Utilization of primary health care services among Syrian refugee and Lebanese women targeted by the ICRC program in Lebanon: a cross-sectional study

Abstract

BackgroundThe Syrian crisis has put tremendous strain on the Lebanese health system, particularly in the historically underserved border region. The ICRC Primary Health Care program has focused on refugee and host communities in these areas. This study objectives were: 1) to determine whether the ICRC program was reaching the most vulnerable populations; 2) to understand the key perceived health needs in the catchment areas of the ICRC supported facilities; and 3) to identify barriers to utilization of health care services.MethodsBetween July and September 2017 we conducted two cross-sectional studies - one randomized household survey and one clinic-based - in the catchment areas of three ICRC-supported facilities, targeting women of reproductive age and caretakers of children under five. Differences between groups were analysed with t-test or chi-squared test.ResultsIn the household survey, similar socio-demographic profiles were observed between Syrian refugee women and vulnerable Lebanese hosts. With regard to the study objectives:The most vulnerable populations were those seen in the ICRC-supported facilities.For both populations, the most common reasons for seeking care were non-communicable diseases (40.6%) and sexual and reproductive health issues (28.6%). Yet the people reaching the ICRC supported facilities were more likely to seek care for communicable diseases affecting their children (37.8%), rather than for the most common reasons expressed in the household survey.In the catchment areas, reported gaps included low immunization coverage and low levels of antenatal care and family planning both for Syrian and Lebanese. Dental care also emerged as an issue. Out of pocket expenditures was reported as a critical barrier for utilization of primary health care services for both populations, while the most important barrier for utilization of ICRC-supported services was lack of awareness.ConclusionsDespite the ICRC reaching the most vulnerable Syrian and Lebanese communities, the population-based survey revealed that important gaps exist in terms of utilization of health care services among women of reproductive age and their children. A stronger outreach component is needed to address lack of awareness. Innovative solutions are also needed to address cost barriers at the levels of both facility and individual user.

Conducting operational research in humanitarian settings: is there a shared path for humanitarians, national public health authorities and academics?

“…The research question that the ICRC and the MoPH sought to answer was how to account for the low utilization of sexual and reproductive health services for women attending the ICRC supported facilities. The gap in understanding was a key and common issue discussed between the ICRC and the MoPH PHC teams at field and management levels [1]. While the field response teams (ICRC, MoPH) had a good understanding of the operational context, using the right research methodology to answer this question depended on the precision of the research question, on whether the ICRC and the MoPH could realistically answer it, and whether the academic partner understood the specificities of the context [22].…”

“…It is in the interest of all, however, to ensure that the humanitarian response is appropriate, reaches the most vulnerable, and mitigates the effects of the crisis on the population and the implicated health system [21,[38][39][40]. The first objective of this paper is to identify retrospectively key factors that allowed the ICRC, the Lebanese Ministry of Public Health (MoPH) and the Harvard FXB Center for Health and Human Rights (FXB Center) to overcome key documented barriers in a partnership to conduct field operational research in Lebanon [1].…”

“…The key question became: Was the ICRC primary health care support reaching those most affected by the crisis and matching beneficiaries' needs in terms of access, cost and appropriateness? The research aim was to evaluate ICRC support in response to the Syrian crisis, to inform evidence-based health programming, and to nurture a set of discussions around policy with the MoPH in Lebanon [1].…”

“…This analysis derives from the experience gained through the collaborative engagement in Lebanon of a humanitarian organization, an academic centre, and a government agency. The research initiative focused on utilization of Primary Health Care (PHC) services by Lebanese and Syrian women and extended for over 4 years, from the inception of the project until the first peer-reviewed publication [1].…”

Prevalence of Non-Communicable Diseases and Associated Medication Use Among Syrian Refugees in Lebanon: An Analysis of Country-Wide Data from the Sijilli Electronic Health Records Database

“…In response to the exponential increase in demand for healthcare services, joint efforts have been made among different healthcare stakeholders present in Lebanon to respond to the needs of refugee populations and to ensure the widest possible coverage of services (20). Yet, these efforts were ine cient (21) due to several impediments (22), with inability to pay out-of-pocket costs, and lack of knowledge about available healthcare services reported as the major barriers to access among refugees (23).…”