Despite financial limitations and Israeli occupation arbitrary practices, neonatal mortality in Palestine has dropped from 22 to 12 deaths in every 1,000 births in the period of 1991 – 2015. However, when compared to neighbouring countries, the number of neonatal deaths in Palestine is still high, for instance 5/1000 die in Lebanon and 2/1000 die in Israel.
Burden of neonatal health in Palestine is very high. In 2016, there were 130,497 live births, 1,793 of which were transferred to neonatal intensive care units with an estimated cost of $10 million! The cost of neonatal referrals, those transferred from governmental to private or NGO facilities, makes 4.7% of the total national referrals budget of MoH. Since many birth cases take place at private hospitals, there is also a high out-of-pocket expenditure incurred by the newborn family. Add to all those expenses, the socioeconomic consequences of neonatal illnesses, knowing that the very same conditions that lead to neonatal death may lead to severe disabilities.
In 2016, the neonatal health status alerted the Ministry of Health, which in turn urged PNIPH to assess neonatal health services at all neonatal and delivery hospitals in West Bank and Gaza. More than 35 hospitals of which are governmental, private, or NGO were visited and assessed based on availability and accessibility of neonatal services. Interviews were conducted with the heads of related units at all hospitals, in addition to decision makers at MoH and mothers of infants staying at intensive care units at the time. Furthermore, guidelines for neonatal referrals at each hospital were reviewed to increase the effectiveness of the process.
Based on the study, PNIPH informed MoH with actionable insights and recommendations. Amongst the most important insights are: lack of specialties and subspecialties among health human resources; limited number of available incubators, equipment, and medication; difficulty and delays in transferring neonates to more specialized hospitals; and the occurrence of inappropriate referrals.
Influencing policy is always at the heart of PNIPH work, and that can never be possible without the close collaboration of MoH. After negotiating the results of the study, MoH has taken a quick initiative by assigning Dr. Hatem Khammash, head of neonatal unit at Al Maqased Hospital in East Jerusalem, as the Minister’s advisor for neonatal issues; who in turn will follow up and supervise the Ministry’s intervention to advance neonatal health services, and ultimately, improve neonatal health status in Palestine.
Furthermore, PNIPH is cooperating with experts from MoH to plan a better design for the neonatal referral system, which will aim at boosting its efficiency, reducing its financial burden, and reap better results out of it in the upcoming years.
Neonatal mortality, which is mortality of infants within the first 28 days of life, is most pronounced in low and middle income countries, where 99% of worldwide neonatal deaths occur. Globally, 2 out of 3 infants die in their first month, two thirds of them die during the first week, and two thirds of those who die during the first week die in the first 24 hours.
Approximately, 7,000 newborns die every day, making neonatal health a key indicator of population health.