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UNRWA , as part of national health systems of Palestine

UNRWA , as part of national health systems of Palestine. Akihiro Seita a.seita@unrwa.org. What is UNRWA ?. Registered Palestine refugees (total: 5 million). Established in 1949 Protect & assist Palestine Refugees education, health, relief, etc. 30,000 staff Budget: USD 600M/year

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UNRWA , as part of national health systems of Palestine

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  1. UNRWA, as part of national health systems of Palestine Akihiro Seita a.seita@unrwa.org

  2. What is UNRWA? Registered Palestine refugees (total: 5 million) • Established in 1949 • Protect & assist Palestine Refugees • education, health, relief, etc. • 30,000 staff • Budget: USD 600M/year • Health services • 138 PHC health centers • 3,100 health staff • USD 100M a year • MCH • NCD (DM & hypertension) • Acute illness Syria (520K) Lebanon (450K) West Bank (754K) Jordan (2,070K) Gaza (1,240K) UNRWA: United Nations Relief & Works Agency for Palestine Refugees in the Near East http://www.unrwa.org/sites/default/files/2014_01_uif_-_english.pdf

  3. Almost 2 million Palestine refugees • 40% in 27 camps • ¼ million students in 342 schools • 6 million visits to 64 health centers UNRWA in Palestine http://www.unrwa.org/sites/default/files/2014_01_uif_-_english.pdf

  4. Epidemiological transition happened • IMR decreased • NCD skyrocketing • Probably 70-80% causes of deaths UNRWA health services • What we need to do?  What is health problem? Diabetes only Hypertension & Diabetes Hypertension only http://www.unrwa.org/sites/default/files/2014_01_uif_-_english.pdf

  5. UNRWA health services • From disease centered health centers… to • What we need to do?  Reform health centers Ordinary UNRWA health center

  6. Person-centered health services • Helped with e-health (EMR) • High satisfactions by refugees • Improving quality of services UNRWA health services • What we are doing?  Family health team HC Reformed UNRWA health center

  7. Vision  FHT in all HC by end 2015 • Needs  Stable funds • Response  Deliver results •  Evidence-based UNRWA health services Information for action • Institutional partners • FHT & quality improvement • Columbia university • DM cohort analysis • International Union against TB & Lung Disease • 6 papers & Lancet news • FHT & DM care • Toronto university • What we will need more?  Data analysis & research

  8. UNRWA, as part of national health systems of Palestine, and The Lancet Commission: Global Health 2035

  9. Good payoff for refugees •  to overall investment in Palestine • Future depend on overall development • And, not yet measured VLYs… (1) Payoff from investing health

  10. ↓↓in IMR, thanks to MOH & others • Still, further ↓needs more support to, & collaboration with, MOH & others • Also political solution is needed (2) Convergence in health

  11. Any additional funds are welcome • NCD care is expensive • Efforts needed to ↓ commodity cost • Work with MoH & others critical, but… (3) Fiscal policies to curb NCD

  12. Unhealthy lifestyle is epidemic • Lifestyle change important & possible • Comprehensive approach needed • Work with MoH & others needed, but… (3) Fiscal policies to curb NCD UNRWA’s food-basket in Palestine (3 months quantities)

  13. Financing to UNRWA health services • Funds are all from donors & limited • Main donors are also those for others • Efficiency needed, but how much… (4) Progressive universalism to UHC Donor contributions including projects & in-kind support (2013) Review of UNRWA hospitalization policy (X Modol 2014)

  14. Access to health services • UNRWA is part of national systems • Du/multi-plication of service access • Rational use is needed, but how… (4) Progressive universalism to UHC *Health and Education Efficiency in the West Bank (DFID, Feb 2012) Review of UNRWA hospitalization policy (X Modol 2014)

  15. Financial protection (FP) • PHC services, free of charge • Hp support: co-pay. with limited funds • How to make optimal FP for refugees? (4) Progressive universalism to UHC Review of UNRWA hospitalization policy (X Modol 2014)

  16. UNRWA, as part of national health systems of Palestine, and The Lancet Commission: Global Governance of Health

  17. Political determinants of health

  18. UNRWA and Palestine • (As Rita said) • Health (problem) is political, thus political solution is needed for health solution • (As Assad explained & Mahmoud will explain) • Palestine has no shortage of examples • Occupation in West Bank, Seize in Gaza, etc. etc. • (As I will say now) • UNRWA will do the best to improve services, and work for solutions through Global Governance for Health

  19. Conclusions • UNRWA will continue to support refugees • Focus on NCD, Family health & efficiency • UNRWA is part of Palestine health services • Part of Payoff, Convergence, NCD & UHC • Analysis & Guidance is needed • Rational use of (limited) resources in Palestine • And, will work with Palestine through GGH • Political solutions for Palestine (health)

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