Overview
Since the onset of the civil war in Syria, people have fled to neighboring countries. Over 650,000 Syrians have been registered with UNHCR Jordan office. In addition, Jordan hosts refugees from Iraq, Sudan and Somalia. Access to health care services for refugees in Jordan varies by refugee country of origin and level of required service. UNHCR has adapted a policy of structured provision of health services for different nationalities in order to maintain affordable access to primary, secondary and tertiary health services. UNHCR’s Public Health approach is based on the Primary Health Care (PHC) strategy whereby UNHCR’s role is to facilitate and advocate for access through existing services and to monitor access. Essential secondary and tertiary health services are available to eligible refugees who have been registered with UNHCR and offered through government hospitals and other hospitals supported by UNHCR’s referral partner, Jordan Health Aid Society (JHAS). In order to facilitate the referral process UNHCR has established two levels of authority with the implementing partner. If the estimated treatment cost is less than JODs 750 per person per year then the UNHCR partner will manage the referral directly, while if the referral cost is more than JODs 750 per person per year, the case has to be approved by the UNHCR health unit (for emergency cases) and/or Exceptional Care Committee (ECC) for non-emergency cases before the referral takes place.
The standard operating procedures (SOP) for medical referral care outlines the policy and procedures which are applicable to all the UNHCR registered refugees in Jordan. Referral care considered as an essential part of access to comprehensive health services, thus UNHCR since 2014 has maintained a medical referral database in order to monitor referral trends in urban and camp settings in Jordan. In summary; the Public Health Care Services (PHC) are available to Iraqi refugees at Ministry of Health (MoH) facilities at the non-insured Jordanian rate while they must pay the foreigners’ rate to access secondary and tertiary level services. Syrian refugees, with valid UNHCR registration and security card, can use government health services at all levels at the non-insured Jordanian rate. Non-Iraqi/non-Syrian refugees are charged the foreigners’ rate when utilizing MoH services at all levels. These costs for health services mean that many refugees are unable to access essential and life-saving health care services without additional support.
This report contains results from analyzing data that were collected during the period of January to June 2016, from 10 urban, camp and transit sites clinics. The six urban sites include: Amman, Zarqa, Mafraq, Irbid, Ramtha and the South Mobile Medical Unit. The four camp sites include: Zaatari camp, Azraq camp, King Abdullah Park and Cyber City.
Methodology
Medical referral data were collected on-site daily then compiled and shared on a monthly basis with the JHAS referral hub who conducted the initial data compilation and cleaning. JHAS then shared the clean data with the UNHCR Public Health Unit who then recruited a consultant to support with cleaning and data analysis. Descriptive data analysis was conducted using Microsoft Excel.
Summary of findings
o Between January and June, 2016, a total of 15,524 referrals were conducted. Of these, 10,761 (69.3%) were elective referrals and 4,763 (30.7%) were emergency referrals
o 32 (0.7%) of the 4,763 emergency referrals and 24 (0.2%) of the 10,761 elective referrals died
o Average no of monthly referrals was 2,587, with a low of 1,832 (May) and a high of 3,450 in March.
o 23.6% of refugees were referred at least twice for specialized hospital care in the first half of 2016. The majority of refugees were referred only once (76.4%)
o Syrian refugees (81.4%) were the main nationalities referred while Somali refugees accounted for the least proportion of referrals (0.3%); Females accounted for majority of medical referrals during the reporting period (55.5%)
o Almaqased hospital received 23.6% of the total medical referrals, followed by Al Basheer (13.6%), and Qasr Shabeeb (12.0%). Zaatari camp referred 34.5% of referrals, followed by Madina (26.2%) and Azraq camp (19.7%).
o Average referral expenditure per patient during the reporting period was 149.91 JOD, and the total referral expenditure during the reporting period was 2,327,279 JOD
o 19.6% (455,272.13 JOD) of overall referral expenditure was spent on maternity services with the average cost per maternity referral being 153.14 JOD
o Referrals for maternity services accounted for majority of referrals (23.5%), followed by referrals for diseases of the genitourinary system (22.0%), and circulatory system (10.2%)
o Largest proportion of cost was incurred by referrals for maternity services (19.6%) followed by trauma (17.9%)
o 56 mortalities occurred during the reporting period primarily among infants (28.6%) and the elderly (39.3%)