Mosleh Marwan, Aljeesh Yousef, Dalal Koustuv, Eriksson Charli, Carlerby Heidi, Viitasara Eija
Department of Health Sciences (HLV), Public Health Science, Mid Sweden University, Sundsvall, Sweden.
Ministry of Health, Gaza, Palestine.
J Multidiscip Healthc. 2020 Jul 9;13:593-605. doi: 10.2147/JMDH.S253080. eCollection 2020.
Palestine, like other low-income countries, is confronting an increasing epidemic of non-communicable disease (NCD) and trend of war injury. The management of health problems often presents a critical challenge to the Palestinian health system (PHS). Understanding the perceptions of healthcare providers is essential in exploring the gaps in the health system to develop an effective healthcare intervention. Unfortunately, health research on management of NCD and war injury has largely been neglected and received little attention. Therefore, the study aimed to explore the perspectives of healthcare providers regarding NCD and war injury management in the PHS in the Gaza Strip.
A qualitative study approach was used, based on four focus group discussions (FGDs) involving a purposive sampling strategy of 30 healthcare providers from three main public hospitals in Gaza Strip. A semi-structured topic guide was used, and the focus group interviews data were analyzed using manifest content analysis. The study was approved by the Palestinian Health Research Council (PHRC) for ethics approval.
From the healthcare providers perspective, four main themes and several sub-themes have emerged from the descriptive manifest content analysis: functioning of healthcare system; system-related challenges; patients-related challenges; strategies and actions to navigating the challenges and improving care. Informants frequently discussed that despite some positive aspects in the system, fundamental changes and significant improvements are needed. Some expressed serious concerns that the healthcare system needs complete rebuilding to facilitate the management of NCD and war-related injury. They perceived important barriers to effective management of NCD and war injury such as poor hospital infrastructure and logistics, shortage of micro and sub-specialities and essential resources. Participants also expressed a dilemma and troubles in communication and interactions, especially during emergencies or crises. The informants stressed the unused of updated clinical management guidelines. There was a consensus regarding poor shared-care/task sharing, partnership, and cooperation among healthcare facilities.
Our findings suggest that fundamental changes and significant reforms are needed in the health system to make healthcare services more effective, timely, and efficient. The study disclosed the non-use of clinical guidelines as well as suboptimal sectorial task-sharing among different stakeholders and healthcare providers. A clear and comprehensive healthcare policy considering the gaps in the system must be adopted for the improvement and development of care in the PHS.
与其他低收入国家一样，巴勒斯坦正面临非传染性疾病（NCD）流行加剧和战争伤害趋势上升的问题。健康问题的管理往往给巴勒斯坦卫生系统（PHS）带来严峻挑战。了解医疗服务提供者的看法对于探索卫生系统中的差距以制定有效的医疗干预措施至关重要。不幸的是，关于非传染性疾病和战争伤害管理的卫生研究在很大程度上被忽视，很少受到关注。因此，本研究旨在探讨加沙地带巴勒斯坦卫生系统中医疗服务提供者对非传染性疾病和战争伤害管理的看法。
采用定性研究方法，基于四次焦点小组讨论（FGD），涉及从加沙地带三家主要公立医院中采用目的抽样策略选取的30名医疗服务提供者。使用了半结构化主题指南，并采用显性内容分析法对焦点小组访谈数据进行分析。该研究获得了巴勒斯坦卫生研究委员会（PHRC）的伦理批准。
从医疗服务提供者的角度来看，描述性显性内容分析得出了四个主要主题和几个子主题：卫生系统的运作；与系统相关的挑战；与患者相关的挑战；应对挑战和改善护理的策略与行动。受访者经常讨论到，尽管系统存在一些积极方面，但仍需要进行根本性变革和重大改进。一些人表示严重关切，认为卫生系统需要彻底重建以促进非传染性疾病和战争相关伤害的管理。他们认为非传染性疾病和战争伤害有效管理存在重要障碍，如医院基础设施和后勤差、微观和亚专业以及基本资源短缺。参与者还表达了沟通和互动中的困境与麻烦，特别是在紧急情况或危机期间。受访者强调未使用最新的临床管理指南。对于医疗设施之间共享护理/任务分担、伙伴关系和合作不佳存在共识。
我们的研究结果表明，卫生系统需要进行根本性变革和重大改革，以使医疗服务更有效、及时和高效。该研究揭示了临床指南未被使用以及不同利益相关者和医疗服务提供者之间部门任务分担不理想的情况。必须通过一项考虑到系统差距的清晰、全面的卫生政策，以改善和发展巴勒斯坦卫生系统的护理。
