This Presentation explores the burden of the Syrian refugees on the health care sector in Jordan and suggests policy directions to meet this burden.

1. The Impact of Syrian Refugees
on the Jordanian Health Sector:
Challenges and Policy Directions
The Impact of Syrian Refugees on
the Jordanian Health Sector:
Challenges and Policy Directions
Conference on Syrian Refugees in Jordan: The Question of Society and MediaConference on Syrian Refugees in Jordan: The Question of Society and Media
88--1010 DecDec 20142014 ––Kempinski Hotel Dead SeaKempinski Hotel Dead Sea
Dr. Musa T. AjlouniDr. Musa T. Ajlouni
Philadelphia UniversityPhiladelphia University

2. Objectives of the Study:Objectives of the Study:
1.1. To explore the burden of the Syrian refugeesTo explore the burden of the Syrian refugees
on the health care sector in Jordanon the health care sector in Jordan
2.2. To highlight the main challenges related to thisTo highlight the main challenges related to this
burdenburden
3.3. To suggest policy directions to meet theseTo suggest policy directions to meet these
challenges.challenges.

3. MethodologyMethodology
•• This is a qualitative study that adopted a descriptive andThis is a qualitative study that adopted a descriptive and
analytical methodology based mainly on secondaryanalytical methodology based mainly on secondary
information.information.
•• Data were compiled and analysed from reports,Data were compiled and analysed from reports,
evaluations and web sites related to the Ministry ofevaluations and web sites related to the Ministry of
Health (MOH), World Health Organization, High HealthHealth (MOH), World Health Organization, High Health
Council, Department of Statistics, Ministry of Planning,Council, Department of Statistics, Ministry of Planning,
and National and International Organizations.and National and International Organizations.
•• Personal and telephone interviews were conducted withPersonal and telephone interviews were conducted with
identified representatives from MOH and other healthidentified representatives from MOH and other health
care sectors to fill in the gaps from the reports.care sectors to fill in the gaps from the reports.

4. Findings and ResultsFindings and Results

5. UNHCR Registered SyriansUNHCR Registered Syrians
as ofas of 2525 OctoberOctober 20142014
54%
620,016
(25 Oct.2014)
Syrian
refugees
registered
with
UNHCR
15.7%
Camps
84.3%
Urban
Official Figure for SRs(2014) 1,400,000

6. Planned Figures of SRs Registered byPlanned Figures of SRs Registered by
UNHCR forUNHCR for 20152015
2014 2015 + %
620,016 937,830 51%

7. Distribution of Syrian Refugees according to AgeDistribution of Syrian Refugees according to Age
GroupsGroups
Age GroupMale %Female%Total%
4-09.29.218.4
11-510.510.220.7
17-127.47.214.6
59-1819.223.843
+601.41.93.3
Total47.752.3100

8. (1)
Screening
and First
Aid
(2)
PHC
and
Basic
Secondary
(3)
Primary
+
Secondary
+
Tertiary
RMS
+
Donors
Mostly
Donors
Mostly
MOH
Service
Level
Place
Service
Provider
Providers of Health Services to Syrian Refugees
Boarders Camps Cities

9. Syrian Refugees are Granted Access to
Health Services as Jordanians
“Jordan provides asylum for a large number“Jordan provides asylum for a large number
of refugees, including from Syria and Iraq.of refugees, including from Syria and Iraq.
It hasIt has granted Syrian refugees access togranted Syrian refugees access to
services, such as health and education,services, such as health and education,
in host communities.in host communities.””

10. Percentage of Syrian Patients per totalPercentage of Syrian Patients per total
Patients by GovernoratesPatients by Governorates
Source: Ministry of Planning and International Cooperation: Needs Assessment Review of the Impact of the Syrian
Crisis on Jordan, November 2013

11. The Burden on MOH hospitalsThe Burden on MOH hospitals
Source: Ministry of Planning and International Cooperation: Needs Assessment Review of the Impact of the Syrian
Crisis on Jordan, November 2013

12. The Burden on MOH hospitalsThe Burden on MOH hospitals
•• RamthaRamtha Government Hospital, reports havingGovernment Hospital, reports having
receivedreceived 2525,,000000 war wounded Syrian refugeeswar wounded Syrian refugees
inin 20132013. Seven thousand were admitted to the. Seven thousand were admitted to the
hospital, whilehospital, while 1919,,000000 were referred to otherwere referred to other
hospitals in the Kingdom.hospitals in the Kingdom.
Source: Ministry of Planning and International Cooperation :National Resilience Plan(2014-2016)

13. The Burden on MOH hospitalsThe Burden on MOH hospitals
Source: Ministry of Planning and International Cooperation: Needs Assessment Review of the Impact of the Syrian
Crisis on Jordan, November 2013

14. The Burden on MOH hospitalsThe Burden on MOH hospitals
Source: Ministry of Planning and International Cooperation: Needs Assessment Review of the Impact of the Syrian
Crisis on Jordan, November 2013

15. Syrian refugees attended MOHSyrian refugees attended MOH
Hospitals JanHospitals Jan 20122012 --AugustAugust 20132013

16. Syrian refugees attended MOH PHCSyrian refugees attended MOH PHC CentersCenters
JanJan 20122012 --AugustAugust 20132013
Source: Ministry of Planning and International Cooperation: Needs Assessment Review of the Impact of the Syrian
Crisis on Jordan, November 2013

17. Syrian refugee cancer and renal failure casesSyrian refugee cancer and renal failure cases
presenting at health facilities in Jordanpresenting at health facilities in Jordan
Year Cancer Cases Renal Failure
2011 134 120
2012 188 176
2013 317 300
Source: Ministry of Planning and International Cooperation: Needs Assessment Review of the Impact of the Syrian Crisis on Jordan, November
2013

18. Morbidity Picture among Syrian RefugeesMorbidity Picture among Syrian Refugees
Source: Ministry of Planning and International Cooperation: Needs Assessment Review of the Impact of the Syrian
Crisis on Jordan, November 2013

19. Source: Ministry of Planning and International Cooperation: Needs Assessment Review of the Impact of the Syrian Crisis on Jordan, November
2013

20. The Health Sector in JordanThe Health Sector in Jordan

21. Health Care System Achievements
•• Extensive network of PHC facilitiesExtensive network of PHC facilities
•• High bed/population ratesHigh bed/population rates
•• Physician to population ratio is higher than most ofPhysician to population ratio is higher than most of
MENAMENA
•• Highly skilled HRHHighly skilled HRH
•• Strong higher education systemStrong higher education system
•• 7575 toto 8080 % of the population in Jordan is covered by% of the population in Jordan is covered by
formal health insuranceformal health insurance

22. Health Care System Achievements
•• MOH provides health safety net for allMOH provides health safety net for all
•• Government commitmentGovernment commitment
•• Improvement in health indicatorsImprovement in health indicators
•• Modern health care infrastructuresModern health care infrastructures
•• Accreditation ProgramAccreditation Program
•• Medical TourismMedical Tourism
22
2/1
9/2

23. Jordan Ranks 83/191 According to WHO Ranking
of the World’s Health SystemsSystems
23
1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
11 Norway
12 Portugal
13 Monaco
14 Greece
15 Iceland
16 Luxembourg
17 Netherlands
18 UK
19 Ireland
20 Switzerland
-
-
83 Jordan
-
-
-
-
-
191Sierra Leone
Source:http://www.who.int/healthinfo/paper30.pdf

24. Human Development Index, JordanHuman Development Index, Jordan 20122012
Health scored the highestHealth scored the highest
(0.841)(0.700)

25. Health System
Challenges
Epidemiological, Socio-
economic challenges
Impact of Syrian Refugees on Jordan
Health Sector

26. Health System Challenges

27. Service
Delivery
} High occupancy rates in MOH
hospitals: Some hospitals such as Princess Basma, Princess Rahma,
Ramtha and Mafraq hospital have recorded 100 percent bed occupancy rates.
} At the health centre level, the daily
workload has increased by 9 to 50
percent .
} Hospital beds/10000 pop dropped
from 18 to 15.1
} Adverse effect on quality of health
services.
} Longer waiting lists and queues.
} More complaints and dissatisfaction
rates.
Impact on
Health Sector

28. 28
2/1
9/2
Workforce
Health
Workforce
All hospitals in Northern governorates} All hospitals in Northern governorates
reported severe staff shortages in
most medical specialties:
dermatology, gynecology psychiatry,
emergency, orthopedic,
anesthesiology, internal,
ophthalmology, family medicine,
pediatrics and dentistry.
} Sharp increase of the daily workload
of existing specialists, which cannot
be sustained and may lead to High
drop out rate.
Impact on
Health Sector

29. NationalHealthNationalHealth Indicators /Indicators /
20132013//20142014
Indicator 2013
Without Syrians
(6.4 mils)
2014
With Syrians
(8 mils)
Physician/10000 pop 28.6 23.4
Dentist/10000 pop 10.4 8.5
Nurse (all categ.)/10000 pop 44.8 36.6
Pharmacist/10000 pop 17.8 14.5
Hospital beds/10000 pop 18 15.1
Hospital beds/10000 pop in Mafraq 8 6
Coverage by health care services % 98 90
Estimated

30. Drugs,
vaccines
Drugs,
medicines and
vaccines
Impact on Health
Sector
} All hospitals in Northern governorates
reported serious deficiencies in the supply
of vaccines, delivery-related medications,
cardio-vascular drugs and oral rehydration
therapy.
} Re-appearance of polio as a result of the
recent outbreak of polio in Syria will
require massive immunization campaigns.

31. 31
2/1
9/2
Medical
Technology
} Shortage of Medical equipment
in most Northern hospitals and
clinics(delivery tables, kidney dialysis
units, emergency trolleys, surgical
equipments and sets, radiology and lab
equipment, etc.)
} Overuse of medical equipment
} Maintenance issues
Impact on
Health Sector

32. Financing
} Budget deficit and Shortage of finance to
higher demand and utilization rates
} MOH has already incurred JD 253 million in
additional costs annually.
} Higher expenditure on health(HE) as a
percentage of GDP.
} Less expenditure per capita.
} Higher percentage of total (HE) on
pharmaceuticals.
} Inefficiencies (Over -utilization)
Impact on
Health Sector

33. 2/1
9/2
Inequalities
} Access to health services is uneven
across Governorates
} Higher Out-of- Pocket Spending
Impact on
Health Sector

34. •• Out of PocketOut of Pocket
34
2/1
9/2
Out of Pocket

35. 35
out-of-pocket expenditure
•• Push some households intoPush some households into
povertypoverty
•• Reduce expenditures onReduce expenditures on
other basic needsother basic needs
•• May cause households toMay cause households to
forgo seeking health careforgo seeking health care
and suffer illnessand suffer illness
35
Risk of financial
catastrophe
Out-of-pocket
health expenditure

36. 36
2/1
9/2
Epidemiological, Socio-economic challenges
(SDH)

37. Demography
} Increase of young people
} High dependency ratios.
} Increasing fertility rates
among Syrians
} May slow reaching the
demographic opportunity
Social
Determinants
challenges

38. Sources: Department of Statistics 2012; UNHCR projections through end of 2013

39. Epidemiology
} Increase prevalence rates of
NCDs and injuries.
} Re-emerging of some
communicable diseases
} Environmental health challenges
Social
Determinants
Challenges

40. Socio-economic
} Low economic growth ,high debit
rates
} Scarcity of water resources
} Unplanned urbanization (about
50% of population lives in Greater
Amman Area).
} High rates of poverty and
unemployment
} Unfinished MDGs agenda(beyond
2015)
Socio-economic
challenges

41. Source : REACH ,Evaluating the Effect of the Syrian Refugee Crisis on Stability and Resilience in Jordanian Host
Communities :Preliminary Impact Assessment, January 2014
Tension of Local communitiesTension of Local communities concernedconcerned
affordable housing, education, and health servicesaffordable housing, education, and health services

42. The Health Index Went Down byThe Health Index Went Down by 1212
PointsPoints
0.745
0.829
0.739
0.715
Human Development Index
‫اﻻﺟﻣﺎﻟﻲ‬ ‫اﻟﺑﺷرﯾﺔ‬ ‫اﻟﺗﻧﻣﯾﺔ‬
‫اﻟﺻﺣﺔ‬Health Index ‫اﻟﺗﻌﻠﯾم‬Education Index ‫اﻟدﺧل‬Income Index
‫ﻟﻌﺎم‬ ‫اﻻردن‬ ‫ﻓﻲ‬ ‫اﻟﺑﺷرﯾﺔ‬ ‫اﻟﺗﻧﻣﯾﺔ‬ ‫دﻟﯾل‬2014
Human Development Index,Jordan 2014
Source: UNDP ,Human Development Report 2014
2012
0.841

43. Proposed Policy Interventions
to Meet Health Sector Challenges
Resulting from Syrian Asylum

44. Proposed Policy InterventionsProposed Policy Interventions
ü Significant investment from the donor community should
be secured support MOH budget to reduce the financial
gap resulting from the additional case load created by the
Syrian refugee influx.

45. Tertiary
Secondary
Primary
Donors Should Move Vertical Upward

46. Donors Should Move Horizontally from Camps
To Communities

47. Reg. Refugees
Outside Camps
Hospital Beds
Needed
No. of Field
Hospitals
2014 522334 940 10X(100 beds)
2015 790590 482 5x(100 beds)
Field Hospitals Needed to Serve Registered Refugees Living
Outside Camps

48. ü Expanding the bed, surgical, outpatient, emergency,
maternity, lab and other infrastructure capacity of up to
20 MOH hospitals and 30 health care centres
üü Strengthen MOH preventive programmesStrengthen MOH preventive programmes
üü Strengthen emergency services capacityStrengthen emergency services capacity
üü Support to human resources development andSupport to human resources development and
planning.planning.
Proposed Policy InterventionsProposed Policy Interventions

49. Proposed Policy InterventionsProposed Policy Interventions
üü Coordination and control of of international healthCoordination and control of of international health
programs and services working for Syrianprograms and services working for Syrian
refugees.refugees.
üü Strategic partnership among all health sectors .Strategic partnership among all health sectors .
üü Relying on studies and research to determine realRelying on studies and research to determine real
impact ofimpact of Syrian Asylum on the health sectorSyrian Asylum on the health sector
49

50. If well implemented the National Resilience PlanIf well implemented the National Resilience Plan 20142014--20162016 willwill
translate most of the proposed policy directions into actionstranslate most of the proposed policy directions into actions

51. Health Services for SRs Covered by International Community
(Existing Situation)
2/19/2015 51
Pooled
funds
Total health expenditure
% Cost
covered
51
Breadth (% SRs covered)
Depth and quality
(services covered)
51

52. Health Services for SRs to be Covered by International
Community
(Required Situation)
2/19/2015 52
Pooled funds
Total health expenditure
% Cost
covered
52
Breadth (% SRs covered)
Depth and quality
(services covered)
52
√√

53. Thank You