[ HeRAMS ] Health Resources Availability Mapping System Report: 2ND QUARTER 2017 Turkey Hub Health Cluster for Syria P a g e | 2 HeRAMS (Health Resources Availability Mapping System) is a standardized approach supported by a software-based platform that aims at strengthening the collection, collation and analysis of information on the availability of health resources and services in humanitarian context. It aims to address the needs/gaps expressed by the health cluster on coordination and management by providing timely, relevant, and reliable information. HeRAMS provides a tool for assessing, monitoring, and processing a comprehensive set of available data collected at health facility level. It covers; geographical location of the HF, demographic data on catchment area, type, functionality, building type, inpatient capacity, managing and supporting partners, health personnel, access and security, and health services provided at different levels of healthcare. This report provides a summary of the analysis of the available health resources and services in Syria, the report is produced with the data provided mainly by Turkey hub health cluster members national and international non-governmental organizations as well as health authorities. Dr Annette Heinzelmann Dr Jamshed Tanoli Dr Abd Arrahman Mohamed Elamein Alomar Emergency Coordinator Health Cluster Coordinator Information Management Officer World Health Organization World Health Organization HC National Co-Lead World Health Organization Mobile: +90 530 011 4948 Mobile: +90 530 238 8669 Mobile: +90 538 052 9213 Mobile: +905343554947 Email: Email: [email protected] Email: aalomar@sams- Email: [email protected] [email protected] usa.net P a g e | 3 Acronyms ANC Antenatal care BEmONC Basic Emergency Obstetric and Newborn Care CEmOC Comprehensive emergency obstetric care CHW Community Health Worker HeRAMS Health Resources Availability Mapping System HF Health Facility HIV Human Immunodeficiency Virus HW Health Worker IMCI Integrated Management of Childhood Illness MW Mid Wife MUAC Mid-Upper Arm Circumference PHC Primary Health Care STD Standard STI Sexually transmitted infection P a g e | 4 1. Distribution of Health facilities Primary Health Care facilities are classified into different standard categories based (The Essential Primary health Care Package). The following graph provides the distribution of the functional primary and secondary health facilities (static and mobile). Figure 1.Distribution of functioning Health facilities 90 85 80 76 70 60 48 49 50 40 36 35 34 30 20 15 10 0 General Hospital Specialized Comprehensive Health Centre Health Unit Mobile clinic Specialized Care Other Hospital Health Centre Facility Out of 49 main managing health partners, 42 are reported in this quarter, 403 Health facilities reported, out which 378 functional HFs compared to 355 in March 2017. 84 (22%) are Hospitals, 169(45%) are fixed PHCs, 76 (20%) are mobile clinics, 34 (9%) specialized care facility * while 15 (4%) ** other health facilities. Out of total functioning health facilities, 51% of facilities are in Idleb , 28% in Aleppo, 7% in Hama,6% in Rural Damascus,4% in Homs, while about 1% in Al-Hasakeh, Ar-Raqqa, Damascus, Dar'a and Lattakia Increase on the number of specialized hospitals from 42 to 48, decline on the number of fixed PHCs from 172 to 169. Increase in the mobile clinics number from 66 to 76 compared to the previous quarter. Specialized care facilities increased from 29 to 34, other facilities increased from 10 to 15. * Specialized health centers (Physical Rehabilitation centers, Leishmaniosis centers .Etc.) **Ambulance network, Blood Bank, Central Lab P a g e | 5 2. Functionality status Figure 2. Functionality status of Health facilities Functionality has been assessed at three levels: fully functioning which mean open and providing full package of essential services, partially functioning means open but not providing the 69, 17% full package of essential services, or not functioning. Out of 403 assessed health facilities, 77% (309) were reported fully 25, 6% functioning compared to 74% in quarter one, 17% (69) partially functioning, 6% (25) out of service, means that 23% 309, 77% of the facilities were non-functioning or partially functioning. See Figure 2. Fully Functioning Non-functioning Partially Functioning 3. Condition of health facilities Figure 3 Level of Damage infrastructure The condition of the health facilities infrastructure has been assessed at three levels: fully damaged: major damage requiring 3, 1% 63, 16% complete reconstruction, partially damaged: requiring substantial to large scale repair, and not damaged, 25% (101) health facilities were reported damaged [1% fully damaged and 24% partially damaged], 59% (239) were reported intact, while 16% (63) of 98, 24% health facilities were not relevant to evaluate. See figure 3. 239, 59% Not damaged Partially damaged Fully damaged Not relevant (e.g mobile clinic) P a g e | 6 4. Health facilities based on date of establishment The health facilities has been assessed according to Figure 4 New establlished HFs whether the health facility exist prior to the crisis or new established health facilities, 67% (255) health facilities were newly established, while 33% (123) of health facilities were prior to the crisis. See figure 4. Out of the new established health facilities 35% were 33% established in new building, 20% works in residential building, 16% in governmental Building, 5% in schools and 23% in others public building. 67% New established HFs Prior to the crisis health facility 5. Health facilities delivery points Figure 5 Delivery point types 85% health facilities are located in settlements while 15% are located in IDP camps. HF located in IDP Camp Its worth to mention that 61% of HFs located in 4% and serving exclusively settlement are also serving IDPs and 11% of IDP 11% IDPs facilities are also serving residents HF located in IDP Camp but also serving Residents 24% HF located in Settlement 61% and serving exclusively Residents HF located in Settlement but also serving IDPs P a g e | 7 6. Health facilities resources Figure 6: Accessibility to patients Figure 7: Electricity Figure 8: Water Sources 0% 4% 1% Fully accessible Fully Functioning 31.0% Available Not accessible Non-functioning 62.4% Not available 96% Partially accessible 6.3% Not available 99% 0.3% Partially Functioning 4% of functioning facilities reported difficulties in 37.6% of the functioning facilities works 1% of the facilities are without water accessibility mainly due to security reasons. without/with an interrupted electricity services Figure 9: Source of Electricity Figure 10: Modiliaty of health facilites 100% 90% 90% 80% 70% 25% 60% 50% 40% 30% 20% 12% 10% 7% 65% 10% 5% 0% National Neighborhood Private Other Electricity generator generator Percentage of health facilities per source of electricity. *Some facilities have more than one source Permanent structure Others Temporary structure 25% of facilities are in temporary structure building. P a g e | 8 7. Provision of Provision of General Clinical Services Figure 11:Outpatient services: 100% 3% The main reasons for the non- 17% 13% 15% 90% 26% availability of outpatient services are 80% 33% 34% lack of health staff, lack of operational 70% cost and lack of drugs and medical 60% supplies. 50% 97% 40% 83% 87% 85% 74% 30% 67% 66% 20% 10% 0% Comprehensive General Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Hospital Facility Hospital Available Not available Figure 12: Inpatient capacity 100% 6% 6% 90% The availability of inpatient services in 80% the general and specialized hospitals is 70% 71% more than 94%, while 11% of these 60% hospitals provide inpatient services 50% 94% 94% with low capacity. 40% It’s worth to mention that only 29% of 30% the comprehensive health centers are 20% 29% providing inpatient service while it’s 10% necessary as per essential primary 0% Comprehensive Health Centre General Hospital Specialized Hospital health care package. Available Not available P a g e | 9 Figure 13:*Basic Laboratory Services 100% 3% 2% 90% 26% In hospitals basic laboratory services 80% availability is about 98%, while 74% of 70% 64% 63% comprehensive health Centers 60% 79% 85% providing basic laboratory Services. 50% 97% 98% 40% 74% 30% *CBC, urine analysis, stool microscopy, sputum 20% 36% 37% microscopy 10% 21% 15% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital Available Not available Figure 14: *Basic Imaging Service 100% 6% 90% 15% 89% of the hospitals provide Basic 80% imaging services while 16% of primary 70% 63% health facilities providing this Service. 60% 73% 98% 50% 94% 40% 85% 30% 20% 37% 10% 27% *X-Ray and Ultrasound 0% 2% Comprehensive Health General Hospital Health Centre Health Unit Specialized Hospital Centre Available Not available P a g e | 10 Figure 15: Pharmacy having Essential 100% 3% 3% 2% 2% 10% 5% Drugs 90% 80% Most of the reported health facilities 70% 62% have pharmacy having essential drugs. 60% 50% 97% 97% 98% 98% 90% 95% 40% 40% provide it partially as there is no 30% sustainable drugs and consumables 20% 38% supply and management system. 10% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital Available Not available 100% 3% 3% 4% 90% Figure 16:Referral capacity 32% 29% 80% 73% of the facilities have referral 70% 57% mechanism in place, such