community health institutionalization, dr.aljeesh, phd. & mr.al-khaldi, mph, 2014

Institutionalizing Community Health Programs into Palestinian Health Care

System, Palestine, 2014

Dr. Yousef Al-Jeesh, PhD.Mr. Mohammed Al-Khaldi, MPH

Feb. 2014Community health institutionalization, Aljeesh and Al-Khaldi, ICSD-v, IUG.1


Introduction

PHCS suffers from serious problems: a chronic lack of logistics, weak coordination and cooperation, scarcity of resources, dearth information system, weak health R&D, institutional complexities, as well as inadequate prevention and promotion measures meaning “community health”. In addition to major factors: political instability, geographic separation, and economic hardship due to occupation consequences.As community health projects in PHCS experiencing severe weakness in light of our need for these activities. It must be addressed seriously in order for its Institutionalization.

Definitions Community healthThe health status of a defined group of people and the actions and conditions, both private and public, to promote, protect, and preserve their health.InstitutionalizationA term refers to the process of “routine” for embedding, fixing or inserting something within an organization, social system, or society as a whole.


Components of CH practice

• Promotion of healthful living• Prevention of health threats• Treatment of disorders• Rehabilitation• Evaluation, and • Research


Characteristics of CH practice

• Population-focused

• Promotion of health/Prevention of illness

• Aggregate measurements and analysis

• Management & organization theory

• Involvement and collaboration.


• Homes• Ambulatory service centers• Schools• Occupational heath settings• Residential institutions, and • Community at large


CH SETTINGS

Community health Vs. Public health

• Involves doctors and other health professionals in a community.

• Protects the health of all those in a particular community.

• Keeps the food, water supply, and general environment healthy for the community.

• Concerned with overall health statistics.


• Involves the health of the nation.

• Protects the health of everyone.

• Gives free health care to individuals.

• Concerned with the health of individuals.

PH is considered a big umbrella includes CH.

Health system Process


Alma-Ata declaration 1978, Kazakhstan

• Attainment of the goal of Health for All. • Strongly reaffirms that the health achieved by full

spectrum of human needs socially, politically and environmentally.

• The health partners should be work collectively.• The community-based initiatives approach (CBI)

was adopted by this conference to realized the social and economic development.


Strengthening the PHCS (RAND, 2005)


It requires : community-wide collaboration Different parties involvement of health

system Training and empowerment of health

educator, social workers, community groups to strengthen health promotion and disease prevention.

Stu

dy imp

ortan

ce

Weak concern about the CH approach.Scarcity of relevant studies and lack of sufficient knowledge

about the reality of CH.The first domestic and academic study. Importance of the topic addressed one of the most important

HCS pillars. CH linked with the society determinants and its contributing in

the development and prosperity.CH institutionalization will leads to great implications on the

health sector and people. Provide clear insights for CH development.


Study Aim

The study aims to investigate the status and the nature of community health programs in the Palestinian health sector (governmental, NGOs and Private) to be built-in.


Methodology• Reviewing literature, national reports.• The study used qualitative approach by conducting 7th in-depth

interviews with experts like academicians, policy makers, legislators, health managers for gathering data about the phenomenon.

• One interview held with consultant, the second one with NGO expert, the third with expert from PLC, the fourth with experts from private sector, fifth with governmental official and the sixth, seventh and eighth interviews were carried with 3 academicians, Jan. and Feb. 2014

• Used Non-probability convenience and purposive selection, and the Interview questions were developed through literature and experts consultations.

• In content comparative analysis, data were systematically analyzed within steps. Raw data were carefully processed by Open Coded Thematic Analysis OCTA in order to make analytical interpretations.

Feb. 2014Community health institutionalization, Aljeesh and Al-Khaldi, ICSD-v, IUG.

13

Study Findings(Experts Perspective)


Experts over all perception about CH status

There is no full satisfaction and the CH programs status did not reach the required level due to its fragmentation and duplication.

MOH official stressed that he is generally satisfied about CH. There are harmonized views that the CH need to intensive efforts and

support to be well-developed. Half of experts confirmed that some of CH in gov. and UNRWA like

FP, vaccination, NCD, MCH, screening, health education are useful and respectable, but mostly of these activities are disintegrated and not well-planned.

Another expert asserted that the private sector is far away from CH. NGO view expressed displeased refer to all sectors focus more in

services on the individually- oriented not collectively “community- oriented”. Add, the NGO pay huge efforts without comprehensive coverage of CH components.


Perceptions about actual CH operations at 3 preventions levels

The majority emphasize that CH operations are mainly represented in provision school health, ANC, PNC, NCDs, dental care, FP, child health, radiology, mental health, lab, pharmacy, immunization, awareness, and rehabilitation. Other CH services are still very weak and not functioned- well currently.


CH programs effectiveness efficiency against standardization

• There is a great consensus among experts that they don’t think the CH programs work effectively and efficiently, and that they don’t meet the international standards.

• While, MOH official asserted the opposite. • While, most of them totally agreed that the only effective

and efficient standardized program is vaccination and immunization.

• They stressed on taking further improvement measures to the other programs according to the Int’l standards like CDC, WHO.


CH Programs Challenges and Gaps

• Lack f integration, comprehensiveness and duplication of the services

• Priority for curative services and advanced technology• Lack of standards and protocols• Shortage of staff and insufficiency of financing• Absence of regulated strategy or long-term program

sustainability, planning and coordination• Relevancy to actual needs• Capacity building and development programs about CH are

lack• Deficiency of data and evidence about the CH• Poor experience in the CH scope• Community culture


CH Policies and Protocols availability

• Perception mainstream indicating that the CH programs mostly do not work and go through agreed and standardized protocol among service providers, but with the acknowledgment that there are some protocols that regulate activities such as immunization services, ANC, NCDs.

• In contrast, MOH experts revealed that the majority of public health programs like sanitation, water, food, diseases managed by international standards and protocols.


Steps for CH Institutionalization

• Attaining the integration and relevancy “actual needs and priorities”

• Sustained and comprehensive strategic plan• Training , education, and curriculum• Coordination and networking• Cultivating “program champion” • Independence subsystem component• Fund sufficiency, trained staff plenty, effective information

system • Community, culture, participation and involvement• M&E including impact-based indicators IBI


20

Recommendations


Recommendation for Institutionalization (Institutional aspect)


• Important of existing national committee aiming to policies formulation, regulation, & monitoring.

• Develop effective NA tools to determine the crucial needs.• Develop a community health information system.• Implement a comprehensive M&E system and adopt

community-based research approach.• Recruiting specialized PH/CH professionals.• Emphasize on strategic and collective partnership and

coordination with all relevant parties: municipalities, ministries, universities, NGOs, CBOs, Unions …ect.

Recommendation for Institutionalization (Technical aspect)• The crucial need of CH programs meet the standardization.• More focusing on equity and targeting excluded groups, and

reactivate strongly the ambulatory services.• Great attention in continuity of health services and follow-up.• Call for re/referal and awareness and home visiting system

improvement across health providers domestically and aboard.• Request to adopt the community-based health services

approach within the HCS operations.• PHCS must operates preventive/promoter more than curative.• Conducting capacity building and education programs.• Resources allocation (fund, personnel, logistics).


Recommendation for Institutionalization (Community scope)

Culture is the most important• Build active inter-sectoral partnership

encouraging the community participation inclusive politicians, religion and tribal leaders, youth activists, kinetic women, ..ect.

• Focus on developing active, systematic and universal health education and public hearing plans to change the behavior and the real needs of the people.


Recommendation for Institutionalization

(donor agencies)

Urge the donors and their organizations to

play important role in supporting the

community health development and its

programs on the health sector in Palestine.


THANK YOU


26

community health institutionalization, dr.aljeesh, phd. & mr.al-khaldi, mph, 2014

Health & Medicine

health of

health promotion

health status

public health

community health projects

definitions community

health managers

health professionals