Health system profile, occupied Palestinian territory

Socioeconomic geopolitical mapping Palestinian people are living in two distinct areas (the West Bank, including East Jerusalem, and the Gaza Strip) that form the Occupied Palestinian Territory. The Occupied Palestinian Territory ranked 110 out of 182 countries on the United Nations Development Programme (UNDP) Human Development Index in 2008. The rates for both total literacy and female literacy have improved over the past decade, and the proportion of women participating in the labour force increased from an estimated 13.4% in 2004 to around 18.0% in 2008. Demographics and health status The total Palestinian population according to the 2010 estimate was 4 048 403, of whom 62.0% reside in the West Bank, 49.2% are females, 41.1% are under 15 years old, and 2.9% are above 65 years old. A review of health status outcomes over the past decade shows quite different patterns: life expectancy at birth stalled at around 72 years, mortality indicators, however, improved, with a decrease in infant mortality rate (from 25.5/1000 live births in 2000 to 20.6 in 2010) and under-five mortality rate (from 28.7/1000 live births in 2000 to 25.1 in 2010). In contrast, indicators related to childhood malnutrition and chronic diseases and conflict-related injuries have worsened overtime: the rate of stunting in children has risen by about 41.3%, and common chronic diseases have increased in prevalence by about 58.2% since 2000. Health system organization There are four major health service providers in the Occupied Palestinian Territory: the Ministry of Health (MoH), United Nations Relief and Works Agency (UNRWA), non-governmental organizations (NGOs), and private for-profit providers. The MoH provides primary, secondary and tertiary health services and purchases unavailable tertiary health services from domestic and foreign providers. The UNRWA provides primary care services only for refugees, and purchases secondary care services for hardship cases. NGOs provide primary, secondary and some tertiary services. The private for-profit sector provides all three levels of care though a variety of specialized hospitals and investigation centres. Governance/oversight The legal institutional framework governing the health sector is embodied in the Palestinian Constitution 2003 and Public Health Law No. 20-2004. Accordingly, the MoH is the steward of the health system and is responsible by law for overseeing the system and ensuring equitable and affordable access to quality health services for all Palestinians. Public health services are directed in a centralized manner. In line with the decentralization agenda of the MoH, however, a new organizational structure was adopted in 2008. This offered greater executive authority to the general directorates in the governorates. Health care finance and expenditure Total health expenditure grew steadily during the past decade (from US$ 384.3 million in 2000 to US$ 893.8 million in 2008). Similarly, the share of gross domestic product (GDP) committed to health grew from 9.5% in 2000 to 15.6% in 2008, while health expenditure per capita grew from US$ 137 to US$ 248 over the same period. Health care is funded through: the public sector (average contribution over the last decade 32.7%, supported by the MoH and transfers from the Ministry of Finance and external donations); the private sector (37.4% by household direct out-of-pocket payments), the private not-for-profit sector (UNRWA and NGOs) 22.0%, and 2.9% from external sources. Financing through contributions to governmental health insurance and private health insurance companies averaged about 2.4% and 2.3% respectively between 2000 and 2008. The contribution of each the above sources has fluctuated considerably since 2000, particularly during 2002–2005. Human resources The MoH is the largest employer within the Palestinian health sector, employing a total of 14 619 individuals (59% of health human resources in 2010). A review of the MoH human resource profiles during the last decade shows significant variations in overall employment as well as in the distribution of key human resources, indicating the impact of various ad hoc factors rather than a planned policy for human resources development. Overall, the ratios of health professionals to population indicate a favourable situation in terms of the overall supply of health professional categories in the Occupied Palestinian Territory. The physician to population ratio increased from 56.6/100 000 in 2002 to 77.2/100 000 in 2010. Significant increases were also observed for the ratios of dentists, pharmacists and nurses to population. Health service delivery Primary health care (PHC) services are provided by the four health providers: the MoH, NGOs, UNRWA and the private sector. The MoH operates the majority of PHC centres (56% in 2010); there are 1.9 centres per 10 000 individuals. The distribution of PHC facilities indicates a regional imbalance between the West Bank (1.5/10 000 population) and the Gaza Strip (0.4/10 000 population). Secondary services are provided by 76 hospitals with a total stock of 5108 beds (about 1.3 beds per 1000 capita in 2010). The average number of patients admitted to hospitals in 2010 is estimated at 8 per 1000 capita. The average length of stay is estimated at 2.5 days. The average occupancy rate shows an increase from 72% in 2000 to 81% in 2010; a rate similar to the bed occupancy rates in most Organisation for Economic Cooperation and Development (OECD) countries. Tertiary care services are provided through a limited number of specialized hospitals, with these being concentrated in the urban areas or in inaccessible areas of Jerusalem. Health system reforms A new National Health Strategy Plan for the period 2011–2013 was published by the MoH. Contrary to previous plans, the latest plan was developed with inputs from many health care stakeholders. In addition, the health system objectives were consolidated into four national health programmes with target completion time, budgeting, task responsibilities and planned outcomes all being detailed.