Research

Assessment of Neonatal Services at Hospitals in Palestine

Global Background

The neonatal period, which spans the first 28 days of a newborn’s life, is considered an integral indicator of future child survival. The burden of neonatal mortality is most pronounced in low and middle-income countries, where 99% of neonatal deaths occur.

Approximately, 2 million newborn die during the first 7 days of birth. In 2015, it was estimated that 5.9 million children under-five died, with a global mortality rate of 42.5/1000 live births, and a neonatal mortality rate (NMR) of 19/1000 live births.

Situation in Palestine

As a developing middle-income country, Palestine mirrors some of the same trends and challenges faced globally in neonatal health. In 2016, based on Ministry of Health (MoH) annual report 2017, there were 72,327 live births in the West Bank, and 58,170 live births in Gaza Strip. In Palestine, in 2016, there were 1793 referrals for neonatal services with an estimated cost of 34,996,588 ILS for the incubators, not including surgeries.

Study Objectives

Assess the availability, distribution and accessibility of/to neonatal health services at Palestinian hospitals in the West Bank (WB, including East Jerusalem (EJ)) and Gaza Strip (GS) to inform policy and aid organizations to help fill in the gap in neonatal services in Palestine.

WHO tool “Hospital care for mothers and newborn babies: quality assessment and improvement tool” was used to evaluate the quality of care at the hospital level, identify areas of improvement, and develop future action plans. All 63 hospitals providing delivery and neonatal care participated in the study.

Main Findings

There are a total of 38 neonatal units in Palestine, 35 of which provide delivery services. About 79% of neonatal units and 78% of incubators in Palestine are based in West Bank, which makes the number of incubators in Gaza much less than what is needed. Furthermore, not all facilities in Palestine are designed effectively to promote breastfeeding and parenteral feeding.

There are only 10 neonatologists in Palestine, some of which work on part-time basis. Moreover, sub-specialty consultants in different medical and surgical areas can only be found at few specific hospitals. In 2018, the number of practicing specialized neonatal nurses reached 86.

Basic amenities can only be found at 19 out of the 38 facilities, making the other 19 facilities non-suitable for essential care of sick newborns.

Main Recommendations:

1. Building effective referral system (regionalization)
2. Upgrading hospitals that provide neonatal services
3. Developing an effective transport system
4. Implementing standards of care to all MoH neonatal care units as well as non-governmental units as part of licensing the services and referrals.
5. Regulating In Vitro Fertilization (IVF) centers for number of embryos to be transferred.