Palestinian Health Care System Research Articles

Adherence to the evidence-based recommendations in managing bone health, pain, and mobility of patients with multiple myeloma: a mixed method in the Palestinian healthcare system

BackgroundConsensus/evidence-based recommendations for assessing, managing, and monitoring bone health, pain, and mobility in patients with multiple myeloma were developed. This study was conducted to assess the adherence of the hematologists-oncologists to the consensus/evidence-based recommendations for assessing, managing, and monitoring bone health, pain, and mobility in patients with multiple myeloma who received care in the Palestinian healthcare system.MethodsA mixed method was used in this study. The consensus/evidence-based recommendations were identified through a systematic search in Scopus, PubMed, SpringerLink, ScienceDirect, and Google Scholar. A panel of 5 researchers (3 hematologists-oncologists, 3 medical students, and 1 pharmacologist) sorted the consensus/evidence-based recommendations and developed the survey tool during 3 iterative meetings. The extent to which the hematologists-oncologists in the 5 centers caring for patients with multiple myeloma adhered to the consensus/evidence-based recommendations was assessed using a questionnaire.ResultsResponses were collected from 10 hematologists-oncologists in all 5 healthcare centers where patients with multiple myeloma receive healthcare in the West Bank of Palestine. The median number of years in the practice of the hematologists-oncologists was 7.5 [2.75, 14.0] years and the median number of patients with multiple myeloma care per month was 12.5 [7.5, 21.25]. The vast majority (90%) of the hematologists-oncologists reported inadequate adherence to screening for medication problems related to bone health, pain, cardiopulmonary fitness, healthy behaviors, nutritional deficits, and mental health. Of the hematologists-oncologists, 70% reported inadequate adherence to ordering and evaluating calcium, vitamin D, alkaline phosphatase, electrolytes, and phosphorus levels to monitor bone health and 60% reported inadequate adherence to prescribing calcium and vitamin D supplements whenever there was a need.ConclusionThe findings of this study suggested inadequate adherence to the consensus/evidence-based recommendations and highlighted areas for improvement to ensure that patients receive optimal care. The findings suggested a need for further education and training on the latest guidelines and recommendations. Decision-makers and policymakers might need to design measures and implement policies to improve adherence to the consensus/evidence-based recommendations. Addressing these gaps in adherence to the consensus/evidence-based recommendations may improve the care and outcomes of patients with multiple myeloma.

Predictors of health-related quality of life of the patients treated for MM: the first study in the Palestinian healthcare system.

Little studies were conducted to assess the health -related quality of life (HR-QoL) of patients with multiple myeloma (MM) in developing and resource-limited countries. This study assessed the HR-QoL of patients with MM who received treatment in the Palestinian healthcare system as an example of healthcare systems in developing and resource-limited countries. Predictors of deteriorated HR-QoL of the affected patients were also identified. In this cross-sectional study, the tool was a questionnaire that collected the demographic and disease variables of the patients. The questionnaire also contained the EORTC QLQ-MY24 items. The questionnaire was piloted to ensure readability, clarity, and comprehensibility. Additionally, the test-retest reliability and internal consistency were also assessed. In this study, 45.5% of patients with MM who were treated in the Palestinian healthcare system returned usable questionnaires. The mean age of the patients was 60.7 ± 7.5 years and the mean time elapsed since diagnosis was 2.6 ± 1.7 years. Of the patients, 54.3%, 47.8%, 46.7%, 66.3%, 46.7%, and 46.7% reported frequent bone pain, pain that increased with activity, back pain, feeling ill, lost hair, and feeling restless or agitated, respectively. Higher disease symptom scores were predicted by low self-rated satisfaction with the ability to do daily life activities and low self-rated satisfaction with overall health. The side effects of treatment scores were predicted by longer time elapsed since diagnosis and low self-rated satisfaction with overall health. Future perspective scores were predicted by low self-rated satisfaction with overall health. On the other hand, social support scores were predicted by having a university education and not receiving radiotherapy. Patients with MM who were treated in the Palestinian healthcare system reported a heavy burden of disease symptoms, treatment adverse effects, and dissatisfaction with the information they received about their disease. The findings reported in this study are informative to hemato-oncologists and other healthcare providers who care for patients with MM in Palestine and other developing and resource-limited countries. Policymakers might use the findings reported in this study to design interventions to improve the HR-QoL of the patients.

The reluctance to the vaccine, mental health, fear of covid-19 and quality of life among Palestinians: an exploratory comparative study in different geographical areas

PurposeThis study aims to explore the effect of mental health in terms of depression, anxiety, stress, fear of COVID-19 and quality of life (QoL) on the reluctance to be vaccinated in a population of Palestinian adults living in occupied Palestinian territories and Israel.Design/methodology/approachThe authors recruited 1,122 Palestinian adults who consented to participate in the study; 722 were females, and the mean age of the sample was 40.83 (SD 8.8). Depression, anxiety, and stress scale (DASS), World Health Organization QoL-BREF, FCov-19 and reluctance to the vaccine scale were administered; hierarchical regression analysis was applied to test vaccine reluctance as a dependent variable, and mental health, fear of COVID-19 and QoL as independent variables. This study hypothesized influence of such variables on the vaccine choice with differences due to the participants’ geographical locations.FindingsFindings showed an effect of mental health, particularly depression, QoL and fear of COVID on vaccine reluctance, with depression and fear of COVID in the West Bank and Gaza, while in Israel, QoL played a role in vaccination choices.Research limitations/implicationsThe future needs to be comprehended more thoroughly to discover mutations and fluctuations over time in vaccine hesitancy and the increasing role of psychological distress, diminished QoL and fear of Covid-19. Online recruitment might not have allowed the study to include the most disadvantaged strips of the Palestinian population.Practical implicationsHuman rights perspectives must be considered in public health and public mental health policies to ensure the QoL and well-being for the Palestinian population during and following the pandemic.Social implicationsThe crumbling of the Palestinian health-care system exacerbated the sense of dread among the population and made them less likely to vaccinate. The pandemic-like spread of Covid-19 prompts a plea for the global community to actively advocate for the urgent re-establishment of equity, autonomy and durability of the medical infrastructure in the occupied territories and equal entitlements for the Palestinians in Israel.Originality/valueThe results demonstrated the importance for public mental health to consider the multiple levels implied in the vaccine refusal in Palestine and Israel among the Palestinian population.

Caring for women with epilepsy in Palestine: A qualitative study of the current status

ObjectiveThis qualitative study was conducted to explore the current status of caring for women with epilepsy (WWE) in the Palestinian healthcare system. MethodsThis study used an explorative qualitative design. A purposive sampling technique was used to recruit the participants. Semi-structured in-depth interviews were conducted with neurologists (n = 6), gynecologists (n = 5), psychiatrists (n = 3), an internist (n = 1), and clinical pharmacists (n = 5). The interpretive description methodology was used to thematically analyze the qualitative data. ResultsA total of 745 min (12.4 h) of interview time were analyzed. The qualitative data collected in this study were categorized under 3 major themes and multiple subthemes. The 3 major themes were: (1) diagnosis and care for patients with epilepsy, (2) general issues in caring for patients with epilepsy, and (3) consideration of women’s issues in the pharmacotherapy of epilepsy. Formally adopted protocols/criteria for the diagnosis and care for WWE were lacking. ConclusionFindings of this qualitative study showed a need to formally adopt uniform guidelines that can guide the diagnosis and care of WWE in the Palestinian healthcare system. The findings of this study might be informative to healthcare providers, decision-makers in healthcare authorities, WWE, and patient advocacy groups who could be interested in improving and benchmarking healthcare services provided to WWE. Future studies are still needed to quantitatively measure adherence to the international guidelines in caring for WWE.

Gathering policymakers\u2019 perspectives as an essential step in planning and implementing palliative care services at a national level: an example from a resource-limited country

BackgroundDespite increasing recognition of the role played by palliative care (PC) services, the priorities of policymakers in supporting PC remain unclear and have sometimes engendered controversy. There are few studies exploring policymakers’ perspectives towards PC services, with most shedding light on obstacles to PC development. Furthermore, no study has explored policymakers’ perspectives towards providing PC at the national level in resource-limited countries. This study provides a platform for providing PC as part of the Palestinian healthcare system (HCS) by exploring policymakers’ perspectives on PC, an essential step to developing a PC programme.MethodsA descriptive qualitative study design was employed using semi-structured interviews. Participants were those identified as responsible for making executive and legislative decisions about health services (including PC) in the HCS. Data were analysed using qualitative content analysis.ResultsTwelve decision and policymakers participated in the study. Four categories were generated from the content analysis: (1) the nature of current PC healthcare services, (2) the potential benefits of PC, (3) challenges to providing PC, and (4) considerations in providing PC. The current PC services provided to Palestinian patients with life-limiting illnesses and their families are not comprehensive, and are limited to symptom management. There is a Palestinian national strategic plan for developing PC; however, the development goals are not clearly defined, and the plan’s capabilities are inadequate. Several challenges to the provision of PC were found to relate to issues of education and training, the allocation of funding, and the availability of medications.ConclusionsIntegrating PC into the Palestinian university curricula as a compulsory course and establishing higher degree programmes in PC to overcome the shortage of PC specialists is required. Developing policies aligned with national laws could help enhance health services to patients and their families and resolve several challenges. Cooperating with national and international institutions in seeking funding could boost PC development and medication availability.

Assessment of the Educational and Health Care System-Related Issues From Physicians' and Nurses' Perspectives Before Developing a Palliative Care Program Within the Palestinian Health Care System: A Cross-sectional Study.

A scarcity in research assessing the palliative care (PC) educational and health care system-related issues has been reported in the Middle East region; the region comprises a wide range of economically diverse countries. Discrepancies across countries have created difficulties in adopting other countries' experiences. This study aimed to assess PC knowledge, attitude, educational needs, and health care system-related issues from physicians' and nurses' perspectives before developing PC services within the Palestinian health care system. One hundred sixty-nine professionals participated in this cross-sectional survey. Data were collected by validated instruments. Professionals had insufficient knowledge about PC, but they had positive attitudes toward end-of-life care and care of the dying. Patients'/families' avoidance of talking about issues around dying and lack of training for staff related to PC were the most 2 significant barriers to providing PC. Educational level and previous training were found to be associated significantly with knowledge and attitudes toward PC. Study conclusions support the recommendation for integration of education about PC within the health curricula and in-service training and should cover the basic and advanced principles of PC and symptom management.

"COVID-19 and the Armed Conflict on Gaza, The Palestinian Healthcare System Response"

"COVID-19 and the Armed Conflict on Gaza, The Palestinian Healthcare System Response"

The acceptance and awareness of healthcare providers towards doctor of pharmacy (Phram D) in the Palestinian health care system

Clinical pharmacy (Pharm.D or MSc Clinical Pharmacy graduates) is a patient care oriented specialty. It aims to improve patient therapeutic outcomes and minimize medication errors. In Palestine, it is a new specialty taught at two universities. In order to implement this new specialty in healthcare settings, healthcare providers should have a high awareness about it, its role and importance in clinical settings. This study aimed to evaluate the awareness and acceptance levels among healthcare providers’ about clinical pharmacy specialty. A cross sectional study carried out using a self-administered questionnaire that was developed and tested by a panel of experts for validity and reliability, then it was distributed and filled by the convenient sample of health care providers in the northern and middle of Palestine between January and March 2019. An awareness scale and acceptance scale were developed from the questions used to identify the healthcare providers’ awareness and acceptance. Chi-square (X2) -testing was performed to check for the significant association. Data were analyzed using SPSS (version22). Among 309 respondents, 203(65.7%) were male, 67(21.7%) were working at Jerusalem, 229(74.1%) of them completed their first degree at Arab countries and 69(54.7%) completed higher education. Regarding their work, 169(54.7%) were physicians, followed by 85(27.5%) nurses and 55(17.8%) pharmacists. Results revealed that the majority of healthcare providers had a moderate 182(58.9%) and good 81(26.2%) awareness level toward the Clinical pharmacy specialty roles and 217 (70.2%) had a good acceptance level toward their implementation among the health worker team. Significant differences were found between healthcare providers’ awareness level and their sex (P = 0.001), professions (P = 0.006) and job descriptions (P = 0.013). There were no significant differences between the health care providers’ acceptance level and their age, sex, qualification, profession and job descriptions. Our results revealed the ability to collaborate in the integration of such specialty within the Palestinian healthcare system. Additional interest from the Ministry of Health is recommended to integrate clinical pharmacy workers among the health system and promote their relations with other disciplines.

The effectiveness of counselling interventions in reducing HbA1c concentrations in patients with type 2 diabetes: a modelling study

BackgroundThe burden of type 2 diabetes is increasing rapidly in the occupied Palestinian territory. Different counselling interventions have been applied worldwide to reduce HbA1c concentrations in patients with type 2 diabetes. Achieving good glycaemic control is important for prevention of complications of type 2 diabetes. The aim of this modelling study was to assess the effectiveness of different counselling interventions in improving glycaemic control in patients with type 2 diabetes. MethodsThe scientific literature was reviewed to identify relevant interventions that can reduce HbA1c concentrations in patients with type 2 diabetes. We included articles describing interventions tested at the primary health-care level and targeting patients with type 2 diabetes. Based on WHO's “Best Buys”, and taking into consideration their feasibility, acceptability, and potential effectiveness, we identified different forms of counselling interventions at the primary health-care level. The effect of each identified intervention on HbA1c concentrations and the duration of this effect were collected in predefined tables. A regression line was plotted to find an estimate of the effect of each intervention through calculating the correlation between the changes in HbA1c from each intervention versus the duration of the intervention. The unstandardised β-coefficient was identified for each intervention to predict its effectiveness in reducing HbA1c concentrations. FindingsWe identified three main effective counselling interventions at the primary health-care level: (1) individual counselling intervention by multidisciplinary teams of health-care professionals, which provided individual counselling sessions depending on the patients' glycaemic control status; (2) the community health-worker intervention, which provided a set of home counselling visits for patients with uncontrolled type 2 diabetes; and (3) short message service (SMS)-based intervention (sending patients a number of counselling SMS weekly). All interventions were effective in reducing mean HbA1c concentrations in patients with type 2 diabetes. The SMS-based intervention was the most effective (β=0·65, R2=0·10), followed by the community health-worker intervention (β=0·27, R2=0·28) and the individual counselling intervention (β=0·14, R2=0·01). InterpretationWe compared the effectiveness of a set of interventions that are considered relativity low cost and applicable at the level of primary health care (the “Best Buys”). Implementing at least one of these effective interventions within the Palestinian health-care system could help improve glycaemic control and eventually reduce the prevalence of complications associated with type 2 diabetes. Controlling HbA1c concentration will not only reduce the epidemiological burden of type 2 diabetes and its complications but it will also reduce the economic burden within Palestinian health-care system. FundingEastern Mediterranean Regional office of WHO.

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

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.

Importance of Spiritual Care for Cardiac Patients Admitted to Coronary Care Units in the Gaza Strip

This study aimed to assess the perception of hospitalized cardiac patients in coronary care units (CCUs) in the Gaza Strip about the importance of assessing and providing spiritual care to them. This was a cross-sectional study. A valid and reliable instrument previously developed by Musa was used to assess patients' perception about the importance of assessing spiritual needs and providing spiritual care to cardiac patients admitted to CCUs. Out of 279 cardiac patients, 275 (response rate of 98.6%) agreed to be involved in this study. Results revealed that both assessing spiritual needs (69.69%) and providing spiritual care (76.97%) were very important to cardiac patients with rating spiritual care intervention as more important than spiritual assessment. Assessing and providing spiritual care is crucial to cardiac patients. Therefore, health policy makers need to pay more attention to this group of vulnerable patients and need to adopt a spiritual care policy into the Palestinian health care system, which might help to decrease their stress, length of hospitalization, and the cost of treatment.

Palliative Care Situation in Palestinian Authority

Palliative care is a very new concept in Palestine. In fact, it is still not applicable or provided within the Palestinian health care system. However, Al-Sadeel Society had organized a one day workshop in Bethlehem on November 2008 for the health professionals from the governmental and non-governmental sectors to initiate and introduce the idea of palliative care for the first time in Palestine. The general population of Palestine is approximately 2.4 millions (2007), with a life expectancy of 74.3 years of age, the death rate is 3.7 per 1000 population, having 8,910 deaths a year. Deaths due to cancer were 2,305 in five years (1999-2003), where 5,542 new cases were newly diagnosed in the same period. Health services available for cancer patients are hospital units either in patient or day care units. According to the ministry of health (MOH) statistics there are 75 beds in oncology departments in MOH hospitals; represent 2.7% of the total number of beds available, and 60 beds in daily care departments with an occupancy rate at 231.8%. There is no hospice or bereavement follow up care available for patients or their families. Despite the fact that the Palestinian culture is one of the cultures that respect and care for the elderly, but at the end of life, when the load of symptoms is high, most of the patient are care for at hospitals, and usually dye there, because the families are not able to care for their patients, and as there is no system for home care available for the Palestinian patients, and if it is available it is available in limited places and on private bases that are expensive and not affordable to the majority of patients, gross domestic product (GPD) per capita= 1,100 as 2007 estimates). We conducted a needs assessment survey within the only four facilities that provide care for the oncology patients in the West Bank and were filled by the direct health care providers. The results were expressing the fact that there is no palliative care service available for cancer patients or their families, absence of organizations strategic planning for palliative care, No presence of educational resources for palliative care, No presence of communication or consultation to the clergy man, Absence of bereavement support group, no active follow up for the patient and the family, no standards for palliative care service or training programs in palliative care, no home care service for palliative care, absence of community awareness for palliative care And Absence of national standard for palliative care. The recommendations that we can conclude, depending on the needs assessment that we did, and according to the recommendations that come up through the workshop that was organized by Al-Sadeel Society and was attended by key personnel from the Palestinian MOH who summarized the conclusion, are as follows: 1. The need for better quality care for the cancer patient.2. The need for training of health professionals in palliative care.3. The importance of networking and cooperation between the national NGO's and the MOH.4. The need for public awareness regarding the early detection for cancer especially breast cancer.5. The need for national policy and standards for palliative care and opioids legislations.6. The importance of base line data and research. 7. The need for interdisciplinary team work in the issue of cancer. 8. To involve palliative care education within the curriculum of schools of health professions.

Catastrophic Healthcare Payments and Impoverishment in the Occupied Palestinian Territory

Financial protection from the risks of ill health has globally recognized importance as a principal performance goal of any health system. This type of financial protection involves minimizing catastrophic payments for healthcare and their associated impoverishing effects. Realization of this performance goal is heavily influenced by factors related to the overall policy environment and sociopolitical context in each country. To examine the incidence and intensity of catastrophic and impoverishing healthcare payments borne by Palestinian households between 1998 and 2007. The incidence and intensity of these effects are examined within the historically unique policy and socioeconomic context of the occupied Palestinian territory. A healthcare payment was considered catastrophic if it exceeded 10% of household resources, or 40% of resources net of food expenditures. The impoverishing effect of healthcare was examined by comparing poverty incidence and intensity before and after healthcare payments. The data source was a series of annual expenditure and consumption surveys covering 1998 and 2004-7, and including representative samples of Palestinian households (n = 1231-3098, per year). Total household expenditure was used as a proxy for household level of resources; and the sum of household expenses on a comprehensive list of medical goods and services was used to estimate healthcare payments. While only around 1% of the surveyed households spent ≥40% of their total household expenditures (net of food expenses) on healthcare in 1998, the percentage was almost doubled in 2007. In terms of impoverishing effect, while 11.8% of surveyed households fell into deep poverty in 1998 due to healthcare payments, 12.5% of households entered deep poverty for the same reason in 2006. Over the same period, the monthly amount by which poor households failed to reach the deep poverty line due to healthcare payments increased from $US9.4 to $US12.9. The inability of the Palestinian healthcare system to protect against the financial risks of ill health could be attributed to the prevailing sociopolitical conditions of the occupied Palestinian territory, and to some intrinsic system characteristics. It is recommended that pro-poor financing schemes be pursued to mitigate the negative impact of the recurrent health shocks affecting Palestinian households.

Human resources for health in Palestine: a policy analysis: Part I: Current situation and recent developments

Human Resources for Health Development (HRD) has been a priority and focus of attention in the Palestinian healthcare system since the changeover of authority on the system at the end of 1994. This analysis examines HRD between 1994 and 2001. The aim is to provide an insight into and better understanding of the issue in a conflicting and transitional context. The results of this analysis are presented in two parts. Part I looks at the current situation and recent developments in Human Resources for Health (HRH) in Palestine. On the one hand, it analyses the relationship between HRH deficiencies and major policy options and strategies. On the other hand, it examines the correlation between HRH policy development and the policy context. Particular attention is given to the links between national health policy priorities and health sector reform initiatives. Part II focuses on the process of HRH policy formulation and implementation.

A ‘transitional’ context for health policy development: the Palestinian case

The objective of this article is to focus on the challenges and opportunities the Palestinian health care system is currently facing in a ‘ transitional period’, which started subsequent to the Oslo Agreement in 1993. The characteristics of ‘ transition’ have to be highlighted in order to understand the context and peculiarities in which the Palestinian health care system is operating. A descriptive analysis is provided of the historical, political, economic and socio-demographic elements to gain an insight into the complex context of the Occupied Palestinian Territories, a country in ‘ transition’.