Institutionalising community health programmes into the Palestinian health-care system: a qualitative study

Abstract

BackgroundCommunity health is a field of public health and one of the important pillars of the health system that addresses health protection, promotion, and preservation. The occupied Palestinian territory is a fragile setting with an unstable health system that hardly functions. The aim of this study was to investigate the status of community health programmes and to generate useful suggestions for system strengthening. MethodsThe study was done in the Gaza Strip in 2014, using a descriptive analytical and qualitative approach that involved a review of literature and reports and a structured, open-ended survey. The survey was developed by expert consultation and involved ten experts selected from five sectors (the ministry of health, academia, and private, local, and international non-governmental organisations). Data were analysed in Excel and with the coding and thematic analysis technique. FindingsPerceptions about the status of community health programmes were controversial, with some respondents describing them as fragmented and others stating that several community health programmes are functioning well. Two respondents believed that community health is still undeveloped. Participants who were fairly satisfied with community health programmes mainly worked at the ministry of health and the United Nations Relief and Works Agency, highlighting immunisation, family planning, screening, and awareness, but stating that the private sector is still inadequate. Three experts perceived the community health programmes as having an individual rather than community focus. Five experts said that some programmes are effective and efficient. Most participants agreed that community health programmes are confined to primary care and lack continuity with secondary care. Half of the experts said that the availability of community health programmes led to regulated protocols and policies that were not implemented, whereas the rest only existed in some programmes. The largest challenges in improving the performance of community health programmes are lack of coordination and standardisation, fragmented efforts, resource scarcity, weak training, lack of a unified community health strategy, poor planning, and needs that are irrelevant. Community health is undervalued, and public awareness and engagement is weak. InterpretationMost community health programmes are not well embedded despite progress in some programmes. Community health needs to be institutionally cultivated. Community health programmes should be strengthened on the basis of clear national, integrated, and collective strategies that reflect community health priorities driven by political commitment and active community participation. A consolidated coordination network, allocated resources, and recruitment of community health professionals are needed alongside capacity building and education programmes. FundingNone.