Doocy Shannon, Lyles Emily, Akhu-Zaheya Laila, Burton Ann, Burnham Gilbert
Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Suite E8132, Baltimore, MD, 21205, USA.
Jordan University of Science and Technology School of Nursing, Irbid, Jordan.
Int J Equity Health. 2016 Jul 14;15(1):108. doi: 10.1186/s12939-016-0399-4.
The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system. Changing lifestyles and aging populations are shifting the global disease burden towards increased non-infectious diseases including chronic conditions, co-morbidities, and injuries which are more complicated and costly to manage. The strain placed on health systems threatens the ability to ensure the health needs of both refugees and host country populations are adequately addressed. In light of the increasing challenges facing host governments and humanitarian actors to meet health needs of Syrian refugees and affected host communities, this study was undertaken to assess utilization of health services among Syrian refugees in non-camp settings.
A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. Differences in household characteristics by geographic region, facility type, and sector utilized were examined using chi-square and t-test methods.
Care-seeking was high with 86.1 % of households reporting an adult sought medical care the last time it was needed. Approximately half (51.5 %) of services were sought from public sector facilities, 38.7 % in private facilities, and 9.8 % in charity/NGO facilities. Among adult care seekers, 87.4 % were prescribed medication during the most recent visit, 89.8 % of which obtained the medication. Overall, 51.8 % of households reported out-of-pocket expenditures for the consultation or medications at the most recent visit (mean US$39.9, median US$4.2).
Despite high levels of care-seeking, cost was an important barrier to health service access for Syrian refugees in Jordan. The cessation of free access to health care since the time of the survey is likely to have worsened health equity for refugees. Dependence of refugees on the public facilities for primary and specialist care has placed a great burden on the Jordanian health system. To improve accessibility and affordability of health services in an equitable manner for both refugees and Jordanian host communities, strategies that should be considered going forward include shifting resources for non-communicable diseases and other traditional hospital services to the primary level and creating strong health promotion programs emphasizing prevention and self-care are strategies.
叙利亚难民涌入约旦给约旦卫生系统带来了巨大负担。生活方式的改变和人口老龄化使全球疾病负担向包括慢性病、合并症和伤害在内的非传染性疾病转移，这些疾病的管理更为复杂且成本更高。卫生系统面临的压力威胁到确保难民和东道国人口的健康需求得到充分满足的能力。鉴于东道国政府和人道主义行为体在满足叙利亚难民和受影响东道社区的卫生需求方面面临的挑战日益增加，本研究旨在评估非营地环境下叙利亚难民的卫生服务利用情况。
2014年6月对约旦的叙利亚难民进行了一项调查，以描述其就医行为以及与获得医疗服务相关的问题。采用与规模成比例的概率抽样的整群设计，以获得1550户非营地叙利亚难民家庭的全国代表性样本。使用卡方检验和t检验方法研究按地理区域、设施类型和所利用部门划分的家庭特征差异。
就医率很高，86.1%的家庭报告称家中成年人在最近一次需要医疗服务时寻求过治疗。约一半（51.5%）的服务是在公共部门设施寻求的，38.7%在私立设施，9.8%在慈善/非政府组织设施。在寻求治疗的成年人中，87.4%在最近一次就诊时被开了药，其中89.8%拿到了药。总体而言，51.8%的家庭报告在最近一次就诊时为咨询或药物支付了自付费用（平均39.9美元，中位数4.2美元）。
尽管就医率很高，但成本是约旦叙利亚难民获得卫生服务的一个重要障碍。自调查以来免费获得卫生保健的终止可能使难民的健康公平状况恶化。难民对公共设施提供的初级和专科护理的依赖给约旦卫生系统带来了巨大负担。为了以公平的方式提高难民和约旦东道社区获得卫生服务的可及性和可负担性，未来应考虑的策略包括将用于非传染性疾病和其他传统医院服务的资源转移到基层，并制定强调预防和自我护理的强有力的健康促进计划。
