Introduction

During the period 4-8 February, Near East Consulting (NEC) conducted a health survey of over 1,100 randomly selected Palestinians in the West Bank, the Gaza Strip, and East Jerusalem; 781 of the interviews were successfully completed. The survey covered a number of issues relating to family health and well, including mental health, the prevalence of different diseases, health insurance and medical coverage, obstacles to health care service delivery, quality of health services and evaluations of healthcare professionals. Interviews were conducted by telephone. The margin of error for the survey is +/- 3.5%, with a 95% confidence level.

I. Summary of findings

1. Prevalence of depression; and 2. chronic illness and disability

31% of respondents, and slightly more men than women, characterized themselves as ‘very depressed.’ This figure is nearly one-third lower than that recoded during the worst month of 2006. Extreme depression was more prevalent among refugees then the remainder of the population.

47% of all Palestinian households include at least one person suffering from some type of chronic illness or disability. ‘Diabetes’ and ‘Heart Related Problems’ were cited as the most common ailments by slightly more than one quarter of all respondents, respectively.

Both the incidence of depression and illness were strongly related to poverty. One third more hardship cases than non-poor households suffered some kind of depression.

Families falling within the hardship category were more than 2.5 times as likely to suffer disability than non-poor families, and more than 1.5 times as likely to suffer chronic illness.

3. Insurance coverage and main care providers

64% of households said all their members enjoy some type of health insurance coverage. Coverage tended to be family-wide: if one member was insured, the remainder were also likely to be so; only 17% of families indicated that they had partial coverage. 20% had no coverage at all.

Though villagers were somewhat less likely than city dwellers to be insured, there were no significant differences across income groups; indeed, hardship families were least likely to be without any coverage. In addition, refugees were at least 1.3 times more likely to enjoy full coverage than the rest of the population.

The Palestinian Authority is by far the largest health insurance provider in the Occupied Territories, covering 69% of households. Between them, UNRWA1 and private insurance companies account for an additional 14%.

In the main however, the PA covers medical expenses for only 30% of families; 33% covered their own expenses. Poor households were nearly 1.5 times more likely to rely primarily on the PA than were families above the poverty line. Hardship cases relied comparatively less on the PA (24%) and more on UNRWA (16%).

The PA Ministry of Health was the main care provider for nearly half of all families; private institutions accounted for 28%, and UNRWA for 21%. Households above the poverty line were nearly twice as reliant on private care (40%) as were poor households (24%).

4. Use of health care services

Household use of different types of health services generally ranged in incidence from 40% in the case of specialized care for non-acute problems, to 13% in the case of general urgent health care service s. However, only 4% of families had received mental health care in the past year, notwithstanding high levels of depression.

Variance across sub-groups was primarily determined by poverty level. Hardship cases were up to 2 times more likely than non-poor households to have used most types of services. Both refugee camp residents and hardship cases were twice as likely to have benefited from mental health services.

Only 35% of Gaza households had received specialized cared, compared to 43% of West Bankers. One reason may be that the only Palestinian center for tertiary care– the Muqassed Hospital in East Jerusalem, is located in the West Bank.

More than half of all households indicated that care was received within two hours; 11% had sought some type of care but not received any. In addition, 15% had needed care but deferred seeking it. This figure included 19% of West Bank respondents but only 9% of Gazans, a difference is possibly attributable to internal movement restrictions prevailing in the West Bank.

Rural households and poor families - particularly hardship cases - were about 1.5 times more likely than comparable sub groups to have been denied care, or to have waited longer hours. The greater difficulties encountered by such families were also notable because they were less likely than better-off respondents to have deferred treatment.

5. Obstacles to health care delivery

The most prevalent obstacles to care delivery were financial and capacity constraints; 25% of respondents said they could not afford care, 23% that there were too many other people waiting, and 17% that there was not enough staff attending to them.

As expected, financial constraints impacted households below the poverty line much more than other categories of respondents. However, for refugees and refugee camp residents in particular, capacity constraints were a relatively bigger obstacle than cost. Rural households were over two times more likely than urban families to cite either distance or lack of transportation as a significant obstacle, and were also much more likely to be affected by checkpoints and other Israeli movement restrictions

6. Evaluation of service quality

Capacity constraints were generally felt more in terms of the time afforded patients, rather than the time spent waiting; nearly one third of families suggested that they would have liked more time with their health care professional; whereas less than one fifth were outright dissatisfied with waiting time.

Refugee camp families expressed the highest incidence of dissatisfaction with the duration of their consultation (49%), along with hardship families ( 42%), who were nearly twice as likely to have wanted more time as were non-poor households.

Though 90% of respondents were to some degree satisfied with the availability of drugs, poor households were at least twice as likely find drugs hard to come by than were nonpoor households. Gazans were also having more difficulty (14%) than West Bankers (8%), possibly owing to their greater poverty or tighter external closures.

Overall, a vast 96 % of respondents expressed some degree of satisfaction with the working hours or their PHC and its distance from their homes. Hospitals were deemed somewhat more difficult to reach, but in general, distance seems to be a problem primarily when compounded by lack of affordable transportation, and the existence of checkpoints.

92% majority households were satisfied to some degree with the attitude of the health staff who attended them, with 57% finding it friendly and supportive, and 35% cold but respectful. Responses did not vary significantly among different categories of respondents.

7. Evaluation of health professionals

For no category of health professionals evaluated for their qualifications and professionalism did more than 10% of respondents give a rating of ‘very bad’ or ‘bad.’

This, the lowest rating was given to general practitioners, who fared poorly compared to specialist doctors. In general, other health professional with which families have frequent contact, including pharmacists, nurses and para-professionals, were given high ratings.

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