Updates

10 Year Evaluation 2012 - 2022

REPORT: 10 year evaluation of FFMP work Links to PDF

  • The transformation of primary healthcare systems worldwide requires policy, systems, and structural changes to achieve adequate universal health coverage. Family Health Care (FHC) presents a viable solution to address these challenges by delivering high-quality, continuous, and comprehensive care services centred around patients and families. The Palestinian Ministry of Health (MoH) and the United Nations Relief Works Agency (UNRWA) in the West Bank have expressed their commitment to implementing the necessary transformations towards FHC.

    Since 2012, the Foundation for Family Medicine (FFMP) in Palestine and the Medical Aid for Palestinians (FFMP/MAP) have collaborated with key stakeholders to provide expertise, mentorship, and support for the development of FHC in the West Bank. Their efforts have included advising, training, and providing academic support to the Family Medicine (FM) training programme at An-Najah University [1]. Additionally, the FFMP/MAP has been engaged with the Palestinian Health Authorities to ensure ongoing commitment and leadership for the integration of FHC and the required structural and administrative reforms within the health systems.

    After nearly a decade of progress, the FFMP and MAP commissioned an independent evaluation to assess the achievements in developing FM/FHC in the West Bank and to inform, evidence-based future planning. The evaluation aims to accomplish three primary objectives. Firstly, it aims to provide insights into the nature and extent of FHC implementation in the West Bank. Secondly, it seeks to identify the factors and initiatives that have facilitated successful development and implementation of FHC, as well as those that have hindered progress. Lastly, the evaluation aims to inform decisions for improving the strategy and coordination between the FFMP/MAP and key stakeholders.

    The evaluation's main objectives are as follows:

    1. Mapping the development and implementation of FHC in the West Bank since 2010.

    2. Identifying examples of "good practice" that support FHC principles at the structural, individual, and contextual levels (including policy and strategy).

    3. Cataloguing and describing the activities undertaken by the FFMP/MAP to support the development and implementation of FHC in the West Bank.

    4. Highlighting the strengths and weaknesses of the FFMP/MAP's strategy and actions in promoting FHC in the region.

    5. Developing recommendations and options to guide future work by the FFMP/MAP and other stakeholders.

    To conduct the evaluation, a team of national evaluation consultants was selected through an open competition and contracted from June 1, 2022 to end April, 2023. The evaluation focused on the developments in FHC that had taken place at three levels: policy and infrastructural support at the Ministry of Health, interactions within the districts and clinics with the environment, physical infrastructure, and market systems that impact the delivery of FHC-based primary care, and individual changes. Implementation of the Seven pillars of FHC in Palestine was a key interest in considering changes at district and clinical levels [2].

    The evaluation team employed system thinking concepts to identify key stakeholders and the mechanics of the transition to FHC. The team also drew on the concepts of Outcome Harvesting (OH) methodology [3] as it is particularly suited to initiatives like the MoH's implementation of FHC that are situated in complex settings with multiple partners and stakeholders, and where the pathway to achieving ultimate goals may not be clear. However, a less participatory-intensive version of OH was employed to assess progress and achievements given stakeholders’ and clinical staff’s limited availability and the complexity of the Palestinian context.

    Data were collected from various categories of staff trained in FHC principles, including FM specialists, nurses, other health professionals and administrators, working in both MoH-managed PHC and FHC centres and UNRWA PHC centres. Equally, semi-structured interviews were conducted with key informants from various organisations, including the Ministry of Health (MoH), United Nations Relief Works Agency (UNRWA), Palestinian National Institute of Public Health, WHO Regional Office, Juzoor, the Palestinian Medical Council, An-Najah University, and the European Investment Bank (donor

    To gather first-hand information about experiences and perspectives in the clinics, a sample of eight clinics was selected for visits. The selection criteria included geographical location (six districts were retained covering the north, centre, and south of the West Bank), PHC clinics where staff had little/no FHC training, and FHC clinics where many of the staff had received FHC training. During these visits, the team observed the activities and organisation of the clinics and conducted open-ended interviews with the clinical staff, administrators and patients present on that day. The ET then followed up with interviews of key staff in the relevant district health authorities.

    Two surveys were conducted electronically to follow up on themes emerging from the visits. The first was administered to Family Medicine (FM) practitioners working in MoH clinics, while the second survey targeted the PHC teams that had participated in the FHC Transitional Training Programme. Key documents were also reviewed to gather initial information and validate the qualitative data collected through interviews. The interview data were analysed and coded based on emerging themes, and outcome statements were formulated using all the data collected. Ten outcome statements were ultimately retained for the report.

    Before outlining the main findings and conclusions, it is important to set the study in context. The internal
    fragmentation and military occupation imposed by Israel produce many obstacles such as limited resources, lack of availability of specific treatments, restrictions on geographical movement, and frequent violent conflicts, all of which had significant consequences on both data collection and outcomes. These
    conditions not only constrain the system and potential changes but also exacerbate the physical and
    mental health of the Palestinians. Therefore, the findings and progress should be understood within these limitations. Throughout the main study phase (September 2022 to March 2023), there were several escalation episodes, with the Israeli army conducting operations in different locations in the West Bank, resulting in injuries and fatalities. The MoH announced an emergency situation, and strike actions occurred due to new union directives on job tasks. Various health worker unions made decisions regarding the tasks their members should or should not perform. For example, nurses were instructed not to engage in case registration or provide prescribed medications, including repeat prescriptions for non- communicable diseases and chronic patients. Pharmacists and their assistants were advised not to collect patients' contributions to medication costs or manage cash, among other restrictions. While the strike actions did not affect the MoH clinics in main centres and cities due to sufficient staffing, small clinics faced challenges implementing union decisions, and staff resorted to strike actions.

    1. The An Najah FM residency programme was launched in 2010 and was the first to offer an FM, academic training programme.

    2. The Seven pillars of FHC in Palestine model was developed by FFMP/MAP in collaboration with the MoH and other stakeholders.

    3. https://outcomeharvesting.net/outcome-harvesting-traditional-vs-oh

Archive

  • General News
    • The MAP Board approved funding to cover the ongoing MAP/FFMP support for the development of family medicine (FM) and family health care (FHC) in Palestine for 2023 and 2024
    • The final report of a formal evaluation of the development of FM and FHC in Palestine, and MAP/FFMP’s contribution to that development over the past 10 years, will be available soon
    FM Residency Programme
    • Five residents are approaching their Board exams
    • There are another 35 residents at varying stages of the programme
    • It is hoped that another cohort of residents will be supported by the MoH this year
    • Our direct financial support for An Najah National University (ANNU) Faculty of Family and Community Medicine has ended, as have our scholarships for FM residents
    • There will be an increased focus on training and mentoring the clinical supervisors (MoH and other) for the residents during their primary health care (PHC) placements, with opportunities for the greater involvement of our volunteer network
    • The MoH has recommended 11 PHC centres, distributed throughout the West Bank, be designated as FM training centres by the Palestine Medical Council (PMC). The PMC has already accredited some and the process of accreditation is ongoing. Each of these centres has at least one Board certified FM specialist working there
    Transitional Training Programme (TTP)
    • In the latest rollout of the TTP, managed by Juzoor and funded by the Italian Cooperation (IC), 93% of PHC workers completed the full course within the three targeted districts
    • Feedback has been extremely positive, with the results of a formal evaluation to follow over the coming weeks
    • The full online course is now available on the MoH managed Moodle platform
    • Further work is planned to customise the TTP for different professional groups and improve the pre/post module quizzes
    • Some funding is available within the MAP budget to rollout the TTP to another district or two this year, with another grant application to the IC also planned to secure the significant funding required to cover the rest of the West Bank and then Gaza
    FHC Strategy/Systems Development
    • The MoH leadership team for FM and FHC has changed recently. Dr Beesan is no longer at the MoH, with the team now composed of Drs Imad, Rana and Elaf
    • We are working with the MoH, supporting their planned development of a more detailed strategy for FM/FHC, complete with an operational plan, budget and framework for M+E – the re-establishment of a National Committee, chaired by the MoH and with representatives from all relevant stakeholders, is key to this process
    • 15 FM specialists, selected by the MoH and including Drs Beesan, Rana and Elaf, have been provided with discounted international affiliate membership by the RCGP; giving them access to the College’s full array of journals and online educational resources. The group will also meet on a quarterly basis to provide peer support and discuss material
    • Six FM specialists, four funded by MAP and two self-funded and including Drs Beesan, Suha and Rana, have been granted places on Toronto University’s International Programme to Strengthen FM and PHC. Toronto is a WHO Collaborating Centre and this series of online sessions provides wonderful educational and networking opportunities, with participants from all over the world
    Academic Network of Medical Schools
    • Under the leadership of the Ministry of Higher Education (MoHE), we have met online with representatives from the seven medical schools in Palestine (five in the West Bank and two in Gaza) to discuss current models for the undergraduate teaching of FM and FHC, the challenges faced, the possibility of working with them to develop a shared framework for the evolution of this teaching and ultimately how we might support relevant faculty members within these medical schools
    • This could also become a major piece of work for our network of volunteers
    Palestine Association of Family Medicine (PAFM)
    • MAP and FFMP continue to support the development of PAFM’s website and delivery of a series of webinars, as well as planning future competitive scholarships
    • We’ll share the webinar topics and timetable as soon as we have it, together with a request for help!
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  • Dear Friends and Supporters:


    Trustees have met together for the first time without our founding chief executive, Paul Wallace. We agreed to send round this Newsletter to update all those interested in our programme and to outline some possibilities for our work moving forward again later this year.

    General News
    • As a result of the war in Gaza and volatile security situation in the West Bank, no missions have been conducted since summer 2023 and MAP funding for our family medicine/family health care (FM/FHC) programme has been temporarily suspended while they focus all their attention on addressing the humanitarian emergency.
    • Elements of the FM programme are still continuing despite all the obstacles and there is an on-going demand for our support judging from our conversations with key counterparts in the West Bank
    • A new scoping mission is now planned for the end of August 2024, to deliver some Non-Communicable Disease (NCD) training workshops for Ministry of Health (MoH) FM specialists, residents and GPs and meet as many of our former partners as possible to plan a new phase of our work.
    • We are, of course, still reeling from the death of Paul Wallace, founder of FFMP, in late February this year. His wisdom, passion and incredible commitment were the driving force for this programme and we will try our very best to honour his legacy.
    FM Residency Programme
    • An Najah National University (ANNU) has continued to manage the residency programme, despite huge disruption and uncertainty and the need to deliver much of the academic sessions online.
    • The MoH has appointed an, as yet, unknown number of new residents to the programme this year.
    • There has been no further progress with the Palestine Medical Council (PMC) accreditation of FM/FHC training centres in the West Bank, nor with supervision arrangements for FM residents within MoH Primary Health Care (PHC) clinics.
    Transitional Training Programme (TTP)
    • With ongoing support by David Jewell, Shameq Sayeed and a dedicated, part-time MAP staff member based in Ramallah, the TTP was successfully rolled-out to Bethlehem and Ramallah districts, targeting a total of 12 MoH and two UNRWA PHC clinics – a remarkable achievement in the circumstances and testament to the genuine interest in the programme by primary care staff. Participants have until the end of May 2024 to complete the programme, with evaluation of this phase to be conducted in June 2024.
    • A customised programme, with core/optional modules for doctors, nurses, pharmacists, technicians and administrative staff, will be finalised by FFMP by the end of June 2024, with content on the MoH Moodle platform subsequently updated.
    • With support from MAP and/or other donors/partners we then hope to roll the programme out to the rest of the West Bank and into Gaza.
    FHC Strategy/Systems Development
    • Unsurprisingly, the MoH has not made any further progress in finalising and implementing the draft MoH FM/FHC strategy for 2023-27. This is one of many issues to be discussed with the MoH in person during the planned August mission.
    Academic Network of Medical Schools
    • It has not been possible to progress the work, led by Amanda Howe, to support interested medical schools in the West Bank and Gaza in a review/revision of the undergraduate curriculum; particularly the FM/FHC components. Again we hope to meet West Bank representatives of this network during the planned August mission.
    • Our practical contribution to undergraduate FM education in Palestine began with a highly successful, online, interactive child health case study for 5th year students at Al Quds university in August 2023. We hope to deliver this session again this year and expand the number/range of case studies, initially in collaboration with Al Quds and Hebron universities, but ultimately offering the resource to all interested medical schools in Palestine.
    Palestine Association of Family Medicine (PAFM)
    • As a consequence of MAP’s re-focussed priorities, funding has ceased for Suha Hamshari’s (President of PAFM) administrative assistant, who was responsible for developing their website, routine communication with members and planning of the webinars. We are considering how we can help restore this funding.
    • The planned online tutorial/mentoring groups for FM residents/specialists and ToT workshops for those supervising FM residents have not been able currently to proceed. Both these initiatives were to be co-facilitated by PAFM members and UK/US FM specialists.
    • Prior to October 2023 we had secured funding/support from WHO Jerusalem and RCGP International to deliver a series of ToT workshops in the West Bank. This initiative is on hold until the security situation in the region improves.
    • We also hope to resurrect our plan to co-present a series of webinars for FM specialists and residents in the West Bank and Gaza later this year.

    Trustees appreciate the concern and support of the many friends and supporters of FFMP and the work of Enlighten and related website supported by Therese ZinK
    Foundation for FM Palestine