Summary Report | Public Health Centres Syrian Arab ... · (Health Resources & services Availability Mapping System) tool. This report provides descriptive analysis of the situation

This is to acknowledge that the data provided in this report is a product of joint collaboration between the World Health

Organization and Ministry of Health in the Syrian Arab Republic. The report covers the third quarter of 2015.

HeRAMS Summary Report | Public Health Centres Syrian Arab Republic

2015 3rd Quarter

HeRAMS| Public Health Centres Reports, July to September 2015 Page 1 of 29

Contents

Exceutive Sumamry ................................................................................................................................. 2

1. Completeness of reporting ............................................................................................................. 4

2. Functionality Status ........................................................................................................................ 5

3. Accessibility Status .......................................................................................................................... 7

4. Infrasturctual Patterns .................................................................................................................... 9

4.1 Condition of the building ........................................................................................................ 9

4.2 Water sources and functionality status ................................................................................ 11

4.3 Availability of electricity generators ..................................................................................... 12

4.4 Availability of Refrigerators .................................................................................................. 13

5. Availability of Health Human Resources ....................................................................................... 14

6. Availability of Health Services ....................................................................................................... 16

6.1 General Clinical services........................................................................................................ 18

6.2 Emergency services ............................................................................................................... 19

6.3 Child Health ........................................................................................................................... 20

6.4 Nutrition ................................................................................................................................ 21

6.5 Sexual & Reproductive Health .............................................................................................. 22

6.6 Non Communicable Diseases (NCDs) .................................................................................... 25

6.7 Mental health care ................................................................................................................ 25

7. Availability of Medical Equipment ................................................................................................ 26

8. Availability of Priority Medicines .................................................................................................. 28


Exceutive Sumamry

Regular assessments to monitor the impact of the crisis on the health facilities functionality,

accessibility, condition status, availability of resources and services, are conducted using HeRAMS

(Health Resources & services Availability Mapping System) tool.

This report provides descriptive analysis of the situation of the public health centres of MoH

(Ministry of Health), from all 14 governorates of Syria, during the 3rd Quarter 2015. The total

assessed health centres in the 3rd Quarter 2015 is 1,783.

Completeness of Centre's reporting

The completeness of reporting of health centres has increased in the 3rd Quarter to reach 97%,

compared to 96% at the end of 2nd Quarter.

Functionality status of the health centres

By end of the 3rd Quarter 2015 and out of 1,783 assessed public health centres, 46% (824) were

reported fully functioning, 25% (438) partially functioning, 26% (468) non-functioning (completely

out of service), while the functionality status of 3% (53) of health centres were unknown.

Accessibility status

By end of the 3rd Quarter 2015, 76% (1,359) health centres were reported accessible, 1% (19) hard-

to-access, and 22% (382) were inaccessible, while the accessibility status of 1% (23) health centres

were unknown.

Infrastructure of Health Centres

By end of the 3rd Quarter 2015, 23% (410) health centres were reported damaged [6% fully

damaged and 17% partially damaged], 66% (1,173) of public health centres were reported intact,

while the building’s condition of 11% (200) health centres were unknown.

Assessing the availability of water sources at functional public centres indicated that 84% (1,055) are

using main pipelines, 2% (31) are mainly using wells, while 7% (90) are using both (main pipeline and

well).

Availability of electricity generators and refrigerators were monitored at health centres’ level. Gaps

were observed in many governorates.

Human Resources

By end of the 3rd Quarter 2015, the proportions of different categories of health staff among the

total functional (fully and partially) health centres (1,262 /1,783), remained almost the same as 2nd

Quarter 2015. The resident doctors represented (1%) of total health staff at centres’ level, followed

by general practitioners (4%); pharmacists (4%); laboratory (7%); specialists (8%); dentists (10%);

midwives (11%); and nurses (55%).


Availability of Health Services

The availability of core health services is monitored through HeRAMS at health centre’s level,

considering a standard list of health services [includes: General Clinical and Emergency Services,

Child Health, Nutrition, Sexual & Reproductive Health, Non-communicable Diseases and Mental

Health].

As a result of disrupted healthcare delivery, limited provision of many health services, even within

the functional health centres were observed.

Availability of Medical Equipment

Analysis of availability of essential equipment has been measured across all functioning health

centres [fully and partially functioning] (1,262 /1,783), in terms of functional equipment out of the

total available equipment in the health centre. The produced analysis provides good indication of

the current readiness of the health centres to provide the health services, and also to guide focused

planning for procurement and distribution of equipment and machines, to fill-in identified gaps that

were observe even within the functional health centres.

Availability of Priority Medicines

Availability of medicines and consumables at health centres’ level has been evaluated based on a

standard list of identified priority medicines and medical supplies for duration of one quarter. Gaps

of medicines and medical supplies are identified even within the functional health centres (i.e., gap

of 75% gap of Anti-diabetic preparations, 68% of Cardiac and /or Vascular Drugs, 61% of Antibiotics,

52% of Anti-allergic including Steroids, 50% of ORS, and 38% of Antiseptics).


1. Completeness of reporting

The completeness of reporting of health centres has

increased in the 3rd Quarter to reach 97%, compared to 96%

at the end of 2nd Quarter, due to slight improvement of

reporting from Idleb governorate [Figure 1].

The total assessed health centres in the 3rd Quarter 2015 is

1,783.

The classification of health centres (1,783) per type is

presented in [Figure 2], of which the majority is Primary

Healthcare Centres (85%), followed by medical points (8%),

specialized centres (5%), and comprehensive/ polyclinics

(2%).

The levels of completeness of reporting of health centres at

governorate level are presented in [Figure 3]. Out of a total

reported 1,730 health centre, 1,464 (85%) are PHC centres.

The security escalations and accessibility remain a key

challenge for completeness of reporting; the main gap of

reporting is observed in Idleb (32%), while minor gaps were

in Hama (4%), Rural Damascus (3%), and Aleppo (1%).

Figure 3: Completeness of reporting of health centres at governorate level, 3rd

Quarter 2015

The following sections provide descriptive and trend analysis on the functionality status,

accessibility, and infrastructure of the public health centres, availability of resources & services, and

available equipment and medicines by end of the 3rd Quarter 2015.

The provided analysis supports informed decision making, better planning and allocation of

resources, and contributes to significant and focused humanitarian response by WHO and health

sector partners.

227 222

181 169 165

116 114 103 103 97 93

73 61 59

224 221

175 162 165

116

78

103 103 97 93

73 61 59

0

50

100

150

200

250

Aleppo Homs RuralDamascus

Hama Tartous Lattakia Idleb Deir-ez-Zor Dar'a Al-Hasakeh As-Sweida Ar-Raqqa Damascus Quneitra

Total Centres Total Reported

Comprehensive Clinic 2%

(43)

Specialized Centre 5%

(85)

Medical Point 8%

(141)

Primary Health Care Centre, 85%

(1,514)

Figure 2: Classification of centres

Reported 97%

(1730)

Gap; 3% (53)

Figure 1: Completeness of Reporting- Q3 2015


2. Functionality Status

Functionality of the health centres has been

defined and assessed at three levels;

Fully Functioning: a health centre is open,

accessible, and provides healthcare services

with full capacity (i.e., staffing, equipment,

and infrastructure).

Partially functioning: a health centre is open

and provides healthcare services, but with

limited capacity (i.e., either shortage of

staffing, equipment, or damage in

infrastructure).

Not functioning: a health centre is out of service, because it is either fully damaged,

inaccessible, no available staff, or no equipment.

By end of the 3rd Quarter 2015 and out of 1,783 assessed public health centres, 46% (824) were

reported fully functioning, 25% (438) partially functioning, 26% (468) non-functioning

(completely out of service), while the functionality status of 3% (53) of health centres were

unknown [Figure 4].

Detailed analysis on the functionality status of the health centres at governorate level is shown

in [Figure 5] and [Map 1].

Figure 5: Functionality status of health centres per governorate, 3rd

Quarter 2015

165

87

104

51

118

147

28

76

18

11

12

3

3

1

0

4

3

1

24

30

3

39

61

41

103

66

45

18

0

2

9

9

20

44

28

60

24

45

109

34

30

54

0

0

0

0

7

1

0

6

0

0

3

0

36

0

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Tartous

As-Sweida

Lattakia

Damascus

Hama

Homs

Quneitra

Rural Damascus

Dar'a

Al-Hasakeh

Aleppo

Deir-ez-Zor

Idleb

Ar-Raqqa

Fully Functioning Partially Functioning Non-functioning No Report

Fully Functioning 46% (824)

Partially Functioning 25% (438)

Non-functioning 26% (468)

No Report 3% (53)

Figure 4: Functionality Status- Q3 2015


Map 1: Functionality status of the public health centres, 3rd

Quarter 2015

The number of non-functioning health centres increased slightly from 464 to 468 (between 2nd

Quarter and 3rd Quarter of 2015). During the same period, the number of partially functioning

centres has increased from 411 to 438 [Figure 6], where the functionality status of many health

centres has changed from fully functioning to partially functioning in the 3rd Quarter 2015 as a direct

impact of deteriorating security situation. Improvement of completeness of reporting (particularly in

Idleb), resulted in increased number of health centres reported as partially functioning, which was

un-known during the 2nd Quarter 2015.

Figure 6: Trend analysis of functionality status, between 1st

Quarter 2014 and 3rd

Quarter 2015

876 887 857 862 832 836 824

291

376

374

466

392 411

438

161

311

387

385

419 464 468

416

170 132

63 134

72 53 0

100

200

300

400

500

600

700

800

900

1000

Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015



3. Accessibility Status

Accessibility to health centres is defined at three levels:

Accessible: a health centre is easily accessible for

patients and health staff.

Hard-to-reach: a health centre is hardly reached,

due to security situation or long distance.

Inaccessible: a health centre is not accessible

because of the security situation, or a centre is

accessible only to a small fraction of the population,

or military people (inaccessible to civilians).

By end of the 3rd Quarter 2015, 76% (1,359) health centres were reported accessible, 1% (19)

hard-to-access, and 22% (382) were inaccessible, while the accessibility status of 1% (23) health

centres were unknown [Figure 7].

Detailed analysis on the accessibility status of the health centres at governorate level is presented in

[Figure 8] and [Map 2].

Figure 8: Accessibility status of the health centres per governorate, 3rd

Quarter 2015

165

90

107

66

52

141

85

175

77

78

119

59

31

114

0

1

0

0

0

2

1

3

2

0

1

4

0

5

0

2

9

7

9

26

17

44

24

16

60

34

28

106

0

0

0

0

0

0

0

0

0

20

1

0

0

2

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Tartous

As-Sweida

Lattakia

Ar-Raqqa

Damascus

Hama

Deir-ez-Zor

Homs

Dar'a

Idleb

Rural Damascus

Al-Hasakeh

Quneitra

Aleppo

Yes Hard to access No No Report

Yes 76% (1,359)

Hard to access 1%

(19)

No 22% (382)

No Report 1% (23)

Figure 7: Accessibility status- Q3 2015


The trend analysis of accessibility status of health centres from 1st Quarter 2014 to 3rd Quarter

2015 is presented in Figure 9.

Figure 9: Trend analysis of accessibility status of health centres between 1st

Quarter 2014 and 3rd

Quarter

2015

The number of inaccessible health centres declined slightly from 385 to 382 (between end of 2nd

Quarter and end of 3rd Quarter 2015).

Map 2: Acecssibility to public health centres , 3rd

Quarter 2015

1162

1374 1396 1397 1266

1348 1359

0 0 7

5 13 12 19

208

324 342 342 478

385 382 374

46

5

32 20 38 23 0

200

400

600

800

1000

1200

1400

1600

Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015

Yes Hard to access No No Report


4. Infrasturctual Patterns

The following sub-sections provide analysis on infrastructural patterns of health centres, including

building’s condition, water sources, avalability of electricity generators, and availability of

refrigrators.

4.1 Condition of the building

The level of damage to health centres’ buildings was

measured at three levels:

Fully damaged: either, all the building is

destroyed, about 75% or more of the building is

destroyed, or damage of the essential services’

buildings.

Partially damaged: part of the building is

damaged.

Intact: there is no damage in the building.

Analysis of the level of damage provides good

indication on the potential costs for reconstruction.

By end of the 3rd Quarter 2015, 23% (410) health centres were reported damaged [6% fully damaged

and 17% partially damaged], 66% (1,173) were reported intact, while the building’s condition of 11%

(200) health centres were unknown [Figure 10].

The completeness of reporting level of damage of health centres has increased slightly in the 3rd

Quarter to reach 89%, compared to 88% at the end of 2nd Quarter 2015.

Key gaps on reporting the level of damage of the health centres are observed in Quneitra 44%

(26/59), Aleppo 32% (72/227) and Idleb 30% (34/114).

Detailed analysis of the damage status of te health centres at governorate level is presented in

[Figure 11] and [Map 3].

Figure 11: level damage of the health centres per governorate, 3rd

Quarter 2015

0

1

9

0

8

14

4

6

27

12

2

15

7

4

1

0

3

2

13

9

33

23

38

38

2

48

37

54

164

92

104

52

182

78

119

63

94

53

29

92

36

15

0

0

0

7

19

2

13

5

22

0

26

72

34

0

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Tartous

As-Sweida

Lattakia

Damascus

Homs

Deir-ez-Zor

Hama

Al-Hasakeh

Rural Damascus

Dar'a

Quneitra

Aleppo

Idleb

Ar-Raqqa

Fully damaged Partially damaged Not damaged No Report

Fully damaged 6% (109)

Partially damaged 17% (301)

Not damaged

66% (1173)

No Report 11% (200)

Figure 10: Level of Damage - Q3 2015


Map 3: Distribution and Level of damage of the public health centres, 3rd Quarter 2015

It is essential to cross-analyze the infrastructural damage of the public health centres in relation to

the functionality status (i.e. provision of services). Some health centres have resiliently continued to

provide services regardless of the level of damage of the building; through optimizing intact parts of

the building or in a few cases operating from other neighboring facilities. The national figures

translate as follows:

Out of the 301 partially damaged health centres, 150 health centres were reported partially

functioning, 130 out of service (non-functioning), 9 of health centres were unknown status,

while 12 were reported to be fully functioning providing all services through salvaging medical

equipment from the damaged section of the health centre with full staffing capacity.

Out of the 109 health centres with fully damaged buildings, 87 were reported non-functioning

while 20 health centres have opted for innovative ways to continue providing health services to

populations in need through partially functioning from other nearby temporary locations and

provide health services with limited staff capacity and resources (details of the 20 health centres

are available in the HeRAMS database), while functionality status of 2 of health centres was

unknown.

Health centres with intact buildings (1,173 health centres) do not directly reflect full

functionality, only 812 of the 1,173 intact health centres are fully functioning, while 266 are

partially functioning and 84 health centres are not functioning all together, due to limited access

of patients and health staff to the facilities resulting from the dire security situation as well as

critical shortage of supplies, while functionality status of 11 of health centres were unknown.


The trend analysis of infrastructural damage of health centres from 1st Quarter 2014 to 3rd Quarter

2015 is presented in Figure 12.

Figure 12: Trend analysis of buildings’ damage of health centres, between 1st

Quarter 2014 and 3rd Quarter

2015

4.2 Water sources and functionality status

Availability of water sources at health centres was

assessed using a standard checklist of main types of

water sources (i.e., main pipeline, well, or both [main

pipeline and well]).

By end of the 3rd Quarter 2015 and out of 1,262

functional health centres, 84% (1,055) are using main

pipelines, 2% (31) are mainly using wells, while 7%

(90) are using both [main pipeline and well] [Figure

13].

Detailed analysis of availability and distribution of

water sources at functional health centres is

presented at governorate level on [Figure 14].

Figure 14: Distribution of water sources/ types at functional health centres, per governorate, 3rd

Quarter

2015

17 33 39 75 93 106 109

345 400 330

312 261

287 301

910 973

1063 1177

1092 1172 1173

472

338 318 212

331

218 200

0

200

400

600

800

1000

1200

1400

Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015

Fully damaged Partially damaged Not damaged No Report

14

20

25

44

47

53

55

69

82

103

106

128

146

163

0

6

2

2

5

25

12

4

2

8

0

7

15

2

0

4

0

1

0

10

2

3

5

1

1

0

4

0

0

16

4

5

0

27

0

3

2

3

0

7

12

0

5

2

0

0

0

0

0

0

0

0

0

0

0

0

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Ar-Raqqa

Idleb

Quneitra

Al-Hasakeh

Damascus

Aleppo

Deir-ez-Zor

Dar'a

As-Sweida

Rural Damascus

Lattakia

Hama

Homs

Tartous

Main Pipeline Main Pipeline and Well Well Other No Report

Main Pipeline 84%

(1055)

Main Pipeline and Well 7% (90)

Well 2% (31)

Other 6% (79)

No Report 0.6% (7)

Figure 13: Main Sources of Water - Q3 2015


Functionality status of the water sources was measured at three levels; fully functioning, partially

functioning, and not functioning. Figure 15, provides details on functionality status of water sources

at functional health centres, (1,262 /1,783) per governorate.

Figure 15: Functionality status of the water sources at health centres, 3rd

Quarter 2015

4.3 Availability of electricity generators

Electricity generators turned to be highly demanded with the current situation, where electricity

power is widely disrupted and majority of public health centres are dependent on generators'

power. Availability of electrical generators was measured at functional health centres [Figure 16].

Figure 16: Availability of generators in the functional health centres, per governorate, 3rd

Quarter 2015

165

126

85

83

63

56

50

28

23

17

14

10

7

12

80

8

44

56

2

20

39

13

91

25

7

69

4

11

0

0

3

0

3

17

0

10

12

0

0

1

0

0

0

0

1

0

1

0

1

5

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Tartous

Hama

Homs

As-Sweida

Lattakia

Rural Damascus

Damascus

Al-Hasakeh

Dar'a

Quneitra

Aleppo

Idleb

Ar-Raqqa

Deir-ez-Zor


39

23 23

9 10

0

36

17 10

26

4

21

10 13 13

91 90

39

97

165

141

125

42 43

12

58

81

18

0 1 2 0 0 0 0 0 0 0 3 0 0 0 0

20

40

60

80

100

120

140

160

180

Damascus RuralDamascus

Aleppo Idleb Lattakia Tartous Homs Hama Al-Hasakeh Deir-ez-Zor Ar-Raqqa Dar'a As-Sweida Quneitra

Available Not-available No Report


4.4 Availability of Refrigerators

Availability of refrigerators in health centres is measured through HeRAMS at three levels: available

and functioning, available but not-functioning, or not-available. The summary figures of availability

of refrigerators in functioning health centres are presented [Figure 17].

The health centres with gap on refrigerators, seek support of the area municipality, a nearby school,

or a nearby house to store vaccines and medicines.

Figure 17: Availability of refrigerators in the functional health centres, per governorate, 3rd

Quarter 2015

49

108

80

34

102

156 154

139

40

69

16

64

81

27

0 2

23

7 2 1

10

0 4

0 0

10 2 1 3 4

10 6 3

8 13

3 8

0 0 5 8

3 0 1 2 1 0 0 0 0 0 0 3 0 0 0 0

20

40

60

80

100

120

140

160

180



Available Available but not-functioning Not-available No Report


5. Availability of Health Human Resources

Availability of health human resources has been

analyzed across functional health centres

considering different staffing categories.

Analysis of proportions of available health staff, by

end of the 3rd Quarter 2015, within the functional

health centres (fully and partially) is shown in

[Figure 18].

The resident doctors represented (1%) of total

health staff at centres’ level, followed by general

practitioners (4%); pharmacists (4%); laboratory

(7%); specialists (8%); dentists (10%); midwives

(11%); and nurses (55%).

The Distribution of the total health staff, by end of the 3rd Quarter 2015, per staff category and

governorate is shown in [Figure 19].

Figure 19: Distribution of total health staff at health centres per governorate, September 2015

The distribution of medical staff [a total of general practitioner, specialist, resident doctor, dentist],

in functional health centres per governorate is presented in Map 4. The highest density of medical

staff is observed in Tartous [total functional centres is 165], followed by Homs [total functional

centres is 177], and Damascus [total functional centres is 52].

45

85

96

25

13

1

14

0

13

3

13

0

54

30

18

26

23

20

26

6

22

0

14

9

14

14

7

24

9

29

4

19

5

74

64

14

66

48

53

15

2

11

41

0

0 24

26

19

3

10

3 15

12

0

17

6

22

2

13

3

34

20

9

51

8

25

0

27

2

81

78

25

81

14

8

37

44

5

10

89

39

5

48

4

16

20

21

02

21

21

10

91

33

3

67

6

12

2

74

9

13

45

29

1

12

3 2

80

51

18

66

24

3

27

1

14

0

58

47

27

81

74

54

97

17

4

23

7

99

35

0

34

8

40

8

28

1

15

2

13

4

22

16

2

75

48

36

32

15

5

12

16

4 3

28

11

8

56

19

9

25

54

5

9

0

500

1000

1500

2000

2500



Practitioner Specialist Doctor Resident Doctor Dentist Nurses Laboratory Midwives Pharmacists Technicians

Practitioner 4%

Specialist Doctor

8% Resident Doctor

1%

Dentist 10%

Nurses 55%

Laboratory 7%

Midwives 11%

Pharmacists 4%

Figure 13: Health Staff, Sep2015


Map 4: Distribution of medical staff [a total of general practitioners, specialists, resident doctors, and

dentists] per governorate, September 2015

By analyzing the proportion of male to female doctors (a total of: general practitioners, specialists,

resident doctors, and dentists), lowest proportions were seen in Al-Hasakeh, Ar-Raqqa, and Deir-ez-

Zor governorates [Figure 20].

Figure 20: Proportion of Doctors by gender, per governorate, September 2015

317 322 233

53

206

544 462 392

170 139 47 140 170 74

322 216 186

20

281

387 241 224

42 43 13 48 61 36

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



Male Female


6. Availability of Health Services

Availability of the core health services is monitored through HeRAMS at a health centre’s level,

considering a standard list of health services, as follows:

General Clinical services

Emergency services

Child Health: EPI, screening of MUAC, and Diarrhea management

Nutrition: screening of malnutrition for pregnant and lactating women

Sexual & Reproductive Health: Syndromic management of sexually transmitted infections, Antenatal care, Emergency contraception

Non-communicable Diseases: Surgical care, Cardiovascular services, Hypertension management, Diabetes management

Mental health care

Figure 21 shows the percentage of availability of health services across all functional (fully and

partially) health centres (1,262 /1,783).

Figure 21: Percentage of availability of health services, across all functional health centres, 3rd

Quarter 2015

**Detailed information on availability of services per governorate and health centres is available in

the HeRAMS Database.

27%

44%

50%

53%

56%

58%

62%

62%

62%

66%

69%

75%

77%

78%

78%

85%

86%

90%

90%

Syndromic management of sexually transmitted infections

Basic laboratory

Cardiovascular services

Emergency contraception

Referral capacity

Screening of malnutrition for pregnant & lactating women

Screening of under nutrition/malnutrition (growth monitoring orMUAC or W/H, H/A)

Prophylaxis and treatment of opportunistic infections

Diabetes management

Surgical care

Hypertension management

Diarrhea Management

Antenatal care

Emergency services for Accidents and Injuries

Tetanus Shot

EPI: routine immunization against all national target diseases andadequate cold chain in place

Regular reporting to the national surveillance system

Standard precautions

Solid waste management


The following section provides descriptive analysis for the workload and utilization of services in

functional health centres throughout 2015, per governorate.

The workload was analyzed in terms of total consultations in all functional health centres during

January and September 2015 [Figure 22]. The total reported workload across all governorates is

9,070,045; disaggregated as 3,081,920 in the 1st Quarter, 3,204,896 in the 2nd Quarter and 2,783,229

in the 3rd Quarter 2015. The number of consultations in functional health centres has dropped

significantly between the 2nd Quarter and 3rd Quarter 2015, which was due to shortage of staffing

and medicines mainly reported in hard-to-reach areas (such as Al-Zabadni in Rural Damascus, Dar’a

city, and Ras-Alain in Al-Hasakeh).

Figure 22: Estimated workload of functional health centres (consultations), January to September 2015

The proportion of workload of functional

health centres per governorate is

provided on Figure 23.

Detailed analysis on utilization of the core health services during the 3rd Quarter 2015 is provided on

the following sub-sections, including:

General Clinical and Emergency Services, Child Health, Nutrition, Sexual & Reproductive Health, Non-

communicable Diseases and Mental Health

1,156,071

1,077,748 1,067,221 1,053,966 996,226

899,032

821,945

431,673 405,990 381,537

263,343 255,671

145,212 114,410

0

200000

400000

600000

800000

1000000

1200000

1400000

Homs Hama RuralDamascus

Damascus Lattakia Tartous Aleppo Dar'a Al-Hasakeh As-Sweida Quneitra Deir-ez-Zor Ar-Raqqa Idleb

Homs 13%

Hama 12%

Rural Damascus 12%

Damascus 12% Lattakia

11%

Tartous 10%

Aleppo 9%

Dar'a 5%

Al-Hasakeh 4%

As-Sweida 4%

Quneitra 3% Deir-ez-Zor

3%

Ar-Raqqa 1%

Idleb 1%

Figure 23: Proportions of workload in health centres, January to September 2015, per governorate


6.1 General Clinical services

The following sections provide analysis on the utilization of health services in functional health

centres at governorate level.

i. Outpatient

The number of outpatients was assessed at a health centre level, and the total reported number in

the 3rd Quarter 2015 is 1,098,414; disaggregated at governorate level in Figure 24.

Figure 24: The number of Outpatients in health centres, 3rd

Quarter 2015

The high workload on health centres in Rural Damascus, Aleppo, and Homs is due to limited

availability of public hospitals and high number of people in need. Moreover the high workload in

Hama, Tartous and Lattakia health centres is due to increasing number of IDPs and high number of

functional health centres.

ii. Basic laboratory services

The number of patients received services in health centres’ laboratories, was assessed at a health

centre level. The total reported number in the 3rd Quarter 2015 is 580,288; disaggregated at

governorate level in Figure 25.

Figure 25: The number of patients received services in laboratories in health centres, 3rd

Quarter 2015

In Homs city, the conflict situation has severely impacted public hospitals’ functionality. To fill-in gaps, capacity of the health centres was upgraded through providing medical equipment/ machines, salvaging equipment and relocating health staff from closed hospitals and affected health centres. For example, high number of patients received laboratory services during the 3rd Quarter 2015 is reported in Karm Al-Shami comprehensive clinics, which was upgraded to serve high number of

174,887

153,233 145,225

114,475 113,147 113,027 112,600

46,485 36,521

24,121 23,873 14,960 13,735 12,125

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000

RuralDamascus

Aleppo Hama Damascus Homs Tartous Lattakia Quneitra As-Sweida Al-Hasakeh Dar'a Idleb Deir-ez-Zor Ar-Raqqa

135,849

101,468

85,533

51,117 48,564 48,366 42,699

30,156 24,268

9,546 1,776 445 380 121

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

Homs Hama As-Sweida RuralDamascus

Damascus Lattakia Tartous Aleppo Dar'a Quneitra Al-Hasakeh Ar-Raqqa Deir-ez-Zor Idleb


people in Homs city and its neighborhood. The centre is providing diabetes medicines, which justifies the increased number of serviced people in laboratory. The high numbers in Hama and As-Sweida is justified by increasing number of IDPs from rural areas and neighboring governorates.

iii. Referral capacity

Referral capacity and number of referred cases was measured at a health centre level. The total

reported number in the 3rd Quarter 2015 is 12,238; disaggregated at governorate level in Figure 26.

Figure 26: The number of referred cases, 3rd

Quarter 2015

In Damascus, the high number of referred cases is due to increase of IDPs and referral of diabetic

patients to specialized diabetic centres. In Hama, the high numbers of IDPs (especially women and

children from rural Hama, Ar-Raqqa and Idleb) has impacted provision of health services (including

referral of cases to other specialized centres or hospitals). Of note, the Directorates of Health of Ar-

Raqqa and Idleb are operating from Hama.

6.2 Emergency services

The number of cases and injured people reported in emergency units of health centres was assessed

at a health centre level. The total reported number in the 3rd Quarter 2015 is 149,048; disaggregated

at governorate level in Figure 27.

Figure 27: The number of accidents and injuries reported in health centres, 3rd

Quarter 2015

The high figures reported in Homs are due to increasing workload of health centres, due to

deteriorating security situation and limited availability of public hospitals.

3,182 3,142

1,243 1,232 1,041

689 679 431

250 248 46 42 13 0

0

500

1,000

1,500

2,000

2,500

3,000

3,500

Damascus Hama As-Sweida Dar'a RuralDamascus

Tartous Aleppo Lattakia Ar-Raqqa Homs Deir-ez-Zor Quneitra Al-Hasakeh Idleb

59,011

22,112 17,087

11,389 10,094 7,790

5,111 4,617 4,416 2,611 2,470 2,281 59 0

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

Homs Hama RuralDamascus

As-Sweida Dar'a Tartous Quneitra Aleppo Damascus Idleb Lattakia Al-HasakehDeir-ez-Zor Ar-Raqqa


6.3 Child Health

Availability and utilization of child health services in health centres is assessed for EPI, screening of

under nutrition/malnutrition, and diarrhea management for children.

i. EPI: routine immunization against all national target diseases and adequate cold chain in

place:

The number of children received routine immunization service through EPI was assessed at a health

centre level. The total reported number in the 3rd Quarter 2015 is 498,390 children; disaggregated

at governorate level in Figure 28.

Figure 28: The number children received routine immunization service in health centres, 3rd

Quarter 2015

In Aleppo, there 73 health centre provides routine immunization service; the delay in receiving

vaccines in many centres, due to security situation, resulted in accumulative children numbers when

vaccine is available.

ii. Screening of under nutrition/malnutrition (growth monitoring or MUAC or W/H, H/A):

Screening of children for under nutrition/malnutrition was assessed at a health centre level. The

total reported number in the 3rd Quarter 2015 is 105,493; disaggregated at governorate level in

Figure 29.

Figure 29: The number of screened children for under nutrition/malnutrition in health centres, 3rd

Quarter

2015

The highest reported figures in Hama, Damascus and followed by Rural Damascus reflect the strong

nutritional surveillance systems in place in addition to increased influx of IDPs to the mentioned

governorates during the 3rd Quarter 2015.

69,271

54,615 53,644 52,559 48,013

38,073 34,174 33,339 32,664

27,333 27,227

11,350 10,964 5,164

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Aleppo Hama RuralDamascus

Homs Damascus Lattakia Deir-ez-Zor Dar'a Tartous Ar-Raqqa Al-Hasakeh As-Sweida Idleb Quneitra

27,540

23,741

14,066

11,278

8,274

4,676 4,626 4,195 3,000 2,840

499 416 177 165

0

5,000

10,000

15,000

20,000

25,000

30,000

Hama Damascus RuralDamascus

Homs As-Sweida Aleppo Dar'a Quneitra Ar-Raqqa Deir-ez-Zor Idleb Al-Hasakeh Tartous Lattakia


iii. Diarrhea Management:

Diarrhea Management for children was assessed at a health centre level. The total reported number

in the 3rd Quarter 2015 is 35,693; disaggregated at governorate level in Figure 30.

Figure 30: The number of diarrhea cases (children) in health centres, 3rd

Quarter 2015

6.4 Nutrition

Screening of malnutrition for pregnant & lactating women was assessed at a health centre level.

The total reported number in the 3rd Quarter 2015 is 24,484; disaggregated at governorate level in

Figure 31.

Figure 31: The number of screened pregnant & lactating women for of malnutrition, 3rd

Quarter 2015

Consistent and complete reporting from Hama continues because of the availability of strong

technical professional staff and follow-up. Moreover, the influx of IDPs especially women and

children from Ar-Raqqa and Idleb have also contributed to higher reported figures in Hama during

the 3rd Quarter of 2015.

7,390 6,851

5,200

3,242 2,931 2,801

2,280 2,215

711 640 555 528 349 0

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

RuralDamascus

Hama Homs Aleppo Lattakia Damascus Al-Hasakeh Tartous As-Sweida Dar'a Deir-ez-Zor Quneitra Idleb Ar-Raqqa

6,188

3,303 3,207 2,756

2,242 2,116 1,665

890 834 648 439

159 37 0 0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Hama RuralDamascus

Homs Damascus As-Sweida Tartous Aleppo Dar'a Al-Hasakeh Idleb Deir-ez-Zor Quneitra Lattakia Ar-Raqqa


6.5 Sexual & Reproductive Health

Availability and utilization of sexual & reproductive health care in health centres is assessed at a

health centre level for syndromic management of sexually transmitted infections, antenatal care,

normal deliveries, essential newborn care, and tetanus shots.

i. Syndromic management of sexually transmitted infections:

The number of patients with sexually transmitted infections (STIs) was assessed at a health centre

level. The total reported number in the 3rd Quarter 2015 is 1,395; disaggregated at governorate level

in Figure 32.

Of note: the availability of Syndromic management of STIs is reported in six governorates and

mainly in comprehensive/ poly clinics. In other governorates, if any case reported to a health centre,

they refer it to the hospitals based on available capacity.

Figure 32: The number of cases reported with sexually transmitted infections in health centres, 3rd

Quarter

2015

The high number of cases reported with STIs in Tartous, Damascus, Hama, and Lattakia is due to

availability of capacity and qualified health providers, in addition to high numbers of IDPs and lack of

hygiene in shelters.

ii. Antenatal care

a) Antenatal visits:

The number of antenatal visits was assessed at a health centre level. The total reported number of

visits for pregnant women received the service in the 3rd Quarter 2015 is 57,869; disaggregated at


Figure 33: The number of Antenatal visits in health centres, 3rd

Quarter 2015

The high reported figures in Hama are due to increased numbers of IDPs (especially women and

children from rural Hama, Ar-Raqqa and Idleb), in addition to increased capacity and availability of

service in many specialized and comprehensive clinics in Hama city.

573

373

221 214

12 2 0 0 0 0 0 0 0 0 0

100

200

300

400

500

600

700

Tartous Damascus Hama Lattakia As-Sweida RuralDamascus

Aleppo Idleb Homs Al-HasakehDeir-ez-Zor Ar-Raqqa Dar'a Quneitra

18,633

6,367 6,287 5,772

4,002 3,904 3,242 3,096 2,312 1,994 1,325

396 364 175

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

Hama Lattakia Homs RuralDamascus

Dar'a Damascus Tartous Aleppo Al-Hasakeh As-Sweida Ar-Raqqa Idleb Deir-ez-Zor Quneitra


b) Tetanus Shots:

The number of pregnant women received Tetanus Shots was assessed at a health centre level. The

total reported number of women received the service in the 3rd Quarter 2015 is 23,211;

disaggregated at governorate level in Figure 34.

Figure 34: The number of pregnant women received Tetanus Shot in health centres, 3rd

Quarter 2015

In Aleppo, the health centres provide tetanus shot services is high (73 centre).

iii. Normal deliveries:

The number of Normal deliveries was assessed at a health centre level. The total reported number

in the 3rd Quarter 2015 is 981; disaggregated at governorate level in Figure 35.

Figure 35: The number of Normal deliveries in health centres, 3rd

Quarter 2015

The high number of normal deliveries in Dar’a is reported from health centres provide the service in

areas with limited availability of functional public hospitals:

Tseel health centre in Nawa health district performed 249 normal deliveries. Of note, in Nawa

district there are two hospitals; one is fully damaged [Jasim Hospital], while the other is partially

damaged and partially functioning with limited capacity [Nawa hospital].

The comprehensive clinics in Geza, located in Busra health district, performed 106 normal

deliveries. The only public hospital in Busra district is non-functioning and partially damaged.

The comprehensive clinics in Dar’a city performed 72 normal deliveries. The maternity hospital is

Dar’a city is non-functional, while the national hospital is partially providing this service with

very limited capacity.

5,054

2,984 2,979

2,352 1,999 1,988

1,381 1,228 1,219 854

365 364 297 147

0

1,000

2,000

3,000

4,000

5,000

6,000

Aleppo Hama Homs RuralDamascus

Tartous Lattakia Dar'a Idleb Damascus Al-Hasakeh Quneitra Ar-Raqqa As-Sweida Deir-ez-Zor

427

167 147

103

60 35

18 16 8 0 0

50

100

150

200

250

300

350

400

450

Dar'a RuralDamascus

Homs Damascus As-Sweida Hama Lattakia Quneitra Al-Hasakeh Ar-Raqqa Aleppo Idleb Tartous Deir-ez-Zor


iv. Essential newborn care:

Availability and utilization of essential newborn care service (including basic newborn resuscitation

+ warmth (recommended method: Kangaroo Mother Care - KMC) + eye prophylaxis + clean cord care

+ early and exclusive breast feeding 24/24 & 7/7)), was assessed at a health centre level. The total

reported number of women received the service in the 3rd Quarter 2015 is 1,215; disaggregated at


Figure 36: The number of women received essential newborn care in health centres, 3rd

Quarter 2015

v. Basic Emergency Obstetric Care (BEmOC):

Availability and utilization of BEmOC service (including parenteral antibiotics +

oxytocic/anticonvulsivant drugs + manual removal of placenta + removal of retained products with

manual vacuum aspiration (MVA) + assisted vaginal delivery 24/24 & 7/7), was assessed at a health

centre level. The total reported number of women received the service in the 3rd Quarter 2015 is

169; disaggregated at governorate level in Figure 37.

Figure 37: The number of women received BEmOC in health centres, 3rd

Quarter 2015

The high figures in Dar’a is mainly reported from the comprehensive clinics in Dar’a city, which is

providing 24/7 service to all Dar’a city and neighboring districts, as a replacement to the maternity

and national hospitals in Dar’a city.

429 427

166

87 60

20 18 8 0 0 0 0

50

100

150

200

250

300

350

400

450

500

Damascus Dar'a RuralDamascus

Homs As-Sweida Hama Lattakia Al-Hasakeh Idleb Ar-Raqqa Quneitra Aleppo Tartous Deir-ez-Zor

130

20 18

1 0 0 0 0 0 0 0 0 0 0 0

20

40

60

80

100

120

140

Dar'a Homs Hama Damascus RuralDamascus

Idleb Lattakia Al-Hasakeh Ar-Raqqa As-Sweida Quneitra Aleppo Tartous Deir-ez-Zor


6.6 Non Communicable Diseases (NCDs)

Availability and utilization of NCDS health care services in health centres is assessed at a health

centre level for surgical care [minor surgeries, dressing services, …], cardiovascular, hypertensions,

and diabetes.

The total reported number of NCDs’ consultations in the 3rd Quarter 2015 is as follows: surgical care

[121,652] cardiovascular [35,682], hypertensions [87,132], and diabetes [200,227]; disaggregated

figures are provided at governorate level in Figure 37.

Figure 37: The number of NCDs consultations (Surgical care, Cardiovascular, Hypertension and Diabetes) in

health centres, 3rd Quarter 2015

Among all NCDs, Diabetes patients’ consultations are the highest reported figures, mainly in Lattakia,

Damascus, Tartous and Rural Damascus, which is due to availability of medicines and supplies.

6.7 Mental health care

Availability and utilization of mental health care services was assessed at a health centre level. The

total reported number in the 3rd Quarter 2015 is 6,674; disaggregated at governorate level in Figure

38.

Figure 38: The number of mental health cases in health centres, 3rd

Quarter 2015

7872

2068

3

2367

76

2133

2

167

68

1761

1

9441

489

298 0

4440

1484

1

5434

9988

5021

414

27 26

41

9636

3679

1833

739

12

0 71

65 15

56

2155

6

1156

3

2910

209

1274

3

7578

1222

5

5937

1975

57

0 513

5351

4515

2884

7

2102

2

147

60

1576

5431

9

2128

4

1596

3

1046

8

7028

32

0

6128

1447

0

4330

0

10000

20000

30000

40000

50000

60000



Surgical care Cardiovascular Hypertension Diabetes

1,237 1,144

830

684 678 605

534 496 412

54 0 0 0 0

0

200

400

600

800

1,000

1,200

1,400

Damascus Lattakia Aleppo Tartous Hama Quneitra Homs RuralDamascus

Dar'a As-Sweida Idleb Al-HasakehDeir-ez-Zor Ar-Raqqa


7. Availability of Medical Equipment

The availability of different types of essential equipment and supplies was assessed at a health

centre level, based on a standard checklist1.

In its fifth year of crisis, Syria’s public health centres are still suffering from shortages and/or

malfunction of medical devices/ equipment to provide health care services. In insecure

governorates, medical devices are either destroyed, burned, or malfunctioned, while in safe areas

the medical devices are overburdened by increased numbers of people (actual numbers of people in

the area, in addition to IDPs and patients /injured people from surrounding areas).

Maintenance of malfunctioned devices remains a concern, due to non-availability of spare parts,

accredited agent to provide maintenance support, or difficulty of accessibility in many cases.

Analysis of availability of essential equipment was measured across all functional health centres

(1,262 / 1,783), in terms of functional equipment out of the total available equipment in the health

centre. The produced analysis provides good indication of the current readiness of the health

centres to provide health services, and also to guide focused planning for procurement of equipment

and machines, to fill-in identified gaps.

Gaps on essential equipment and machines were observed, even within the functional health

centres. Further details are provided in Figure 39.

Figure 39: Percentage of functional essential equipment/ total available equipment in functional health

centres, 3rd

Quarter 2015

1 A more detailed list of essential equipment is available upon request.

70%

76%

85%

87%

88%

88%

89%

92%

92%

93%

94%

94%

94%

94%

95%

Blood_pressure machine

Oxygen cylinders

Ambu bag (Paediatric and Adult)

Weighing Scale for infants

Weighing Scale for adults

Light source (flashlight acceptable)

Pulse Oximeter

Delivery_table

Sterilizer/ Autoclave

Safe / Clean delivery kit

Height Measurement Device

Length Measurement Device

Vaginal examination set

Minor_surgical

Fetoscope


Map 5: Percent of functional specialized equipment/ total available equipment in functional health centres,

end of September 2015


8. Availability of Priority Medicines

Availability of medicines and consumables at health centres’ level has been evaluated based on a standard list of identified priority medicines (driven from the national Essential Medicine List), and medical supplies for duration of one month. Gaps of medicines and medical supplies are identified even within the functional health centres (i.e., gap of 75% gap of Anti-diabetic preparations, 68% of Cardiac and /or Vascular Drugs, 61% of Antibiotics, 52% of Anti-allergic including Steroids, 50% of ORS, and 38% of Antiseptics) [Figure 40].

Figure 40: Availability of medicines and medical consumables at functional health centres, 3rd

Quarter 2015

**More details on availability of medicines and consumables at a health centre level are available in HeRAMS Database. Percentages of available medicines in functioning health centres by end of the 3rd Quarter 2015, at governorate level, are presented in Map 6. Map 6: Percentage of available medicines at functional health centres, end of June 2015

25%

32%

39%

48%

50%

62%

Anti-diabetic preparations

Cardiac and /or Vascular Drugs (Anti-hypertensive Drugs, Diuretics, …)

Antibiotics

Anti-allergic including Steroids

ORS

Antiseptics


© World Health Organization 2015. All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

WHO-EM/SYR/016/E

Documents

Summary Report | Public Health Centres Syrian Arab ... · (Health Resources & services Availability Mapping System) tool. This report provides descriptive analysis of the situation