Summary Report | Public Health Centres Syrian Arab ... · (Health Resources & services Availability...
Transcript of Summary Report | Public Health Centres Syrian Arab ... · (Health Resources & services Availability...
This is to acknowledge that the data provided in this report is a product of joint collaboration between the World Health
Organization and Ministry of Health in the Syrian Arab Republic. The report covers the third quarter of 2015.
HeRAMS Summary Report | Public Health Centres Syrian Arab Republic
2015 3rd Quarter
HeRAMS| Public Health Centres Reports, July to September 2015 Page 1 of 29
Contents
Exceutive Sumamry ................................................................................................................................. 2
1. Completeness of reporting ............................................................................................................. 4
2. Functionality Status ........................................................................................................................ 5
3. Accessibility Status .......................................................................................................................... 7
4. Infrasturctual Patterns .................................................................................................................... 9
4.1 Condition of the building ........................................................................................................ 9
4.2 Water sources and functionality status ................................................................................ 11
4.3 Availability of electricity generators ..................................................................................... 12
4.4 Availability of Refrigerators .................................................................................................. 13
5. Availability of Health Human Resources ....................................................................................... 14
6. Availability of Health Services ....................................................................................................... 16
6.1 General Clinical services........................................................................................................ 18
6.2 Emergency services ............................................................................................................... 19
6.3 Child Health ........................................................................................................................... 20
6.4 Nutrition ................................................................................................................................ 21
6.5 Sexual & Reproductive Health .............................................................................................. 22
6.6 Non Communicable Diseases (NCDs) .................................................................................... 25
6.7 Mental health care ................................................................................................................ 25
7. Availability of Medical Equipment ................................................................................................ 26
8. Availability of Priority Medicines .................................................................................................. 28
HeRAMS| Public Health Centres Reports, July to September 2015 Page 2 of 29
Exceutive Sumamry
Regular assessments to monitor the impact of the crisis on the health facilities functionality,
accessibility, condition status, availability of resources and services, are conducted using HeRAMS
(Health Resources & services Availability Mapping System) tool.
This report provides descriptive analysis of the situation of the public health centres of MoH
(Ministry of Health), from all 14 governorates of Syria, during the 3rd Quarter 2015. The total
assessed health centres in the 3rd Quarter 2015 is 1,783.
Completeness of Centre's reporting
The completeness of reporting of health centres has increased in the 3rd Quarter to reach 97%,
compared to 96% at the end of 2nd Quarter.
Functionality status of the health centres
By end of the 3rd Quarter 2015 and out of 1,783 assessed public health centres, 46% (824) were
reported fully functioning, 25% (438) partially functioning, 26% (468) non-functioning (completely
out of service), while the functionality status of 3% (53) of health centres were unknown.
Accessibility status
By end of the 3rd Quarter 2015, 76% (1,359) health centres were reported accessible, 1% (19) hard-
to-access, and 22% (382) were inaccessible, while the accessibility status of 1% (23) health centres
were unknown.
Infrastructure of Health Centres
By end of the 3rd Quarter 2015, 23% (410) health centres were reported damaged [6% fully
damaged and 17% partially damaged], 66% (1,173) of public health centres were reported intact,
while the building’s condition of 11% (200) health centres were unknown.
Assessing the availability of water sources at functional public centres indicated that 84% (1,055) are
using main pipelines, 2% (31) are mainly using wells, while 7% (90) are using both (main pipeline and
well).
Availability of electricity generators and refrigerators were monitored at health centres’ level. Gaps
were observed in many governorates.
Human Resources
By end of the 3rd Quarter 2015, the proportions of different categories of health staff among the
total functional (fully and partially) health centres (1,262 /1,783), remained almost the same as 2nd
Quarter 2015. The resident doctors represented (1%) of total health staff at centres’ level, followed
by general practitioners (4%); pharmacists (4%); laboratory (7%); specialists (8%); dentists (10%);
midwives (11%); and nurses (55%).
HeRAMS| Public Health Centres Reports, July to September 2015 Page 3 of 29
Availability of Health Services
The availability of core health services is monitored through HeRAMS at health centre’s level,
considering a standard list of health services [includes: General Clinical and Emergency Services,
Child Health, Nutrition, Sexual & Reproductive Health, Non-communicable Diseases and Mental
Health].
As a result of disrupted healthcare delivery, limited provision of many health services, even within
the functional health centres were observed.
Availability of Medical Equipment
Analysis of availability of essential equipment has been measured across all functioning health
centres [fully and partially functioning] (1,262 /1,783), in terms of functional equipment out of the
total available equipment in the health centre. The produced analysis provides good indication of
the current readiness of the health centres to provide the health services, and also to guide focused
planning for procurement and distribution of equipment and machines, to fill-in identified gaps that
were observe even within the functional health centres.
Availability of Priority Medicines
Availability of medicines and consumables at health centres’ level has been evaluated based on a
standard list of identified priority medicines and medical supplies for duration of one quarter. Gaps
of medicines and medical supplies are identified even within the functional health centres (i.e., gap
of 75% gap of Anti-diabetic preparations, 68% of Cardiac and /or Vascular Drugs, 61% of Antibiotics,
52% of Anti-allergic including Steroids, 50% of ORS, and 38% of Antiseptics).
HeRAMS| Public Health Centres Reports, July to September 2015 Page 4 of 29
1. Completeness of reporting
The completeness of reporting of health centres has
increased in the 3rd Quarter to reach 97%, compared to 96%
at the end of 2nd Quarter, due to slight improvement of
reporting from Idleb governorate [Figure 1].
The total assessed health centres in the 3rd Quarter 2015 is
1,783.
The classification of health centres (1,783) per type is
presented in [Figure 2], of which the majority is Primary
Healthcare Centres (85%), followed by medical points (8%),
specialized centres (5%), and comprehensive/ polyclinics
(2%).
The levels of completeness of reporting of health centres at
governorate level are presented in [Figure 3]. Out of a total
reported 1,730 health centre, 1,464 (85%) are PHC centres.
The security escalations and accessibility remain a key
challenge for completeness of reporting; the main gap of
reporting is observed in Idleb (32%), while minor gaps were
in Hama (4%), Rural Damascus (3%), and Aleppo (1%).
Figure 3: Completeness of reporting of health centres at governorate level, 3rd
Quarter 2015
The following sections provide descriptive and trend analysis on the functionality status,
accessibility, and infrastructure of the public health centres, availability of resources & services, and
available equipment and medicines by end of the 3rd Quarter 2015.
The provided analysis supports informed decision making, better planning and allocation of
resources, and contributes to significant and focused humanitarian response by WHO and health
sector partners.
227 222
181 169 165
116 114 103 103 97 93
73 61 59
224 221
175 162 165
116
78
103 103 97 93
73 61 59
0
50
100
150
200
250
Aleppo Homs RuralDamascus
Hama Tartous Lattakia Idleb Deir-ez-Zor Dar'a Al-Hasakeh As-Sweida Ar-Raqqa Damascus Quneitra
Total Centres Total Reported
Comprehensive Clinic 2%
(43)
Specialized Centre 5%
(85)
Medical Point 8%
(141)
Primary Health Care Centre, 85%
(1,514)
Figure 2: Classification of centres
Reported 97%
(1730)
Gap; 3% (53)
Figure 1: Completeness of Reporting- Q3 2015
HeRAMS| Public Health Centres Reports, July to September 2015 Page 5 of 29
2. Functionality Status
Functionality of the health centres has been
defined and assessed at three levels;
Fully Functioning: a health centre is open,
accessible, and provides healthcare services
with full capacity (i.e., staffing, equipment,
and infrastructure).
Partially functioning: a health centre is open
and provides healthcare services, but with
limited capacity (i.e., either shortage of
staffing, equipment, or damage in
infrastructure).
Not functioning: a health centre is out of service, because it is either fully damaged,
inaccessible, no available staff, or no equipment.
By end of the 3rd Quarter 2015 and out of 1,783 assessed public health centres, 46% (824) were
reported fully functioning, 25% (438) partially functioning, 26% (468) non-functioning
(completely out of service), while the functionality status of 3% (53) of health centres were
unknown [Figure 4].
Detailed analysis on the functionality status of the health centres at governorate level is shown
in [Figure 5] and [Map 1].
Figure 5: Functionality status of health centres per governorate, 3rd
Quarter 2015
165
87
104
51
118
147
28
76
18
11
12
3
3
1
0
4
3
1
24
30
3
39
61
41
103
66
45
18
0
2
9
9
20
44
28
60
24
45
109
34
30
54
0
0
0
0
7
1
0
6
0
0
3
0
36
0
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Tartous
As-Sweida
Lattakia
Damascus
Hama
Homs
Quneitra
Rural Damascus
Dar'a
Al-Hasakeh
Aleppo
Deir-ez-Zor
Idleb
Ar-Raqqa
Fully Functioning Partially Functioning Non-functioning No Report
Fully Functioning 46% (824)
Partially Functioning 25% (438)
Non-functioning 26% (468)
No Report 3% (53)
Figure 4: Functionality Status- Q3 2015
HeRAMS| Public Health Centres Reports, July to September 2015 Page 6 of 29
Map 1: Functionality status of the public health centres, 3rd
Quarter 2015
The number of non-functioning health centres increased slightly from 464 to 468 (between 2nd
Quarter and 3rd Quarter of 2015). During the same period, the number of partially functioning
centres has increased from 411 to 438 [Figure 6], where the functionality status of many health
centres has changed from fully functioning to partially functioning in the 3rd Quarter 2015 as a direct
impact of deteriorating security situation. Improvement of completeness of reporting (particularly in
Idleb), resulted in increased number of health centres reported as partially functioning, which was
un-known during the 2nd Quarter 2015.
Figure 6: Trend analysis of functionality status, between 1st
Quarter 2014 and 3rd
Quarter 2015
876 887 857 862 832 836 824
291
376
374
466
392 411
438
161
311
387
385
419 464 468
416
170 132
63 134
72 53 0
100
200
300
400
500
600
700
800
900
1000
Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015
Fully Functioning Partially Functioning Non-functioning No Report
HeRAMS| Public Health Centres Reports, July to September 2015 Page 7 of 29
3. Accessibility Status
Accessibility to health centres is defined at three levels:
Accessible: a health centre is easily accessible for
patients and health staff.
Hard-to-reach: a health centre is hardly reached,
due to security situation or long distance.
Inaccessible: a health centre is not accessible
because of the security situation, or a centre is
accessible only to a small fraction of the population,
or military people (inaccessible to civilians).
By end of the 3rd Quarter 2015, 76% (1,359) health centres were reported accessible, 1% (19)
hard-to-access, and 22% (382) were inaccessible, while the accessibility status of 1% (23) health
centres were unknown [Figure 7].
Detailed analysis on the accessibility status of the health centres at governorate level is presented in
[Figure 8] and [Map 2].
Figure 8: Accessibility status of the health centres per governorate, 3rd
Quarter 2015
165
90
107
66
52
141
85
175
77
78
119
59
31
114
0
1
0
0
0
2
1
3
2
0
1
4
0
5
0
2
9
7
9
26
17
44
24
16
60
34
28
106
0
0
0
0
0
0
0
0
0
20
1
0
0
2
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Tartous
As-Sweida
Lattakia
Ar-Raqqa
Damascus
Hama
Deir-ez-Zor
Homs
Dar'a
Idleb
Rural Damascus
Al-Hasakeh
Quneitra
Aleppo
Yes Hard to access No No Report
Yes 76% (1,359)
Hard to access 1%
(19)
No 22% (382)
No Report 1% (23)
Figure 7: Accessibility status- Q3 2015
HeRAMS| Public Health Centres Reports, July to September 2015 Page 8 of 29
The trend analysis of accessibility status of health centres from 1st Quarter 2014 to 3rd Quarter
2015 is presented in Figure 9.
Figure 9: Trend analysis of accessibility status of health centres between 1st
Quarter 2014 and 3rd
Quarter
2015
The number of inaccessible health centres declined slightly from 385 to 382 (between end of 2nd
Quarter and end of 3rd Quarter 2015).
Map 2: Acecssibility to public health centres , 3rd
Quarter 2015
1162
1374 1396 1397 1266
1348 1359
0 0 7
5 13 12 19
208
324 342 342 478
385 382 374
46
5
32 20 38 23 0
200
400
600
800
1000
1200
1400
1600
Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015
Yes Hard to access No No Report
HeRAMS| Public Health Centres Reports, July to September 2015 Page 9 of 29
4. Infrasturctual Patterns
The following sub-sections provide analysis on infrastructural patterns of health centres, including
building’s condition, water sources, avalability of electricity generators, and availability of
refrigrators.
4.1 Condition of the building
The level of damage to health centres’ buildings was
measured at three levels:
Fully damaged: either, all the building is
destroyed, about 75% or more of the building is
destroyed, or damage of the essential services’
buildings.
Partially damaged: part of the building is
damaged.
Intact: there is no damage in the building.
Analysis of the level of damage provides good
indication on the potential costs for reconstruction.
By end of the 3rd Quarter 2015, 23% (410) health centres were reported damaged [6% fully damaged
and 17% partially damaged], 66% (1,173) were reported intact, while the building’s condition of 11%
(200) health centres were unknown [Figure 10].
The completeness of reporting level of damage of health centres has increased slightly in the 3rd
Quarter to reach 89%, compared to 88% at the end of 2nd Quarter 2015.
Key gaps on reporting the level of damage of the health centres are observed in Quneitra 44%
(26/59), Aleppo 32% (72/227) and Idleb 30% (34/114).
Detailed analysis of the damage status of te health centres at governorate level is presented in
[Figure 11] and [Map 3].
Figure 11: level damage of the health centres per governorate, 3rd
Quarter 2015
0
1
9
0
8
14
4
6
27
12
2
15
7
4
1
0
3
2
13
9
33
23
38
38
2
48
37
54
164
92
104
52
182
78
119
63
94
53
29
92
36
15
0
0
0
7
19
2
13
5
22
0
26
72
34
0
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Tartous
As-Sweida
Lattakia
Damascus
Homs
Deir-ez-Zor
Hama
Al-Hasakeh
Rural Damascus
Dar'a
Quneitra
Aleppo
Idleb
Ar-Raqqa
Fully damaged Partially damaged Not damaged No Report
Fully damaged 6% (109)
Partially damaged 17% (301)
Not damaged
66% (1173)
No Report 11% (200)
Figure 10: Level of Damage - Q3 2015
HeRAMS| Public Health Centres Reports, July to September 2015 Page 10 of 29
Map 3: Distribution and Level of damage of the public health centres, 3rd Quarter 2015
It is essential to cross-analyze the infrastructural damage of the public health centres in relation to
the functionality status (i.e. provision of services). Some health centres have resiliently continued to
provide services regardless of the level of damage of the building; through optimizing intact parts of
the building or in a few cases operating from other neighboring facilities. The national figures
translate as follows:
Out of the 301 partially damaged health centres, 150 health centres were reported partially
functioning, 130 out of service (non-functioning), 9 of health centres were unknown status,
while 12 were reported to be fully functioning providing all services through salvaging medical
equipment from the damaged section of the health centre with full staffing capacity.
Out of the 109 health centres with fully damaged buildings, 87 were reported non-functioning
while 20 health centres have opted for innovative ways to continue providing health services to
populations in need through partially functioning from other nearby temporary locations and
provide health services with limited staff capacity and resources (details of the 20 health centres
are available in the HeRAMS database), while functionality status of 2 of health centres was
unknown.
Health centres with intact buildings (1,173 health centres) do not directly reflect full
functionality, only 812 of the 1,173 intact health centres are fully functioning, while 266 are
partially functioning and 84 health centres are not functioning all together, due to limited access
of patients and health staff to the facilities resulting from the dire security situation as well as
critical shortage of supplies, while functionality status of 11 of health centres were unknown.
HeRAMS| Public Health Centres Reports, July to September 2015 Page 11 of 29
The trend analysis of infrastructural damage of health centres from 1st Quarter 2014 to 3rd Quarter
2015 is presented in Figure 12.
Figure 12: Trend analysis of buildings’ damage of health centres, between 1st
Quarter 2014 and 3rd Quarter
2015
4.2 Water sources and functionality status
Availability of water sources at health centres was
assessed using a standard checklist of main types of
water sources (i.e., main pipeline, well, or both [main
pipeline and well]).
By end of the 3rd Quarter 2015 and out of 1,262
functional health centres, 84% (1,055) are using main
pipelines, 2% (31) are mainly using wells, while 7%
(90) are using both [main pipeline and well] [Figure
13].
Detailed analysis of availability and distribution of
water sources at functional health centres is
presented at governorate level on [Figure 14].
Figure 14: Distribution of water sources/ types at functional health centres, per governorate, 3rd
Quarter
2015
17 33 39 75 93 106 109
345 400 330
312 261
287 301
910 973
1063 1177
1092 1172 1173
472
338 318 212
331
218 200
0
200
400
600
800
1000
1200
1400
Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015
Fully damaged Partially damaged Not damaged No Report
14
20
25
44
47
53
55
69
82
103
106
128
146
163
0
6
2
2
5
25
12
4
2
8
0
7
15
2
0
4
0
1
0
10
2
3
5
1
1
0
4
0
0
16
4
5
0
27
0
3
2
3
0
7
12
0
5
2
0
0
0
0
0
0
0
0
0
0
0
0
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Ar-Raqqa
Idleb
Quneitra
Al-Hasakeh
Damascus
Aleppo
Deir-ez-Zor
Dar'a
As-Sweida
Rural Damascus
Lattakia
Hama
Homs
Tartous
Main Pipeline Main Pipeline and Well Well Other No Report
Main Pipeline 84%
(1055)
Main Pipeline and Well 7% (90)
Well 2% (31)
Other 6% (79)
No Report 0.6% (7)
Figure 13: Main Sources of Water - Q3 2015
HeRAMS| Public Health Centres Reports, July to September 2015 Page 12 of 29
Functionality status of the water sources was measured at three levels; fully functioning, partially
functioning, and not functioning. Figure 15, provides details on functionality status of water sources
at functional health centres, (1,262 /1,783) per governorate.
Figure 15: Functionality status of the water sources at health centres, 3rd
Quarter 2015
4.3 Availability of electricity generators
Electricity generators turned to be highly demanded with the current situation, where electricity
power is widely disrupted and majority of public health centres are dependent on generators'
power. Availability of electrical generators was measured at functional health centres [Figure 16].
Figure 16: Availability of generators in the functional health centres, per governorate, 3rd
Quarter 2015
165
126
85
83
63
56
50
28
23
17
14
10
7
12
80
8
44
56
2
20
39
13
91
25
7
69
4
11
0
0
3
0
3
17
0
10
12
0
0
1
0
0
0
0
1
0
1
0
1
5
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Tartous
Hama
Homs
As-Sweida
Lattakia
Rural Damascus
Damascus
Al-Hasakeh
Dar'a
Quneitra
Aleppo
Idleb
Ar-Raqqa
Deir-ez-Zor
Fully Functioning Partially Functioning Non-functioning No Report
39
23 23
9 10
0
36
17 10
26
4
21
10 13 13
91 90
39
97
165
141
125
42 43
12
58
81
18
0 1 2 0 0 0 0 0 0 0 3 0 0 0 0
20
40
60
80
100
120
140
160
180
Damascus RuralDamascus
Aleppo Idleb Lattakia Tartous Homs Hama Al-Hasakeh Deir-ez-Zor Ar-Raqqa Dar'a As-Sweida Quneitra
Available Not-available No Report
HeRAMS| Public Health Centres Reports, July to September 2015 Page 13 of 29
4.4 Availability of Refrigerators
Availability of refrigerators in health centres is measured through HeRAMS at three levels: available
and functioning, available but not-functioning, or not-available. The summary figures of availability
of refrigerators in functioning health centres are presented [Figure 17].
The health centres with gap on refrigerators, seek support of the area municipality, a nearby school,
or a nearby house to store vaccines and medicines.
Figure 17: Availability of refrigerators in the functional health centres, per governorate, 3rd
Quarter 2015
49
108
80
34
102
156 154
139
40
69
16
64
81
27
0 2
23
7 2 1
10
0 4
0 0
10 2 1 3 4
10 6 3
8 13
3 8
0 0 5 8
3 0 1 2 1 0 0 0 0 0 0 3 0 0 0 0
20
40
60
80
100
120
140
160
180
Damascus RuralDamascus
Aleppo Idleb Lattakia Tartous Homs Hama Al-Hasakeh Deir-ez-Zor Ar-Raqqa Dar'a As-Sweida Quneitra
Available Available but not-functioning Not-available No Report
HeRAMS| Public Health Centres Reports, July to September 2015 Page 14 of 29
5. Availability of Health Human Resources
Availability of health human resources has been
analyzed across functional health centres
considering different staffing categories.
Analysis of proportions of available health staff, by
end of the 3rd Quarter 2015, within the functional
health centres (fully and partially) is shown in
[Figure 18].
The resident doctors represented (1%) of total
health staff at centres’ level, followed by general
practitioners (4%); pharmacists (4%); laboratory
(7%); specialists (8%); dentists (10%); midwives
(11%); and nurses (55%).
The Distribution of the total health staff, by end of the 3rd Quarter 2015, per staff category and
governorate is shown in [Figure 19].
Figure 19: Distribution of total health staff at health centres per governorate, September 2015
The distribution of medical staff [a total of general practitioner, specialist, resident doctor, dentist],
in functional health centres per governorate is presented in Map 4. The highest density of medical
staff is observed in Tartous [total functional centres is 165], followed by Homs [total functional
centres is 177], and Damascus [total functional centres is 52].
45
85
96
25
13
1
14
0
13
3
13
0
54
30
18
26
23
20
26
6
22
0
14
9
14
14
7
24
9
29
4
19
5
74
64
14
66
48
53
15
2
11
41
0
0 24
26
19
3
10
3 15
12
0
17
6
22
2
13
3
34
20
9
51
8
25
0
27
2
81
78
25
81
14
8
37
44
5
10
89
39
5
48
4
16
20
21
02
21
21
10
91
33
3
67
6
12
2
74
9
13
45
29
1
12
3 2
80
51
18
66
24
3
27
1
14
0
58
47
27
81
74
54
97
17
4
23
7
99
35
0
34
8
40
8
28
1
15
2
13
4
22
16
2
75
48
36
32
15
5
12
16
4 3
28
11
8
56
19
9
25
54
5
9
0
500
1000
1500
2000
2500
Damascus RuralDamascus
Aleppo Idleb Lattakia Tartous Homs Hama Al-Hasakeh Deir-ez-Zor Ar-Raqqa Dar'a As-Sweida Quneitra
Practitioner Specialist Doctor Resident Doctor Dentist Nurses Laboratory Midwives Pharmacists Technicians
Practitioner 4%
Specialist Doctor
8% Resident Doctor
1%
Dentist 10%
Nurses 55%
Laboratory 7%
Midwives 11%
Pharmacists 4%
Figure 13: Health Staff, Sep2015
HeRAMS| Public Health Centres Reports, July to September 2015 Page 15 of 29
Map 4: Distribution of medical staff [a total of general practitioners, specialists, resident doctors, and
dentists] per governorate, September 2015
By analyzing the proportion of male to female doctors (a total of: general practitioners, specialists,
resident doctors, and dentists), lowest proportions were seen in Al-Hasakeh, Ar-Raqqa, and Deir-ez-
Zor governorates [Figure 20].
Figure 20: Proportion of Doctors by gender, per governorate, September 2015
317 322 233
53
206
544 462 392
170 139 47 140 170 74
322 216 186
20
281
387 241 224
42 43 13 48 61 36
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Damascus RuralDamascus
Aleppo Idleb Lattakia Tartous Homs Hama Al-Hasakeh Deir-ez-Zor Ar-Raqqa Dar'a As-Sweida Quneitra
Male Female
HeRAMS| Public Health Centres Reports, July to September 2015 Page 16 of 29
6. Availability of Health Services
Availability of the core health services is monitored through HeRAMS at a health centre’s level,
considering a standard list of health services, as follows:
General Clinical services
Emergency services
Child Health: EPI, screening of MUAC, and Diarrhea management
Nutrition: screening of malnutrition for pregnant and lactating women
Sexual & Reproductive Health: Syndromic management of sexually transmitted infections, Antenatal care, Emergency contraception
Non-communicable Diseases: Surgical care, Cardiovascular services, Hypertension management, Diabetes management
Mental health care
Figure 21 shows the percentage of availability of health services across all functional (fully and
partially) health centres (1,262 /1,783).
Figure 21: Percentage of availability of health services, across all functional health centres, 3rd
Quarter 2015
**Detailed information on availability of services per governorate and health centres is available in
the HeRAMS Database.
27%
44%
50%
53%
56%
58%
62%
62%
62%
66%
69%
75%
77%
78%
78%
85%
86%
90%
90%
Syndromic management of sexually transmitted infections
Basic laboratory
Cardiovascular services
Emergency contraception
Referral capacity
Screening of malnutrition for pregnant & lactating women
Screening of under nutrition/malnutrition (growth monitoring orMUAC or W/H, H/A)
Prophylaxis and treatment of opportunistic infections
Diabetes management
Surgical care
Hypertension management
Diarrhea Management
Antenatal care
Emergency services for Accidents and Injuries
Tetanus Shot
EPI: routine immunization against all national target diseases andadequate cold chain in place
Regular reporting to the national surveillance system
Standard precautions
Solid waste management
HeRAMS| Public Health Centres Reports, July to September 2015 Page 17 of 29
The following section provides descriptive analysis for the workload and utilization of services in
functional health centres throughout 2015, per governorate.
The workload was analyzed in terms of total consultations in all functional health centres during
January and September 2015 [Figure 22]. The total reported workload across all governorates is
9,070,045; disaggregated as 3,081,920 in the 1st Quarter, 3,204,896 in the 2nd Quarter and 2,783,229
in the 3rd Quarter 2015. The number of consultations in functional health centres has dropped
significantly between the 2nd Quarter and 3rd Quarter 2015, which was due to shortage of staffing
and medicines mainly reported in hard-to-reach areas (such as Al-Zabadni in Rural Damascus, Dar’a
city, and Ras-Alain in Al-Hasakeh).
Figure 22: Estimated workload of functional health centres (consultations), January to September 2015
The proportion of workload of functional
health centres per governorate is
provided on Figure 23.
Detailed analysis on utilization of the core health services during the 3rd Quarter 2015 is provided on
the following sub-sections, including:
General Clinical and Emergency Services, Child Health, Nutrition, Sexual & Reproductive Health, Non-
communicable Diseases and Mental Health
1,156,071
1,077,748 1,067,221 1,053,966 996,226
899,032
821,945
431,673 405,990 381,537
263,343 255,671
145,212 114,410
0
200000
400000
600000
800000
1000000
1200000
1400000
Homs Hama RuralDamascus
Damascus Lattakia Tartous Aleppo Dar'a Al-Hasakeh As-Sweida Quneitra Deir-ez-Zor Ar-Raqqa Idleb
Homs 13%
Hama 12%
Rural Damascus 12%
Damascus 12% Lattakia
11%
Tartous 10%
Aleppo 9%
Dar'a 5%
Al-Hasakeh 4%
As-Sweida 4%
Quneitra 3% Deir-ez-Zor
3%
Ar-Raqqa 1%
Idleb 1%
Figure 23: Proportions of workload in health centres, January to September 2015, per governorate
HeRAMS| Public Health Centres Reports, July to September 2015 Page 18 of 29
6.1 General Clinical services
The following sections provide analysis on the utilization of health services in functional health
centres at governorate level.
i. Outpatient
The number of outpatients was assessed at a health centre level, and the total reported number in
the 3rd Quarter 2015 is 1,098,414; disaggregated at governorate level in Figure 24.
Figure 24: The number of Outpatients in health centres, 3rd
Quarter 2015
The high workload on health centres in Rural Damascus, Aleppo, and Homs is due to limited
availability of public hospitals and high number of people in need. Moreover the high workload in
Hama, Tartous and Lattakia health centres is due to increasing number of IDPs and high number of
functional health centres.
ii. Basic laboratory services
The number of patients received services in health centres’ laboratories, was assessed at a health
centre level. The total reported number in the 3rd Quarter 2015 is 580,288; disaggregated at
governorate level in Figure 25.
Figure 25: The number of patients received services in laboratories in health centres, 3rd
Quarter 2015
In Homs city, the conflict situation has severely impacted public hospitals’ functionality. To fill-in gaps, capacity of the health centres was upgraded through providing medical equipment/ machines, salvaging equipment and relocating health staff from closed hospitals and affected health centres. For example, high number of patients received laboratory services during the 3rd Quarter 2015 is reported in Karm Al-Shami comprehensive clinics, which was upgraded to serve high number of
174,887
153,233 145,225
114,475 113,147 113,027 112,600
46,485 36,521
24,121 23,873 14,960 13,735 12,125
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
200,000
RuralDamascus
Aleppo Hama Damascus Homs Tartous Lattakia Quneitra As-Sweida Al-Hasakeh Dar'a Idleb Deir-ez-Zor Ar-Raqqa
135,849
101,468
85,533
51,117 48,564 48,366 42,699
30,156 24,268
9,546 1,776 445 380 121
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
Homs Hama As-Sweida RuralDamascus
Damascus Lattakia Tartous Aleppo Dar'a Quneitra Al-Hasakeh Ar-Raqqa Deir-ez-Zor Idleb
HeRAMS| Public Health Centres Reports, July to September 2015 Page 19 of 29
people in Homs city and its neighborhood. The centre is providing diabetes medicines, which justifies the increased number of serviced people in laboratory. The high numbers in Hama and As-Sweida is justified by increasing number of IDPs from rural areas and neighboring governorates.
iii. Referral capacity
Referral capacity and number of referred cases was measured at a health centre level. The total
reported number in the 3rd Quarter 2015 is 12,238; disaggregated at governorate level in Figure 26.
Figure 26: The number of referred cases, 3rd
Quarter 2015
In Damascus, the high number of referred cases is due to increase of IDPs and referral of diabetic
patients to specialized diabetic centres. In Hama, the high numbers of IDPs (especially women and
children from rural Hama, Ar-Raqqa and Idleb) has impacted provision of health services (including
referral of cases to other specialized centres or hospitals). Of note, the Directorates of Health of Ar-
Raqqa and Idleb are operating from Hama.
6.2 Emergency services
The number of cases and injured people reported in emergency units of health centres was assessed
at a health centre level. The total reported number in the 3rd Quarter 2015 is 149,048; disaggregated
at governorate level in Figure 27.
Figure 27: The number of accidents and injuries reported in health centres, 3rd
Quarter 2015
The high figures reported in Homs are due to increasing workload of health centres, due to
deteriorating security situation and limited availability of public hospitals.
3,182 3,142
1,243 1,232 1,041
689 679 431
250 248 46 42 13 0
0
500
1,000
1,500
2,000
2,500
3,000
3,500
Damascus Hama As-Sweida Dar'a RuralDamascus
Tartous Aleppo Lattakia Ar-Raqqa Homs Deir-ez-Zor Quneitra Al-Hasakeh Idleb
59,011
22,112 17,087
11,389 10,094 7,790
5,111 4,617 4,416 2,611 2,470 2,281 59 0
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
Homs Hama RuralDamascus
As-Sweida Dar'a Tartous Quneitra Aleppo Damascus Idleb Lattakia Al-HasakehDeir-ez-Zor Ar-Raqqa
HeRAMS| Public Health Centres Reports, July to September 2015 Page 20 of 29
6.3 Child Health
Availability and utilization of child health services in health centres is assessed for EPI, screening of
under nutrition/malnutrition, and diarrhea management for children.
i. EPI: routine immunization against all national target diseases and adequate cold chain in
place:
The number of children received routine immunization service through EPI was assessed at a health
centre level. The total reported number in the 3rd Quarter 2015 is 498,390 children; disaggregated
at governorate level in Figure 28.
Figure 28: The number children received routine immunization service in health centres, 3rd
Quarter 2015
In Aleppo, there 73 health centre provides routine immunization service; the delay in receiving
vaccines in many centres, due to security situation, resulted in accumulative children numbers when
vaccine is available.
ii. Screening of under nutrition/malnutrition (growth monitoring or MUAC or W/H, H/A):
Screening of children for under nutrition/malnutrition was assessed at a health centre level. The
total reported number in the 3rd Quarter 2015 is 105,493; disaggregated at governorate level in
Figure 29.
Figure 29: The number of screened children for under nutrition/malnutrition in health centres, 3rd
Quarter
2015
The highest reported figures in Hama, Damascus and followed by Rural Damascus reflect the strong
nutritional surveillance systems in place in addition to increased influx of IDPs to the mentioned
governorates during the 3rd Quarter 2015.
69,271
54,615 53,644 52,559 48,013
38,073 34,174 33,339 32,664
27,333 27,227
11,350 10,964 5,164
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
Aleppo Hama RuralDamascus
Homs Damascus Lattakia Deir-ez-Zor Dar'a Tartous Ar-Raqqa Al-Hasakeh As-Sweida Idleb Quneitra
27,540
23,741
14,066
11,278
8,274
4,676 4,626 4,195 3,000 2,840
499 416 177 165
0
5,000
10,000
15,000
20,000
25,000
30,000
Hama Damascus RuralDamascus
Homs As-Sweida Aleppo Dar'a Quneitra Ar-Raqqa Deir-ez-Zor Idleb Al-Hasakeh Tartous Lattakia
HeRAMS| Public Health Centres Reports, July to September 2015 Page 21 of 29
iii. Diarrhea Management:
Diarrhea Management for children was assessed at a health centre level. The total reported number
in the 3rd Quarter 2015 is 35,693; disaggregated at governorate level in Figure 30.
Figure 30: The number of diarrhea cases (children) in health centres, 3rd
Quarter 2015
6.4 Nutrition
Screening of malnutrition for pregnant & lactating women was assessed at a health centre level.
The total reported number in the 3rd Quarter 2015 is 24,484; disaggregated at governorate level in
Figure 31.
Figure 31: The number of screened pregnant & lactating women for of malnutrition, 3rd
Quarter 2015
Consistent and complete reporting from Hama continues because of the availability of strong
technical professional staff and follow-up. Moreover, the influx of IDPs especially women and
children from Ar-Raqqa and Idleb have also contributed to higher reported figures in Hama during
the 3rd Quarter of 2015.
7,390 6,851
5,200
3,242 2,931 2,801
2,280 2,215
711 640 555 528 349 0
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
RuralDamascus
Hama Homs Aleppo Lattakia Damascus Al-Hasakeh Tartous As-Sweida Dar'a Deir-ez-Zor Quneitra Idleb Ar-Raqqa
6,188
3,303 3,207 2,756
2,242 2,116 1,665
890 834 648 439
159 37 0 0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
Hama RuralDamascus
Homs Damascus As-Sweida Tartous Aleppo Dar'a Al-Hasakeh Idleb Deir-ez-Zor Quneitra Lattakia Ar-Raqqa
HeRAMS| Public Health Centres Reports, July to September 2015 Page 22 of 29
6.5 Sexual & Reproductive Health
Availability and utilization of sexual & reproductive health care in health centres is assessed at a
health centre level for syndromic management of sexually transmitted infections, antenatal care,
normal deliveries, essential newborn care, and tetanus shots.
i. Syndromic management of sexually transmitted infections:
The number of patients with sexually transmitted infections (STIs) was assessed at a health centre
level. The total reported number in the 3rd Quarter 2015 is 1,395; disaggregated at governorate level
in Figure 32.
Of note: the availability of Syndromic management of STIs is reported in six governorates and
mainly in comprehensive/ poly clinics. In other governorates, if any case reported to a health centre,
they refer it to the hospitals based on available capacity.
Figure 32: The number of cases reported with sexually transmitted infections in health centres, 3rd
Quarter
2015
The high number of cases reported with STIs in Tartous, Damascus, Hama, and Lattakia is due to
availability of capacity and qualified health providers, in addition to high numbers of IDPs and lack of
hygiene in shelters.
ii. Antenatal care
a) Antenatal visits:
The number of antenatal visits was assessed at a health centre level. The total reported number of
visits for pregnant women received the service in the 3rd Quarter 2015 is 57,869; disaggregated at
governorate level in Figure 33.
Figure 33: The number of Antenatal visits in health centres, 3rd
Quarter 2015
The high reported figures in Hama are due to increased numbers of IDPs (especially women and
children from rural Hama, Ar-Raqqa and Idleb), in addition to increased capacity and availability of
service in many specialized and comprehensive clinics in Hama city.
573
373
221 214
12 2 0 0 0 0 0 0 0 0 0
100
200
300
400
500
600
700
Tartous Damascus Hama Lattakia As-Sweida RuralDamascus
Aleppo Idleb Homs Al-HasakehDeir-ez-Zor Ar-Raqqa Dar'a Quneitra
18,633
6,367 6,287 5,772
4,002 3,904 3,242 3,096 2,312 1,994 1,325
396 364 175
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
Hama Lattakia Homs RuralDamascus
Dar'a Damascus Tartous Aleppo Al-Hasakeh As-Sweida Ar-Raqqa Idleb Deir-ez-Zor Quneitra
HeRAMS| Public Health Centres Reports, July to September 2015 Page 23 of 29
b) Tetanus Shots:
The number of pregnant women received Tetanus Shots was assessed at a health centre level. The
total reported number of women received the service in the 3rd Quarter 2015 is 23,211;
disaggregated at governorate level in Figure 34.
Figure 34: The number of pregnant women received Tetanus Shot in health centres, 3rd
Quarter 2015
In Aleppo, the health centres provide tetanus shot services is high (73 centre).
iii. Normal deliveries:
The number of Normal deliveries was assessed at a health centre level. The total reported number
in the 3rd Quarter 2015 is 981; disaggregated at governorate level in Figure 35.
Figure 35: The number of Normal deliveries in health centres, 3rd
Quarter 2015
The high number of normal deliveries in Dar’a is reported from health centres provide the service in
areas with limited availability of functional public hospitals:
Tseel health centre in Nawa health district performed 249 normal deliveries. Of note, in Nawa
district there are two hospitals; one is fully damaged [Jasim Hospital], while the other is partially
damaged and partially functioning with limited capacity [Nawa hospital].
The comprehensive clinics in Geza, located in Busra health district, performed 106 normal
deliveries. The only public hospital in Busra district is non-functioning and partially damaged.
The comprehensive clinics in Dar’a city performed 72 normal deliveries. The maternity hospital is
Dar’a city is non-functional, while the national hospital is partially providing this service with
very limited capacity.
5,054
2,984 2,979
2,352 1,999 1,988
1,381 1,228 1,219 854
365 364 297 147
0
1,000
2,000
3,000
4,000
5,000
6,000
Aleppo Hama Homs RuralDamascus
Tartous Lattakia Dar'a Idleb Damascus Al-Hasakeh Quneitra Ar-Raqqa As-Sweida Deir-ez-Zor
427
167 147
103
60 35
18 16 8 0 0
50
100
150
200
250
300
350
400
450
Dar'a RuralDamascus
Homs Damascus As-Sweida Hama Lattakia Quneitra Al-Hasakeh Ar-Raqqa Aleppo Idleb Tartous Deir-ez-Zor
HeRAMS| Public Health Centres Reports, July to September 2015 Page 24 of 29
iv. Essential newborn care:
Availability and utilization of essential newborn care service (including basic newborn resuscitation
+ warmth (recommended method: Kangaroo Mother Care - KMC) + eye prophylaxis + clean cord care
+ early and exclusive breast feeding 24/24 & 7/7)), was assessed at a health centre level. The total
reported number of women received the service in the 3rd Quarter 2015 is 1,215; disaggregated at
governorate level in Figure 36.
Figure 36: The number of women received essential newborn care in health centres, 3rd
Quarter 2015
v. Basic Emergency Obstetric Care (BEmOC):
Availability and utilization of BEmOC service (including parenteral antibiotics +
oxytocic/anticonvulsivant drugs + manual removal of placenta + removal of retained products with
manual vacuum aspiration (MVA) + assisted vaginal delivery 24/24 & 7/7), was assessed at a health
centre level. The total reported number of women received the service in the 3rd Quarter 2015 is
169; disaggregated at governorate level in Figure 37.
Figure 37: The number of women received BEmOC in health centres, 3rd
Quarter 2015
The high figures in Dar’a is mainly reported from the comprehensive clinics in Dar’a city, which is
providing 24/7 service to all Dar’a city and neighboring districts, as a replacement to the maternity
and national hospitals in Dar’a city.
429 427
166
87 60
20 18 8 0 0 0 0
50
100
150
200
250
300
350
400
450
500
Damascus Dar'a RuralDamascus
Homs As-Sweida Hama Lattakia Al-Hasakeh Idleb Ar-Raqqa Quneitra Aleppo Tartous Deir-ez-Zor
130
20 18
1 0 0 0 0 0 0 0 0 0 0 0
20
40
60
80
100
120
140
Dar'a Homs Hama Damascus RuralDamascus
Idleb Lattakia Al-Hasakeh Ar-Raqqa As-Sweida Quneitra Aleppo Tartous Deir-ez-Zor
HeRAMS| Public Health Centres Reports, July to September 2015 Page 25 of 29
6.6 Non Communicable Diseases (NCDs)
Availability and utilization of NCDS health care services in health centres is assessed at a health
centre level for surgical care [minor surgeries, dressing services, …], cardiovascular, hypertensions,
and diabetes.
The total reported number of NCDs’ consultations in the 3rd Quarter 2015 is as follows: surgical care
[121,652] cardiovascular [35,682], hypertensions [87,132], and diabetes [200,227]; disaggregated
figures are provided at governorate level in Figure 37.
Figure 37: The number of NCDs consultations (Surgical care, Cardiovascular, Hypertension and Diabetes) in
health centres, 3rd Quarter 2015
Among all NCDs, Diabetes patients’ consultations are the highest reported figures, mainly in Lattakia,
Damascus, Tartous and Rural Damascus, which is due to availability of medicines and supplies.
6.7 Mental health care
Availability and utilization of mental health care services was assessed at a health centre level. The
total reported number in the 3rd Quarter 2015 is 6,674; disaggregated at governorate level in Figure
38.
Figure 38: The number of mental health cases in health centres, 3rd
Quarter 2015
7872
2068
3
2367
76
2133
2
167
68
1761
1
9441
489
298 0
4440
1484
1
5434
9988
5021
414
27 26
41
9636
3679
1833
739
12
0 71
65 15
56
2155
6
1156
3
2910
209
1274
3
7578
1222
5
5937
1975
57
0 513
5351
4515
2884
7
2102
2
147
60
1576
5431
9
2128
4
1596
3
1046
8
7028
32
0
6128
1447
0
4330
0
10000
20000
30000
40000
50000
60000
Damascus RuralDamascus
Aleppo Idleb Lattakia Tartous Homs Hama Al-Hasakeh Deir-ez-Zor Ar-Raqqa Dar'a As-Sweida Quneitra
Surgical care Cardiovascular Hypertension Diabetes
1,237 1,144
830
684 678 605
534 496 412
54 0 0 0 0
0
200
400
600
800
1,000
1,200
1,400
Damascus Lattakia Aleppo Tartous Hama Quneitra Homs RuralDamascus
Dar'a As-Sweida Idleb Al-HasakehDeir-ez-Zor Ar-Raqqa
HeRAMS| Public Health Centres Reports, July to September 2015 Page 26 of 29
7. Availability of Medical Equipment
The availability of different types of essential equipment and supplies was assessed at a health
centre level, based on a standard checklist1.
In its fifth year of crisis, Syria’s public health centres are still suffering from shortages and/or
malfunction of medical devices/ equipment to provide health care services. In insecure
governorates, medical devices are either destroyed, burned, or malfunctioned, while in safe areas
the medical devices are overburdened by increased numbers of people (actual numbers of people in
the area, in addition to IDPs and patients /injured people from surrounding areas).
Maintenance of malfunctioned devices remains a concern, due to non-availability of spare parts,
accredited agent to provide maintenance support, or difficulty of accessibility in many cases.
Analysis of availability of essential equipment was measured across all functional health centres
(1,262 / 1,783), in terms of functional equipment out of the total available equipment in the health
centre. The produced analysis provides good indication of the current readiness of the health
centres to provide health services, and also to guide focused planning for procurement of equipment
and machines, to fill-in identified gaps.
Gaps on essential equipment and machines were observed, even within the functional health
centres. Further details are provided in Figure 39.
Figure 39: Percentage of functional essential equipment/ total available equipment in functional health
centres, 3rd
Quarter 2015
1 A more detailed list of essential equipment is available upon request.
70%
76%
85%
87%
88%
88%
89%
92%
92%
93%
94%
94%
94%
94%
95%
Blood_pressure machine
Oxygen cylinders
Ambu bag (Paediatric and Adult)
Weighing Scale for infants
Weighing Scale for adults
Light source (flashlight acceptable)
Pulse Oximeter
Delivery_table
Sterilizer/ Autoclave
Safe / Clean delivery kit
Height Measurement Device
Length Measurement Device
Vaginal examination set
Minor_surgical
Fetoscope
HeRAMS| Public Health Centres Reports, July to September 2015 Page 27 of 29
Map 5: Percent of functional specialized equipment/ total available equipment in functional health centres,
end of September 2015
HeRAMS| Public Health Centres Reports, July to September 2015 Page 28 of 29
8. Availability of Priority Medicines
Availability of medicines and consumables at health centres’ level has been evaluated based on a standard list of identified priority medicines (driven from the national Essential Medicine List), and medical supplies for duration of one month. Gaps of medicines and medical supplies are identified even within the functional health centres (i.e., gap of 75% gap of Anti-diabetic preparations, 68% of Cardiac and /or Vascular Drugs, 61% of Antibiotics, 52% of Anti-allergic including Steroids, 50% of ORS, and 38% of Antiseptics) [Figure 40].
Figure 40: Availability of medicines and medical consumables at functional health centres, 3rd
Quarter 2015
**More details on availability of medicines and consumables at a health centre level are available in HeRAMS Database. Percentages of available medicines in functioning health centres by end of the 3rd Quarter 2015, at governorate level, are presented in Map 6. Map 6: Percentage of available medicines at functional health centres, end of June 2015
25%
32%
39%
48%
50%
62%
Anti-diabetic preparations
Cardiac and /or Vascular Drugs (Anti-hypertensive Drugs, Diuretics, …)
Antibiotics
Anti-allergic including Steroids
ORS
Antiseptics
HeRAMS| Public Health Centres Reports, July to September 2015 Page 29 of 29
© World Health Organization 2015. All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
WHO-EM/SYR/016/E