Interview with her Royal Highness Queen Nour Al-Hussein on child health care

Interview with the administration of Basmah Hospital in Irbid – Jordan

 

Mother and Child Care / Health Care in Jordan

 

General Practice was the backbone of the health services in Jordan until the middle of this century. Subsequently, disproportionate resources were committed to train specialists and build capacity in secondary health care, largely at the expense of primary care, which lagged behind.

Health providers in Jordan eventually came to realize the weaknesses and high costs of this imbalance in the health care system. Attempts to remedy inadequacies in primary health care had focused primarily on coverage issues while training came much later. In 1983, the Royal Medical Services established the first training program in family medicine in Jordan (second in the region to Bahrain). The Ministry of Health, the University of Jordan and the Jordan University of Science and Technology followed this step. Later, largely in response to such initiatives, the Jordan Medical Board, the highest certifying medical authority in Jordan, established an end of training assessment in General Practice. This marked a welcomed recognition of General Practice as a separate specialty, although initially the examining committee in Family Medicine included only one family practitioner. It was not before 1993, that the committee on family medicine of the Jordan Medical Board came to be manned by trained family practitioners.

Today Jordan has clear, elaborate and relevant national standards for training programs in General Practice. At present, such programs comprise a three-year hospital residency component, and a fourth year of supervised training in a health center. The number of trained General Practitioners capable of dispensing quality primary care has increased considerably in the past two decades, although it still falls short of meeting existing population needs in primary health care. Moreover, the full effect of the training programs on practice will not be optimized as long as training remains to be an option and not a prerequisite for  registration in General Practice. General Practice also continues to suffer from institutional weaknesses, although private and public sector primary health care facilities have increased considerably in the last two decades and spread throughout the Kingdom. There are still no supervisory measures to ensure quality; standards vary considerably from one facility to another even within the public sector. General Practice is also not yet well recognized, not to say esteemed; predominantly, patients refer themselves directly to specialists, a practice that is costly, and weights heavily on already stretched secondary health care facilities in the public sector. In order to integrate primary health care fully in the health care system, and optimize the benefits of general practice, Jordan needs a committed policy in this regard that addresses issues of standardization, quality assurance, patient education, facilities upgrade, and coordination and

cooperation between primary and secondary health care providers both in private and public sector.

 

Health prosperity in Jordan passed several phases as follows:

 

¨    The first ministry of health had been established On December 14^th, 1950 .

¨    MOH started its responsibilities In 1951, which considered the beginning of health prosperity in Jordan.

¨    Establishment of six departments in the kingdom districts ,related to the central management of MOH , in which the head of each department was a physician.

¨    The fist nursing college was opened In 1953 .

¨    The physician union/association had been established In 1954.

¨    The central laboratory for medical tests had been established In 1955.

¨    Nursing college of Princess Mona had been established In 1962.

¨    The first health insurance system in the kingdom had been implemented among force army members In 1963.

¨    The first civil health insurance system was implemented in the kingdom In 1965.

¨    a medicine faculty was established in Jordan University In 1970.

¨    Public health law number 43 for 1966 was replaced by Public health law, number 21 for 1971.

¨    The medical Hussein City was inaugurated In 1973.

¨    Publish of high health council system, number 60, for 1977.

¨    The allied medical professions institute was inaugurated in Irbid In 1978.

¨    a pharmacy faculty was inaugurated in Jordan University  In 1980.

 

 

Health indicators

 

 

 

The Benefits Of Family Planning

 

What are the benefits of family planning ?

The goal of using family planning and birth control is to create periodic pregnancy aiming to give the number wanted of children, at the proper  time. On the other hand we keep the mother and children healthy and wealthy. Family planning is necessary for:

1- The Safety Of Your Family :-

  Family planning enables the parents to :

-         Improve the standard of food and housing .

-         Offering the proper care and in order to get a happy family with strong base that helps to overcome tough economical circumstances.

2- Your Child :-

It gives mothers enough time to :

-         To continue breast feeding .

-         To look after the baby emotionally and physically .

And also it minimizes many health problems like:

-         Early birth (prior to the ultimate date of delivery) .

-         High level of deaths among infants .

-         Poor nutrition for infants and brothers and sisters .

3- Your Health:-

It gives the mother enough time to :

-         Regain her strength and health .

-         Take care of herself, her husband and children.

4- Your Husband :-

It helps the husband to over come the financial problems and to offer every one in the family a better and more stable life .

 

 

Jordan Health Care Quality problems:

 

Quality of health services:-

 

Health services are widely available in Jordan. However little is known about the quality of these services. Quality in this regard relates to several issues:

1- Comprehensiveness of the services: Family planning services are widely available throughout the country. However the full range of contraceptive methods is available only in limited number of facilities. In many centers, the only available method may be the pill, which limits the choices of the client and the provider. Quality counseling may not be widely available. The contact of antenatal care may not be comprehensive and the small proportion of women receiving tetanus toxoid injections, which is 13 percent, evidences this. The same can be said with respect to premarital examination and postal care. Reproductive health remains distinct from curative services in primary health care centers. Full integration is recommended.

Health centers and hospitals are widely distributed in the country and it is difficult and inappropriate to think of making all services including laboratory, radiology, and other available in all these facilities. However an efficient referral system may be the right solution.

 2- Lack of quality control measures including clinical audit and accreditation. Irrational use of drugs and technology, the lack of standards for management of diseases, and the unethical practices by the few are all issues that need to be considered.

 3- The physical environment of the center: the lack of space, for example, leads to crowding, makes it difficult to assure privacy. A poorly organized and maintained place is deterrent for patients to seek care. Psychologically, their confidence in the providers may be affected.

 4- The team providing the service: continuity of care is an agreed upon aspect of quality of care. The turnover of staff is high especially in remote areas, which is an impediment for continuity care. The professional capabilities and skills of the staff to provide the required services is another dimension of quality that needs to be assessed and subsequently upgraded. Ongoing training, education, and re-licensing should be considered. A primary care physician, for example, may be placed in a hospital for one week on annual basis. Public as well as private hospitals may participate in this activity according to a suitable plan. Better understanding and cooperation between the public and private sectors may be a byproduct of such activity. The issue of staff motivation is also important. It is difficult to expect high quality services from an unmotivated health worker even if he/ she is well trained and skillful. Little is known about this complex issue.

   5- Client satisfaction: A study by PHCL (PHCL, 2002) revealed that client satisfaction with the range of MOH services was relatively favorable, particularly with cost of services. However, they were dissatisfied with the waiting time, short consulting time, lack of adequate time for asking questions, and shortages of medicines, specialist services, and laboratory services.

   6- Equity: there is evidence of regional differentials in health indicators. However, more important differentials may exist within regions. Little is known about the population groups living in remote underserved areas and about Bedouins.

 

 

Challenges To The Health System:

 

The health system in Jordan faces numerous challenges:

 

1.      The economic situation in Jordan has faced several crises many of which are beyond its will and ability to cope. The regional instability over the past 2 decades resulted in substantial harm for the Jordanian economy and a large national debt. Jordan has to face the consequences of two wars on Iraq, the main trade partner, the Palestinian crises, the rising oil prices, and the associated political instability in the region. All these occurring in an area of the unmerciful globalization. This led to deterioration of living standards of Jordanians and decline in the actual per capital income. Health has to suffer in such situation.

2.     The high population growth rate, the epidemiological transition, the rising cost of health care, and the growing expectations of people pose challenges to the health care system in the country.

3.     Jordan spends over 9 percent of its GDP on health. Given the economic situation, sustaining this level of spending, rather than increasing it, constitutes a huge burden and may deprive other sectors from funds needed for a balanced social and economic development.

4.     Inadequate monitoring and regulation of the private sector.

 

  Suggested Recommendations:

 

1.     Reorientation of the system towards cost containment while improving the health status of citizens, especially the poor and the disadvantaged by:

a.     Provide essential cost-effective intervention to all people especially the poor and the marginalized. Interventions should be selected on the basis of evidence-based return on health status of people. Many costly interventions are currently practiced with no or little evidence of their value. Money should be put in areas with the highest return.

b.     Rationalization of drug use: over one third of health expenditures is on medicines; three fourths of which is private.

c.     Rationalization of the use of medical technology including unnecessary laboratory tests, X-rays, CT, MRI, and others.

d.     Avoid overspending on expensive underutilized medical equipment. For example, Gamma Knives and MRI’s in one hospital may be utilized to the maximum through coordination with other hospitals. Another hospital may have an advanced cardiology laboratory, which can be shared by other hospitals and so on. Medical technology is rapidly advancing; new expensive equipment today will surely be out of date in the near future. To make such an investment cost effective without unduly increasing the financial burden on clients, the solution is to fully utilize the equipment before it becomes obsolete.

e.     Improve the efficiency of the health personnel.

 

      2- Slow expansion in new hospitals and utilize efficiently the excess capacity in the private sector.

      3- Develop outreach services to provide primary health care services underserved people in remote areas.

      4- Improve the quality of health services to be responsive to the expectations of people:

a.     Improve attitudes of health workers and communication between health workers and clients.

b.     Improve the physical environment of health facilities: renovation and rehabilitation of facilities, cleanliness…etc.

c.     Adequate staffing.

d.     Prevent unethical conduct.

e.     Train health workers and improve their skill: workshops, courses, and continuous medical education.

Performance-linked monetary and non-monetary incentives. Good performance has to be rewarded. A system for such incentives should be developed.

 

 

 

 

 

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