1. HEALTH CARE SYSTEM IN PALESTINE

2. Definition
A health system is the combined entity of all resources, actors and institutions related to the financing, regulation and provision of all activities whose primary intent is to improve or maintain health (WHO, 2000).
A health care system is an arrangement in which health care is delivered. There are many variations of health care systems around the world.

3. Goals
The goals for health systems according to the World Health Report Health systems:
improving performance (WHO, 2000)
responsiveness to the expectations of the population and fair financial contribution.

4. Duckett (2004) proposed a two dimensional approach to evaluation of health care systems: quality, efficiency and acceptability on one dimension and equity on another.

5. Why is it important to observe the health care system in Palestine ?
1. To provide up to date quality information on the health system, its performance and reforms to be used by policy makers.
2. To provide a sound foundation for comparative analytical work on specific health system issues.

6. What is a successful health system ?
A "successful" Palestinian health system should at a minimum :
Maintain an effective and well regulated public health system.
Provide reasonable access to high quality preventive and curative services for all Palestinians.
Maintain high quality programs for training health professionals.

7. Achieve health outcomes at the population level that meet or exceed international guidelines such as those recommended by the WHO.
Be effective , efficient and financially viable.
Encompass the possibility of cooperation with neighboring countries on issues of common interest .

8. Financing direct or out-of-pocket payments. general taxation.
social health insurance.
voluntary or private health insurance.
donations or community health insurance.

9. Health care has the following characteristics
The provision of critical health care treatment is often regarded as a basic human right regardless of whether the individual has the means to pay some treatments cost more than a typical family's life savings.
Health care professionals are bound by law and their oaths of service to provide lifesaving treatment.
Asymmetric information.
High risk level.

10. Models
Purely private enterprise health care systems are comparatively rare.
The other major models are public insurance systems.

11. Public insurance systems
Social security health care model where workers and their families are insured by the state.
Publicly funded health care model where the residents of the country are insured by the state and health care workers are employed by the state.

12. Publicly funded health care model where the residents of the country are insured by the state and those who provide health care work in private enterprises.
Social health insurance where the whole population or most of the population is a member of a sickness insurance company.

13. HEALTH CARE SYSTEM IN PALESTINE
A Health Care System Still Fragmented and Increasingly Unaffordable.

14. HEALTH CARE SYSTEM IN PALESTINE
Socio Economic Geopolitical Mapping.
Health status and demographics.
Health System organization & governance.
Health System Finance & Expenditure.
Human Resources.
Health service delivery.
Health System Reforms.

15. Indicators of Health status
2004
2000
1995
Indicators
M/F: 71.1 / 74.1
M/F: 71.8/ 73.5 -
Life Expectancy at Birth
20.5 22 25
Infant Mortality Rate
25.4
27.3
Probability of dying before 5th birthday/1000
10.0*
37.3
Maternal Mortality Rate
98.8
95.9
Percent Normal birth weight babies
9.4%-1.9%
9%-2.5%(2002)
Prevalence of stunting/wasting
* underestimated

16. Top 10 causes of Mortality/Morbidity
Rank Mortality (2003) Morbidity
Heart diseases.
Cerebro-vascular.
Peri-natal death.
Malignancy.
Accidents.
Senility.
Hypertension.
Pneumonia and other respiratory.
Diabetes mellitus.
Renal failure.

17. Age and Sex Composition of the Palestinian Population in Gaza Strip and the West Bank (including East Jerusalem) 2005

18. Demographic Indicators
2004
2000
1995
Indicators
28.6
33.2
46.5
Crude Birth Rate
2.8
3.2
4.1
Crude Death Rate
2.5 -
Population Growth Rate
97.5
100.6
102.5
Dependency Ratio
46.3
46.9
49.7
% Population <15 years
4.31
6.7
Total Fertility Rate

19. Providers of health care in Palestine
MOH (Main) : provides primary, secondary and tertiary health services and purchase the unavailable tertiary health services from domestic and abroad providers.
UNRWA : provides primary care services only for refugee and purchase secondary care services for the hardship cases.

20. Non governmental organizations (NGOs) provide primary, secondary and some tertiary services.
Private Sector (for profit provider) : provides the three level of care through a variety of specialized hospitals and investigation centers.

21. Health Expenditure Data and Trends
2004
1995
Indicators
138.4
122 $
Total health expenditure /capital.
13%
8.6%
Total health expenditure as % of GDP. -
Investment Expenditure on Health.
33.3%
Public sector % of total health expenditure.

22. Sources of finance by percent
2002
2000
1995
1990
Source
General Government
15%
Central 7%
(Premium)
Social Security -
Private 2%
Private Social Insurance
Insurance
(Co-payment)
Out of Pocket
11%
Non profit Institutions
Private firms and corporations
48%
External resources

23. The external source is distributed among supporting the MOH recurrent budget (8%), MOH investments (16%), UNRWA (10%), and NGOs (14%).

24. Health Expenditures by Category
 2004
2000
Expenditure 
$ M
95.72 $M
Total expenditure: 
39$/Capita -
Capital expenditure
% by item
56.1%
47.5%
Staff costs
18.6%
20.9%
Drugs and supplies
14.9%
6.5%
Medical referral

25. INSURANCE SYSTEM
Public health insurance covers worker employees and their families who pays the fees of medical insurance and children below 3 years of age.
Private medical insurance companies.

26. HUMAN RESOURCES
57% of health human resources in Palestine are employed by MOH, There are 9.73 physicians,16 nurses, 1.43 pharmacists, 7.43 paramedics and 17.5 administrators and workers per populations in Palestine in 2004.
There are 0.47 physicians and nurses per hospital bed in Palestine. There is one physician for populations and one nurse for 2,265 populations in PHC clinics in Palestine.

27. Personnel per 100,000 Population
Health care personnel
2004
2000
Personnel per 100,000 Population
150.9*
75.2*
Physicians
9.2**
6.9**
Dentists
14.3**
7.4**
Pharmacists
144.9
122.9
Nurses
74.3
47.7
Paramedical staff
14.9
12.3
Midwives
7.4
22.2
Community Health Workers
175.0
108.8
Others
* Includes physicians and specialists.
** Underestimated, the private sector is not included.

28. Package of Services for Health Care
* Primary Health Care
Health Post covers less than 1,000 populations.
Health Clinic covers populations.
Health centre covers populations.
Comprehensive Health Centre covers 10,000-25,000 populations.

29. * Non personal Services: Preventive/Promotive Care
Availability and accessibility.
Environmental health.
Health education/promotion.

30. * Secondary/Tertiary Care
2004
2000
1995
1.3
1.4 -
Hospital Beds/1,000
8.6
5.9
Admissions/100
2.6
2.8
3.2
Average LOS (days)
81.1
72.4
68.5
Occupancy Rate (%)

31. Public/private distribution of hospital beds
Ministry of Health owned and operates 22 hospitals with total capacity of 2,735 beds. 17 hospitals provide general hospital services, two psychiatric hospitals with 319 beds, two pediatric hospitals in Gaza Strip with 222 beds and one ophthalmic hospital with 31 beds.

32. Public/private distribution of hospital beds
There are 31 hospitals with a capacity of 1,565 beds owned and operated by NGOs in Palestine in 2004.
NGOs hospitals provide secondary, maternity, geriatric and rehabilitation services. There are no geriatric or rehabilitation hospitals in public or private sectors.

33. Public/private distribution of hospital beds
Private sector has 23 hospitals with total capacity of 461 beds. Private hospitals provide special types of health service such as Intra Vitro Fertilization (IVF), Ophthalmic, maternity and surgical services.

34. Pharmaceuticals Essential drugs list by level of care.
Manufacture of Medicines and Vaccines.
Regulatory Authority Systems for Registration, Licensing, Surveillance, quality control, pricing.
Systems for procurement, supply, distribution.

35. Health System Reforms
A National Strategic Health Plan was prepared in 1998 to cover five years
It was partially implemented and affected by the Intifada events from September There is a current evaluation to this plan for preparation for a Health system reform.