20 January 2020, Ramallah – Strong political leadership and engagement at a recent health reform workshop in the Occupied Palestinian Territory (oPt), has demonstrated further commitment towards achieving Universal Health Coverage (UHC), to enable all Palestinians to access quality health services without financial distress.

Despite Palestine’s long tradition of health insurance, people’s out of pocket expenses for healthcare remain high. 

“No one should get sick and die just because they’re poor, or because the services they need are too far away,” said Dr Gerald Rockenschaub, WHO Head of Office. “Universal health coverage means ensuring people can get quality health services, where and when they need them – it means much more than just health insurance and health care.”

The workshop in Ramallah, hosted by the World Health Organization (WHO) and the Ministry of Health (MoH), was an initial consultation to discuss health financing reform (including health insurance) in further steps towards Universal Health Coverage for all.  It follows a high-level mission in August 2019, which made 14 strategic recommendations to strengthen Palestine’s health system capacities with an emphasis on health service delivery and sustainable financing.

At the workshop, the Palestinian Authority’s Minister of Health, Dr Mai Al Kaila (pictured), stressed the Government’s commitment to achieve Universal Health Coverage and emphasised the Ministry is already taking measures in this direction. WHO welcomed the Government’s continued commitment and strong partner engagement and Dr Rockenschaub stressed the importance of ongoing policy dialogue and political leadership to help achieve UHC.

Senior experts from WHO locally and globally facilitated the dialogue among a wide range of partners on health financing reform recommendations in presence of the Prime Minister’s Office, NGOs, donors, human rights organisations, Policy Forum, the Palestinian Institute of Public Health and representatives from the East Jerusalem Hospital Network.

Dr Awad Mataria, Director of Universal Health Coverage and Health Systems at WHO Regional Office for the Eastern Mediterranean, presented the current context of health financing stressing, highlighting the challenges and the need to strengthen the system, while Dr Agnès Soucat, Director Health Systems Governance and Financing, discussed recommendations and appropriate examples Palestine can follow to ensure reform and progress towards UHC.

 Following this workshop, WHO will develop an action plan and a road map with an implementation outline of the identified priority actions described in the 14 recommendations. WHO will continue to support the Ministry of Health and all health partners in ongoing policy dialogue and technical support to achieve UHC as a means to promote the human right to health for all Palestinians.

Huda is a nurse in the cancer outpatient department at Al Rantisi Hospital in Gaza City. She has been working with cancer patients for 15 years. 

The work is not easy and cancer departments in Gaza face severe shortages of drugs and supplies, as well as lack of equipment. In November 2019, almost half (48%) of essential drugs stocks were at zero stock in Gaza’s Central Drugs Store. For chemotherapy drugs, the situation is even worse with 63% of essential drugs at zero stock.

Huda comments, “In addition to suffering the effects of cancer, patients suffer a lack of services, shortages of drugs and denial of their permits to reach services outside Gaza. We don’t have enough psychological support services or intensive care beds. When a woman has an appointment to get chemotherapy and the drug isn’t available, she’s disappointed and upset. It affects us as caregivers as well. Patients referred for care out of Gaza are also denied permits to exit. We feel frustrated and helpless to watch as a patient’s health deteriorates. Chemotherapy drugs require a specific schedule according to the treatment plan and delays mean worse outcomes for patients.»

Cancer patients require care outside the clinic, and Huda shares her personal number so that they have someone to turn to in moments of need or crisis. She contacts local societies to link patients into the mental health and psychosocial support services that are available. 

Huda has her own personal experience of cancer, after her husband was diagnosed with testicular cancer over ten years ago. Her personal experience has given her insights into the need for strengthening psychological support for cancer patients and their families. “We were very shocked, but I tried to support my husband and to fight the battle with him. I’ve lived what it means to have a relative fighting cancer and I know the suffering patients go through during their journeys to get treatment. Especially when they have to reach health services outside Gaza.”

Huda is 38-years-old and has three children. She lives with her husband and children in Gaza City. She reflects on the crisis facing the health sector in Gaza, “We are living in a very hard situation. I always dream that cancer patients will have a specialized hospital here and that all the services they need will be available. Patients and health workers deserve a better environment. We deserve our rights.”

Related links: 

WHO monthly reports on referral of patients from the Gaza Strip, November 2019 

WHO obstetrician and gynaecologist Dr Nashwa Skaik, who leads the pioneering Early Essential Newborn Care project which assists with 75 per cent of all births in Gaza, has been awarded WHO Director-General’s Award of Excellence for her work. Credit: WHO22 December 2019, Gaza – “Families and in particular, mothers and infants, are the essence of any society and they should never be neglected. I am immensely honoured and grateful for this recognition, which is a true reflection of the global and regional efforts to improve mother and newborn health in all settings. This reward is a huge boost to myself and the team in our office,” Dr Nashwa Skaik, WHO’s obstetrician and gynaecologist in Gaza, reflects after receiving the WHO Director-General’s Award of Excellence for her work managing a pioneering maternal and newborn health care project in the Gaza Strip to prevent and treat the key causes of newborn mortality and diseases. 

In Palestine, babies aged less than one month old account for 50 per cent of deaths in children under five. Half of these deaths in babies occur in the first day of life, mainly from complications related to prematurity, birth asphyxia and infection.

Based on international evidence, Dr Nashwa and  colleagues at WHO, rolled out the Early Essential Newborn Care project in 2017 with the Ministry of Health in Gaza to ensure that quality essential care is provided during critical moments around birth, in addition to care for premature, low-birthweight and sick babies.

The project has strengthened the Ministry of Health’s system from the bottom up, by coaching local clinical staff with a package of simple and cost-effective evidence-based interventions during childbirth and immediately after, and focusing on the elimination of harmful and outdated practices in the first 24 hours of life. This includes reshaping policy and guidelines, managing supplies and staff, and providing health information.

The project now covers 75 per cent of all births in Gaza in maternity and neonatal units in four targeted hospitals and widespread adoption has resulted in significant improvements since 2017 in key areas including the following.

Early and exclusive breastfeeding: take up improved from 21% to 52.5% from 2017 to 2019. These practices, where infants receive breastmilk within one hour of birth and where they only receive breastmilk without additional food or drink, are known to lower newborn deaths by 22%. Breastfeeding protects the baby from common childhood illnesses such as diarrhoea and pneumonia and may also have longer-term health benefits, such as reducing the risk of overweight and obesity in childhood and adolescence.

Babies receiving sustained skin-to-skin contact: this increased from 0% to 35% from 2017 to 2019. This practice, where a baby is laid directly on their mother’s bare chest shortly after birth, is essential for preventing temperature loss and diseases that lead to infection and death. Among infants who received this care, there is a reduction in newborn admission to intensive care due to respiratory problems by 5% in Gaza. In addition, it helps parents bond with their babies and supports better physical and developmental outcomes for the baby.

Dr Skaik said she treasures the opportunities she gets at WHO:

“They are like no other place. I enjoy my everyday work with the team and the space I am given to be more creative and innovative. We try our best to deliver high quality and unique care to all mothers and babies in Gaza, which ensures that they thrive and survive despite the difficult circumstances.”

The WHO team congratulates Dr Skaik and her colleagues for their dedication and achievements in improving the lives of mothers and babies in Gaza.