Background The Syrian refugee crisis has led to massive displacement into neighboring countries including Jordan. This crisis has caused a significant strain on the sexual and reproductive health (SRH) services to the host communities and Syrian refugees. The Minimum Initial Service Package (MISP) is a standard package of services that should be implemented at the onset of an emergency. Due to their importance in protracted humanitarian crisis, this systematic review aimed to assess the utilization of SRH and MISP after 9 years of the crisis. Methods We searched PubMed, Medline/Ovid and Scopus for both quantitative and qualitative studies from 1 January 2011 to 30 November 2019. Our search included both free text key words and Medical Subject Headings (MeSH) for various forms and acronmym of the following terms: (Sexual and) Reproductive Health, Sexual/Gender-based/Family/Intimate partner violence, Minimum Initial Service Package, MISP, Women, Girls, Adolescents, Syrian, Refugee, Jordan, Humanitarian crisis, War, (armed) conflict, and Disaster. Boolean operators and star truncation (*) were used as needed. We further conducted an in-depth review of the available grey literature published during the same timeframe. Using a narrative synthesis approach, two authors independently extracted and analyzed data from published papers. After removal of duplicates, screening, and assessing for eligibility of 161 initially identified citations, 19 papers were selected for review. Results Findings from this review indicated a number of barriers to access, utilization, and implementation of SRH services, including lack of reliable information on sexual and gender-based violence (SGBV), aggravation of early marriages by crisis setting, gaps in the knowledge and use of family planning services, inadequate STIs and HIV coverage, and some issues around the provision of maternal health services. Conclusion The findings from this review are suggestive of a number of barriers pertaining to access, utilization, and implementation of SRH services. This is especially true for transitioning from MISP to comprehensive SRH services, and particularly for refugees outside camps. Following are needed to address identified barriers: improved inter-agency coordination, better inclusion/engagement of local initiatives and civil societies in SRH services delivery, improved quality of SRH services, adequate and regular training of healthcare providers, and increased awareness of Syrian women and adolescent girls. Also, more implementing research is required to identify ways to transition SRH provision from the MISP to comprehensive care for the Syrian refugee population in Jordan.

Research is essential for evidence-based decision making. This study aimed to identify research priorities in the areas of field epidemiology and public health in the Eastern Mediterranean Region (EMR) from the perspectives of public health professionals. A Delphi technique, using online survey, was employed to reach 168 public health professionals who have experience in the EMR countries. The study took place between November 2019 and January 2020. Consensus on the research priorities was reached after two-round online questionnaires. A list of top 10 field epidemiology and public health research priorities in the EMR was developed. Of those priorities, four fell under health in emergency, war and armed conflict, two under communicable diseases, two under immunization, one under digital health, and one under sexual, reproductive, and adolescent health. Availability, adequacy, and quality of health services in crisis settings were scored as a top priority (mean = 4.4, rank 1), followed by use of technology to improve the collection, documentation, and analysis of health data (mean = 4.28, rank 2), and capacity of countries in the region to respond to emergencies (mean = 4.25, rank 3). This study was conducted prior to COVID-19 pandemic and, thus, it did not capture COVID-19 research as a priority area. Nevertheless, identified priorities under communicable diseases including outbreak investigation of infectious diseases, epidemics and challenges related to communicable diseases in the EMR were still notable. In conclusion, the field epidemiology and public health research priorities identified in this study through a systematic inclusive process could be useful to make informed decisions and gear the research efforts to improve the health of people in the EMR.

The rapid increase in the ageing population and health conditions are imposing a higher challenge to the health care system that requires multidisciplinary teamwork utilizing coordinated care approach. This study examined the effects of integrated care model on quality of care received by older hospitalized patients in West Bank. A quantitative interrupted time series design (pretest and posttest multiple time series, quasi-experiment design) was used. The study examined the effects of integrated care model on admitted older patients (n=32) in the West Bank measuring ten dimensions of quality of care and four health indicators. There was a significant improvement in the dimensions of quality of care: dimensions: nurses’ communications with patients, physicians’ communications with patients, staff response to patients’ needs, pain management, explanations on medications, amount of information given on discharge plan, patients' area cleanliness, patients' area quietness, rating of the hospital, and willingness to recommend the hospital. Incidence of falls and incidence of pressure ulcer improved after implementing the model, while readmission rate and average length of stay did not improve. This study contributed to the limited body of knowledge related to the effect of integrated care model on hospitalized older patients’ quality of care in Palestine/ West Bank. Integrated care has the potential to improve care outcomes among hospitalized older patients.

Background: Millions of Syrians have been forcibly displaced since the start of civil war in March 2011. The vast majority of these refugees live in neighbouring countries including Jordan as one of the affected countries in the Middle East. Adolescent girls and women are among the most vulnerable populations in this humanitarian crisis. MISP/SRH interventions and programs have been implemented by various humanitarian organizations, governments, and other health care providers, to prevent and manage the consequences of sexual violence, reduce HIV transmission, minimize maternal/neonatal morbidity and mortality, reduce unintended pregnancies and unmet family planning needs, and plan for comprehensive SRH services as soon as the situation permits. After almost nine years of the protracted Syrian crisis, it is essential to examine available evidence around the effectiveness of SRH interventions for Syrian refugees in Jordan in order to inform the humanitarian community including the government by identifying best practices, essential gaps, bottlenecks, and lessons learnt. Methods: In 2018, an assessment using a previously validated MISP/SRH survey tool and combining both quantitative and qualitative research methods was conducted in four governorates of Jordan (Amman, Irbid, Zarqa and Mafraq) to evaluate the availability of MISP/SRH interventions and programs. Data were obtained from interviews with key informants (KIs). For the analysis SPSS-IBM statistical software was used.Results: Overall, 58 KIs affiliated with a total of 15 different entities/agencies were were selected for this assessment. KIs/respondents had different levels of knowledge and sources of information about the MISP/SRH services and had variable engagement in implementation. The results of this assessment highlighted significant knowledge gaps about the implementation of the different MISP objectives and priorities, even after almost nine years of the initial onset of the crisis. Among the different MISP activities, family planning, maternal health, condom distribution, and newborn health services had the highest level of preparation and implementation, while availability of antiretrovirals (ARVs) for prevention of mother-to-child transmission (PMTCT) and access to safe blood had the lowest level of preparation and implementation. This assessment also showed lack of national coordination in the provision of the different SRH services, lack of a national plan for capacity building, and lack of adequate logistics support systems and funding. Conclusions: Important gaps in the knowledge and implementation of MISP/SRH activities continue to exist in Jordan, almost nine years into the protracted Syrian displacement. Areas in need of focus included: national coordination in the provision of SRH services, developing a national plan for capacity building, improving logistics support systems, and allocating sufficient funding for the provision of MISP/SRH services. Areas, particularly, in need of additional funding included: Capacity building of services provides with specific focus on MISP training activities around the different MISP/SRH services, facilitating emergency preparedness, improving coordination, and improving referral systems.

Background: Millions of Syrians have been forcibly displaced since March 2011. Most of them live in neighbouring countries, including Jordan, with adolescent girls and women as the most vulnerable populations. After almost nine years of the protracted crisis, it was essential to examine available evidence around the effectiveness of MISP/SRH interventions implemented for them in Jordan to inform the humanitarian community and the government by identifying best practices, essential gaps, bottlenecks, and lessons learnt. Methods: Using a previously validated MISP/SRH survey tool and combining quantitative and qualitative research methods, an assessment was conducted in 2018 in four governorates of Jordan to evaluate the availability of MISP/SRH interventions/programs. Data were obtained by trained data collectors and analyzed in SPSS-IBM.Results: Overall, 58 key informants (KIs) from 15 different entities/agencies participated in the assessment. KIs/respondents had various levels of knowledge/sources of information about the MISP/SRH services and had variable engagement in implementation. The results of this assessment highlighted significant knowledge gaps about the implementation of MISP objectives and priorities, even after almost nine years of the onset of the crisis. Among different MISP activities, family planning, maternal health, condom distribution, and newborn health services had the highest level of preparation and implementation, while availability of antiretrovirals (ARVs) for prevention of mother-to-child transmission (PMTCT) and access to safe blood had the lowest level of preparation and implementation. This assessment also showed lack of national coordination in the provision of different SRH services, lack of a national plan for capacity building, and lack of adequate logistics support systems and funding. Conclusions: Important gaps in the knowledge and implementation of MISP/SRH activities continue to exist in Jordan almost nine years into the Syrian displacement. Areas in need of focus include: national coordination in the provision of SRH services, a national plan for capacity building, logistics support systems, and funding for MISP/SRH services provision. Additional funding needs include: Capacity building of service providers with focus on training activities around different MISP/SRH services, facilitating emergency preparedness, improving coordination, and improving referral systems.