OBJECTIVE: United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides primary health care services including care for diabetes and hypertension, with limited resources under diffic...OBJECTIVE: United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides primary health care services including care for diabetes and hypertension, with limited resources under difficult circumstances in Gaza, West Bank, Jordan, Lebanon and Syria. A total of 114,911 people with diabetes were registered with UNRWA health centres in 2011. The aim of this cross-sectional observational study was to assess the quality of diabetes care in the UNRWA primary health care centres. METHOD: The study population consisted of 1600 people with diabetes attending the 32 largest UNRWA health centres and treated there for at least one year. Between April and Sept. 2012 data from medical records, including results of clinical examinations and laboratory tests performed during the last one year, current management including self-care education and evidence of diabetes complications were collected and recorded in a previously validated data collection form (DCF). Patients were interviewed and clinically examined on the day of the audit and blood collected for HbA1c testing which was done at a central lab using High-performance liquid chromatography (HPLC) method (HLC®-723G8 Tosoh Corporation, Japan). Data was transferred from paper records into a computer and analysed with Epi-info 2000. RESULTS: Type 1 diabetes was present in 4.3% and type 2 diabetes in 95.7%. Co-morbid hypertension was present in 68.5%;90.3% were either obese (64.0%) or overweight (26.3%). Clinical management of diabetes was largely in line with UNRWA’s technical instructions (TI) for diabetes. Records for 2 hour postprandial glucose (2 h PPG), serum cholesterol, serum creatinine, and urine protein analysis were available in 94.7%, 96.4%, 91.4% and 87.5%, cases, respectively. Records of annual fundoscopic eye examination were available in 47.3% cases but foot examinations were less well documented. Most patients (95.6%) were on anti-diabetic drugs—68.2% oral anti diabetic drugs (OAD) only, 14.4% combination of OAD and insulin, and 12.9% insulin only. While 44.8% patients had 2 h PPG ≤ 180 mg/dl, only 28.2% had HbA1c ≤ 7%;55.5% and 28.2% had BP ≤ 140/90 and ≤130/80 mm of Hg respectively. Serum cholesterol ≥ 200 mg/dl, serum creatinine ≥ 1.2 mg/dl and macro albuminuria were noted in 39.8%, 6.4% and 10.3% cases respectively. Peripheral neuropathy (52.6%), foot infections (17%), diabetic retinopathy (11%) and myocardial infarction (9.6%) were the most common long term complications. One or more episodes of hypoglycaemia were reported by 25% cases in total and in 48% of those using insulin. 17.7% and 22.6% cases received no or ≥4 self-care education sessions respectively. CONCLUSION: The study confirmed that UNRWA doctors and nurses follow TI for diabetes and hypertension fairly well. Financial constraints and the consequent effects on UNRWA TI and policies related to diabetes care were important constraints. Key challenges identified were: reliance on 2 h PPG to measure control;non-availability of routine HbA1c testing, self-monitoring of blood glucose (SMBG) and statins within the UNRWA system;and high levels of obesity in the community. Addressing these will further strengthen UNRWA health system’s efforts of providing services for diabetes and hypertension at the primary care level. Given that most developing countries either have no or only rudimentary services for diabetes and hypertension at the primary care level, UNRWA’s efforts can serve as an inspiration to others.展开更多
Integrating Lean and Six Sigma found a powerful business tool for the strategy improvement process and saving time is produced. The main aim of this study is to identify the impact of Lean Six Sigma (LSS) practices on...Integrating Lean and Six Sigma found a powerful business tool for the strategy improvement process and saving time is produced. The main aim of this study is to identify the impact of Lean Six Sigma (LSS) practices on physiotherapy service quality at healthcare centers of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), using a descriptive-analytical approach. Data were collected using a questionnaire distributed among 49 physiotherapists working at UNRWA healthcare centers as a census sampling method between July 2016 and August 2017, following the stratified random sampling method. The Statistical Package for Social Science (SPSS) was used to analyze the collected data. The results revealed that there was a statistically significant relationship between Lean Six Sigma (LSS) dimensions and the quality of healthcare services provided in physiotherapy units at the UNRWA healthcare centers. Moreover, the application of Lean Six Sigma dimensions was adopted at 81% of UNRWA healthcare centers. Moreover, the percentage of patients’ satisfaction regarding the quality of healthcare services provided in physiotherapy units was 89%. The study emphasized the effectiveness of Lean Six Sigma dimensions application on the quality healthcare services provided in physiotherapy units at the UNRWA healthcare centers. Furthermore, employee training and reward according to a needs assessment to implement Lean Six Sigma successfully is highly recommended.展开更多
Background: UNRWA provides primary healthcare for around 5.9 million Palestine refugees (PRs) in Jordan, Lebanon, Syria, West Bank and Gaza. In 2015, UNRWA started, in cooperation with Microclinic International (MCI),...Background: UNRWA provides primary healthcare for around 5.9 million Palestine refugees (PRs) in Jordan, Lebanon, Syria, West Bank and Gaza. In 2015, UNRWA started, in cooperation with Microclinic International (MCI), to implement an innovative diabetes program, aiming at improving awareness about diabetes care among PRs with Diabetes Mellitus (DM). This program takes advantage of a unique model of “microclinic” MCI social network program, a novel social network based on diabetes education intervention. Methods: A quasi-experimental study was conducted to evaluate the impact of the UNRWA-MCI program in 115 UNRWA’s HCs in Jordan, Lebanon, West Bank and Gaza. 1000 participants were randomly selected from around 60,000 participants in the program. After training 996 nurses on UNRWA-MCI diabetes care modules, groups of 10 - 15 participants with their social networks (around 20 participants in each group) attended eight weekly sessions, during which the program was introduced. Anthropometric and blood pressure (BP) measurements were collected on weekly basis, while glycated hemoglobin (HbA1c) was tested before involvement in the program and after completion of sessions with a three month period between both measurements. SPSS Version 22 was used for data analysis. The study protocol was reviewed and cleared by UNRWA, Health Department ethical committee. Results: Out of 1000 patients randomly selected for the evaluation of the impact of the program, 969 (81.9% females, 18.1% males) have completed the study. The average weight loss was 2.0 ± 4.6 Kg and significant improvements were seen in waist circumference (WC), HbA1c and BP (p ≤ 0.001 for all). Overall drop in HbA1c was 0.6 ± 1.2 with 8.5% increase in patients with HbA1c < 7.0 and 9.8% decrease in those with HbA1c ≥ 7.0. About 10.0% of patients with abnormal BP (higher than 140/90 mg/dl based on UNRWA’s criteria for BP of diabetics) had shifted to normal BP. Conclusions and Recommendations: UNRWA-MCI program improved anthropometric measurements, HbA1c and BP in diabetic PRs. It improved diabetes care management for PRs, and led to the involvement of their social networks to support their behavior change for a healthy lifestyle.展开更多
The refugee convention of 1951^1 defined a refugee as“someone who is unable or unwilling to return to their country of origin owing to the well-founded fear of being persecuted for reasons of race,religion,nationalit...The refugee convention of 1951^1 defined a refugee as“someone who is unable or unwilling to return to their country of origin owing to the well-founded fear of being persecuted for reasons of race,religion,nationality membership in particular social group,or political opinion.”The convention also lays down basic minimum standards for the treatment of refugees,without prejudice to States granting more favorable treatment to refugees.Such rights include access to courts,to primary education,to work,and the provision for documentation,including refugee travel documents in passport forms”.None of these conditions have been applied to the Palestinian refugees.Following Israel’s war of independence in 1948-49,about 800,000 Palestinians became refugees mainly in Jordan,Syria,Lebanon,and Egypt,where their descendants still live.UNRWA was created in 1949 as a“fire extinguisher”to provide the refugees in these four States with short-term survival assistance.UNRWA’s original mandate was for three years,assuming that the refugees will soon be absorbed by the countries of their refuge.This hope never materialized,and almost 70 years later,the third and fourth generation of Palestinians are still being considered by UNRWA as“refugees”.Our research shows that flows in UNRWA’s working principles have resulted in the prolonging of the problem,and the hindering of its resolution.A comparison with the World Bank’s assistance programs proves that UNRWA’s programs are clearly part of the problem and not part of the solution.展开更多
文摘OBJECTIVE: United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides primary health care services including care for diabetes and hypertension, with limited resources under difficult circumstances in Gaza, West Bank, Jordan, Lebanon and Syria. A total of 114,911 people with diabetes were registered with UNRWA health centres in 2011. The aim of this cross-sectional observational study was to assess the quality of diabetes care in the UNRWA primary health care centres. METHOD: The study population consisted of 1600 people with diabetes attending the 32 largest UNRWA health centres and treated there for at least one year. Between April and Sept. 2012 data from medical records, including results of clinical examinations and laboratory tests performed during the last one year, current management including self-care education and evidence of diabetes complications were collected and recorded in a previously validated data collection form (DCF). Patients were interviewed and clinically examined on the day of the audit and blood collected for HbA1c testing which was done at a central lab using High-performance liquid chromatography (HPLC) method (HLC®-723G8 Tosoh Corporation, Japan). Data was transferred from paper records into a computer and analysed with Epi-info 2000. RESULTS: Type 1 diabetes was present in 4.3% and type 2 diabetes in 95.7%. Co-morbid hypertension was present in 68.5%;90.3% were either obese (64.0%) or overweight (26.3%). Clinical management of diabetes was largely in line with UNRWA’s technical instructions (TI) for diabetes. Records for 2 hour postprandial glucose (2 h PPG), serum cholesterol, serum creatinine, and urine protein analysis were available in 94.7%, 96.4%, 91.4% and 87.5%, cases, respectively. Records of annual fundoscopic eye examination were available in 47.3% cases but foot examinations were less well documented. Most patients (95.6%) were on anti-diabetic drugs—68.2% oral anti diabetic drugs (OAD) only, 14.4% combination of OAD and insulin, and 12.9% insulin only. While 44.8% patients had 2 h PPG ≤ 180 mg/dl, only 28.2% had HbA1c ≤ 7%;55.5% and 28.2% had BP ≤ 140/90 and ≤130/80 mm of Hg respectively. Serum cholesterol ≥ 200 mg/dl, serum creatinine ≥ 1.2 mg/dl and macro albuminuria were noted in 39.8%, 6.4% and 10.3% cases respectively. Peripheral neuropathy (52.6%), foot infections (17%), diabetic retinopathy (11%) and myocardial infarction (9.6%) were the most common long term complications. One or more episodes of hypoglycaemia were reported by 25% cases in total and in 48% of those using insulin. 17.7% and 22.6% cases received no or ≥4 self-care education sessions respectively. CONCLUSION: The study confirmed that UNRWA doctors and nurses follow TI for diabetes and hypertension fairly well. Financial constraints and the consequent effects on UNRWA TI and policies related to diabetes care were important constraints. Key challenges identified were: reliance on 2 h PPG to measure control;non-availability of routine HbA1c testing, self-monitoring of blood glucose (SMBG) and statins within the UNRWA system;and high levels of obesity in the community. Addressing these will further strengthen UNRWA health system’s efforts of providing services for diabetes and hypertension at the primary care level. Given that most developing countries either have no or only rudimentary services for diabetes and hypertension at the primary care level, UNRWA’s efforts can serve as an inspiration to others.
文摘Integrating Lean and Six Sigma found a powerful business tool for the strategy improvement process and saving time is produced. The main aim of this study is to identify the impact of Lean Six Sigma (LSS) practices on physiotherapy service quality at healthcare centers of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), using a descriptive-analytical approach. Data were collected using a questionnaire distributed among 49 physiotherapists working at UNRWA healthcare centers as a census sampling method between July 2016 and August 2017, following the stratified random sampling method. The Statistical Package for Social Science (SPSS) was used to analyze the collected data. The results revealed that there was a statistically significant relationship between Lean Six Sigma (LSS) dimensions and the quality of healthcare services provided in physiotherapy units at the UNRWA healthcare centers. Moreover, the application of Lean Six Sigma dimensions was adopted at 81% of UNRWA healthcare centers. Moreover, the percentage of patients’ satisfaction regarding the quality of healthcare services provided in physiotherapy units was 89%. The study emphasized the effectiveness of Lean Six Sigma dimensions application on the quality healthcare services provided in physiotherapy units at the UNRWA healthcare centers. Furthermore, employee training and reward according to a needs assessment to implement Lean Six Sigma successfully is highly recommended.
文摘Background: UNRWA provides primary healthcare for around 5.9 million Palestine refugees (PRs) in Jordan, Lebanon, Syria, West Bank and Gaza. In 2015, UNRWA started, in cooperation with Microclinic International (MCI), to implement an innovative diabetes program, aiming at improving awareness about diabetes care among PRs with Diabetes Mellitus (DM). This program takes advantage of a unique model of “microclinic” MCI social network program, a novel social network based on diabetes education intervention. Methods: A quasi-experimental study was conducted to evaluate the impact of the UNRWA-MCI program in 115 UNRWA’s HCs in Jordan, Lebanon, West Bank and Gaza. 1000 participants were randomly selected from around 60,000 participants in the program. After training 996 nurses on UNRWA-MCI diabetes care modules, groups of 10 - 15 participants with their social networks (around 20 participants in each group) attended eight weekly sessions, during which the program was introduced. Anthropometric and blood pressure (BP) measurements were collected on weekly basis, while glycated hemoglobin (HbA1c) was tested before involvement in the program and after completion of sessions with a three month period between both measurements. SPSS Version 22 was used for data analysis. The study protocol was reviewed and cleared by UNRWA, Health Department ethical committee. Results: Out of 1000 patients randomly selected for the evaluation of the impact of the program, 969 (81.9% females, 18.1% males) have completed the study. The average weight loss was 2.0 ± 4.6 Kg and significant improvements were seen in waist circumference (WC), HbA1c and BP (p ≤ 0.001 for all). Overall drop in HbA1c was 0.6 ± 1.2 with 8.5% increase in patients with HbA1c < 7.0 and 9.8% decrease in those with HbA1c ≥ 7.0. About 10.0% of patients with abnormal BP (higher than 140/90 mg/dl based on UNRWA’s criteria for BP of diabetics) had shifted to normal BP. Conclusions and Recommendations: UNRWA-MCI program improved anthropometric measurements, HbA1c and BP in diabetic PRs. It improved diabetes care management for PRs, and led to the involvement of their social networks to support their behavior change for a healthy lifestyle.
文摘The refugee convention of 1951^1 defined a refugee as“someone who is unable or unwilling to return to their country of origin owing to the well-founded fear of being persecuted for reasons of race,religion,nationality membership in particular social group,or political opinion.”The convention also lays down basic minimum standards for the treatment of refugees,without prejudice to States granting more favorable treatment to refugees.Such rights include access to courts,to primary education,to work,and the provision for documentation,including refugee travel documents in passport forms”.None of these conditions have been applied to the Palestinian refugees.Following Israel’s war of independence in 1948-49,about 800,000 Palestinians became refugees mainly in Jordan,Syria,Lebanon,and Egypt,where their descendants still live.UNRWA was created in 1949 as a“fire extinguisher”to provide the refugees in these four States with short-term survival assistance.UNRWA’s original mandate was for three years,assuming that the refugees will soon be absorbed by the countries of their refuge.This hope never materialized,and almost 70 years later,the third and fourth generation of Palestinians are still being considered by UNRWA as“refugees”.Our research shows that flows in UNRWA’s working principles have resulted in the prolonging of the problem,and the hindering of its resolution.A comparison with the World Bank’s assistance programs proves that UNRWA’s programs are clearly part of the problem and not part of the solution.
