The Primary Health Care Department (PHC) Back to Appeal 2004 In Palestine, PRCS is directly operating 26 primary health care centers- 21 in the West Bank and 5 in Gaza. The PHC department offers medical, humanitarian and social services to the Palestinian people. The department believes that “Health” is a resource that all families should promote and/or restore, and that local communities are capable to define their health needs within the department’s community-based programs. In 2003 onwards, the PRCS Primary Health Care Department will continue to provide quality, comprehensive and financially affordable services to local communities where PRCS exists. The department seeks to continuously improve the quality of all its services while meeting the healthcare needs of local communities. The PHC centers will maximize collaboration with PRCS branches and fully support the process of community organization while facing the prevailing challenges of the present Palestinian circumstances.

The Primary Health Care components Community organization Community organization addresses processes and institutions through which community members participate in health promotion and protection. This includes involvement of community members in decision making related to planning health activities and sustaining health projects/programs. Through this function communities are assisted to improve their health and to take advantage of development opportunities. Community members are involved in health programs so that their needs are addressed in the PHC activities. The process of community organization varies from one community to the other and depends on the nature of the program and health priorities of each community. The department believes that community organization contributes to establishing, sustaining and promoting the utilization of services. The first and most essential step in initiating a health program is to establish a positive rapport with target groups. This rapport is expected to promote a sense of ownership of project activities- thus contributing to its success. Health education Good communication with clients can stimulate the utilization of services. People respond positively when they have their questions answered privately and respectfully. All possible communication channels are used to reach the target population such as printed materials, home visits and reaching out to groups and individuals. PHC staff use appropriate technical terminology during the health talks to insure that clients understand the health messages and apply them correctly. PHC staff members do their best to present knowledge in a way that it does not conflict with the existing attitudes and beliefs, e.g. when addressing family planning issues. It is essential that PHC staff understands and respect the attitudes, beliefs and culture, which determine the people’s health behavior. PHC staff members identify the health education needs in targeted communities and address them in the most appropriate manner. Health education programs are developed, implemented and evaluated. Programs always ensure that community health needs are met and health problems are addressed.

PRCS Primary Health Care Program 2003-2005

Logical Framework

Home Based Care Health starts at home. Family members live at home healthy, or burdened with risks or health problems. At home, decisions affecting the health of families are made- by mother, father or other family member. Home based care targets persons with life style diseases, high-risk pregnancies, newborns, elderly, and other persons with special health care needs. Being at home with the patient and family, Community Health Teams have the opportunity to teach self-care, address health education needs and assist individuals and families in making appropriate decisions regarding their health. The importance of Home Based Care can never be over emphasized.

Woman and Child Health Healthy women mean healthy mothers and children. Children are the leaders and decision makers of the future. Consequently, healthy children reflect a healthy community. The Woman and Child Health project targets women at all stages of life and children up to 3 years. Traditions, customs, values and habits affecting the health of women and children are identified and addressed appropriately. Health education is a valuable tool in this respect. Community Health Teams seek to promote antenatal care, post natal care and child growth monitoring. The PHC department is currently establishing Safe Motherhood groups in local communities to act as mediators with the PHC centers and to assist in transmitting correct health messages to local communities.

Dental Care Dentistry in PHC complements all other PHC technical functions. Preventive and curative dental health services have been integrated into the PHC activities at several centers as well as in the community based activities. This project aims at promoting dental health in schools, kindergarten, among pregnant women and elderly.

Medical Care PHC seeks to provide quality medical care for the sick as well as for individuals and groups at risk. Around, 49% of patients who receive medical care are 0-6 years of age, which implies the need for developing the child health component of primary health care.

School Health The school health component of PHC is coordinated with the Ministry of Education. Accordingly, the society provides periodic medical and dental check-ups to pupils, and organizes health awareness campaigns and community-based first aid courses to pupils as well as to schoolteachers in local communities where PRCS exists.

Diagnostic Services 1.

Laboratory services: Basic laboratory investigations- CBC, sugar, urine and stool analysis, are done routinely in all PHC centers. Special chemistry tests are done in most centers as requested. Laboratory technicians participate in free medical days whereby free laboratory investigations are done for pupils or for other vulnerable groups. The PHC department looks forward for using quality controls in all centers.

2. X-Ray Services: Limited to Salfeet PHC, Bani Naem PHC and Silwad PHC.

PRCS Primary Health Care Program 2003-2005

Logical Framework

Community Based First Aid This project is based on three aspects: dissemination of Red Cross and Red Crescent principles, provision of health awareness sessions, and teaching first aid. The activities are offered through trained technical staff and volunteers. Target groups are selected in cooperation with local health committees following a comprehensive assessment of community needs.

Future Plans 1. Promote the woman and child health component of PHC. 2. Introduce developmental screening project from birth to 6 years of age. 3. Promote the role of dentists in preventive oral health. 4. Maintain quality control in PHC laboratories. 5. Develop the home-based component of PHC. 6. Review the role of community health committees in disaster preparedness. 7. Collaborate with the PRCS branches and other PRCS departments in establishing joint programs. Back to Appeal 2004

PRCS Primary Health Care Program 2003-2005

Logical Framework

Primary Health Care Back to Appeal 2004 PHC program- Logical Framework 1. Primary Health Care program in the different locations PROJECT CENTER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.

Ramallah Silwad Der Abu Mishaal Biddo Qatanneh Azmout Tubas Qabatia Arrabeh Jaba’ Anabta Salfeet Kifel Hares Bidia Hajjah Habla Beit Fajjar Al-Khader Tarqumia Idna Bani Naem Halhoul Jabalia Khalil El-Wazir El-Mawasi

Woman & child health X

X X X

X X X X X

Health education***

Home based care

X X X X X X X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X X

Regular medical & nursing care X X X X X X X X X X X X X X X X X X X X X X X X X

Diagnostic services*

Dental care

X XX X X X X X X X X X XX X X X X X X X X X-Ray X

X X X X X X X X X X X X X

Dispensary

Rapid damage assessment**

X X X X X X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X X X X X X X

26. Maen X X X X X X * X: refers to Laboratory services, XX: the center has both X-Ray & Laboratory ** Rapid damage assessment project is part of the PRCS Disaster Preparedness & response program. *** Health Education includes: CBFA, awareness sessions & campaigns, school health program, free medical day, free dental days, free lab days

PRCS Primary Health Care Program 2003-2005

Logical Framework

COMMENTS

Agreement with MOH Agreement with MOH Agreement with MOH Agreement with MOH

Agreement with MOH

Agreement with MOH

Irregular program due to siege Agreement with MOH

PHC program- Logical Framework (2003-2005) (Back to Appeal 2004) OVERALL GOAL Improved general health and well being of the most vulnerable of the Palestinian population, with a shared responsibility for health care and health issues between the national society, local authorities and community members. OBJECTIVE Stable provision of affordable quality Primary Health Care services with an expanded scope of services for selected vulnerable groups EXPECTED RESULTS 1. Women and children in 26 local communities in Palestine benefit from steady mother and child care, and safe motherhood groups are playing an active role in promoting the PHC program at the local community level.

2. An effective mechanism exists to transfer health knowledge to health professionals and to groups and individual beneficiaries in Palestine A/OT and among Palestinian refugees in the Diaspora.

3. People affected by Al-Aqsa Uprising and other patients in need benefit from regular Home Based Care provided by PRCS Community Health Teams in 26 local communities in Palestine A/OT. 4. PHC centers and their professional network

OBJECTIVELY VERIFIABLE INDICATORS

SOURCES OF VERIFICATION

- General health status of the Palestinian population.

- Statistics of Ministry of health and Palestinian Central Bureau of Statistics

# Of annual consultations at PHC centers

- PRCS annual reports

- Accessibility of health professionals to centers in Palestine improves

- Annual 10% increase in the number of women and children consulting at PRCS PHC centers - 26 active safe motherhood groups established & trained - 2 community activities organized by safe motherhood groups per month in each PHC center

- PRCS-PHC annual reports

- Funding is guaranteed

- 150 health professionals participate in one or more training sessions per year - 26 active Community Health Committees - 416 health education sessions carried out by the 26 PHC centers/month in Palestine - 99,840 persons benefit from health education sessions in Palestine/year - 34,566 Palestinian refugees benefit from health education sessions/year - 2 health education brochures are published each year - 2 youth summer camps/center (Lebanon) - 9360 home visits carried out per year in all 26 locations in Palestine - 52 health professionals participated in annual meetings to share experiences and present selected care plans - # Of volunteers registered on the

- Special annual report on PHC human resource development - PRCS-PHC annual reports - Logs /attendance sheets of participants in the health education sessions

PRCS Primary Health Care Program 2003-2005

- Samples of the published brochures - PRCS-PHC annual reports - Sample care plans - Home care log sheets

- PRCS-PHC annual reports Logical Framework

RISKS & ASSUMPTIONS

are capable of providing timely professional medical advice and medications to populations or families in crisis as a result of the current conflict in Palestine. 5. PHC centers are capable of providing essential routine diagnostic services to the served populations. ACTIVITIES 1.1 Training of 72 health professionals on woman & child health issues. 1.2 Establishment & training of 26 Safe Motherhood Groups 1.3 Carrying out 624 community activities/year focusing on woman & child health 2.1 Training of 150 health professionals on current health issues, communications, TOT. 2.2 Review of Community Health Committees membership & establish CHC for Leb. centers. 2.3 Annual Community Profiles (26 locations in Palestine + 9 in Lebanon= 35 centers). 2.4 Health education activities in 35 centers: - School Health: 1120 sessions/year - MCH: 1680 sessions/year - Chronic illnesses: 1680 sessions/year - HIV-Aids awareness: 420 sessions/year - CBFA courses: 140 course/year 2.5 Health education brochures: 70,000 copies/year (Palestine & Lebanon) 2.6 Youth summer camps (Lebanon): 18 camps 2.7 Micro-projects for 35 locations 3.1 Performing home visits: 9,360 (Palestine) 3.2 Hold the Home Care annual meeting: 52 participants 4.1 Recruitment & orientation of professional volunteers on Humanitarian Values & PRCS protocols. 4.2 170,000 medical consultations are carried out/year. 5.1 Diagnostic services are provided.

professional network - # Of persons receiving timely consultations and medicines during crisis situations - # Of laboratory investigations/year - # Of X-Rays carried out units/year MEANS - PRCS staff - Training - Transport - Communication means: Tel, fax, VHF, email - Incentives for volunteers - Hygiene kits - Essential MCH equipment for 26 centers - Printed materials - Computers & printers - Furniture for PHC centers - Stationary - Micro-projects - Replenish home care kits - Rent - CBFA training - Summer camps - Medicines - Medical supplies - Medical records - Laboratory kits - X-Ray supplies

PRCS Primary Health Care Program 2003-2005

- Dispensaries log sheets - Medical consultations log sheets

- PRCS-PHC annual reports - Lab & X-Ray log sheets COST (USD) Total: USD 5,646,484 1. Woman & child health: 133,624 2. Health education: 1,527,100 3. Home based care: 305,432 4. Professional network: 13,400 5. Communications: 31,200 6. Medicines & supplies: 460,200 7. Salaries (Palestine) 2,072,481 8. Salaries (Lebanon): 1,029,600 9. Equipment: 73,447

Logical Framework

PERCONDITIONS Political situation does not deteriorate, which may hinder implementation.

BUDGET (2003-2005) (See Budget for Appeal 2004)

No. 1.

2.

3. 4.

Description Training of 72 health professionals on Woman & Child Health issues: (65hrs. = 13days) a. Trainers’ Honoraria b. Catering c. Transportation d. Hall Rent e. Teaching Materials f. Audio Visual Aids Establishment & Training of 26 SMC: (7hrs/day/location) a. Trainers’ Honoraria b. Catering c. Transportation d. Teaching Materials e. Audio Visual Aids f. SMC Kits: Carrying out 624 community activities/year focusing on WCH: a. Community Events Training of 150 Health Professionals on current health issues, communication, TOT: (30hrs = 6days) a. Trainers’ Honoraria b. Catering c. Transportation d. Hall Rent e. Teaching Materials f. Audio Visual Aids

Estimated Cost (USD)

Total (USD) 34,024

35USD/hr x 65hrs/day x 4groups = 9,100 10USD/day x 72trainees x 13days = 9,360 12USD/day x 72trainees x 13days = 11,232 50USD/day x 13days x 4groups = 2,600 6USD/trainee x 72trainees = 432 1OHP x 25USD/day x 13days x 4groups = 1,300 30,160 35USD/hr x 7hrs/day x 1day x 26locations = 6,370 10USD/day x 10trainees/committee x 26SMC x 1day = 2,600 3USD/person x 260persons x 1day = 780 6USD/person x 260persons = 1,560 1OHP x 25USD/day x 1day x 26locations = 650 70USD/kit x 260kits = 18,200

PRCS Primary Health Care Program 2003-2005

37,440 30USD/event x 624events/year x 2years = 37,440 26,700 35USD/hr x 30hrs x 4groups = 4,200 10USD/day x 150trainees x 6days = 9,000 12USD/day x 150trainees x 6days = 10,800 50USD/day x 6days x 4groups = 1,200 6USD/trainee x 150trainees = 900 1OHP x 25USD/day x 6days x 4groups = 600

Logical Framework

No. 5.

Description Review of 26CHC membership in Palestine & establish 9CHC for Lebanon Centers: a. Gatherings 6. Annual Community Profile: 26locations in Palestine & 9locations in Lebanon (Implementation) a. Trainers’ Honoraria b. Per Diems c. Transportation d. Survey Packs: e. Data Analysis 7. Health Education Activities in 35centers 8. Health Education Brochures: (70,000copies/year) a. Production of Health Education Materials: 9. Youth Summer Camps in Lebanon: (18camps) a. Summer Camps including orientation, clothes, catering, transportation, stationary, gifts & rewards, etc… 10. Micro-projects in 35 locations: a. Micro-projects: 11. Performing 9360 Home Visits/year in 26 locations in Palestine: a. Home Visits:

Estimated Cost (USD)

Total (USD) 4,200

30USD/gathering x 2gatherings/year x 35CHC x 2years = 4,200 46,200 35USD/hr x 140hrs/year x 2years = 9,800 2teams x 35centers x 5USD/day x 10days/year x 2years = 7,000 5USD/day x 70persons x 10days/year x 2years = 7,000 2teams x 35centers x 10USD/pack/year x 2years = 1,400 60USD/hr. x 175hrs./year x 2years = 21,000 -

0 280,000

2USD/copy x 70,000copies/year x 2years = 280,000 288,000 8,000USD/camp x 18camps/year x 2years = 288,000 70,000 1,000USD/micro-project x 35micro-projects/year x 2years = 70,000 299,520 16USD/visit x 9360visits/year x 2years = 299,520

PRCS Primary Health Care Program 2003-2005

Logical Framework

No. Description 12. Hold Home Care Annual Meeting: a. Catering b. Transportation c. Hall Rent d. Teaching Materials: 13. Recruitment & Orientation of Professional Volunteers on Humanitarian Values & PRCS Protocols in Palestine: a. Per Diems regarding meeting: 14.

15. 16. 17. 18. 19.

b. Miscellaneous including Honoraria: Salaries in 26 PHC locations in Palestine: a. General Physicians: b. Lab Technicians: c. Nurses d. Social Workers Transportation of staff in 26 locations in Palestine (Extra Cost): a. Transport (10% of the salaries): Salaries in 9 PHC locations in Lebanon: a. General Physicians: b. Other Staff: Transportation of staff in 9 locations in Lebanon (Extra Cost): a. Transport (10% of the salaries): Communication Means: a. Communications: Hygiene Kits: a. Hygiene Kits:

Estimated Cost (USD)

Total (USD) 3,312

10USD/day/year x 52persons x 2years = 1,040 12USD/day/year x 52persons x 2years = 1,248 50USD/day/year x 2years x 4groups = 400 6USD/person/year x 52persons x 2years = 624 13,400 10volunteers/location x 26locations x 20USD/volunteer/meeting/year x 2years = 10,400 3,000 1,884,074.3 718.67USD/G.P./month x 26G.Ps x 24months = 448,450.08 575.17USD/lab.Tec./month x 26lab. Tec. X 24months = 358,906.08 575.17USD/nurse/month x 52nurses X 24months = 717,812.16 575.17USD/S.W/month x 26S.W X 24months = 358,906.08 188,407.43 188,407.43 936,000 400USD/G.P./month x 20G.Ps x 24months = 192,000 250USD/person/month x 124persons X 24months = 744,000 93,600 93,600 31,200 50USD/location/month x 26locations x 24months = 31,200

PRCS Primary Health Care Program 2003-2005

700,000 20USD/kit x 17500kits x 2years = 700,000

Logical Framework

No. Description 20. CBFA Training: a. CBFA Kits: b. Miscellaneous regarding CBFA Courses: 21. Essential Supplies for centers in Palestine: a. Medicines & Medical Supplies:

22. 23. 24. 25.

b. Lab Kits: c. X-Ray Supplies: d. Dental Supplies: e. Medical Records: Essential MCH Equipment: a. Ultrasounds for Qabatia & Deir Abu Mish’al: Replenish of Home Care Kits: a. Home Care Kits: Upgrading 2 Dental Units in Bedia & Salfeet: a. Dental Unit including x-ray & Dentistry Instruments: Upgrading Bani Na’im’s Diagnostic Equipment: a. Diagnostic & Lab Equipment: Grand Total:

Estimated Cost (USD)

Total (USD) 112,000

15USD/kit x 20kits/training x 140course/year x 2years = 84,000 100USD/course x 140course/year x 2years = 28,000 460,200 1,400USD/center/3months x 26centers x 4times/year x 2years = 291,200 500USD/center/3months x 26centers x 4times/year x 2years = 104,000 500USD/center/3months x 3centers x 4times/year x 2years = 12,000 500USD/center/3months x 11centers x 4times/year x 2years = 44,000 4,500USD/year x 2years = 9,000

PRCS Primary Health Care Program 2003-2005

32,000 16,000USD/device x 2Devices = 32,000 2,600 50USD/kit x 26kits x 2years = 2,600 40,000 20,000USD/device x 2Devices = 40,000 33,447.41 33,447.41 5,646,485.1

Logical Framework

Targeted group

Type of action

Number of sessions/groups per Year

Number of participants per Year

TOTAL

Women Children

Safe Motherhood groups

26 groups

School Health

1120 sessions

Youth summer camps in Lebanon. HIV-Aids awareness

18 camps

MCH

1680 sessions

Chronic illnesses

1680 sessions

Community activities

624 activity

CBFA courses

140 sessions

20 20 100 30 30 30 25 30 72

520 22,400 1800 12,600 50,400 50,400 16,050 4,200 72

5 170000 52

9,360 170,000 52 70,000 407,854

Woman& Child

Other

420 sessions

Training of health professionals on woman & child health issues. Performing home visits

9360 visit

medical consultations Hold the Home Care annual meeting Health education brochures

70000 brochures

TOTAL

PRCS Primary Health Care Program 2003-2005

Logical Framework