Diabetes and associated complications constitute a major health problem in the Occupied Palestinian Territories (OPT). Prevalence as well as mortality and complication rates for both type 1 and type 2 diabetics are highest among the most vulnerable populations; especially the tribal Bedouins who constitute a significant part of the refugee population of the West Bank and do not have proper access to health care services.The Ministry of Health (MoH), which is the largest health care provider in the OPT, runs approximately 60% of the primary health care centres while the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) is the second largest provider. Guidelines for the management of diabetes and other NCDs have been developed. However, training, supervision, follow-up and assessments of these interventions are absent.The burden of diabetes is growing rapidly, especially among the refugees who are already extremely vulnerable. To cease this adverse development it is essential to improve access to quality care, especially for the vulnerable populations.The aim of the project is to improve general diabetes care and management of diabetic foot in Gaza and the West Bank in UNRWA clinics providing service to Palestinian refugees.
The project is initiated by UNRWA in collaboration with the Ministry of Health (MoH) and the Palestinian Medical Relief Society. UNRWA has also created partnerships with public and private organisations including WHO and one of WDF's long-term partners Augusta Victoria Hospital (AVH) situated in the West Bank (WDF06-170 and WDF07-264).This particular project consists of two separate components for Gaza and the West Bank to account for the vast structural differences and accessibility between the two areas:1. Gaza-component:The goal of the Gaza-component is to upgrade the management of diabetic foot in UNRWA health centres in the Gaza Strip. The project seeks to reduce diabetic foot infections, ulcers, gangrene and amputations by ensuring prevention and early detection of complications. This is to be done through capacity building of health professionals, health education and awareness-raising and establishment of diabetic foot units in each of the 20 existing UNRWA health centres in Gaza. The intention is to reach people with type 1 and type 2 diabetes, with co-morbidities and the diabetes population in general population.A Field Disease Control Officer and three NCD medical officers will be trained as trainers in foot care. They will train 170 different health care professionals from all of the 20 UNRWA health centres. In addition, diabetes education sessions and awareness camps will be conducted every month.2. West Bank-component:The goal of the West Bank-component is to improve the detection and management of diabetes - particularly among the refugee population. This will be done by strengthening 41 UNRWA health clinics throughout the area. The project will help build capacity of health care professionals for diabetes management, and to mental health counsellors who will be trained on how to manage the psychosocial issues faced by people with diabetes. Screening and monitoring will be carried out and all essential medicines will be made available free of charge through the UNRWA clinics. Half-yearly fairs will be hosted at each clinic outside its opening hours, offering free blood glucose testing for people above 40 years of age and distributing educational materials to raise awareness. The fairs will be announced and supported by radio messages targeting mainly refugee camp populations.Furthermore, five existing mobile health units will be strengthened by introducing diabetes screening and care. These mobile clinics will provide services to the tribal Bedouin communities who have been subjected to forced displacement and who have very limited access to health care services.The long term perspective of the project - and the UNRWA effort as a whole - is to hand over the running of the health centres to the Palestinian Authority once a durable solution is found to the Palestinian conflict and once the refugees are resettled.
Gaza component:• 20 foot clinics established or strengthened in 20 UNRWA clinics in the Gaza Strip• Capacity built for 4 trainers of trainers (ToT)• 340 health care professionals trained in examination of diabetic foot• 68,906 people screened for diabetic foot • 1,581 diabetic foot patients referred for foot treatment• Patient education materials produced• 292 community outreach camps conductedWest Bank component:• 47 general clinics in West Bank strengthened to provide diabetes care• IEC materials produced• 218 health care providers trained in "Diabetes Treatment Psychological Resistance Management"• 176 doctors and nurses trained in diabetes management and case study reviews• 16,000 refugees at risk screened for diabetes• 95,000 refugees including 5,000 from Bedouin tribes reached through awareness activities • 84 public health fairs conducted