Improving service provision for people living with NCDs in occupied Palestinian territory: Lessons from the COVID-19 pandemic

The unique political circumstances of occupied Palestinian territory create challenges to health care provision that most countries don’t face, such as intermittent electricity supply and unpredictable changes to medicine supplies. This affects how occupied Palestinian territory is able to treat noncommunicable diseases (NCDs), which are responsible for 70–80% of all deaths in the country. In spite of the challenges they face, authorities have steadily improved service provision for people living with NCDs over the last decade.

The Ministry of Health has been working with WHO and the European Union to improve access to mental health services and integrate them into primary health care (PHC).

Since 2013, occupied Palestinian territory has been implementing and expanding a Baby-Friendly Hospital Initiative to give babies the best possible start in life.

Occupied Palestinian territory used existing medicine management systems, which are designed to cope with emergency situations, to ensure the supply of NCD medicines and others during the pandemic.

Reform of mental health services

Since 2001, occupied Palestinian territory has been working with WHO and a range of partners including the EU to reform mental health provision. The early aim of the reform was to deinstitutionalize mental health services, traditionally concentrated in tertiary psychiatric facilities; redistribute mental health resources into a community-based system; and collaborate with other bodies such as nongovernmental organizations.

These goals were broadly achieved by 2011, through the Strategic Operational Plan created by the Ministry of Health, WHO and the EU. Achievements of the plan included:

Since 2011, the Strategic Operational Plan has been integrating mental health services into all governmental primary health care facilities in Gaza Strip and 12 primary health centres in the West Bank. It has also worked to integrate mental health care into two general hospitals in Gaza Strip and incorporate social inclusion programmes in the two psychiatric hospitals and all community mental health centres in the West Bank and Gaza Strip.

The plan also delivered: community mental health education programmes; training on key clinical interventions for mental health professionals; and monitoring, evaluation and improvement of mental health information management.

Occupied Palestinian territory’s successful integration of mental health services into primary care has shown that it is possible to develop mental health services in low-resource and conflict-affected settings.

Launch of the Baby-Friendly Hospital Initiative

Occupied Palestinian territory launched its Baby-Friendly Hospital Initiative in 2013. This supports and promotes exclusive breastfeeding for children under six months as well as complementary breastfeeding for children aged 6 to 24 months.

The Nutrition Department of the Ministry of Health supported the initiative by developing:

• Implementation action plans
• An infant and young child feeding strategy and policy
• A staff training plan
• A patient education plan
• Data collection tools
• A national regulation covering the marketing of breast-milk substitutes
• Technical regulations relating to infant formula and follow-on formula

An external evaluation is required before a facility can obtain a “Baby-Friendly Hospital” accreditation, which lasts three years. Audit tools were developed for use in such evaluations. The Ministry of Health ensures that standards of care are met through ongoing data collection and quality improvement activities.

By September 2019, 23 facilities in occupied Palestinian territory had been given Baby-Friendly accreditation. These facilities were from public, private and nongovernmental sectors, as well as the United Nations Relief and Works Agency.

Since nutrition in early years can have a major impact on the development of NCDs in later life, these significant efforts by occupied Palestinian territory are a simple, cost-effective way of giving its children greater protection in the future.

Service delivery for NCDs during the pandemic

The Ministry of Health and the United Nations Relief and Works Agency are the main health care providers, with additional health facilities provided by nongovernmental organizations, the military and the private sector.

The health system is set up for almost constant emergency, with a centralized electronic system for monitoring medication levels and reporting stockouts. Medications are organized into strategic stock for crises and a stock for routine dispensing, with many medications manufactured locally. However, people living with NCDs can only receive two weeks’ supply of their medication at primary health facilities, because of frequent shortages.

When news of the outbreak of COVID-19 was reported from China, occupied Palestinian territory immediately started stockpiling and rationing key medications and alcohol disinfectants, such as hand sanitizer and alcohol wipes. Each hospital formed its own COVID-19 committee and trained teams in infection prevention measures.

From the beginning of the first lockdown in March 2020, the Ministry of Health put in place a number of measures to help people living with NCDs:

• Created a helpline, through which patients could order medicines for home delivery
• Supplied NCD patients with two to three months’ medicines, through primary health care centres
• Advertised medicine collection times through social media, at mosques and in municipalities

The gaps in supply were bridged by United Nations Relief and Works Agency outreach clinics during the first six months of lockdown. Supermarkets and pharmacies also cooperated informally to work around curfews and ensure people received medicines.

Although occupied Palestinian territory’s general emergency preparedness helped the country to mobilize quickly and flexibly during the pandemic, lack of resources and an intermittent electricity supply created serious challenges. However, this spotlight on weaknesses in occupied Palestinian territory’s health care system allows the country to see where improvements can be made in the future.

This country story is part of a series on sharing successful strategies from the Eastern Mediterranean Region mitigating noncommunicable diseases and mental health disorders during the COVID-19 pandemic and beyond. Discover additional stories and insights in the full report published by the World Health Organization Regional Office for the Eastern Mediterranean.