Health

Health

Health status of the population improved

Refugees and people of concern among Africans and Iraqis have access to primary, referral and emergency health care services through public and NGOs partners.
 
Ministry of Health (MoH) primary and emergency care services continue to be accessible to refugees and people of concern at equal nominal fees with nationals.

Complementary access to these services contributes to the reduction in morbidity, disability and mortality rates amongst people of concern to UNHCR.

In 2014, UNHCR started exploring the economic feasibility of a public medical insurance scheme/model. In 2015 this model - if proven feasible - could be then expanded as is the case for nationals in public primary and referral care settings.
 
In addition, UNHCR will keep prioritizing referrals to increasingly take place in public health care centres.    

Health status of the population improved

Results and impact

During 2015, a total of 52,874 visits were recorded for primary curative health care (73%) and 19,845 referrals recorded for secondary and tertiary care (27%). Among the attended visits at primary health care clinics, 12,682 (17%) chronic illness consultations were offered for 1,674 individuals. Assistive devices and rehabilitation care was offered to 366 people living with disabilities and 515 people of concern visited the geriatric clinic at Caritas in Garden City.

In coordination with UNHCR, MSF, Caritas and Arab Medical Union, 2,384 detainees of all nationalities were medically attended in some 33 police detention centres in Alexandria, the Northern coast and Delta governorates through 162 visits by Caritas and AMU, and received care for their acute or chronic illnesses with some authorized hospital care referrals. Caritas also offered 92,665 meals for detainees in 2015. 

In coordination with the Ministry of Health, UNHCR continued its support to the Ministry’s Expanded Program of Immunization with communication and mass information, reaching out to refugees and migrant communities to be part of Egypt all-inclusive national polio, measles and rubella vaccination campaigns in 2015.

Through Refuge Egypt’s clinics, UNHCR supported 9,197 consultations for children under five.  Some, 1,163 children were newly enrolled at the well-baby (0-2 years) and well-child clinics (2-5 years), and 3,405 children under five benefited from Refuge Egypt growth monitoring, early childhood development screening and related health awareness and care services.

Also, 922 new pregnant women received antenatal care and a total of 6,265 follow-up visits were extended for pregnant women, among whom 33 women were identified as high-risk pregnancy cases and received needed specialized referral care. 

Some 660 pregnant refugee women received cash for birth delivery assistance and 334 reportedly delivered by C-section, with one reported maternal mortality. Also, 64 neonatal hospital admissions including for neonatal incubator care were reported with four neonatal mortalities and 195 cases were referred for specialized care including inpatient care for under-five children.

In terms of tuberculosis and HIV care and treatment, Refuge Egypt provided 717 follow-up consultations for people of concern suffering from tuberculosis with 56 new cases identified and enrolled for treatment. In coordination with the Ministry of Health’s national tuberculosis programme, Refuge Egypt and Caritas, seven campaigns were conducted in November - December 2015 in greater Cairo for active tuberculosis case detection; six new cases were identified and provided access to treatment.

In 2015, some 1,129 voluntary counselling and testing services were conducted, while 97 people of concern living with HIV received lifesaving ARVs through Refuge Egypt clinics with support from the Ministry of Health’s national AIDS programme and the Global Fund.

Four pregnant women living with HIV benefited from prevention of mother to child transmission interventions. In addition, four female survivors of rape were supported, counselled and received PEP for HIV for 28 days and prophylactic STIs presumptive therapy. All tested negative for HIV after the completion of the window period from the incident date.

Refuge Egypt provided 1,826 food bags for pregnant women to supplement nutrition during pregnancy and 1,646 food bags were provided for the beneficiaries of the well-baby clinic and for lactating mothers. Also some, 724 food bags were provided for malnourished children in the well-baby and well child clinics, 417 food bags for people living with HIV and 124 food bags for tuberculosis patients.

UNHCR, through its implementing partner Caritas, continued extending its care for eight stateless elderly individuals, with six receiving monthly medication for osteoarthritis, diabetes and cardiovascular diseases. 

Unmet needs

UNHCR faces difficulties in covering many life-saving and emergency interventions for African and Iraqi populations due to limited resources. This is particularly critical for people of concern suffering from cancers, renal failure and cardio-vascular diseases. Advocacy and networking to identify external additional resources continued to be required even though these are not always sufficient to either cover all related needs or to sustain such a support in the medium to long-term.

Impact Indicator Baseline Year-End Target
Extent persons of concern have access to primary health care 75 75 100
Extent persons of concern have access to secondary and tertiary health care 50 60 100
Output Performance Indicator Year-End Target
Access to non communicable disease programmes provided # of full time psychiatric staff for mental health 15 5
Referral mechanisms established # of persons referred to secondary and tertiary medical care 5,000 6,500
Access to primary health care services provided or supported Access of PoC to NGO or faith-based primary health care facilities ensured (yes/no) 95 100
Health services to children under 5 delivered Integrated management of childhood illness (IMCI) implemented (yes/no) 80 100

Health status of the population improved

Syrians have access to the public health system thanks to a governmental decree allowing Syrians to benefit from health services on equal footing with nationals. However, while the public preventative primary healthcare is accessible and free, curative care is costly and not always available. Furthermore, supporting referrals to secondary and tertiary level healthcare is needed for life saving treatment.

Registered Syrians have access to preventive and curative medical care at primary, secondary and tertiary levels through UNHCR’s health implementing partners in Greater Cairo, Alexandria and Damietta respectively, having witnessed the highest Syrian case load. Medical assistance criteria control the ceiling of the costs and cost sharing, except for the immunization services for the under five children, which falls under the overall responsibility of the Ministry of Health and is free of charge.

In 2013, UNHCR assisted Syrian refugees with primary and secondary health care through its health partners. People of concern suffering from chronic diseases have been assisted on a monthly basis with the required medications. Refugees who are in need for tertiary health care that exceeds a certain budget ceiling are referred to the Exceptional Care Committee (ECC) for a review of their case and decision on the level of assistance. Furthermore, Syrians visiting facilities of UNHCR’s health providers benefited from 44,952 visits to primary health care. Support is also provided to Syrians in need of secondary and tertiary health care whereby as of December, Syrians benefited from 24,628 referrals to secondary and tertiary health care.

According to the joint needs assessment led by UNHCR in November 2013, distance and cost of healthcare were raised as the main challenges to accessing health services. Therefore, to address such challenges and to cope with the increasing demand, UNHCR will continue its assistance to refugees in 2014 and will focus on increasing geographical coverage in line with the utilization indicators for the last quarter of 2013.

In 2015, the objective is to sustain access, quality and geographical coverage to health services for Syrian refugee in Egypt. This will be achieved by sustaining the support to the Ministry of Health facilities, strengthening UNHCR’s health providers’ capacity, and awareness raising among Syrians through community health outreach program. 

Referrals to secondary and tertiary lifesaving treatment will be provided, under the control of the exceptional care committee, based on a vulnerability targeting criteria and availability of funds.

Health status of the population improved

Results and impact

During 2015, UNHCR worked towards reinforcing its collaboration with the Ministry of Health through the signature of an memorandum of understanding (MOU) to enhance access of people of concern to public primary health care and secondary curative care services. The MOU aims at providing access to all people of concern registered with UNHCR to primary health care and public hospitals in the areas of high concentration of refugees at the same level as the local population.

UNHCR contributed more than USD 1 million to support specialized hospitals in different governorates to provide optimized breast cancer screening and basic diagnostic resources. In addition, UNHCR also supported infrastructure and medical equipment in 20 primary health-care facilities.

In 2014, UNHCR, had put forward a mainstreaming strategy to integrate Syrian refugees into public primary health-care facilities and to gradually phase out parallel health care services, with a view to enhance resilience and sustainability. The second phase of the strategy started in April 2015 to mainstream Syrian refugees into public health facilities in Greater Cairo and 90,000 Syrians were able to gain access to over 60 primary health-care facilities.

UNHCR also shifted from a strategy that directly reimbursed health facilities for providing maternal care to pregnant Syrian refugee women to a programme where pregnant women received cash assistance to the equivalent amount as the cost ofl services including delivery. UNHCR partners continued to offer two antenatal care consultations to ensure identification of high-risk pregnancies and follow-up on the outcomes of the delivery. Accordingly, 425 Syrians pregnant women were assisted by UNHCR partners in Cairo and Alexandria: 1,298 received antenatal care visits and 60 cases identified as high-risk pregnancies; 33 neonatal admissions; and 99 women received voluntary counselling and testing.

Some 94,187 primary health care consultations were conducted, including 58,716 consultations for non-communicable chronic diseases by UNHCR’s partners.

UNHCR engaged a new pilot project to provide a referral system for secondary and tertiary health care for Syrian refugees in Alexandria and Damietta, and create a network of specialised facilities (hospitals, pharmacies and laboratories). The total number of referrals for secondary and tertiary health care, including specialist consultations, investigations, hospital admissions and emergencies, reached 43,402 in 2015.

The Health Sector raised refugee awareness about the available health services and disseminated health messages among the Syrian community through flyers and 16,688 household visits, conducted through some 90 trained community health volunteers.

In coordination with partners Caritas and AMU, UNHCR was able to support 221 Syrian detainees with medication in 30 detention centres.

In coordination with the Ministry of Heealth’s expanded programme of immunizationaround 14,000 Syrian children were vaccinated for polio.  around 16,500 Syrian children were vaccinated for measles and rubella.

UNHCR developed a new internal partner monitoring tool that aims to broaden the scope of monitoring function to include the quality and the outcome of health-care services provided to people of concern, along with the routine monitoring of health services utilization pattern. The monitoring tool was introduced to implementing partners and amended to UNHCR’s project agreements for 2016.

Unmet needs

As a result of underfunding, the health sector faces difficulties in supporting Syrian refugees who are in need of tertiary life-saving interventions as well as supporting hospitals to provide timely and quality care for the target population.

Impact Indicator Baseline Year-End Target
Extent persons of concern have access to primary health care 85 85 100
Extent persons of concern have access to secondary and tertiary health care 65 75 100
Output Performance Indicator Year-End Target
Access to non communicable disease programmes provided # of full time psychiatric staff for mental health 2 5
Referral mechanisms established # of persons referred to secondary and tertiary medical care 12,473 14,000
Access to primary health care services provided or supported Access of PoC to NGO or faith-based primary health care facilities ensured (yes/no) 85 100
Access to primary health care services provided or supported Access of PoC to national/government primary health care facilities ensured (yes/no) 85 100