The contribution of the international fund to developing the Palestinian health care system: focus NGOs, Palestine, 2013.


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The contribution of the international fund to developing the Palestinian health care system: focus NGOs, Palestine, 2013.

  1. 1.  To assess the contributions of the IF through the NGOs in developing the PHCS in the Gaza Strip, thus providing suggestions about the appropriate utilization of donated funds. Mohammed Al Khaldi 2
  2. 2.  To illustrate the nature, features and trends of the internationally donated funds. To appraise the relevance, appropriateness, effectiveness and sustainability of the IF. To assess the contribution of the IF in supporting HCS different components. To identify strengths, weaknesses and factors affecting the IF. To provide recommendations for better utilization of IF in supporting PHCS. Mohammed Al Khaldi 3
  3. 3. Relevancy & Appropriateness Political, economical & financial factors Characteristics: Types, features, nature, mechanisms, S & W Input (IF) Coordination & Process Outputcooperation Efficiency, M&E Transparency & Responsiveness to Palestinian society needsgovernance NGO development Meeting NHGs & MDGs (Indicators) Effectiveness & Sustainability Self developed Mohammed Al Khaldi 4
  4. 4. Methodology Mohammed Al Khaldi 5
  5. 5. Descriptive analytic design, withtriangulation between qualitativeand quantitative approaches. Mohammed Al Khaldi 6
  6. 6. All Palestinian health NGOs (59) that work in the GS which areconcerned in the health field and receive external fund in theimplementation of its activities. 6 of them actually inactive.The study participants was 53 health NGOs were included butthe organizations that responded were 48 health NGOs.Response rate: The study population formed 53 healthPNGOs and only 48 health PNGOs responded with aresponse rate 90%. Mohammed Al Khaldi 7
  7. 7. The study focus on health PNGOs, itwas conducted at the 48 selected healthPNGOs in all GS governorates inPalestine to reflect representativeresults. Mohammed Al Khaldi 8
  8. 8.  The study was conducted in November 2011 till April 2012. Actual data was collected in November 2011 to January 2012. Data analysis and discussion was completed in March and April 2012. Mohammed Al Khaldi 9
  9. 9.  Quantitatively: Census sampling approach was used. MOH, MOI, UNESCO directory, PNGOs cluster and HI Guide lists was obtained, they were merged into one single list, then the NGOs that were frequently, inactive, closed, or the organizations that that do not work in providing health services were excluded. They were 59 NGOs, 53 NGOs meet the criteria and 6 did not. Qualitatively: Purposive sampling approach was used. conducting In-depth interviews with 8 keys informants policy makers, experts, academics who were selected with the supervisor. Mohammed Al Khaldi 10
  10. 10.  To have official institutionalized status. To be independent from the government, and self- administered. A non-profit. Not inherited, membership is voluntary and is not based on blood or tribe. Representative which means that membership is limited to a specific sector and aims to defend the interests of that sector. It must be licensed. Actually operates. Works in the health scope, and provides health services. Health NGOs that do not meet the above criteria were excluded. Mohammed Al Khaldi 11
  11. 11. Mohammed Al Khaldi 12
  12. 12.  The researcher conducted initial study before starting data collection. 3 health PNGOs were chosen from the target population. There is no major changes were introduced therefore we included them. Mohammed Al Khaldi 13
  13. 13.  1. Interviewed questionnaire: the questionnaire was prepared and designed by the researcher to get information about general of NGOs and IF, and directors perceptions about IF contributions in the health sector. 2. In-depth interviews with 8 experts, whom were purposively chosen. The researcher agreed with the experts on the time and place of the interview which lasted in a week. Every interview took from 40 - 60 minutes; all interviews were tape recorded, then data were ordered and coded. Mohammed Al Khaldi 14
  14. 14. Data processing were conducted using the (SPSS 19) including; Data were gathered and then the filled questionnaires were reviewed, Appropriate data entry model were designed Coding of variables Data entry Data cleaning Frequencies and descriptive analysis for NGOs, respondents characteristics and the other variables in the questionnaire. In-depth interviews were analyzed using Open Coding Thematic Analysis (OCTA). Mohammed Al Khaldi 15
  15. 15. Reliability Study instrument standardization and filling out it the same way with all PNGOs. In order to test the internal consistency of the questionnaire, The Cronbach’s Coeffecient alpha value for the entire questionnaire was (0.899). Mohammed Al Khaldi 16
  16. 16. Validity Face validity: the researcher organized the questionnaire in domains with logical sequence to facilitate the filling simplicity. Layout and format look professional. Content validity: the questionnaire was sent to 16 different qualified and experienced referees. In qualitative part, the researcher reviewed the supervisor and colleagues via peers review and member check. Mohammed Al Khaldi 17
  17. 17.  Lack of consistent figures and statistics about IF and NGOs. Some PNGOs were reluctant to disclose financial information. Mohammed Al Khaldi 19
  18. 18. Health NGOs characteristics Mohammed Al Khaldi 21
  19. 19. Rafah 8.3% KhanyounisGovernorates 14.6% Middle area 8.3% Gaza 58.3% North Gaza 10.4% Mohammed Al Khaldi 22
  20. 20. Distribution of NGOs activities coverage National Level 6.3% Local Area 16.7%Governorate level 18.8% GS level 58.3% Mohammed Al Khaldi 23
  21. 21. 95.8% 54.2% 45.8% 35.4% 25% 20.8% 10.4% 4.2% Mohammed Al Khaldi 24
  22. 22. Total number and gender of health NGOs employeesNo. of female employees 54% 46%No. of male employees No. of female employees 1442 No. of male employees 1683 Total No. of NGOs employees 3125 Mohammed Al Khaldi 25
  23. 23. N. Gaza M. Khan. Rafah TotalType of facility Gaza City AreaHealth care 9 23 8 13 8 61 42.6center/PHCHospital 3 6 2 1 0 12 8.3Community-rehabilitation 7 14 7 7 7 42 29.3centerCulture &education 5 11 7 3 2 28 19.5centers Total 24 54 24 24 17 143 100 Mohammed Al Khaldi 26
  24. 24. Health NGO suffer from financial deficit 39.6% 33.3% 25% 2.1% Yes Sometime No Don’t know NGO suffer from a financial deficit Mohammed Al Khaldi 27
  25. 25. Description of financial deficit 52.1% 20.8% Intermittent Constant Description of deficit Mohammed Al Khaldi 28
  26. 26. Distribution of the NGOs needs and prioritiesProviding drugs for the poor freely 4.2% Set corporation policies 16.7% All of above 29.2% Networking 62.5% Community collaboration 62.5%Develope planning & development 70.8% Running expenses 79.2% Specialized HR 81.3% Equipments 81.3% Fund raising 81.3% Mohammed Al Khaldi 29
  27. 27. Directors of health NGOs characteristics Mohammed Al Khaldi 30
  28. 28. Distribution of directors gender 15% 85% Male Female Mohammed Al Khaldi 31
  29. 29. Distribution of director age 47.9% 27.1% 25% to From to From More than years years years Mohammed Al Khaldi 32
  30. 30. 47.9% 37.5% 6.3% 8.3%Secondary Bachelor Master Ph.D& diploma degree degree degree Mohammed Al Khaldi 33
  31. 31. The International Fund characteristics 34 Mohammed Al Khaldi
  32. 32. D. K 2.1% Internal conflicts in the Org 2.1% Managerial obstacles 12.5% Hidden agendas 20.8% Lack of experts in the NGO 27.1%Lack of donors interaction with 64.6% NGOs Prevailing political conditions 83.8% Mohammed Al Khaldi 35
  33. 33. Direct (from donor to OrganizationIndirect (through channels 37% 63% Mohammed Al Khaldi 36
  34. 34. 83.3% 60.4% 45.8% 31.3% NGOs Civilian societies Governmental institutions Individuals donations Mohammed Al Khaldi 37
  35. 35. Types of aid provided to the NGOs (mean percentages) Development Relife (emergency Budget support 9% 38% 53% Mohammed Al Khaldi 38
  36. 36. The conditions of donors 14.6%Donor respect of the organization 56.3% rules NGO long experience and 58.3% reputation Necessity of the service 64.6% Organization need 68.8% The existence of a common vision 72.9% Mohammed Al Khaldi 39
  37. 37. 2% 8% thousand Less than 10% thousand to From thousand to From23% million 38% million to From million to From 19% million to From Mohammed A l Khaldi 40
  38. 38. Distribution of NGOs according fund sources Other Sources Self Fund PNA Inside Green 5% 3% 1% Land Palestinian 2% Diaspora 8% Local Donations IF (Foreign & 23% Arab) 59% Mohammed Al Khaldi 41
  39. 39. Distribution of challenges and factors affecting the IF Health and epidemiological challenges 29.2%Weakness of donor MGM & transparency 37.5% Socio-demographic challenges 37.5% Lack of community cooperation and participation 45.8% Incompatibility of NGOs goals with donors 52.1% Economical and financial factors 54.2% Organizational factors (weak of NGO strategic MGM, capacities 56.3% The absence of common visions & local , international coordination 64.6% Political factors 95.8% Mohammed Al Khaldi 42
  40. 40. Distribution of the largest 20 donors agencies HI 19% UNFPA 22% CA 23% MH 24% EU 27% NDC 28% OXFAM 28% MC 29% AMU 29% IHH and Yardim 37% UNRWA 39% WAMY 42% Care 44% ANERA 46% SC 57% USAID 57% OPEC 67% WA 79% Arab Fund 85% IR 86% 0 10 20 30 40 50 60 70 80 90 100 Mohammed Al Khaldi 43
  41. 41. Study domains mean percentages Overall domains 68.46% Coordination & cooperation 60.67% Meeting MDGs 63.39% Meeting NHGs 64.86%Responsiveness to Palestinian needs 65.07% Nature of the IF 68.63% Meeting needs of NGOs 68.79% Transparency & governance 71.41% M&E 73.61% …Efficiency, effectiveness & 75.79% Sustainability 78.3% Mohammed Al Khaldi 44
  42. 42.  The importance of fund continuity and donor commitment with increasing itsrole in crisis conditions such as medical materials shortage and electricity cut. Emphasis on working closely with national bodies based on national health anddevelopmental indicators through clear common agendas to ensure appropriatenessand effective results. Adopt transparency and credibility in disseminating information, as well asinvolving the NGOs decision makers and local society planning. Donors should utilize a holistic and systematic approach (health determinants) infunding programs by concerning less on ad-hoc project complimentary long-termdevelopmental programs. Emancipate the fund from any restrictive conditions and ought to support NGOsself-reliance and respect the local and NGOs rules. Donors are supposed to follow and apply the OECD, Paris decl., AAA, andBusan conference principles to strengthen the IF effectiveness. Encourage the need for coordination and interaction with the all variedPalestinian actors on the basis of effective partnership to achieve the desired goals. Mohammed Al Khaldi 45
  43. 43.  More fund utilization as much as possible to serve its vision that is fully harmonized with the priorities of the national health goals. Promote coordination, and create networks between all health actors strengthen their role in attaining the desired goals. Increase their financial and managerial capabilities empowerment especially in M&E, governance and planning. Invest diversified financial resources generation like prosperous projects and pricing its services to increase the revenues, reduce aid dependency and keep its sustainability. Mohammed Al Khaldi 46
  44. 44. Recommendations (NGOs level) (cont’) Pay more attention to programs that serve children, women, and support the principles of life quality through public health awareness. Reinforce the NCDs programs and elderly care and develop mental health services. Set plans that include mechanisms to improve the health environment infrastructure in order to control diseases and threats. Develop services with high quality, equity, focus on the beneficiaries sound, as well as encourage to use fund in other ways like health research and establishing effective HIS. Mohammed Al Khaldi 47
  45. 45.  Establish independent national health committee representatives from the MOH, NGOs, private sector, academics and civil society to set the national health priorities and to manage the negotiations with the donors and fund allocation. Reactivate relevant acts and set clear policies by legislative authorities to regulate the donor agencies work, and reactivating the monitory bodies duty to track the donors performance. Establish a unified information system that is related to the projects and the IF money to use it in the decisions making and planning. Find alternative funding sources like the PNA, companies, banks, businessmen and Arab and Islamic fund. Act deeply for the issues of unemployment and poverty in a comprehensive perspective through all parties’ participation. Mohammed Al Khaldi 48
  46. 46. Mohammed Al Khaldi