on the world: a view on human rights
This article is jointly written with Dr Jamila Sherif*
The right to health is a basic and fundamental human right. In developed countries, the first point of contact with the health care system is usually through primary health care: general practitioners, family physicians, community nurses and pharmacists who provide comprehensive, coordinated and continuous health care as part of primary care teams. Yet, in spite of advances in medicine, these essential primary care services remain beyond the access of many worldwide.
The blocks are not always financial. For the besieged people of Gaza, residents of the largest open-air prison, and those living under occupation in the West Bank, there is a lack of adequate infrastructure and training opportunities to provide these services. The people of Gaza and the West Bank are deprived of access to basic health care due to restricted movement at checkpoints, security blockades and by bureaucratic hurdles. A patient requiring transfer from Gaza to a specialist centre in the West Bank for emergency surgery for a life-threatening condition may have to wait one week.
Across Palestine, primary health care services are largely provided by the United Nations Relief and Works Agency for Palestine Refugees (UNRWA), which runs 22 medical centres in the Gaza Strip serving over 1 million people and six mobile health teams in the West Bank helping over 150,000 people each year. Other support is provided by state, private and charitable organisations. Out of a total of 750 primary healthcare clinics in Palestine, 460 are run by the Ministry of Health, 170 by UNRWA and 120 by non-governmental organisations. They provide immediate medical care and maternal and child health programmes. It is estimated that over 95% of health care provision to Palestinians is funded by international aid donations.
Family medicine in Palestine is relatively under-developed, and untrained general practitioners and specialists currently provide most primary care services. Coupled with the physical and psychosocial traumas of war, high levels of poverty, environmental degradation and overcrowding, such a situation would pose a challenge to even qualified and skilled medical practitioners. Professional training abroad for Palestinian health care workers is fraught with difficulties and obstacles.
According to the charity Medical Aid for Palestine (MAP), “Palestine has been very successful in tackling communicable diseases including through very effective vaccination programmes. However rates of non-communicable diseases remain high, with cardiovascular diseases, stroke, and cancer being the leading causes of death.”
To address this situation and to help launch a new initiative to support the implementation of high quality Family Practice in Palestine, on 5th March, the Department of Primary Care and Public Health (PCPH) at Imperial College London hosted a Palestine Family Medicine delegation. The 4-day visit was organised by the International Development of Family Medicine in Palestine (IDFMP), a collaborative initiative by British family medicine academics and was funded by MAP, whose CEO Tony Laurence is a member of the IDFMP steering group; Mr Laurence played a key role in facilitating the visit and chairing discussions.
The visiting delegation included Dr Asad Ramlawi, Director General of Primary Health Care from the Palestinian Ministry of Health, Dr Mahmoud Daher of the World Health Organization in Palestine, Dr Lubna Alsaoudi, Director of the postgraduate family medicine course at the College of Medicine, An-Najah University, Nablus, the only course of its kind in the West Bank, Prof Saleem Haj-Yahia, Dean of Faculty of Medicine and Health Sciences, An Najah University, and representatives from UNRWA and the Italian Foreign Ministry.
The visit was intended to introduce delegates to general practice in the UK and for them to attend the Royal College of General Practitioners (RCGP) Global Health Conference on ‘Family Medicine: Global Impact’. The conference focused on the challenge of achieving universal health coverage and the key role played by primary care in global health development.
In addition to the conference, delegates visited general practices in Hammersmith and Hampstead, London, where they were given a comprehensive overview of how primary care services are delivered in the UK. One of the delegates commented that “It was really interesting to enter into the complexity of the work that the practice daily carry out and to see the location, the context and the people that inhabit the Brook Green Medical Centre. I’m sure that the meeting has produced seeds that will develop in Palestine.”
The delegates visited the PCPH at Imperial College London where they attended presentations on undergraduate and postgraduate training for general practitioners (GP), how to improve the quality of care through primary research and the usefulness of electronic and mobile health practices in empowering patients to better manage their needs.
On 4 March, the delegates visited the Houses of Parliament where they met Baroness Warsi, Baroness Morris and Gavin Shuker MP, who presented briefings on their visits to Palestine.
The delegates also had the opportunity to meet a number of leading practitioners and academics of family medicine in the UK as well as Professor Salman Rawaf, Director of the WHO collaborating Centre for Public Health Education and Training and held focused discussions with the IDFMP on how to develop family medicine training in Palestine.
This successful 4-day visit brought together academics, organisations and institutions at all levels both in the UK and Palestine, and gained the support and approval of others, including RCGP Vice-Chair Amanda Howe, President-Elect of the World Organisation of Family Doctors(WONCA). A first step on a long road, the visit provided an opportunity to draft a strategy for the development of family medicine in Gaza, plans for a training-the-trainers course in Palestine in the next few months, IDFMP support for the establishment of a model family medicine training centre in Hebron, West Bank, and continued support for the postgraduate family medicine course at An-Najah University, particularly through an online learning platform especially developed for this purpose.
Concerning the visit, MAP CEO Tony Laurence said: “This is a long-term initiative of MAP support, which could in due course make a huge difference to the quality of primary care in Palestine.”
For further information about this project: http://idfmp.org/about-idfmp/
* General practitioner and Clinical Teaching Fellow at the PCPH at Imperial College London, where she is the IDFMP contact person