[HeRAMS] Health Resources Availability Mapping System Report: 1ST 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. Map showing areas of operation P a g e | 3 1. Distribution of Health facilities Primary Health Care facili�es are classified into different standard categories based on the provision of services, staff pa�ern and popula�on coverage. The following graph provides the distribu�on of the exis�ng health facili�es (sta�c and mobile); in terms of number of the func�onal facili�es. Figure 1.Distribu�on of func�oning Health facili�es 100 89 90 80 70 66 60 46 50 42 37 40 36 29 30 20 10 10 0 General Hospital Specialized Comprehensive Health Centre Health Unit Mobile clinic Specialized Care Other Hospital Health Centre Facility Out of 45 main managing health partners, 40 are reported in this quarter, 389 Health facili�es reported, out which 355 func�onal HFs compared to 327 in December 2016.*, 78(22%) are Hospitals, 172(49%) are fixed PHCs, 66 (18%) are mobile clinics, 29 (8%) specialized care facility ** while 10 (3%) *** other health facili�es. Out of total func�oning health facili�es, 51% of facili�es are in Idleb , 27% in Aleppo, 8% in Hama,6% in ooRural Damascus,4% in Homs, while about 1% in Al-Hasakeh, Ar-Raqqa, Damascus, Dar'a and La�akia *repor�ng rate increased from 36 partners in December 2016 to 40 in this quarter. ** Specialized health centers (Physical Rehabilita�on centers, Leishmaniosis centers .Etc.) ***Ambulance network, Blood Bank, Central Lab P a g e | 4 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 full package of essential services, or not functioning. Out of 389 66, 17% assessed health facilities, 74% (289) were reported fully functioning, 17% (66) partially functioning, 9% (34) out of 34, 9% service, means that 26% of the facilities were non-functioning or partially functioning with low capacity. See Figure 2. 289, 74% Among non-functioning facilities, 53% were hospitals reported from Aleppo, Rural Damascus, Hama and Idleb respectively. 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 4, 1% 55, 14% complete reconstruction, partially damaged: requiring substantial to large scale repair, and not damaged, 27% (106) health facilities were reported damaged [1% fully damaged and 26% partially damaged], 59% (228) were reported intact, while 14% (55) of 26% 228, 59% health facilities were not relevant to evaluate. See figure 3. Not damaged Partially damaged Fully damaged Not relevant (e.g mobile clinic) P a g e | 5 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% (238) health facilities were newly established, while 33% (117) 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, 21% works in residential building, 17% in governmental Building, 6% in schools and 21% in others public building. 67% New established HFs Prior to the crisis health facility 5. Health facilities delivery points Figure 5 Delivery point types 84% health facilities are located in settlements while 16% are located in IDP camps. HF located in IDP Camp Its worth to mention that 58% of HF located in 5% and serving exclusively 11% IDPs settlement are also serving IDPs and 11% of IDP HF located in IDP Camp facilities are also serving residents but also serving Residents HF located in Settlement 58% 26% and serving exclusively Residents HF located in Settlement but also serving IDPs P a g e | 6 6. Health facilities resources Figure 6: Accessibility to patients Figure 7: Electricity Figure 8: Water Sources 0% 4% Fully Functioning 1% Fully accessible 31% Non-functioning Not accessible Available 63% Not available Not available 96% Partially 99% accessible 6% Partially 0% Functioning 4% of functioning facilities reported difficulties in 37% 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: Availability of chlorine tablets 25% 23% Only 23% of functioning facilities with sufficient chlorine tablets. 24% 28% Sufficiently Insufficiently Not available Not applicable P a g e | 7 7. Provision of General Clinical Services Figure 10:Outpatient services: 100% The main reasons for the lack of 5% 10% 90% 17% 20% 20% availability of outpatient services are 80% 38% 38% lack of health Staff, Lack of finances and 70% Lack of medical supplies (drugs and 60% consumables). 50% 95% 90% 40% 83% 80% 80% 30% 62% 62% 20% 10% 0% Comprehensive General Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Hospital Facility Hospital Available Not available Figure 11: Inpatient capacity 100% 3% 5% 90% The availability of inpatient services in 80% the general and specialized hospitals is 70% 68% more than 95%, while 11% of these 60% hospitals provide inpatient services 50% 97% 95% with low capacity. 40% 30% It’s worth to mention that only 32% of 20% 32% the comprehensive health centers are 10% providing inpatient service while it’s 0% necessary as per essential primary Comprehensive Health Centre General Hospital Specialized Hospital health care package. Available Not available P a g e | 8 Figure 12:*Basic Laboratory Services 100% 3% 90% In hospitals basic laboratory services 24% 80% availability is about 99%, while 76% of 70% 63% 61% comprehensive health Centers 76% 60% 83% providing basic laboratory Services. 50% 97% 100% 40% 76% *CBC, urine analysis, stool microscopy, sputum 30% microscopy 20% 37% 39% 24% 10% 17% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital Available Not available Figure 13: *Basic Imaging Service 100% 3% 90% 14% 91% of the hospitals provide Basic 80% imaging services. 70% 59% 74% 60% 83% 96% 95% 50% 97% 40% 86% 30% *X-Ray and Ultrasound 20% 41% 26% 10% 17% 0% 4% 5% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital Available Not available P a g e | 9 Figure 14: Pharmacy having Essential 100% 0% 5% 3% 2% Drugs 11% 6% 90% 80% Most of the reported health facilities 45% have pharmacy having essential drugs. 70% 60% 40% provide it partially as there is no 50% 100% 95% 97% 98% sustainable drugs and consumables 89% 94% supplies system. 40% 30% 55% 20% 10% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital Available Not available 100% 3% 3% 5% 90% 15% Figure 15:Referral capacity 80% 39% 52% 71% of the facilities have referral 70% 61% mechanism in place, such as 60% communication and safe 50% 97% 97% 95% transportation. The main reason for 40% 85% inadequate referral mechanism in 30% 61% 48% some facilities provides is the shortage 20% 39% of vehicles and finance required for 10% fuel. 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital Available Not available P a g e | 10 8. Provision of Surgery services Figure 16: *Primary Injury care 100% 0% 90% 19% 80% 33% 36% 61% of the facilities are providing 43% 70% 62% 69% primary injury care. 60% 50% 100% *Treatment of open wounds, fracture 40% 81% 67% immobilization, patient stabilization and proper 30% 57% 64% referral (including antibiotics and tetanus toxoid 20% 38% 31% when needed) 10% 0% Comprehensive General Hospital Health Centre Health Unit Mobile clinic Specialized Care Specialized Health Centre Facility Hospital Available Not available Figure 17:*Trauma, surgical care, 100% 0% 90% and elective surgery 26% 80% 86% of the hospitals are providing 70% trauma, surgical care, and elective 60% 84% surgery. 50% 100% 40% 74% *At least 1 operation room with/without gas 30% anaesthetic 20% 10% 16% 0% Comprehensive Health Centre General Hospital Specialized Hospital Available Not available P a g e | 11 Figure 18:Intensive Care Unit 100% 58% of the hospitals are with 80% 33% 50% intensive care unit. 60% 33% of the general hospital lack 40% intensive care mainly due lack of 67% 50% medical supplies. 20% 0% General Hospital Specialized Hospital Available Not available Figure 19:Blood bank services 100% 90% 49% of the hospitals provide blood 80% bank services.