Noncommunicable diseases (NCDs) are the leading cause of death and disease in Jordan, accounting for 78% of all deaths, according to the Jordan National Stepwise Survey (STEPs) for NCD Risk Factors 2019.
Jordan’s government and civil society are working together to decrease this huge NCD burden, with WDF’s support. Since 2007, WDF has supported 11 projects in Jordan with nearly USD 8.5 million in funding.
Jordan has been of particular focus for WDF for several reasons. The country is grappling with a combined NCD-humanitarian burden, due to an expanding refugee population (currently 30% of Jordan’s population, with the vast majority of refugees originating from Syria) putting additional pressure on an already challenged health care system.
Jordan’s government and civil society are committed to improving the situation, and many international agencies working in the country are providing assistance, creating the potential for a multi-sectoral and multi-stakeholder response to this dual challenge.
In 2020, the Ministry and its close partner the Royal Health Awareness Society (RHAS), together with WDF launched an ambitious, multi-year project: The Integrated NCD-Humanitarian Response. The project is working to reduce the burden of NCDs among Syrian refugees in Jordan and Jordanian host communities through a health system focus on NCDs (with emphasis on diabetes and hypertension) - especially at the primary care level.
WDF is responsible for grant monitoring and oversight at country-level, as well as funding. The Novo Nordisk Foundation provided an additional, sizeable grant to WDF in support of the project.
The project focuses on three main tracks: health centres, communities (in particular schools and youth volunteers), and advocacy and policy, backed up by an implementation research component.
It’s WDF’s largest project to date, with the potential to strengthen NCD care and prevention in the country and provide a platform for cross-country knowledge sharing.
In October, a delegation from WDF visited Jordan to see its progress.
Prescription for a healthier life
Al Hashimi Al Shamali Health Center in East Amman has a catchment population of 200,000 people and serves an average of 500 patients every day. Most are low-income, many are refugees, and many suffer from one or more NCDs.
Recently, it gained a powerful new tool: a Healthy Community Clinic (HCC). The HCC is a model created by RHAS and adopted by the Ministry of Health to help health centres like Al Hashimi promote healthy lifestyles and prevent NCDs. HCCs are integrated within the health centre, and offer group awareness sessions, follow-up and personalised care.
The awareness sessions are key tools for lifestyle modification. Doctors throughout the health centre give their patients with NCDs ‘preventive prescriptions’ to refer them to various group awareness sessions, based on their needs, said Dr Rana Ratrout, the centre’s manager.
“There are various sessions and topics, such as obesity, nutrition and tobacco cessation – many people are prescribed all of them. We see patients at least once a month for a whole year, because behavioural change takes time,” she said.
The groups provide flexible support to patients dealing with difficult, chronic health issues, Dr Ratrout said. She noted that during the COVID19 lockdown nurses were able to continue counselling patients via WhatsApp and Zoom.
She invited WDF visitors to join a meeting of one such group – focused on nutrition – and see the engagement of patients and hear their stories.
Omayma Odeh told the visitors that the HCC helped her lose almost 25 kilos, and she is now keeping her weight and blood glucose levels down with the group’s support. Muna Fareed volunteered that she found the sessions “very beneficial” and wished they had been available to her 15 years ago, when she was first diagnosed with diabetes.
Fatima Tawfiq said she has succeeded in introducing healthier meals at home but added that change isn’t easy, especially when trying to change the diet of her family members as well.
A Healthy Community Clinic Awareness session at the Al Hashimi Al Shamali Health Center.
Dr Ratout says she sees signs that patients who adhere to lifestyle modifications they learn in the HCC need less medication and have fewer referrals to the hospital for NCD complications.
“I have seen that the right information can make a huge difference in patients’ lives,” she said. “I would like to continue this outreach to people with and without diabetes.”
The Integrated NCD-Humanitarian Response project is establishing 190 new Healthy Community Clinics in Ministry of Health-run health centres across Jordan.
A refuge for refugees
The Caritas Health Center in downtown Amman has a peaceful, efficient feel. Outside, patients await their appointments in a sun-dappled atrium; inside, clinic staff move quickly through its small, tidy rooms.
The centre is run by the faith-based organisation Caritas Internationalis, which has an agreement with the United Nations High Commissioner for Refugees (UNHCR) to provide health services for Syrian refugees in Jordan. Recently, as part of the Integrated NCD-Humanitarian Response project’s activities, it opened several HCCs in Jordanian Caritas centres in coordination with UNHCR.
“We currently serve Syrians, Iraqis and other refugees, as well as some uninsured Jordanians - the most vulnerable,” Mr Omar Abwi, Caritas Program Manager, told WDF visitors. “The Healthy Community Clinic programme has great benefits. It doesn’t address what people want, it addresses what they need – it makes patients feel empowered and positive about their wellbeing.”
Through its partnership with RHAS, Caritas is also providing stress management and mental wellbeing sessions, which the patients deeply appreciate, he said. He then invited the WDF visitors to observe an awareness session led by a clinic nurse.
After listening to a lively discussion about the importance of walking, healthy diets and other lifestyle choices, Tina Abild, the vice-chair of WDF’s Board, asked: “Is it difficult being told how to live and what to eat?”
Several participants shook their heads emphatically. “No, the information is very helpful,” a man attending the session with his wife said. “There are so many things that we can’t control. But with food, with exercise - everyone can do something.”
A Healthy Community Clinic Awareness Session at the downtown Amman Caritas clinic.
Afterwards Huda Al Dabagh, a Syrian woman with diabetes who volunteers at the clinic, shared what the services offered by Caritas mean to her.
“I followed their advice, lost weight, and now have stable hypertension,” she said. “Now I’m helping my kids and neighbours live healthier and I come here every day. I love sharing what I’ve learned.”
The Integrated NCD-Humanitarian Response project is building NCD capacity at 20 Caritas health centres serving refugees across Jordan.
Community level prevention
While the main focus of Integrated NCD-humanitarian Response is on access to care, a secondary focus is on prevention.
To achieve this, the project is supporting activities to improve NCD knowledge, attitudes and practices towards NCDs among refugee populations and vulnerable Jordanians – with a special focus on youth and school children.
At Queen Nour Secondary School, a girls’ school in East Amman serving 800 low-income and refugee students, WDF visitors had the chance to see one of these programmes in action.
They were greeted by a group of the school’s scouts, who sang a welcoming song before leading them inside, past a prominent ‘no smoking’ sign on the school’s facade. It was the first of many indications that Queen Nour Secondary School is a proud member of Jordan’s Healthy Schools Programme promoting healthy environments and education in schools.
Student scouts greeting visitors outside their Healthy School.
“I have witnessed the transformation of this school through the Healthy Schools Programme,” said Khetam Abdelkhaleq, the school’s principal. “Maintaining Healthy Schools accreditation takes a lot of work - this is an urban poverty pocket in Amman. Especially during COVID, convincing people to continue healthy habits has been difficult. But this partnership encourages us to continue.”
Queen Nour’s Healthy School activities include physical education and nutrition awareness – two responses to the increasing obesity levels in Jordan, she said. (The 2019 WHO STEPs survey found that more than 60% of the Jordanians and Syrians sampled were overweight or obese.) The school has also succeeded in keeping its campus smoke free in a country with one of the highest smoking rates in the world.
WDF visitors met two Healthy Schools volunteers, young adults from the community who provide students with support and coaching. Then, they visited a healthy diet activity where students displayed a breakfast of hummus, vegetables and fresh bread they had prepared, and spoke with students about healthy food at school and at home.
Nutrition class, one of Queen Nour’s Healthy School activities.
The Integrated NCD-Humanitarian Response project is enrolling 160 new public schools in the Healthy Schools Programme.
At the end of their visit, WDF and RHAS representatives visited the Ministry of Health to discuss their ongoing partnership and MoH priorities and challenges with Minister of Health Dr Firas Al Hawari and other ministry officials.
The minister thanked WDF for its continued support, and suggested priority areas for future collaborations to improve and integrate NCD care for Jordanian host communities and refugees.
Meeting at Jordan’s Ministry of Health.
“The visit clearly confirmed that the objectives of this project are closely aligned with Jordan’s health policies, strategies and frameworks. It was encouraging to see the value of the project activities, both in the clinics and in the community,” said Jakob Sloth Madsen, WDF Senior Advisor.
Ms Hanin Odeh, WDF Regional Advisor for the Middle East, said: “The words ‘commitment’ and ‘passion’, resonated frequently when talking with healthcare professionals during our visits to the different health centres, where despite challenges including heavy workloads and COVID, the drive to support NCD patients continued.”
RHAS Director General Amal Ireifij said it was a pleasure to share some of the project’s life-changing impact with the WDF delegation. “We hope this collaboration will result in a national blueprint for NCDs prevention and management that we can share with other countries facing similar challenges,” she added.
In late November, the Ministry of Health, WDF and RHAS co-organised a national conference to share knowledge and lessons learned related to the integrated NCD-humanitarian response in Jordan.
“We hope its insights will inspire replication of successful models in similar contexts regionally and globally,” Mr Madsen said.