Syrian Refugees and Digital Health in Lebanon

There are currently over 1.1 million Syrian refugees in need of healthcare services from an already overstretched Lebanese healthcare system. Access to antenatal care (ANC) services presents a particular challenge. We conducted focus groups with 59 refugees in rural Lebanon to identify contextual and cultural factors that can inform the design of digital technologies to support refugee ANC. Previously identified high utilization of smartphones by the refugee population offers a particular opportunity for using digital technology to support access to ANC as well as health advocacy. Our findings revealed a number of considerations that should be taken into account in the design of refugee ANC technologies, including: refugee health beliefs and experiences, literacy levels, refugee perceptions of negative attitudes of healthcare providers, and hierarchal and familial structures

Integrating Health technologies in Health Services for Syrian Refugees in Lebanon: Qualitative study

Background: Lebanon currently hosts around one million Syrian refugees. There has been an increasing interest in integrating eHealth and mHealth technologies into the provision of primary health care to refugees and Lebanese citizens. Objective: We aimed to gain a deeper understanding of the potential for technology integration in primary health care provision in the context of the protracted Syrian refugee crisis in Lebanon. Methods: A total of 17 face-to-face semistructured interviews were conducted with key informants (n=8) and health care providers (n=9) involved in the provision of health care to the Syrian refugee population in Lebanon. Interviews were audio recorded and directly translated and transcribed from Arabic to English. Thematic analysis was conducted. Results: Study participants indicated that varying resources, primarily time and the availability of technologies at primary health care centers, were the main challenges for integrating technologies for the provision of health care services for refugees. This challenge is compounded by refugees being viewed by participants as a mobile population thus making primary health care centers less willing to invest in refugee health technologies. Lastly, participant views regarding the health and technology literacies of refugees varied and that was considered to be a challenge that needs to be addressed for the successful integration of refugee health technologies. Conclusions: Our findings indicate that in the context of integrating technology into the provision of health care for refugees in a low or middle income country such as Lebanon, some barriers for technology integration related to the availability of resources are similar to those found elsewhere. However, we identified participant views of refugees’ health and technology literacies to be a challenge specific to the context of this refugee crisis. These challenges need to be addressed when considering refugee health technologies. This could be done by increasing the visibility of refugee capabilities and configuring refugee health technologies so that they may create spaces in which refugees are empowered within the health care system and can work toward debunking the views discovered in this study

The impact of digital technology on health of populations affected by humanitarian crises: Recent innovations and current gaps

Digital technology is increasingly used in humanitarian action and promises to improve the health and social well-being of populations affected by both acute and protracted crises. We set out to (1) review the current landscape of digital technologies used by humanitarian actors and affected populations, (2) examine their impact on health and well-being of affected populations, and (3) consider the opportunities for and challenges faced by users of these technologies. Through a systematic search of academic databases and reports, we identified 50 digital technologies used by humanitarian actors, and/or populations affected by crises. We organized them according to the stage of the humanitarian cycle that they were used in, and the health outcomes or determinants of health they affected. Digital technologies were found to facilitate communication, coordination, and collection and analysis of data, enabling timely responses in humanitarian contexts. A lack of evaluation of these technologies, a paternalistic approach to their development, and issues of privacy and equity constituted major challenges. We highlight the need to create a space for dialogue between technology designers and populations affected by humanitarian crises

Syrian Refugees and Digital Health in Lebanon: Opportunities for Improving Antenatal Health

ABSTRACT There are currently over 1.1 million Syrian refugees in need of healthcare services from an already overstretched Lebanese healthcare system. Access to antenatal care (ANC) services presents a particular challenge. We conducted focus groups with 59 refugees in rural Lebanon to identify contextual and cultural factors that can inform the design of digital technologies to support refugee ANC. Previously identified high utilization of smartphones by the refugee population offers a particular opportunity for using digital technology to support access to ANC as well as health advocacy. Our findings revealed a number of considerations that should be taken into account in the design of refugee ANC technologies, including: refugee health beliefs and experiences, literacy levels, refugee perceptions of negative attitudes of healthcare providers, and hierarchal and familial structures

A mixed-methods evaluation of community-based healthy kitchens as social enterprises for refugee women.

BACKGROUND: The aim of this study is to investigate the potential impact of a community-based intervention - the Healthy Kitchens, Healthy Children (HKHC) intervention - on participating women's household's economics and food security status, decision making, mental health and social support. METHODS: We established two healthy kitchens in existing community-based organizations in Palestinian camps in Lebanon. These were set up as small business enterprises, using participatory approaches to develop recipes and train women in food preparation, food safety and entrepreneurship. We used a mixed-methods approach to assess the impact of participating in the program on women's economic, food security, decision making, social and mental health outcomes. A questionnaire was administered to women at baseline and at an 8-month endpoint. The end line survey was complemented by a set of embedded open-ended questions. RESULTS: Thirty-two Palestinian refugee women were employed within the kitchens on a rotating basis. Participating women had a 13% increase in household expenditure. This was translated into a significant increase in food (p < 0.05) and clothing expenditures (p < 0.01), as well as a reduction in food insecurity score (p < 0.01). These findings were supported by qualitative data which found that the kitchens provided women with financial support in addition to a space to form social bonds, discuss personal issues and share experiences. CONCLUSIONS: This model created a social enterprise using the concept of community kitchens linked to schools and allowed women to significantly contribute to household expenditure and improve their food security

Host country responses to non-communicable diseases amongst Syrian refugees: a review

Abstract Background Since the beginning of the Syrian conflict in 2011, Jordan, Lebanon and Turkey have hosted large refugee populations, with a high pre-conflict burden of non-communicable diseases (NCDs). Objectives We aimed to describe the ways in which these three host country health systems have provided NCD services to Syrian refugees over time, and to highlight the successes and challenges they encountered. Methods We conducted a descriptive review of the academic and grey literature, published between March 2011 and March 2017, using PubMed and Google searches complemented with documents provided by relevant stakeholders. Results Forty-one articles and reports met our search criteria. Despite the scarcity of systematic population-level data, these documents highlight the high burden of reported NCDs among Syrian refugees, especially amongst older adults. The three host countries utilized different approaches to the design, delivery and financing of NCD services for these refugees. In Jordan and Lebanon, Ministries of Health and the United Nations High Commissioner for Refugees (UNHCR) coordinate a diverse group of health care providers to deliver health services to Syrian refugees at a subsidized cost. In Turkey, however, services are provided solely by the Disaster and Emergency Management Presidency (AFAD), a Turkish governmental agency, with no cost to patients for primary or secondary care. Access to NCD services varied both within and between countries, with no data available from Turkey. The cost of NCD treatment is the primary barrier to accessing healthcare, with high out-of-pocket payments required for medications and secondary and tertiary care services, despite the availability of free or subsidized primary health services. Financial impediments led refugees to adopt coping strategies, including returning to Syria to seek treatment, with associated frequent treatment interruptions. These gaps were compounded by health system related barriers such as complex referral systems, lack of effective guidance on navigating the health system, limited health facility capacity and suboptimal NCD health education. Conclusion As funding shortages for refugee services continue, innovative service delivery models are needed to create responsive and sustainable solutions to the NCD burden among refugees in host countries