The Royal Health Awareness Society (RHAS), a Jordanian non-governmental organization, commits to scaling its Healthy Community Clinic (HCC) program to 12 comprehensive centers across Jordan to serve Syrian refugees in host communities, as well as vulnerable Jordanians. The new centers will focus on Jordanian districts with high levels of poverty and which are also host communities of Syrian refugees. The scale up will enable RHAS to impact 4,000 persons with high risk of NCDs as well as patients, at least 40% of whom are refugees, helping them to monitor their situation and decrease complications. RHAS will focus on gender balance, ensuring that women enroll in the program. This scaling will complement the extension of national health care options for Syrian refugees, and support Jordans 2015 National Response Plan which identifies NCDs management as one of its top priorities.
Established within existing Ministry of Health (MoH) centers, HCC will provide MoH medical practitioners with training and resources necessary to implement prevention-based care to the population who are most at risk to prevent the incidence of NCDs amongst them, as well as to NCDs patients in host communities, empowering them to manage and control their diseases. RHAS will offer the training to approximately five medical practitioners per center, focusing on preventive health awareness using RHASs developed material. The trained practitioners will then give interactive awareness sessions to patients addressing NCD areas of priority (e.g. cardiovascular diseases, diabetes, and cancer) while encouraging healthy diet plans, exercise and smoking cessation. RHAS will provide medical supplies for running tests necessary to monitor patients progress. RHAS will also work to institutionally strengthen the referral system of patients within the center through introducing an electronic database to track patients medical records.
This approach is cost effective for the patients and government, as prescribed medications and follow up visits significantly decrease due to the adoption of healthy lifestyles. RHAS has implemented the HCC in six centers across three Jordanian governorates, benefitting over 2,000 people with a specific focus on women. The successful track record of improved patient results positions RHAS well to expand the program in four new governorates where refugees and Jordanians are underserved.
RHAS has partnered with MoH to identify needs and priorities of health centers and provide access to the centers facilities and staff. RHAS has partners to leverage financial and in kind support for HCC activities (e.g. Americares), as well as NGOs working with refugees (i.e. MdM) to enhance refugees referral to the HCC nearest to them.
Over a period of 12 months, each center will implement the following activities throughout the commitment duration of two years. As operations at each center will start and end during a different month, the exact timing will depend on financial resources and allocations secured.
Months 1-3: Clinic preparations: Establish an equipped seminar/training room within MoH centers for the awareness sessions, equip the center with adequate medical supplies used for testing patients with NCDs, as well as produce all related awareness and educational materials for both patients and medical staff.
Month 4: Capacity building and training for MoH center medical staff by RHAS experts in which a 6 day training program will run at the center for nurses and doctors to cover both preventive awareness related to NCDs, as well as facilitation, coaching, and presentation skills.
Months 4-12: Publish awareness material within MoH medical centers receiving the patients. This material is both printed and visual, and continues to be available at the center facility for any visiting patient.
Months 5-12: Provide a number of awareness sessions around NCDs and patient self management to patients with NCDs in addition to providing them with means of reducing complications through healthier diet plans, counselling sessions and encouraging physical activity.
Since 2012 and the start of the Syrian war, the Government of Jordan has offered Syrian refugees access to health care services in Ministry of Health (MoH) centers and hospitals as part of its efforts to provide services and safety provision for refugees within its territories. As the number of refugees increases, limited resources and infrastructure pose a major challenge. According to the United Nations High Commissioner of Refugees (UNHCR), approximately 80% (750,000) of Syrian refugees reside in host communities across Jordan. National health care clinics and hospitals, mainly in the North, are running well beyond capacity as a result of the influx of refugee patients, continuously struggling to accommodate thousands of additional consultations, admissions, operations, and deliveries. At the same time, Jordanians seeking health care have to cope with the resulting congestion and longer wait times.
Non-Communicable Diseases (NCDs), such as diabetes, hypertension, cardiovascular diseases, and cancer, are becoming an increasing problem: over the last century, there has been a dramatic shift in the prevalence from acute to chronic diseases. By 2020, worldwide deaths from chronic disease are projected to total more than twice the number of deaths from infectious disease (50 million vs. 20 million). By 2020, it is also predicted that NCDs will account for 80% of the global burden of disease, causing 7 out of every 10 deaths in developing countries. The challenge of chronic disease falls on all nations regardless of national wealth or health system models. Jordan is no exception, as a World Health Organization (WHO) report indicates that NCDs accounted for 76% of deaths in 2014, let alone the high expenditure on health care costing more than $840 million annually.
Similarly, the health profile of Syrian refugees is that of a country undergoing an epidemiological transition to a high burden of NCDs. For example, according to the United Nations 2014 and 2015 Syrian Regional Response Plan, 12% of Syrians suffer from diabetes mellitus and 30% suffer of hypertension, a high proportion which indicates an unmet need to tackle NCDs among the Syrian refugee population, particularly among refugees residing outside camps where immediate, curative needs have not been met.
NCD management in Jordan for refugees has been insufficient due to a lack of adequate monitoring, treatment interruption, and the failure to provide patients with a multidisciplinary approach. Due to the continuous influx of refugee and asylum-seekers, investment in host communities health services is critical. The similar NCD profile among Jordanians and Syrian refugees presents a unique opportunity to concurrently build capacity within the national health care system to address NCD diagnosis and management in local vulnerable populations and refugee populations.