1. Fatima, Mohamed & their children 1 Health of Fatima and her family How they enjoy their health status? What are their health concerns?

2. Fatima has no worry about babies lives UNRWA Health Progress 2

3. 3 Ref: WHO World Statistics Report Fatima may worry about life-style illness UNRWA Health Problem (1) CD: Communicable Disease NCD: Non-Communicable Disease

4. Ref: UNRWA Health Report 2010 4 Fatima may not get proper care UNRWA Health Problem (2)

5. Health Center When Fatima, Mohamed & their children go to the health center 5

6. ` ` Pharmacy Clerk room Laboratory Pre & Post natal care General clinic (Drs office) Growth monitoring & Immunization NCD clinic Present: When Fatima, Mohamed & their children go to the health center Oral health (dental) ` ` ` Family planning Dressing 6

7. UNRWA Health Reform Family Health Team 7

8. ` ` Pharmacy Clerk room Laboratory Pre & Post natal care General clinic (Drs office) Growth monitoring & Immunization NCD clinic Pre-Reform: When Fatima, Mohamed & their children go to the health center Oral health (dental) ` ` ` Family planning Dressing 8

9. ` ` Pharmacy Clerk room Laboratory Post Reform: When Fatima, Mohamed & their children go to the health center Oral health (dental) ` ` ` Family planning Family Health Team Comprehensive, Continuity of care ` ` ` 9

10. UNRWA Health Reform: Vision Family Health Team approach – Primary health care delivery through health team to address health needs of families holistically. Person-centered, not disease centered Comprehensive, not disease specific Continuity of care Community-oriented – Globally accepted approach in primary health care UK (GP), Canada (FHT), and many developed countries Adopted in many countries in Middle East – Jordan (Family physician), Palestine (PHC vision) – Extensive experience in Egypt & GCC countries 10

11. Family Health Team and Fatimas Family UNRWA Health Reform Vision 11 Strong bond FHT & Family - Address all health needs of family -Help family to stay healthy - Effective appointment system Education -Early detection of education problems -School health Relief & Social Serv. -Care for gender- based violence -Care for poverty (assistive devices) Referral - Effective referral to specialized care Host countries -Improvement of care -Alignment of health policy Family Value Arab Spring - UNRWA value on stability, youth, human rights etc. Donor & Partners - Health reform based on modern universal value & standards All other services -Family protection -Empowerment with microfinancing UNRWA Partners Community

12. Limited in new areas, vertical, overcrowded, quality compromised Poor knowledge on refugees conditions Command-control sys Improper appraisal Un-updated structure Fragmented health information system Very low health expenditure per capita UNRWA closed in itself with others From Reviews to Reform document Family health team Family Health Team approach UNRWA Health: From Review to Reform -Person-centered, continuity of care -Team work by health professionals -Revised structure to support FHT -e-Health & health information system - Platform for synergy with other UNRWA programs, and collaboration with partners Appointment system Operational research & surveys Hospitalization arrangement support Raising fund with FHT Health Reform

13. UNRWA Health Expenditures 13 All others Hospital Medicine & equipment Salaries

14. UNRWA Health Reform: Steps 14 201120122013201420152020 PreparationUNRWA PilotField PilotsExpansion Extensive preparation -technical -teamwork -e-Health & HIS -re-organization -communication -1 st pilot in 1-2 health center -Learning & assessment - Pilots in all fields - Expansion to all health centers 01-2 (1 st pilot) 6 (Field pilots) 63 (those in camps) 137 (All) Family Health Team health centers

15. UNRWA Health Reform: Resources Family Health Team – In principle, no additional resources required eventually Optimal ways to utilize existing resources – Staff, health centers, and funds – Still, additional resources are needed to bring changes Preparation for pilot phases – E-health including information systems – Training – Communication – Technical assistance Once changes are in place, GF will absorb changes 15