The Palestinian Economy. Theoretical and Practical Challenges

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impoverishment, there have been substantial patient transfers from one provider to
another (Mataria, Khatib et al. 2009). As elsewhere, health care provision in the OPT
follows a pyramidal structure, with primary care at the bottom level, secondary and
tertiary care at the middle and top levels, respectively. Each of the four providers operates
its own facilities at almost all the three levels. Primary-level represents the first level of
contact for the individuals, family and community with the health care system
(WHO/UNICEF 1978), and refers to basic health care that is provided by physicians
(general practioners – GP) trained in family practice, internal medicines, or pediatrics,
or by nonphysicians such as nurses. Secondary-level refers to care provided by
speciality providers (e.g., urologists and cardiologists) who generally do not have the
first contact with patients. These providers usually see patients after referral from a
primary or community health professional. Tertiary-level refers to care provided by
highly specialised providers (e.g., neurologists, cardiac surgeons, and intensive care
units) in facilities equipped for special investigation and treatment (Schoenbaum, Afifi
et al. 2005).
The Primary health care (PHC) was considered as the backbone of the Palestinian
health care sector, and a strategy towards the achievement of affordable and accessible
health care for the entire population (NHP 1994; NSHP 1999b). In the context of the
OPT, PHC services comprise public health activities, 2 reproductive health and front-line
diagnosis and treatment. These are provided by a pool of PHC centers and a number of
sole and group medical clinics (MOH-MHIS 2002). Following the establishment of the
Palestinian MoH, the number of PHC centers in the OPT has increased from 454 in 1994
to 654 in 2005 (+44.1%). Today, the OPT count about 1.9 PHC center per 10,000
individuals (MOH-MHIS 2002). Table 2.1 summarises the distribution of PHC centers
between the WB and GS, as stratified by the type of provider. On the other hand,
secondary and tertiary care services are provided through a limited number of general and
specialised hospitals, mainly, located in the urban areas. There is clear shortage in tertiary
health care services, with those available being concentrated in inaccessible Jerusalem
areas, due to Israeli restrictions prohibiting Palestinian from accessing the holy city (HPU
2008b). Hospitals distribution by region and type of provider are also summarised in
Table 2.1. Beside these three levels of health care provision, a number of general and
specialised medical and paramedical practices, pharmacies, and diagnostic units – e.g.,
medical laboratories, radiology and imaging centers – are also available and distributed
2 Immunisation, childcare and health education are mainly provided by the MoH and UNRWA free of charge.