95%. It is worthwhile mentioning that such progress is done with a low level of
financing. Health expenditure per registered refugee in UNRWA was only USD 19.8 in 2010. This is significantly
lower than the per capita governmental health expenditure of the host countries of UNRWA and also that of
other middle income countries. One important reason behind is the commitment of health personnel throughout
UNRWA. Based on my 20-year experience in public health, I can say that it is very rare to see such committed
health personnel throughout the services.
Still, the challenges in health status and services are paramount. Non-communicable diseases, or so-called
life-style illnesses, are becoming predominant. Evidence indicates that non-communicable diseases account
for 70% to 80% of deaths among Palestine refugees. These are life-long, difficult to prevent and hard to control
health conditions. Health services of UNRWA have yet to cope with such challenges. Health centres are usually
overwhelmed with a large number of patients. On average, one physician sees 100 patients per day. The time
available for each consultation does not favour quality of care, including care for non-communicable diseases.
Increasing cost for hospitalizations is also affecting the health financing of UNRWA. Unfortunately, this has
often forced refugees to make considerable out-of-pocket payment for hospitalization care when they do not
have access to other financing schemes like a health insurance. Addressing such challenges with low level of
financing (i.e. less than USD 20 per registered refugee) is truly a daunting task, particularly in the current global
financial crisis.
Prevailing social and economic difficulties and political instability also negatively affect health outcomes.
Unemployment is extremely high among productive age groups. Poverty level still remains high. The latest
survey in Lebanon, for example, indicated that 67% of the refugees are poor. Such economic and social stress
sometimes results in gender-based violence. Continued blockade by Israel against importation of essential
materials for health facility infrastructure, has affected health service delivery in the Gaza Strip. Similarly,
limitations in access to health care cause a significant health burden in the West Bank.
The health programmes of UNRWA are fully aware of such challenges and difficulties and are committed to
address them through a health reform based on the progress made to date. In 2009, comprehensive health
systems reviews were conducted in each Field. The Mid Term Strategy of UNRWA (2011-2015) is the foundation
of the reform, supported by the life cycle approach. In the reform, addressing the life style illnesses is a key
message. This will entail improvement of quality of care in crowded health centres, and outreaching to communities
to bring changes in life style. Addressing health needs will also entail increasingly costly hospital
payments. In order to make this feasible, fundamental improvements in the health information system through
e-health and, most importantly, support to health workforces through continued education, are required.
Partnerships with host countries, donors and all others will remain critical. In reality, the process of reform is
now under way as characterized in this year’s activities. All Fields have made encouraging innovations along
with the reform, and this is highlighted in this report.
UNRWA is at the critical juncture, whether or not to improve its health services. Although there is no shortage
of difficulties and challenges in the health reform, we have no choice but to succeed so as to continue to better
serve Palestine refugees. This is actually up to all of us in the UNRWA health programme. And because of this,
because I know and admire the commitment and dedication of UNRWA health personnel, I am confident of the
success in the health reform.
Dr. Akihiro Seita
WHO Special Representative
Director of the UNRWA
Health Programme
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