14 research outputs found
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City Life: Three Papers Investigating the Healthcare Experience of Refugees With Noncommunicable Diseases Residing in Urban Settings Across the Middle East and North Africa
The last decade has been defined by the forced displacement of an unprecedented number of people, on a scale not seen since World War II. As of 2018, more than 71 million people across the globe have been forced to migrate as a result of conflict, natural disasters, drought and famine. More than 19 million crossed international borders seeking safety, and were formally registered as refugees. Forced migration has placed stress and pressure on surrounding low-and middle-income countries. This has been most notable in the Middle East and North Africa as a result of the crisis in Syria.
Host countries in the Middle East and North Africa are overwhelmed by this rapid influx, particularly by the healthcare needs of this population. Stakeholders face difficulties providing health services to refugees, owing to the increased number of refugees in urban settings, the large demands on host country health systems and the epidemiologic transition towards non-communicable diseases (NCDs). Health challenges have been exacerbated by weaknesses in the global humanitarian architecture, that result in a fragmented and competitive sector that is unprepared for the current context.
Few comparative analyses have examined the diversity of policies and practices aimed at improving services for urban-based refugees with NCDs in the MENA region. Furthermore, a variety of quantitative studies examined NCD incidence, prevalence and service utilization. However, these studies have quickly become outdated and do not explore, in adequate depth, the refugee experience and perspective on accessing NCD services in urban settings. Lastly, numerous NCD interventions have been recommended for LMICs. However, very little guidance exists to support actors addressing these health concerns in crisis-affected contexts. As a result, this dissertation is presented in three papers and responds to these gaps in the literature. Each paper focuses on a specific aim and research question and together they identify and provide recommendations for improvement to service delivery and policy formulation.
Paper 1 identifies policies and practices, implemented by host countries and humanitarian actors, aimed at improving access to NCD services for urban refugees in the Middle East and North Africa. Paper 2 examines, using qualitative methods, the healthcare access experience of urban-based Syrian refugees who have been diagnosed with NCDs in Jordan. The third portion of this dissertation (Paper 3) is a policy series that provides recommendations for the government of Jordan and humanitarian actors to improve healthcare access for urban-based refugees with NCDs. It is anticipated that this series of publications will be relevant to traditional and non-traditional actors that respond to the health needs of refugees in urban settings in the MENA region
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Addressing noncommunicable diseases among urban refugees in the Middle East and North Africa - a scoping review
Background
More than 5.5 million Syrian refugees have fled violence and settled in mostly urban environments in neighboring countries. The Middle East and North Africa (MENA) region accounts for 6% of the global population but 25% of the population are âof concernâ to the UN Refugee Agency. In addition to large amounts of forced migration, the region is also undergoing an epidemiologic transition towards a heavier burden of noncommunicable diseases (NCDs), which in 2018 accounted for 74% of all deaths in the region. To address NCD needs globally, a myriad of policies and interventions have been implemented in low-income stable country settings. However, little is known about which policies and interventions are currently being implemented or are best suited for refugee hosting countries across the Middle East and North Africa.
Methods
A scoping review of peer-reviewed literature was conducted to identify policies and interventions implemented in the Middle East and North Africa to address the needs of urban refugees with noncommunicable diseases.
Results
This scoping review identified 11 studies from Jordan, Lebanon, Iran, West Bank, Gaza and Syria. These studies addressed three foci of extant work, (1) innovative financing for expensive treatments, (2) improvements to access and quality of treatment and, (3) efforts to prevent new diagnoses and secondary complications. All interventions targeted refugee populations including Palestinians, Sudanese, Syrians, Afghans and Iraqis.
Discussion
The scoping review highlighted five key findings. First, very few studies focused on the prevention of noncommunicable diseases among displaced populations. Second, several interventions made use of health information technologies, including electronic medical records and mHealth applications for patients. Third, the vast majority of publications were solely focused on tackling NCDs through primary care efforts. Fourth, the literature was very sparse in regard to national policy development, and instead favored interventions by NGOs and UN agencies. Last, the perspectives of refugees were notably absent.
Conclusion
Opportunities exist to prioritize prevention efforts, scale up eHealth interventions, expand access to secondary and tertiary services, address the scarcity of research on national policy, and incorporate the perspectives of affected persons in the broader discourse
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Guidance Note on Psychosocial Support: Facilitating psychosocial wellbeing and social and emotional learning
This INEE Guidance Note addresses a gap in the tools that are currently available to educators and professionals operating in emergency and crisis contexts. Although many resources specific to psychosocial programming exist, including the foundational guidance for the humanitarian sector referenced in this document, INEE members working in contexts as diverse as the Ebola crisis in West Africa, the aftermath of the Nepalese earthquake, and the ongoing Syrian crisis expressed a need for PSS guidance that was specifically oriented to the education sector. This INEE Guidance Note encourages more intentional and consistent implementation of practical, good-quality psychosocial interventions on the education frontlines by teachers, education administrators, parents, counselors, peers, ministries, and other education personnel in three concrete ways: â˘The Guidance Note clarifies the education sectorâs importance in supporting the psychosocial wellbeing of children and youth. â˘The Guidance Note provides educators with practical tips and advice about how to integrate PSS into formal and non-formal education efforts. â˘The Guidance Note highlights linkages between PSS in education and other sectors
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Impact of Separation on Refugee Families: Syrian Refugees in Jordan
The ongoing conflict in Syria, now entering its eighth year, has resulted in the largest refugee crisis since World War II. Nearly 6.5 million Syrians have become internally displaced, with an additional 5.6 million forced to leave their country to seek asylum. In the face of this displacement, greater attention is being given to complementary and alternative solutions such as reunification of separated family members. However, serious legal and procedural obstacles are obstructing the reunification of Syrian families across the Middle East and Europe. This study outlines several ways in which family separation negatively impacts Syrian refugees in Jordan. These effects are significant, and include financial burdens, increased child labour, emotional distress, broken social networks, parenting challenges and changes to familial roles
Development of a Brief Instrument for Assessing Healthcare Employee Satisfaction in a Low-Income Setting
BackgroundEthiopia is one of 57 countries identified by the World Health Report 2006 as having a severely limited number of health care professionals. In recognition of this shortage, the Ethiopian Federal Ministry of Health, through the Ethiopian Hospital Management Initiative, prioritized the need to improve retention of health care workers. Accordingly, we sought to develop the Satisfaction of Employees in Health Care (SEHC) survey for use in hospitals and health centers throughout Ethiopia.MethodsLiterature reviews and cognitive interviews were used to generate a staff satisfaction survey for use in the Ethiopian healthcare setting. We pretested the survey in each of the six hospitals and four health centers across Ethiopia (98% response rate). We assessed content validity and convergent validity using factor analysis and examined reliability using the Cronbach alpha coefficients to assess internal consistency. The final survey was comprised of 18 questions about specific aspects of an individual's work and two overall staff satisfaction questions.ResultsWe found support for content validity, as data from the 18 responses factored into three factors, which we characterized as 1) relationship with management and supervisors, 2) job content, and 3) relationships with coworkers. Summary scores for two factors (relationship with management and supervisors and job content) were significantly associated (P-value, 0.70) for the items in the three summary scores.ConclusionsThe introduction of consistent and reliable measures of staff satisfaction is crucial to understand and improve employee retention rates, which threaten the successful achievement of the Millennium Development Goals in low-income countries. The use of the SEHC survey in Ethiopian healthcare facilities has ample leadership support, which is essential for addressing problems that reduce staff satisfaction and exacerbate excessive workforce shortages
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âWhatâs happening in Syria even affects the rocksâ: a qualitative study of the Syrian refugee experience accessing noncommunicable disease services in Jordan
Background
Humanitarian actors and host-countries in the Middle East and North Africa region are challenged with meeting the health needs of Syrian refugees and adjusting the response to contemporary humanitarian conditions â urban-based refugees, stressed host-country health systems and high NCD prevalence. Although several studies have explored NCD prevalence, utilization of services and barriers to access, these analyses took place prior to dramatic shifts in Jordanian health policy and did not account for nuances in health seeking and utilization behaviors or operational barriers. Accordingly, we aimed to understand the depth and nuances of Syrian refugeesâ experiences accessing NCD services in urban and semi-urban settings in Jordan.
Methods
A qualitative study was conducted to explore the healthcare experiences of Syrian refugees in Jordan. The study team conducted 68 in-depth interviews with Syrian refugees in urban and semi-urban locations in central and northern Jordan.
Results
The findings indicated four themes key to understanding the healthcare experience: (1) emotional distress is a central concern and is frequently highlighted as the trigger for a non-communicable disease or its exacerbation; (2) service provision across all sectors â government, NGO, private â is complex, inadequate, expensive and fragmented, making engagement with the health sector physically and financially burdensome; (3) given financial constraints, participants make harmful decisions that further damage their health in order to reduce financial burdens, and (4) host-community members actively exhibit solidarity with their refugee neighbors and specifically do so during emergency health episodes. The findings from this study can be used to inform program design for forcibly displaced persons with NCDs and identify points of entry for effective interventions.
Conclusions
Opportunities exist for humanitarian and host-country actors to provide more comprehensive NCD services and to improve the relevance and the quality of care provided to Syrian refugees in Jordan. Global and national funding will need to align with front-line realities and foster better coordination of services between host-country health systems, private actors and non-governmental organizations
Development of a brief instrument for assessing healthcare employee satisfaction in a low-income setting.
Ethiopia is one of 57 countries identified by the World Health Report 2006 as having a severely limited number of health care professionals. In recognition of this shortage, the Ethiopian Federal Ministry of Health, through the Ethiopian Hospital Management Initiative, prioritized the need to improve retention of health care workers. Accordingly, we sought to develop the Satisfaction of Employees in Health Care (SEHC) survey for use in hospitals and health centers throughout Ethiopia.Literature reviews and cognitive interviews were used to generate a staff satisfaction survey for use in the Ethiopian healthcare setting. We pretested the survey in each of the six hospitals and four health centers across Ethiopia (98% response rate). We assessed content validity and convergent validity using factor analysis and examined reliability using the Cronbach alpha coefficients to assess internal consistency. The final survey was comprised of 18 questions about specific aspects of an individual's work and two overall staff satisfaction questions.We found support for content validity, as data from the 18 responses factored into three factors, which we characterized as 1) relationship with management and supervisors, 2) job content, and 3) relationships with coworkers. Summary scores for two factors (relationship with management and supervisors and job content) were significantly associated (P-value, <0.001) with the two overall satisfaction items. Cronbach's alpha coefficients showed good to excellent internal consistency (Cronbach alpha coefficients >0.70) for the items in the three summary scores.The introduction of consistent and reliable measures of staff satisfaction is crucial to understand and improve employee retention rates, which threaten the successful achievement of the Millennium Development Goals in low-income countries. The use of the SEHC survey in Ethiopian healthcare facilities has ample leadership support, which is essential for addressing problems that reduce staff satisfaction and exacerbate excessive workforce shortages
Satisfaction of Employees in Health Care (SEHC) Survey (<i>English</i>).
<p>Satisfaction of Employees in Health Care (SEHC) Survey (<i>English</i>).</p
Convergent validity: Correlation coefficients for scales with overall staff satisfaction measures (Nâ=â492).
<p>Convergent validity: Correlation coefficients for scales with overall staff satisfaction measures (Nâ=â492).</p