UNRWA and Microclinic International partner to fight diabetes epidemic among Palestine refugees

01 June 2015

In response to an exploding type 2 diabetes epidemic, UNRWA is delivering improved health services to millions of Palestine refugees across the Middle East following reforms. New initiatives such as the Family Health Team (FHT) model and a partnership with Microclinic International (MCI) are key to these reforms.

The cornerstone of the reform is the implementation of the FHT model, which offers a primary care package focused on providing comprehensive and holistic primary health care for the entire family. The FHT was designed to improve the quality, efficiency and effectiveness of health services, particularly targeting non-communicable diseases (NCDs) such as diabetes and hypertension.

As refugees are living longer due to improved health services, and NCDs are becoming the main cause of mortality, the challenge of dealing with emerging health needs is increasing. NCDs are now responsible for more than 70 per cent of deaths among the refugees UNRWA serves. These chronic diseases are costly to treat, and often lifestyle and behaviour-related – resulting from sedentary lifestyles, obesity, unhealthy diets and smoking.

By the end of 2014, a total of 128,000 patients with diabetes were attending UNRWA health centres. Patients with both diabetes and hypertension numbered 89,000. Patients with hypertension alone added up to 103,000. Of all patients diagnosed with diabetes, 40 per cent had controlled conditions. Risk factors among NCD patients included smoking (15.1 per cent), physical inactivity (46.1 per cent) and obesity (42.2 per cent).

During 2013 and 2014, 2,900 patients participated in diabetes campaigns conducted at UNRWA health centres in all fields except Syria. Preliminary results showed improvements in process indicators such as body weight, waist circumference, Two-Hour Post Prandial Plasma Glucose (2hr-PPG), blood pressure and cholesterol levels for participating patients.

To introduce more innovation and expand the reach to all registered diabetic patients, and their families and friends, UNRWA partnered with MCI to implement the organization’s evidence-based Microclinic Programme at all UNRWA health centres. This joint project is funded by the World Diabetes Foundation (WDF), which is supporting the project in all fields except Syria, and will integrate the UNRWA Microclinic Programme into standard care at all of the Agency’s 138 health centres.

MCI is a non-governmental organization that seeks to revolutionize how deadly diseases are prevented and managed worldwide. The organization brings particular expertise in managing chronic conditions and has tested its model using randomized controlled trials in the Middle East and around the world.  “UNRWA’s adoption of the Microclinic model will make a significant stride in helping turn the tide against non-communicable diseases in the Middle East. Behavior change is the first line of defence,” said UNRWA Director of Health Dr. Akihiro Seita.  
An UNRWA team, in cooperation with an MCI trainer, have conducted two three-days training-the-trainer (ToT) workshops for field nursing officers, area nursing officers and senior staff nurses from Jordan, Lebanon, the West Bank and Gaza on the MCI curriculum. The 34 trained facilitators will start a series of training workshops for all the 992 nurses at their fields during the next 12 months.

All trained nurses, through a series of community-based workshops, will recruit diabetic and high-risk patients, in addition to the general public, into groups called ‘Microclinics’. Each Microclinic will be offered theoretical and practical skills and a system of reliable support needed to transform the social and economic determinants of these deadly diseases. Microclinic members are considered UNRWA Ambassadors for disseminating knowledge and healthy practices to their social networks within Palestine refugee communities.

At the end of this initial two-year partnership, it is expected that all diabetic patients and their social networks will have sufficient health education and healthy lifestyle practices to better control their conditions and help others either control existing conditions of prevent the onset of diabetes. The UNRWA Microclinic programme will be integrated into the regular functioning of UNRWA health centres so that the long-term rates of diabetes and related complications can be reduced.