In regions ravaged by war and poverty, health infrastructures are usually vertically integrated, with individual specialized clinics set up to deal with acute cases. This system has proved effective at combating large-scale diseases such as tuberculosis and polio, and in several cases has succeeded in effectively wiping out the diseases. The approach is, however, much less effective at dealing with chronic illnesses, the result of a lifetime of poor health habits. These can only be prevented with a holistic approach.

Chronic non-communicable diseases (NCDs) are becoming an increasingly worrying problem in Palestine, as in much of the rest of the world. A vertical healthcare system causes inefficiencies in the treatment of patients with NCDs, and does little to educate patients on the life choices that lead to them. The United Nations Relief and Works Agency for Palestine Refugees (UNRWA), a relief and humanitarian development organization, has adopted a novel, more horizontal approach for its 137 health centers. Currently, the centers operate under a vertical scheme in which patients visit different clinics within a health center. The clinics act as independent entities within the health center, and communication about patients does not extend much beyond medical chatter. In an attempt to restructure and optimize the facilities, and to create a health care system that can prevent long-term diseases, the UNRWA is now moving towards a family health team model.

Family health teams are health centers in which doctors, nurses and other medical staff, who are trained in a range of illnesses, concentrate on the issues most prevalent in a specific region. This allows for a concentration of efforts against the most common illnesses, reducing the time, money and resources spent on setting up specific clinics. Key to this approach is that they are structured to operate in the same way as a general practitioner, who follows a person throughout the course of their life. Medical staff guide patients on health decisions throughout their lives. Family health teams bring a much more personal approach to healthcare, and can be key in combating chronic diseases by starting to teach good habits at a young age. Vertical arrangements, on the other hand, only deal with the patient for the duration of a specific illness.

The benefits of this kind of implementation are already being witnessed in some health centers. By consolidating medical staff familiar with the most prevalent diseases under one roof, patients now work with a team - instead of individual clinics - and the care becomes much more personalized: it’s now about the person, not the illness. The approach has an added benefit for relief and educational efforts in the region, where operations related to health are now achieved more effectively. For example, the education branch of the UNRWA is improving the health of school children by teaching them through the family health team.

The UNRWA consulted with local refugee communities about family team healthcare, and gained their support. Host countries also support the measures, and are now applying them towards national health policies. As existing teams and infrastructures are being reorganized, no additional staff will be necessary once the set-up period is over, and the system should be able to sustain itself under the current funding scheme.

The plan is to convert 63 refugee health centers by 2015, and all 137 by 2020. Akihiro Seita and his team at the UNRWA present their findings on implementing the family health team model at the 2012 Geneva Health Forum (April 18-20, 2012). Specific results are not yet available, and it will be several years before we see a first generation go through the family health team, but it’s not too difficult to imagine that this approach will be very beneficial to the region.

Read the abstract on the Geneva Health Forum website

(Photo © United Nations Relief and Works Agency for Palestine Refugees)

With many thanks to Dr Slim Slama for his very helpful clarifications used towards this article.