The contribution of the international fund to developing the Palestinian health care system: focus...

The Contributions of the International Funds to Developing

the Palestinian Health Care System: Focus on health NGOs-Gaza, 2012

Mohammed Sh. Al-Khaldi Dr. Bassam Abu Hamad

The overall aim

To assess the contributions of the IF

through the NGOs in developing the

PHCS in the Gaza Strip, thus providing

suggestions about the appropriate

utilization of donated funds.

2

Objectives

To illustrate the nature, features and trends of the internationally

donated funds.

To appraise the relevance, appropriateness, effectiveness and

sustainability of the IF.

To assess the contribution of the IF in supporting HCS different

components.

To identify strengths, weaknesses and factors affecting the IF.

To provide recommendations for better utilization of IF in

supporting PHCS.

Mohammed Al Khaldi 3

Conceptual Framework

Self developed


Input (IF)Input (IF)

OutputOutputProcessProcess

·Relevancy & Appropriateness·Political, economical & financial factors·Characteristics: Types, features, nature, mechanisms, S & W

·Relevancy & Appropriateness·Political, economical & financial factors·Characteristics: Types, features, nature, mechanisms, S & W

·Coordination & cooperation·Efficiency, M&E·Transparency & governance

·Coordination & cooperation·Efficiency, M&E·Transparency & governance

·Responsiveness to Palestinian society needs·NGO development·Meeting NHGs & MDGs (Indicators)·Effectiveness & Sustainability

·Responsiveness to Palestinian society needs·NGO development·Meeting NHGs & MDGs (Indicators)·Effectiveness & Sustainability

Methodology


Study design

Descriptive analytic design, with triangulation between qualitative and quantitative approaches.


Study population

All Palestinian health NGOs (59) that work in the GS which are

concerned in the health field and receive external fund in the

implementation of its activities. 6 of them actually inactive.

The study participants was 53 health NGOs were included but

the organizations that responded were 48 health NGOs.

Response rate: The study population formed 53 health

PNGOs and only 48 health PNGOs responded with a

response rate 90%.


Study setting

The study focus on health PNGOs, it was conducted at the 48 selected health PNGOs in all GS governorates in Palestine to reflect representative results.


Period of study

The study was conducted in November

2011 till April 2012. Actual data was

collected in November 2011 to January

2012. Data analysis and discussion was

completed in March and April 2012.


Sample size and sampling

Quantitatively: Census sampling approach was used. MOH, MOI, UNESCO directory, PNGOs cluster and HI Guide lists was obtained, they were merged into one single list, then the NGOs that were frequently, inactive, closed, or the organizations that that do not work in providing health services were excluded. They were 59 NGOs, 53 NGOs meet the criteria and 6 did not.

Qualitatively: Purposive sampling approach was used. conducting In-depth interviews with 8 keys informants' policy makers, experts, academics who were selected with the supervisor.


Inclusion criteria To have official institutionalized status. To be independent from the government, and self-

administered. A non-profit. Not inherited, membership is voluntary and is not based

on blood or tribe. Representative which means that membership is limited to a

specific sector and aims to defend the interests of that sector. It must be licensed. Actually operates. Works in the health scope, and provides health services.

Health NGOs that do not meet the above criteria were excluded.


Ethical and administrative considerations and procedures

Ethical approval was obtained from Helsinki Committee and SPH to carry out the study.

Administrative approval and informed consent was obtained from all participant PNGOs (NGOs directors)

Prior consent was obtained to conduct the interview with key informants.

Participation in the study was optional.


Pilot study

The researcher conducted initial study before starting data collection.

3 health PNGOs were chosen from the target population.

There is no major changes were introduced therefore we included them.


Data collection 1. Interviewed questionnaire: the questionnaire

was prepared and designed by the researcher to get information about general ch.ch. of NGOs and IF, and directors perceptions about IF contributions in the health sector.

2. In-depth interviews with 8 experts, whom were purposively chosen. The researcher agreed with the experts on the time and place of the interview which lasted in a week. Every interview took from 40 - 60 minutes; all interviews were tape recorded, then data were ordered and coded.


Data Management and Analysis

Data processing were conducted using the (SPSS 19) including;

Data were gathered and then the filled questionnaires were reviewed,

Appropriate data entry model were designed Coding of variables Data entry Data cleaning Frequencies and descriptive analysis for NGOs, respondent's

characteristics and the other variables in the questionnaire. In-depth interviews were analyzed using Open Coding

Thematic Analysis (OCTA).


Reliability

Study instrument standardization and filling out it the same way with all PNGOs. In order to test the internal consistency of the questionnaire, The Cronbach’s Coeffecient alpha value for the entire questionnaire was (0.899).


Validity

Face validity: the researcher organized the questionnaire in domains with logical sequence to facilitate the filling simplicity. Layout and format look professional.

Content validity: the questionnaire was sent to 16 different qualified and experienced referees. In qualitative part, the researcher reviewed the supervisor and colleagues via peers review and member check.


Limitation of the study

Lack of consistent figures and statistics about IF and NGOs.

Some PNGOs were reluctant to disclose financial information.


Results and Analysis

Health NGOs characteristics


Distribution of health NGOs location

22Mohammed Al Khaldi

North Gaza

Gaza

Middle area

Khanyounis

Rafah

Gov

ern

orat

es

0 10 20 30 40 50 60

10.4%

58.3%

8.3%

14.6%

8.3%

Distribution of NGOs activities coverage


GS level

Governorate level

Local Area

National Level

0 10 20 30 40 50 60 70

58.3%

18.8%

16.7%

6.3%

Health NGOs work


Servi

ces p

rovi

sion

Develo

pmen

t

Relief

Train

ing

Rehab

ilita

tion

Advoca

cy

cultu

re/E

ducatio

n

Resea

rch

0

10

20

30

40

50

60

70

80

90

100

95.8%

54.2%45.8%

35.4%25% 20.8%

10.4% 4.2%

Total number and gender of health NGOs employees


46%54%No. of female employees

No. of male employees

1442 No. of female employees

1683 No. of male employees

3125

Total No. of NGOs employees

Distribution of NGOs health facilities


Total Rafah Khan. M. Area

Gaza City

N. Gaza Type of facility

% #

42.6 61 8 13 8 23 9 Health care center/PHC

8.3 12 0 1 2 6 3 Hospital

29.3 42 7 7 7 14 7Community-rehabilitation center

19.5 28 2 3 7 11 5Culture & education centers

100 143 17 24 24 54 24 Total

Health NGO suffer from financial deficit


Yes Sometime No Don’t knowNGO suffer from a financial deficit

0

5

10

15

20

25

30

35

40

45

33.3%

39.6%

25%

2.1%

Description of financial deficit


Intermittent ConstantDescription of deficit

0

10

20

30

40

50

60

52.1%

20.8%

Distribution of the NGOs needs and priorities


Fund raising

Specialized HR

Develope planning & development

Networking

Set corporation policies

0 10 20 30 40 50 60 70 80 90

81.3%

81.3%

81.3%

79.2%

70.8%

62.5%

62.5%

29.2%

16.7%

4.2%

Directors of health NGOs characteristics


Distribution of directors gender

85%

15%

Male

Female

31Mohammed Al Khaldi

Mohammed Al Khaldi

Distribution of director age

32

From 29 to 39 years

From 40 to 50 years

More than 50 years

05

101520253035404550

25%

47.9%

27.1%

Distribution of NGOs directors qualifications


Secondary & diploma de-

gree

Bachelor degree

Master degree Ph.D

0

5

10

15

20

25

30

35

40

45

50

6.3%

47.9%37.5%

8.3%

The International Fund

characteristics


The most important obstacles in securing the IF


Prevailing political conditions

Lack of donors interaction with NGOs

Lack of experts in the NGO

Hidden agendas

Managerial obstacles

Internal conflicts in the Org.

D. K

0 10 20 30 40 50 60 70 80 90

83.8%

64.6%

27.1%

20.8%

12.5%

2.1%

2.1%

IF flow mechanisms


63%

37%

Direct (from donor to Organization)Indirect (through channels)

Types of donors


0

10

20

30

40

50

60

70

80

90

83.3%

60.4%

31.3%

45.8%

Types of aid provided to the NGOs (mean percentages)


53%

38%

9%

Development Relife (emergency)Budget support

Distribution of criteria of accepting the IF


The existence of a common vision

Organization need

Necessity of the service

NGO long experience and reputation

Donor respect of the organization rules

The conditions of donors

0 10 20 30 40 50 60 70 80

72.9%

68.8%

64.6%

58.3%

56.3%

14.6%

Distribution of total IF contributions for years 2009, 2010 and 2011 (USD)

Mohammed A l Khaldi 40

8%

38%

19%

23%

10%

2%

Less than 100 thousand $

From 101 to 500 thousand $

From 501 thousand to 1 mil-lion $

From 1.1 to 5 million $




IF (For-

eign & Arab)59%

Lo-cal Do-na-tion

s22%

Palestini

an Di-as-

pora8%

Other

Sources5%

Self Fund3%

PNA1% Inside Green Land

2%

Distribution of NGOs according fund sources

Distribution of challenges and factors affecting the IF


Political factors

The absence of common visions & local , international coordination

Organizational factors (weak of NGO strategic MGM, capacities)

Economical and financial factors

Incompatibility of NGOs goals with donors

Lack of community cooperation and participation

Socio-demographic challenges

Weakness of donor MGM & transparency

Health and epidemiological challenges

0 10 20 30 40 50 60 70 80 90 100

95.8%

64.6%

56.3%

54.2%

52.1%

45.8%

37.5%

37.5%

29.2%

Distribution of the largest 20 donors agencies


IR Arab Fund

WA OPECUSAID

SC ANERA

Care WAMY

UNRWA IHH and Yardim

AMU MC

OXFAM NDC EU MH CA

UNFPA HI

0 10 20 30 40 50 60 70 80 90 100

86%85%

79%67%

57%57%

46%44%

42%39%

37%29%29%28%28%27%

24%23%22%

19%

Study domains mean percentages


Sustainability

Efficiency, effectiveness & appropriateness

M & E

Transparency & governance

Meeting needs of NGOs

Nature of the IF

Responsiveness to Palestinian needs

Meeting NHGs

Meeting MDGs

Coordination & cooperation

Overall domains

0 10 20 30 40 50 60 70 80 90

78.3%

75.79%

73.61%

71.41%

68.79%

68.63%

65.07%

64.86%

63.39%

60.67%

68.46%

Recommendations

Recommendations (Donor level)

The importance of fund continuity and donor commitment with increasing its role in crisis conditions such as medical materials shortage and electricity cut. Emphasis on working closely with national bodies based on national health and developmental indicators through clear common agendas to ensure appropriateness and effective results. Adopt transparency and credibility in disseminating information, as well as involving the NGOs decision makers and local society planning. Donors should utilize a holistic and systematic approach (health determinants) in funding programs by concerning less on ad-hoc project complimentary long-term developmental programs. Emancipate the fund from any restrictive conditions and ought to support NGOs self-reliance and respect the local and NGOs rules. Donors are supposed to follow and apply the OECD, Paris decl., AAA, and Busan conference principles to strengthen the IF effectiveness. Encourage the need for coordination and interaction with the all varied Palestinian actors on the basis of effective partnership to achieve the desired goals.


Recommendations (NGOs level)

More fund utilization as much as possible to serve its vision that is fully harmonized with the priorities of the national health goals.

Promote coordination, and create networks between all health actors strengthen their role in attaining the desired goals.

Increase their financial and managerial capabilities empowerment especially in M&E, governance and planning.

Invest diversified financial resources generation like prosperous projects and pricing its services to increase the revenues, reduce aid dependency and keep its sustainability.

46

Mohammed Al Khaldi

Recommendations (NGOs level)(cont’)

Pay more attention to programs that serve children, women, and support the principles of life quality through public health awareness.

Reinforce the NCDs programs and elderly care and develop mental health services.

Set plans that include mechanisms to improve the health environment infrastructure in order to control diseases and threats.

Develop services with high quality, equity, focus on the beneficiaries sound, as well as encourage to use fund in other ways like health research and establishing effective HIS.

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Recommendations (National level)


Establish independent national health committee representatives from the MOH, NGOs, private sector, academics and civil society to set the national health priorities and to manage the negotiations with the donors and fund allocation.

Reactivate relevant acts and set clear policies by legislative authorities to regulate the donor agencies work, and reactivating the monitory bodies' duty to track the donors' performance.

Establish a unified information system that is related to the projects and the IF money to use it in the decisions making and planning.

Find alternative funding sources like the PNA, companies, banks,

businessmen and Arab and Islamic fund. Act deeply for the issues of unemployment and poverty in a

comprehensive perspective through all parties’ participation.

Mohammed Al Khaldi

The contribution of the international fund to developing the Palestinian health care system: focus...

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