Bedouin Rural Health ProjectBedouin Rural Health ProjectImproving Access to health careImproving Access to health care

Reconciliation and Health Care Reconciliation and Health Care Workshop Workshop

Amman Amman

17-18th December 200817-18th December 2008

Fadia Hasna RN, PhDFadia Hasna RN, PhD

Bedouin Rural Health ProjectBedouin Rural Health Project

Funded by the European CommissionFunded by the European Commission

Framework 6 Programme -International Co-Framework 6 Programme -International Co-operation Programme (INCO-DEV)operation Programme (INCO-DEV)

With With 2-32-3 Third MemberThird Member Countries & Countries & 22 EuropeanEuropean or or AssociatedAssociated Countries Countries

Theme- health system reformTheme- health system reform

Bedouin Rural Health Project Bedouin Rural Health Project PartnersPartners

UK: University of Warwick (lead)UK: University of Warwick (lead)

University of OxfordUniversity of Oxford Jordan: The University of PhiladelphiaJordan: The University of Philadelphia Lebanon: American University of BeirutLebanon: American University of Beirut France: Cermes, InsermFrance: Cermes, Inserm Sweden: The University of Stockholm Sweden: The University of Stockholm

Bedouin Rural Health Project Aims Bedouin Rural Health Project Aims

Assess current health status, health seekingAssess current health status, health seeking behaviour and current health service provision (completed)behaviour and current health service provision (completed)

Elicit the views of stakeholders-policy makers, Elicit the views of stakeholders-policy makers, health personnel and Bedouin (completed)health personnel and Bedouin (completed)

Develop model interventions in partnership with Develop model interventions in partnership with stakeholders (in progress)stakeholders (in progress)

Evaluate and disseminate the interventionsEvaluate and disseminate the interventions locally, nationally, regionally and internationally locally, nationally, regionally and internationally

Strengths of Health ProvisionStrengths of Health Provision

• Northern Badia is a priority on political agenda.Northern Badia is a priority on political agenda.

Availability of health insuranceAvailability of health insurance

• Network of health centres at three different levels across a large Network of health centres at three different levels across a large rural arearural area

High coordination amongst MOH, Military and local institutesHigh coordination amongst MOH, Military and local institutes

• Availability of MOH databaseAvailability of MOH database

Challenges for Rural Health Challenges for Rural Health ProvisionProvision

Dispersed population, with some mobility Dispersed population, with some mobility

Prevalence Brucella due to livestock raisingPrevalence Brucella due to livestock raising

The need to balance the individual versus collective rights The need to balance the individual versus collective rights to healthto health

A young population with reproductive health needsA young population with reproductive health needs

An aging population with chronic disease.An aging population with chronic disease.

Typology of Challenges to Access to Health Care Typology of Challenges to Access to Health Care for Providers (for Providers (Arksey et al, 2004Arksey et al, 2004))

Professional CharacteristicsProfessional Characteristics

Service IssuesService Issues

Cultural Competence IssuesCultural Competence Issues

Characteristics of the PopulationCharacteristics of the Population

Information & Knowledge IssuesInformation & Knowledge Issues

ConcernsConcerns

Transport and DistanceTransport and Distance Quality of careQuality of care Emergency careEmergency care Childbirth provisionChildbirth provision Staff turnover and GenderStaff turnover and Gender Staff Knowledge of Bedouin lifestyle Staff Knowledge of Bedouin lifestyle

Expectations of the Rural Expectations of the Rural PopulationPopulation

Unrealistic and high expectationsUnrealistic and high expectations

Uneven understanding of health care systemUneven understanding of health care system

Focus on specialist care Focus on specialist care

Lack of regard for general practice or nursesLack of regard for general practice or nurses

Use of private doctorsUse of private doctors

Knowledge and respect for the Knowledge and respect for the lifestyle of Bedouinlifestyle of Bedouin

Some of the people from the cities don’t appreciate what a good culture they've got, and how well their culture suits their life style……

I tell westernized Arabs that we have to realize that we are here as their guests. When we go out to visit them we need to respect their culture, and I think that is one of the problems that builds a barrier between some of the city people …

The other people in Jordan and westerners don’t appreciate what a great culture they have, and we're not there to change their culture, we're there to help their needs (Policymaker).

Cultural Competence of providersCultural Competence of providers

The majority of Bedouins live in the desert. This type of Bedouin The majority of Bedouins live in the desert. This type of Bedouin is not interested in education, health or drinking water. The is not interested in education, health or drinking water. The Bedouin’s sole object is to stay with his herd, buy, sell and trade. Bedouin’s sole object is to stay with his herd, buy, sell and trade. He might ask his child to drop out from school and work as a He might ask his child to drop out from school and work as a shepherd. It does not matter for him if water is clean or unclean. shepherd. It does not matter for him if water is clean or unclean. (Policymaker)(Policymaker)

“When the Bedouin comes to the centre they stare at him and treat him differently. When the doctor comes to examine him, he won't even touch him. He just looks at him and then he tells him to go. They don't consider him human being although his conditions have made him like this. …They will say this is a Bedouin who's smelly, why do they say that? The Bedouin is a human being. “ (Bedouin man)

Cultural Competence and Cultural Competence and Communication SkillsCommunication Skills

“I say that if there is something missing in our staff it is the skill of communication. I always stress the importance of communication skills. It is important that when you work in an area you understand the culture. It is important that he speaks the same dialect of the people of the area. It is important to deal with them in the way they like” (Policymaker)

Providers’ ViewsProviders’ Views

“Parents have no trust in nursing; they don't trust us at all, even though all we do is First Aid before the doctor comes. They keep asking us what are we doing, what medicine we gave, and what effect it has on the patient” (Nurse).

“When some patients come to see a gynaecologist or paediatrician, the nurse comes to take care of the case until the doctor arrives. But people insist that the doctor should see them first. They only want the doctor. In the end they go to a private doctor, then take the medicine and leave”. (Nurse)

Model Intervention 1.Model Intervention 1.Professional training Professional training

Bedouin Health ModuleBedouin Health ModulePrepared byPrepared by

Dr. Fadia HasnaDr. Fadia Hasna

Philadelphia University, Faculty of NursingPhiladelphia University, Faculty of Nursing

Dr. Mohammad Al-SmairanDr. Mohammad Al-Smairan

Jordan Badia Research and Development CentreJordan Badia Research and Development Centre

BackgroundBackground This Bedouin Health module utilizes findings of This Bedouin Health module utilizes findings of

the data collected in Northern Badia during the the data collected in Northern Badia during the years 2007-2008 with policy makers, health years 2007-2008 with policy makers, health providers in Northern Badia, and Bedouin men providers in Northern Badia, and Bedouin men and women and women

Aim: Aim: To sensitize nursing, social work and medical To sensitize nursing, social work and medical

students to the Bedouin culture and health needs students to the Bedouin culture and health needs in Northern Badia of Jordan making them more in Northern Badia of Jordan making them more aware and culturally sensitive to this local aware and culturally sensitive to this local population’s health, economic and psycho-social population’s health, economic and psycho-social needsneeds

OutlineOutline

Structure – Structure – 6 class room based sessions combined with a number 6 class room based sessions combined with a number

of field visitsof field visitsDelivered to nursing and social work students 2008Delivered to nursing and social work students 2008

Course UnitsCourse UnitsUnit 1: The Badia Unit 1: The Badia Unit 2: Population and socio economic conditionsUnit 2: Population and socio economic conditionsUnit 3: Determinants of Health in the North BadiaUnit 3: Determinants of Health in the North BadiaUnit 4: Health ServicesUnit 4: Health ServicesUnit 5: Role of women in Health PromotionUnit 5: Role of women in Health PromotionUnit 6: Possible ways forwardUnit 6: Possible ways forward

Framework for EvaluationFramework for Evaluation

Pre and Post Test Pre and Post Test Focus Groups with nursing and social work Focus Groups with nursing and social work

students as well as the faculty staff who students as well as the faculty staff who were involvedwere involved

This pilot intervention to be transferable to This pilot intervention to be transferable to local universities (Al Hashemieh and Al local universities (Al Hashemieh and Al Bayt, Faculties of Nursing)Bayt, Faculties of Nursing)

Other Possible Project Interventions Other Possible Project Interventions

Recruitment drive of Jordanian Nursing Association in Recruitment drive of Jordanian Nursing Association in schools in Northeast Badiaschools in Northeast Badia

Training Bedouin staff – scholarships for Bedouin nursesTraining Bedouin staff – scholarships for Bedouin nurses

Orientation training for staff in clinics in the Northeast Orientation training for staff in clinics in the Northeast BadiaBadia

More Health promotion in schools as well as in the clinics More Health promotion in schools as well as in the clinics on particular issueson particular issues