Health Management

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Applicability of the Learning Organization Concept to the Ministry of Health: Managers' Perspectives
(Al-Quds University, 2009-08-15) Arwa Abdel Wahab Shalabi; اروى عبد الوهاب زكري شلبي
Universally, organizations facing uncertain, changing, or ambiguous contexts need to be able to learn in an efficient and effective manner. In the absence of learning, organizations and individuals simply repeat old practices and improvements are either fortuitous or short-lived. In line with the recently developed learning organization concepts (LO), organizations are increasingly required to be dynamic learning systems in order to develop and thrive. The overall aim of this study is to ascertain the applicability of the LO concepts to the MOH institutions in Gaza from the managers' perspectives. The design of this study is a quantitative, descriptive, analytical cross-sectional one. Selfadministered standardized questionnaire (Dimensions of the Learning Organization Questionnaire) was completed by 662 managers with a response rate of 74.9%. The overall reliability coefficient was high (0.820). The study indicated the total revealed mean of the five LO disciplines was 5.7 (out of 10) with the highest mean for systems thinking discipline (6.1) and lowest mean for the personal mastery discipline. In addition, the dimensions of the LO revealed a total mean of 5.2 out of 10; with the individual learning being the highest (5.3) and the team learning and organizational learning being the lowest (5.1). The extracted findings reflect weak performance of the MOH as a LO from the perspectives of its managers. In other words, the MOH is not yet considered as a LO implying that it is neither facilitating the learning of its members nor transforming itself as needed. The study concluded statistically significant variations in perceptions among the subjects where the PHC managers had elicited higher mean scores than their counterparts in hospitals (P value 0.05). Also, positive differences were revealed between the managerial positions and the elicited mean scores (P value 0.0001). Congruently, managers who were working in the field of finance and administration had higher mean scores than others who work in technical arenas (P value 0.001). Moreover, male managers elicited higher mean scores than their female counterparts (P value 0.005). Regarding the organizational related variables, the availability of organizational strategies, strategic plan for training, follow up after training and the availability of clear structures were associated with higher means scores with statistically significant differences. The dominant organizational learning style was "Habits Style" which is characterized by repetitive processes and blind automaton. The study provided a framework for strengthening the MOH to become a LO that transforms and develops itself. Special attention should be paid to support sharing knowledge and team learning. A basic, yet essential, approach includes promoting issues pertaining to strategic management.
Assessment of Infection Prevention and Control Practices at Operating Rooms in Nongovernmental Organizations Hospitals - Gaza Governorates
(Al-Quds University, 2012-01-02) Jehad Nasri Elmadhoun; جهاد نصري المدهون
Hospital Acquired infections are considered one of the most serious problems in the world. The problem of infection prevention and control in our Palestinian hospitals becomes more serious especially with scarcity of resources and materials; also the lack of supportive policies and direction can exaggerate the situation. The Center for Disease Prevention and Control recommended that educating healthcare workers regarding infection control measures is the highest priority to prevent and control nosocomial infections. The overall aim of this study is to assess the healthcare workers practices at the operating rooms in Nongovernmental Organizations hospitals in Gaza governorates on the light of infection prevention and control protocols. The design of this study is a descriptive analytical cross sectional with mainly quantitative approach and supported by in-depth interviews. The instruments used in this study were self-administered questionnaire, observation checklist for the physical environment of the operating rooms, observation checklist for the health care workers practices and in-depth interviews with the key persons. Six of the Nongovernmental hospitals in Gaza Governorates were included in the study according to eligibility criteria. The study included 169 participants, out of them 154 responded and completed the self-administered questionnaire with a response rate of 91%. Four hundred seventy seven observation checklists were done to assess the healthcare workers practices and 18 observation checklists were done to assess the physical environment of these operating rooms. General measures of validity and reliability were administered. The research findings show that 81.6% of the respondents were exposed to sharp injuries, 88.7% stated that they need more training, 63% don't know about the Palestinian infection prevention and control protocols, 84.4% stated that there are no copies of the protocols in their operating rooms, 81% of the respondents said that the lack of knowledge and education regarding infection prevention and control is the main obstacle that prevents them of using the protocols, about 78.4%, 62.7% attributed the cause to the insufficient training and lack of supportive policy respectively. Only 39.6% of the respondents stated that their management policies support the infection control practices, 46.1% stated that there is no infection control committee in their hospitals, and 72.1% stated that they were never assessed regarding infection prevention and control. The results of observation checklists show the unavailability of the protocols at the operating rooms in the six hospitals and the general adherence to all items of the protocols is weak, about 48.7% for hands washing, 43.5% for surgical scrub, 56.4% for wearing gloves, 41.9% for skin preparation and 51% for sharp disposals. The study revealed statistically significant relationship between the practice and the knowledge, attitudes, training, air quality, flow system, operating room design and materials. The researcher recommends that Nongovernmental Organizations hospitals need to increase their efforts towards improving healthcare workers compliance to protocols by increasing their awareness, knowledge through training and education programs and to disseminate the protocols to make it available to every healthcare worker or at least to be accessible in each department.
Assessment of Medical Waste Management at Private Dental Clinics in the Gaza Strip: Status and Policy Implication
(Al-Quds University, 2016-08-17) Rola Samir Qeshta; رولا سمير قشطة
Medical wastes are generated in hospitals, clinics and places where diagnosis and treatment are conducted. The management of these wastes is an issue of great concern and importance in view of potential public health risks associated with such wastes. This study aims to ascertain the status of medical waste management in private dental clinics in Gaza Governorates, an important segment of dental health care providers. This study is a quantitative, descriptive, analytical, cross-sectional one. The target population was the dental staff working at private dental clinics in the Gaza Governorates. The researcher used a self-constructed, self-administered questionnaire. In total, 276 respondents completed the questionnaire with a response rate of 98.5%. Statistical Package for the Social Sciences Program (SPSS) has been used for data analysis including cross tabulation, percentages, mean, t test and ANOVA. Finding revealed that 61.2% of participants were males and 42.8% were aged 30 to less than 40 years. The majority of respondents (88%) were dentists and holding bachelor degree (85.5%). Of respondents, 61% have less than 10 years of experience, and only 1.8% were having more than 30 years of experience. The majority of respondents (89.5%) not received any training about dental waste management. With regard to policy and guidelines, more than two thirds of respondents (87.3%) were aware of presence of waste management policy and guidelines, but the majority of them (88.8%) informed unavailability of manual guidelines for dental waste management in their clinics. Concerning management of dental waste, the majority of respondents (79.3%) reported absence of supervision on waste management process, and almost all (94.6%) reported the availability of personal protective equipment in their clinics. Nearly half of the participants (44.6%) evaluated their dealing with hazardous waste in their clinics as excellent and 65.2% of the participants have licensed their clinics. Most of participants (90.6%) were personally familiar with dental wastes, also the majority of them (87.6%) had correct knowledge about the definition of dental waste. (98.5%) of respondents knew that they should be wearing personnel protective equipment when handling a dental product. Regarding practice, the majority of the respondents (86%) reported performing separation of the dental waste before disposal, and 88.4 of them reported that they disposed the dental waste after separation. Moreover, the majority of respondents (84.0%) reported disposing cotton, gauze and other items contaminated with blood by thrown it into the general garbage and only 8.3% of them used correct methods. Nearly one third of participants are not satisfied about current dental waste management. Approximately (80%) of the participants had positive attitudes toward the importance of existence of a manual guidelines for dental waste management. The study concluded that majority of dental staff workers working in private clinics are knowledgeable about dental waste management. The practices towards dental waste require further improvement. There is a need for training and monitoring programs accompanied by supervision and learning.
Assessment of Occupational Safety at Al-Shifa Medical Complex
(Al-Quds University, 2016-01-02) Shehada Rezeq Al-Ajrami; شحادة رزق العجرمي
Occupational Safety at healthcare sector has been identified as an essential issue for the health organizations, patients and health care workers. Little is known about occupational safety issues at the Ministry of Health-Gaza. The study employed a descriptive, analytical cross sectional design with a triangulated approach (quantitative and qualitative). Self-administered questionnaire, key informant interviews and observational checklist according to the Occupational and Safety Health Administration were used for data collection. A proportional stratified systematic random sampling was used from healthcare workers working at the complex who conclude the target population. Of the 370 workers selected, 350 responded and completed the questionnaires, with a response rate of 94.5%. The overall reliability coefficient (Cronbach’s Alpha) for the study questionnaire was 0.93 which is acceptable. Statistical Package for the Social Sciences Program has been used for data analysis. The study revealed that the different dimensions of occupational safety had different mean percentages with an average score of 55.6% reflecting moderate perceptions of healthcare workers towards the current status of occupational safety. Healthcare workers’ compliance with the prevention tools and safety procedures dimension had the highest percentage with 71.13%. Identification of workplace hazards and accidents and availability of prevention means dimensions. had moderate percentages with 67.5% and 54.7% respectively. Meanwhile, related factors of workplace hazards and accidents dimension had a mean score of 49%. Availability of occupational safety rules and guideline and their activation and development dimensions had low percentages with 46.3% and 49.2% respectively. In addition, top management commitment to safety issues and safety training programs had low percentages with 46.7% and 43.1% which elicited the lowest percentage dimension. Furthermore, the study results agreed on that, the current occupational safety means and measurements at the complex are available to some extent but not sufficient and not applicable as required. They were met Occupational Safety and Health Administration standards to some extent in the main three hospitals as well as the special surgery building was elicited the better followed by the surgery building, while the obstetric building had the lowest status. Furthermore, the results showed that the main occupational hazards and diseases to witch healthcare workers exposed were infectious respiratory and skin transmitted diseases according to 49.7% , back pain and musculoskeletal disorders according to 30.8% , needle stick injuries and blood transmitted diseases as reported 28.8% , work overload and violence as agreed 24.2%, varicose veins as claimed 12% , electrical hazards according to10% , carcinogenic hazards as reported 5.7% and vision problems according to 4.2% of the participants. The main factors beyond these hazards were lack of specialized safety department or committee ;lack of prevention tools and safety procedures; lack of compliance to safety guidelines and regulations application; scarcity of employees training programs; lack of protection methods and lack of occupational safety knowledge among the employees. Moreover, the findings revealed that respondents with younger age and fewer years of experience had higher occupational safety scores than their counterparts of older age and longer experience years. Also, there were variations in the overall perception in reference to workplace towards surgical hospital. The nurses had higher mean scores than other professional categories. Furthermore, the respondents with lower educational level perceive occupational safety more than those with higher ones. Therefore, the single respondents and those who work shifts had higher scores than married respondents and those who work only morning shifts. On the other hand, the results showed that no statistical differences were found in overall occupational safety status perceptions in reference to age and weekly working hours. The status of occupational safety is moderate and still needs a lot of efforts to enhance the effective management and successful practicing of safety issues in Al-Shifa Medical Complex by increasing attention and awareness at all levels to promote and improve the current status.
Assessment of the Clinical Nursing Supervision at Governmental Hospitals- Gaza Governorates
(Al-Quds University, 2011-06-02) Ramadan Ali Ramadan Hassan; رمضان علي رمضان حسان
The literature indicates that clinical nursing supervision has a significant impact on the quality of nursing care. The overall aim of this study was to assess the clinical nursing supervision at governmental hospitals in Gaza governorates from the perspectives of both supervisors and supervisees in order to increase the effectiveness of the supervision processes and outcomes. The design of the study is a descriptive, analytical cross sectional one. One hospital from each governorate from the five Gaza Strip governorates was randomly selected. All supervisors (head nurses and nursing supervisors) were included and a systematic proportional random sample was selected from the supervisees. In total, 160 supervisors were included and the response rate among them was 83.1%; meanwhile, the sample size for supervisees was 300 subjects and the response rate was 90%. Two questionnaires were developed to reflect the study domains which based on the Proctor’s three interactive functions of clinical supervision (formative, normative and restorative) in addition to personal, organizational and supervision related variables. Data were collected utilizing the self-administered questionnaire approach and the reliability coefficient (Cronbach’s Alpha was very high (more than 0.9 for the two scales). Findings show that relatively young male supervisors were dominating the supervisory positions (72.2% were males) at the surveyed facilities. Training opportunities in supervision for supervisors was limited as (less than 25% received training courses in supervision). The availability and use of supervisory tools was also limited; about 24% of the supervisors were using checklists. Nearly half of the supervisors reported being involved in setting hospitals’ objectives and strategies. Similarly, 50% of the supervisees reported being engaged in the performance appraisal for themselves and for their peers; however, they didn't receive adequate feedback in this regard. The study shows that overall the supervisors were more positively perceiving their supervisory roles (80.2%) than supervisees who received supervision from them (68.6%). The restorative function was the highest perceived function among both the supervisors (84.8%) and the supervisees (71.7%) while the formative function was the least positively perceived function by both supervisors (77.5%) and supervisees (63.8%). The formative function is the core function of the clinical supervision indicating that the current supervisory system is relatively administrative rather than clinical. Supervisees’ perspectives indicated that positive perceptions were elicited about the clinical supervision of head nurses more than the nursing supervisors with statistically significant differences (P value < 0.05). Supervisors who are head nurses, females and having long experience had elicited higher scores than their counterparts with statistically significant differences (P value < 0.05). On the other hand, supervisees who were females, holding diploma certificate supervisees more positively perceiving the supervision they had received than their counterparts with statistically significant differences (P value < 0.05). The researcher recommends strengthening the clinical aspect of supervision, formulation of clinical supervision policy and promoting the use of supervisory tools such as checklists.
Assessment of the Occupational Safety and Health Standards in the Vocational Training Centers in Gaza Governorates
(Al-Quds University, 2012-08-12) Manar Ahmad Hamad; منار احمد حمد
Background: Vocational training is a very important tool in the development of the communities. The vocational trainees are the products of the vocational training and its tool in the development. Their safety and health are very essential elements so they can fulfill their part in the development. Aim: To assess the levels of occupational safety and health standards application in the training workshops in the vocational training centers in Gaza governorates. Methods: The design of the study was descriptive, to determine the occupational safety and health standards, which should be available in the vocational training centers in Gaza Strip. The sample included all the vocational training centers that belong to local and international NGOs and the government sector and all the trainers working in these centers who had direct supervision and vocational training for the trainees with total number109. In addition to the workshops of the centers where training takes, place. Data was collected through self-administered questionnaire completed by one hundred and four trainers and checklist for eighty-three workshops. The response rate was 95% for employees and 100% for workshops. Result: The providers of the vocational training in Gaza strip are very important providers such as UNRWA, MOL, MOW, and the NGO. Most of the centers provide vocational training for decays. The vocational trainers are well qualified, about 54% of them have experience years more than 10 years. The study results showed that about 70% of the trainers had received training on OSH issues but more than 80% of them did not know the concepts of OSH asked in the study. According to more than 80% of the trainers, the centers provide appropriate personal protective equipment (PPE).However, according to the results of the checklist, in about 50% of the workshops there were no PPE neither provided to the trainees nor training on the use of PPE. Only 26% of the trainers said that their centers have special OSH technician. In addition, 76% of the trainers think that their workshops need changes regarding occupational safety and health. Curriculum of occupational safety and health is available in the centers according to 87% of the trainers. Emergency plans are not available in 84% of the workshops. Alarm system is not available in 71% of the workshops. Regarding the occupational hazards in the workshops, 85% of the workshops do not have any precautions against fire hazards. More than 90% of the workshops have good and accepted electrical hazards precautions. The physiological hazards were as following, the illumination was poor in about third of the workshops. Natural ventilation is accepted but more than 60% of the workshops have no ventilation system. The conditions regarding the chemical hazards in the workshops are very poor. The hand tools used by the trainees are in good condition and suitable for the type of work. In about 40% of the workshops, there are no first aid boxes The study results showed that the most common injuries among the trainees were the cuts (38%), burns and eye injuries (15%), fractures (12%) and electric shock (9%).There were statistically significant differences between the center's providers in reference to the occupational hazards. Conclusion: The vocational centers need to pay more attention to the occupational safety and health standards to ensure the safety of the trainers and trainees. Provision of training to the trainers and trainees regarding OSH issues is required.
The Contributions of the International Funds to Developing the Palestinian Health Care System: Focus on NGOs-Gaza
(Al-Quds University, 2012-09-01) Mohammed Shokri Al-Khaldi; محمد شكري محمد الخالدي
International Fund (IF) has become an important source in developing countries including Palestine. The overall aim of this study was to assess the role of IF in supporting the Palestinian Health System at NGOs sector in Gaza governorates. The study design is cross sectional with triangulation of quantitative and qualitative approaches. The instruments used were interviewed-questionnaire and in-depth interviews with 8 key informants. The study population included 52 NGOs, 48 of them responded (88%). General measures of validity and reliability were administered such as standardization of instrumentation and implementation. The SPSS program has been used for quantitative analysis and open coding thematic analysis for the qualitative analysis. Reliability test analysis was high (0.8) indicating high consistency of the study questionnaire. The research findings show that 85.4% of the NGOs directors were males; most of them were trained at BSc. degree level and had 15 years of experience in average. Most of the NGOs were located in Gaza City (58%) followed by Khanyounis (14.6%). Responses indicated that 95% of NGOs were engaged in providing health services and 54.2% reported working in development oriented activities, 25% in rehabilitation services and 10% were reported working in advocacy and mobilization fields. The overall perceived IF contribution’s score was 2.05 out of 3 (68.46%) indicating that perceptions about IF role were moderate. Reported perceptions about sustainability were more positive and elicited higher mean scores (78.30%). The revealed scores reflecting perceptions about the contributions of IF were as follows efficiency, effectiveness, relevancy and appropriateness was around 75%, evaluation and monitoring domain 73%, transparency and governance 71.41%, meetings of NGOs needs and development domain was 68.79%, while the IF nature domain was 68.63%. Perceptions about responsiveness to the needs of the Palestinian population such as alliveiating human suffering, minimizing the consequences of the occupation and promoting the socio-economic status had elecited moderate scores also. The overall scores reflecting the extent to which IF improves the national health indicators by improving the quality of health serives was moderate (64.86%) indicating gaps in adequacy or utilization of IF. The IF contributions to meeting the Millennium Development Goals such as reducing infant and maternal mortality, fertility, poverty and unempolyment elicited 63.39%. Perceptions about coordination and cooperation were the lowest scores of the study domains (60.67%). More than 70% of respondents stated that their NGOs had suffered from financial deficits mainly due to insufficient funds and the major obstacles in securing fund were political conditions and inadequacy of interactions with donors. The revealed scores reflecting perceptions about the IF contribution to development rather than relief was 75.69%. There were factors affecting and/or affected by the IF in the health field, mainly politics, security, absence of coordination, health NGOs and donors’ vision and goals incompatibility, organizational factors such as NGO strategic management and economical and financial factors. The researcher recommends that donors and NGOs need to proactively coordinate in order to meet the needs of the Plaestinan community. Areas which require more attention include developing mutual vision, closer coordination and paying more attention effectiveness, efficiency and sustainability. NGOs need to improve their capacity to strtagically manage funds in a way that promote meeting public health needs and priorities.
Drugs Prescribing Patterns and Practices at UNRWA Health Centers – Gaza Governorates
(Al-Quds University, 2012-06-04) Mona Arafat El Baba; منى عرفات البابا
The practice of rational drug prescribing is of great importance for the safety of patients and the health facility expenditure. This study aimed to examine prescription patterns among prescribers working at UNRWA health centers and to determine their level of adherence to WHO standards of drug use indicators. The popula"on of the study consisted of #$% prescribers and the sample si&e was #'# prescribers ()$ males and *+ females,- with response rate %%..%/ and #+'# prescrip"ons from all UNRWA health centers in Ga&a Strip. For data collection- constructed- self administered questionnaire and checklist for drug indicators were used. For data analysis- the researcher used frequencies- means- standard deviation- Chi square and One way ANOVA test. The results showed that ))/ of study par"cipants reported knowing the meaning of essen"al drugs- )6.6/ knew the meaning of generic name- $6.'/ knew the generic name for all prescribed drugs. **.*/ knew the generic name for most of the drugs and )).#/ were familiar with the concepts of standards treatment guidelines. Only '*.$/ used generic name very o7en- $$.$/ used generic name o7en and only '*.*/ received training about prescribing patterns. Also- )).8/ reported that a copy of 9:; was available- )8.6/ were using the 9:;- of them- 6'.8/ found that 9:; was easy to be used. Regarding shortage of drugs- +$.*/ of study par"cipants said that they experienced shortage of drugs and +8.8/ reported that the main shortage was in antibiotics followed by dermatological drugs (*8.'/, and NSA<:s (*#.$/,. The ma=ority of study par"cipants )6.#/ said that there is a monitoring system for prescribing of drugs- )'.$/ said that there is a wri>en technical instruc"ons for prescribing- only '..'/ received wri>en feedback and 8+.'/ received verbal feedback regarding their prac"ce. Concerning drug use indicators- the mean number of prescribed drugs was '.%% per prescrip"on- percentage drugs prescribed by generic name was '8.$- percentage of prescribed an"bio"cs was *'.6- percentage of drugs prescribed from 9:; was 6).*% and percentage pf prescribed in=ec"ons was *.#. The results indicated that the highest rate of prescribing drugs in general and from 9:; was from North governorate- the highest number of prescribed drugs was in general ?les (m @ '.)', and the lowest was in mother ?les (m @ '.%.,. The highest rate of prescribing drugs was in the third #. days of the month (m @ '.6+,. The study concluded that further educational activities should be taken to achieve rational prescribing and standards of drug use indicators.
Employees' Perspectives about Communication at the Palestine Red Crescent Society
(Al-Quds University, 2011-02-27) Helmy Jameel Abu Dalal; حلمي جميل ابو دلال
Communication is an essential factor for the success of any organization. It shapes the organization culture and influences the major functions inside the organization including control, motivation, change, decision making and information exchange. This study aimed to assess employees’ perspectives about communication at the Palestine Red Crescent Society (PRCS). The design of this study is a descriptive, analytic, cross sectional one. Stratified random sampling technique was used to select 300 employees. Self-administered questionnaire was distributed and data was analyzed by using the SPSS. The response rate was 87%. Content validity was validated by experts and Cronbach's Alpha consistency test equals 0.864.The result of this study showed that the majority of employees were males (69.3%) and married (85%). The mean age of the PRCS employees was 35.39 years. The most academic qualification hold was Bachelor's Degree (35.2%). Also the result showed that the most commonly communication tool in use during emergency is the mobile (47%), while during routine work face to face is more preferrable (61.7%). Furthermore, the study revealed that the mean of the knowledge dimension equals 3.97 (79.3%), the mean of the perception dimension equals 4.01 (80.2%), the mean of the filed “skills and practice” equals 4.03 (80.5%) and the mean of the filed communication gaps equals 2.96 (59.2%).About half of the employees were satisfied about the current communication level within the organization. Sixty two of the employees didn’t get any training courses in communication skills. About 50% of PRCS employees were facing conflict in the organization and 68% of them had admitting that there are gaps in communication in the organization. Sixty percent of PRCS employees believed that the PRCS administration gives high concern to develop the communication process within the organization.The study revealed the age group 45-50 were having the highest mean with statistically significant differences than the other age groups. Master Degree/PhD holders, employees having more than 15 years of experience and the administrators elecited higher scores in communication skill and practices than their counterpart groups with statsical significant differences (P value is less than 0.05). In contarty, gender, number of family members and work setting didn’t statistically significantly affecting the perceptions about communication among PRCS employees. The study conclude that inservice education, holding training programs and workshop should be established in order to improve the communication process. Developing the PRCS managers’ skills to communicate and interact with their employees is essential.
Evaluation of Community Based Rehabilitation Programs in the North and Gaza Governorates
(Al-Quds University, 2011-06-18) Soad Jameel S. Radwan; سعاد جميل رضوان
Community Based Rehabilitation (CBR) is a specific and important strategy for people with disabilities. This study aims to evaluate the CBR programs in Gaza and North Gaza governorates inorder to provide information that could contribute to support the services delivery and enhance the effectiveness of the programs to disabled persons. Evaluative techniques including triangulation methods combining both qualitative and quantitative techniques were conducted at the National Society for Rehabilitation and Palestinian Medical Relief Society. A sample of 300 beneficiaries have been chosen through a systematic random sample, and participated through a self-constructed interviewed- questionnaire with a response rate of 69.7%. Also, 10 key informants have been selected purposively for interview. In addition to that, 20 medical files were reviewed randomly. The study results revealed the main causes of disability are acquired in 71.6% of cases with various types, mainly accidents that constituted (52.1%), followed by communicable diseases (16.7%), and wars (14.6%). Among disability types, physical disability is the commonest one that formed 76.1%. The prominent services were relief aids (42.8%), followed by assistive devices (28.6%) and physiotherapy (27.1%). There was lack in livelihood domain where vocational training forms only (0.5%), and lack of the income generation and disabled people employment, while the majority (80.6%) of disabled live under the poverty line. The results indicated that 50.3% of visits are less than one visit monthly. Regarding the services provision, there is no difference between males and females. The researcher show that CBR programs are effective, this was elicited from response of the most of disabled’s needs, and improvement in disabled physical health status (P value 0.001), and psychological state (P value 0.001). At the same time, positive proportional correlation was found between the provided services scores and improvement of quality of life domains that contained indicators like feeling security, satisfaction, change in physical and psychological health state and social participation of disabled people (Pearson correlation 0.376 - P value 0.001). The study reflected good networking with different sectors, but governmental collaboration with CBR programs is still weak. On the other hand, communication and interaction of rehabilitation workers with disabled people was cooperative. The limited number of the rehabilitation workers and lack of volunteers increased the workload, and affect work’s process and quality. The study revealed shortage in the documentation and cases evaluation, poor public awareness about disability issues, and weak of the community ownership. Furthermore, application of the disability law number 4-1999 is inactive. This was indicated through the absence of disabled self- advocacy, and lack of the governmental role in maintaining disabled rights. The study provided a set of recommendations that could strengthen the CBR programs including; establishment of a national strategy aiming to create public awareness about the disability issues, and formulating of a local committee for developing polices, empowering the disabled role in the community, enhancing the voluntary work, and developing of staff capacity.
Evaluation of Natal-Care Services Provided by Governmental Hospitals in Gaza Governorates
(Al-Quds University, 2012-12-01) Sahar Abdel Wahhab Shalabi; سحر عبد الوهاب شلبي
Birth is an occasion that changes life. It is a natural process, and there must be a good reason to interfere with this natural process in order not to expose women to high rates of intervention, unfamiliar personnel, lack of privacy and other situations that may be felt as harsh. The overall aim of the study is to evaluate the natal care services provided by governmental hospitals in Gaza Governorates. The design of this study is a quantitative, descriptive, analytical, cross-sectional one and was conducted in governmental maternity hospitals in Gaza Governorates. Data were collected from forty low- risk women during labour and birth using an observational checklist that was prepared to assess the practices for normal childbirth in relation to evidence-based childbirth care and to obtain a rough estimate of the frequency of certain practices. And another checklist for medical records to evaluate the quality of documentation of medical records in terms of completeness, and accuracy. Data were analyzed using Statistical Package for the Social Sciences, Version 17.0. The results indicated that non-evidence-based practices are commonly used to support, and manage birth in Gaza Governorates. High levels of obstetric interventions were observed giving evidence of their inappropriate or routine use, and largely deviated from the well-known best practice recommended by World Health Organization for normal birth. It was found that Intra Venous fluids were used for 60% of the observed women, fetal heart sounds were checked during the 2nd stage of labour in 37.5% , 66.7% of them by continuous Cardiotocograph Partogram was filled in 35% of cases, labour was augmented with oxytocin in 62.5% of cases and with artificial rupture of membranes in77.5% of them. Birthing women were not always treated with respect and their privacy was violated many times, with frequent lack of communication with health care providers and lack of support from health care providers and family members. There were clear differences between observation, and documentation. Augmentation of labour was used commonly by oxytocin (62.5 %), but it was less documented in medical records (52.5%). Blood pressure was measured in the observation only in 37.5% of cases but documented in 72.5%. The overall completeness of records was found to be poor (46.4%). The completeness of demographic information (67.5%) was good in general. But it was for some items very poor, such as general examination and vital signs (12.5%), abdominal examination (10%), vaginal examination (2.5%), and Partograms filling (20%). Incomplete and inaccurate documentation of health records were detected indicating poor quality of care which stresses the need to increased attention for documentation of medical records. This study provides recommendations to support evidence-based practices and encourage normal deliveries, and standardization of medical records among governmental hospitals.
Evaluation of the Current Documentation of Death Certificates in the Gaza Strip
(Al-Quds University, 2011-07-13) Jawad Jaber Badwan; جواد جابر سلامة بدوان
Death certificates represent a data source that many health researchers find useful and attractive for analysis. It is an official document that declares a person is died, how we document the death certificate affect our mortality statistics which are very important. Public health policies depend heavily on the mortality indicators derived from death certificates. Because they are the main source of information about the causes of death and illness preceding death. This study aimed to evaluate the current documentation of death certificates in the Gaza Strip. Triangulated cross sectional quantitative, qualitative study was conducted in order to evaluate the current documentation of death certificates in the Gaza Strip. The instrument used in this study were reviewing death notification certificates through self constructed checklist and in-depth interview with 12 managers. Total of 256 death notification certificates from 1-7-2009 to 31-12-2009 were chosen through systematic sampling method and Epi info program. 0ut of them, 237 death notification certificates were detective, so the detective rate was 92.5%. The study findings show that for reporting of original city, 28.7% was incomplete and 37% of birth dates were improperly reported. For occupation and addresses 56% and 67.9% respectively were incomplete. For data relating to death hour and if the baby live less than 24 hours, missing of these data were 19% and 97% of the certificates respectively. The findings of the study revealed that 38% of the cause of death is not documented completely nor accurately, 100% of the certificates did not mention if the deceased was pregnant or not at time of death, 10.5% of certificates were not certified by physician completely and 11.8% of PHC registration was incomplete. Finally results show that our physicians are not trained, but familial by experience on how to complete death notification certificate and the mortality and morbidity committees within hospital are not active. The researcher concluded that there is a serious problem regarding the documentation of death notification certificates in the Gaza Strip in personal and demographic section, cause of death section, certifying physician section and PHC governorate certification section. And that due to lack of formal training, medical inexperience and perceived lack of certificate importance. The researcher recommended that continuous training for physician on the proper way of completing death notification certificate, reactivation of mortality and morbidity committees within hospitals and initiating of professional committee in the MOH responsible for querying cause of death could help in promoting better and more accurate documentation of death certificates. Also the researcher recommended for further study to investigate the effect of good documentation of death certificates on mortality statistics and health status of the population.
Evaluation of the Status of Strategic Management in Non-Governmental Health Organizations -Gaza Governorates
(Al-Quds University, 2011-08-02) Samira khalil Ahmad Abu Hmaid; سميرة خليل ابو حميد
Strategic management was recently adopted in health sector to cope with huge changes that have been occurring, it is the beginning of efficient and effective managerial system. Therefore, an evaluation of status of strategic management in non-governmental health organizations and identification of obstacles hindering health programming and strategic management in Gaza strip was done with cross-sectional descriptive analytical study. Using self –administered questionnaire , data were derived from 130 managers and chairpersons of 32 health NGOs in Gaza strip aged from 25-70 years,80% of them were males how were working in those organizations in the period of data collection which extend from December 29th, 2010 to January 25th,2011. Data was collected regarding demographic variables, organizational variables and strategic management practice. T test and one way ANOVA were used to analyze the association between dependent and independent variables. The respondent health organizations were providing different health care services; primary health care (46%), secondary and territory health care (15.6%), rehabilitation (68.8%), diagnostic services (50%), psychosocial support (50%), and most of them were providing health education (84%). High percentages of rehabilitations and psychosocial support services indicated to the quick response of NGOs toward the needs of local society as reports talking about increase incidence of mental illness and number of disables due to Israeli attacks and blockade of Gaza Strip, the total number of working health professionals were 1088, only( 35%) of them females. It was concluded that the overall strategic management practice mean scores was 79.8%, but the lowest main scores was for strategic plan (67%). Although the results indicated that 85% of the organization's employees have job description, only 42% of respondent agreed that their organizations conduct annual performance appraisal while 52% of them indicated that there were individual work plans for employees that was annual plan with 26% of respondent. Regarding financial resources of health NGOs,( 61.2%) are from external donation (Arab and foreign) while only 27% from its private revenues. There were statistically significant associations between genders, managerial years of experience, size of organization and strategic management practice (P<0.05). Most respondents considered the unstable political environment in Gaza strip as the main constrain for practice of strategic management followed by limited fund and financial flow instability . The findings of this study are important for understanding gaps of strategic management practice, and landmarks in improving its practice within health NGOs in Gaza Strip. So it is recommended to health NGOs to pay more attention for strategic plans formulation as perfect tool for seeking fund, human recourses management strategies as they the back bone of any organization through more capacity buildings , effective involvement in all management process, and creating culture encourages continuous education and facilitates information transferring. Finally, MOH is required to enforce the complementary relationship with local health NGOs to decrease its dependency on external fund.
Factors Hindering the Implementation of Quality Improvement at the MoH-Gaza.
(Al-Quds University, 2012-07-10) Mahmoud Mohammed Radwan; محمود محمد رضوان
Quality has been identified as one of the key drivers of improved health outcomes and greater efficiency in health service delivery in developing countries. In a fragmented and inefficient health system like the Palestinian one, where resources are scarce and health problems are complex, the need for implementation of Quality Improvement (QI) is even more crucial than elsewhere. Little is known about the most influencing factors for impeding the implementation of QI at the Ministry of Health (MoH). This study aims to investigate the most perceived barrier factors to the successful implementation of QI at the MoH facilities. The study employed a descriptive, analytical cross sectional design with a triangulated approach (quantitative and qualitative). Self-administered questionnaires and key informant interviews were used for data collection. A randomized multi stage stratified sampling was used to select the eligible healthcare providers working at the MoH in two medical complexes (Shifa in Gaza and Nasser in Khanyounis) and five PHC centers (level 4). The calculated sample size was 450, out of them, 397 responded and completed the questionnaires, with a response rate of 88.2%. The overall reliability coefficient for the study instrument was acceptable 0.787. Semi structured, face to face, audiotaped in-depth interviews were conducted with eight key informants as a second data collection instrument. Findings revealed that the most perceived barrier factors to the implementation of QI were top management commitment (Mean=2.17), followed by organizational culture (Mean=2.29), leadership (Mean=2.33), health information system (Mean=2.48), human resources management (Mean=2.49), staff training (Mean=2.53), and staff engagement (Mean=2.57). Although the most common obstacle for the implementation of QI, mentioned by all key informants, was the lack of a strategic plan, majority of them reported the same obstacles elicited from quantitative data. However, the perception of healthcare providers reflected a limited implementation of QI with percentage of (25.1%). Such perception was widely concurred by the key informants. Participants working at hospitals and PHC centers revealed similar perception towards the barrier factors affecting the implementation of QI with statistically insignificant differences (P˃0.05). The findings showed variation in the perceived barriers to the implementation of QI in reference to gender, specialties, and job positions (P˂0.05). Pearson test showed a weak positive correlation between the implementation of QI and top management commitment, structure, leadership, human resource management, monitoring & supervision, staff engagement and training, health information system, financial support, and material resources. The researcher recommends prioritizing the QI in the strategic plan as an approach to improve the performance and the provided healthcare services at the MoH facilities; in addition, strengthening the role of management and leadership through dissemination of quality culture, ensuring the resources, and investment in the training.
Job Autonomy As Perceived By Nursing Managers In Governmental Hospitals In The MOH- Gaza Governorates
(Al-Quds University, 2011-01-02) Khalil Mostafa Shaqfa; خليل مصطفى شقفة
Job autonomy plays an important role in nurses’ job satisfaction, retention and quality of patient care. It is argued that for nursing managers, job autonomy and job satisfaction may be interrelated. Thus, the assessment of job autonomy among nursing managers in health organizations is important for policy and administration purposes as well as professional purposes. The overall aim of this study was to assess the job autonomy among nurses as perceived by nursing managers in the governmental hospitals in Gaza governorates in order to promote professionalism in nursing. A descriptive, analytical cross sectional design was used. Subjects of this study were 301 nurses who represented all the formally assigned nursing managers in governmental hospitals. Self-administered questionnaire was used and 238 participants completed the questionnaire with a response rate of 83%. Data were analyzed using the SPSS program. The content validity was validated by ten experts. The reliability test using Cronbach Alpha coefficient was 0.707. The study extracted six dimensions for autonomy which are: general perspective, (m=3.47), managerial style (m=3.82), job description (m=3.69), job satisfaction (m=4.09), nursing career (m=3.69) and work preference (m=3.06). The highest mean score among dimensions is job satisfaction domain and the lowest is work preference domain (m=3.06). The vast majority of nursing managers (94.2%) preferred to be supervised by a person from the same profession, in addition, nursing managers called for allowing the Chief Nursing Manager in the MOH to overall supervise all nurses in the organization (39.0%). The majority of nursing managers who were working in clinical settings (60.9%) believed that they had adequate autonomy within their work arenas. However, 72.6% of nurse managers believed that the current management style at the MOH inversely affects nursing autonomy. The study results also showed that there were no statistically significant differences in reference to the job title and education level (Pvalue = 0.131 and 0.097 respectively). In contrary, results revealed that there are statistical significant differences at 0.05 between males (M = 3.52 out of 5) and females (M = 3.33); in the favor of males (P value = 0.003). Also, the result showed that there are statistical significant differences in perceptions about autonomy in reference to age were younger felt more autonomous than older counterparts (P value = 0.004). It is concluded that there is a great need to enhance job autonomy among nursing managers through having clearer roles and responsibilities, adopting more effective leadership practices, and developing more flexible work system.
Job Autonomy as Perceived by Physicians Working in Shifa Hospital
(Al-Quds University, 2011-02-02) Hani Abdul Kareem Sammour; هاني عبد الكريم سمور
Job Autonomy is a very important part of job enrichment. It promotes employee's empowerment which leads to improving trust, self-awareness and self efficiency; its application can promote motivation and satisfaction. Objective: The overall aim of this study is to assess the level of job autonomy among physicians working in Shifa Hospital and to determine the personal and organizational factors that may influence job autonomy. Methodology: A descriptive analytic cross sectional study was conducted among physicians working in Shifa Hospital using self-administered questionnaire. A total of 195 questionnaires were distributed to the study population using two stages sampling method (stratified then systematic) from the surgical, medical and maternity wards. A sum of 168 questionnaires were received with a response rate of 86%. The researcher used the SPSS for checking validity, processing and analyzing the data. Results: The mean level of job autonomy among physicians working in Shifa Hospital was 6.67 out of 10 and P-value < 0.05 ( the physicians' perception of job autonomy was 6.57, P-value 0.000, the level of technical autonomy was 7.13, P-value 0.000 and the level of administrative autonomy was 6.07 and P-value 0.563). There were no statistical significance differences in the level of job autonomy between departments (means were 6.87, 6.66 and 6.61 for maternity, medical and surgical departments respectively and the P-value 0.65). Certain personal factors were found to be statistically significant at P-value less than 0.05. Physicians who were highly skilled, working as head of departments, holding PHD degree, older than 40 years and experienced more than 15 years had elicited higher scores on the job autonomy scale than their counterparts with statistical significance differences at P-value less than 0.05. On the other hand, gender and department of work didn’t reflect in statistically significant differences among physicians as the P-value was higher than 0.05. The organizational factors that have been studied were found to be present at variable degrees and all of them were found to have a positive relationship with the level of autonomy at a statistical significant level. Teamwork was found to be present with the highest mean (7.55 and P-value 0.000) then the bureaucratic level of the structure (mean 7.23 and P-value 0.000) then job description at a mean 6.47 and P-value 0.000. Patient safety and accountability were present at a mean 6.14 and 6.05 respectively but not at a statistical significant level. Standardization was not adequately present (mean 5.74 and P-value 0.030). The organizational structure had the highest relationship with the job autonomy (r 0.550 and P-value 0.000) then teamwork (r 0.525 and P-value 0.000). The bureaucratic level had correlation coefficient 0.438 and P-value 0.000. Issues like having job description, patient safety, accountability and standardization had revealed controversial findings and require further exploration and investigations. Recommendation: The study provided a set of recommendations regarding promoting physicians’ autonomy, enhancing standardizations and clarifying roles and responsibilities. It is essential to increase physicians’ involvement in the organizational issues and the management of care to patients. .
Nutrition Knowledge, Attitude and Practice among Nurses and Physicians working at Palestinian Hospitals in the West Bank and Jerusalem
(Al-Quds University, 2024-01-02) Margaret Zaed Ayed Zayed; مرجريت زيد عايد زايد
Nutrition is an important factor in the promotion of health and improving health outcomes of people, especially in hospital settings. Good nutrition also reduces the risk of nosocomial infections and postoperative complications which are both related to shorter hospital stays and less medical cost. Nutrition care needs a multidisciplinary team to achieve the optimal goal. Physicians should diagnose, advice, and coordinate with dietitians to provide nutritional advice. Nurses also have the responsibility to screen patients for malnutrition, support them and ensure their needs are met through monitoring and communicating with other health care teams. Aim: to determine nutrition knowledge, attitudes and practices among physicians and nurses regarding nutrition in four selected hospitals in West Bank and Jerusalem Methods: descriptive-analytical, cross-sectional designs were used. The study population included all nurses and physicians in four Palestinian hospitals in the West Bank and Jerusalem. The sample size was 258 physicians and nurses. Data were collected by self-reported questionnaire that was divided into six major parts asking about Nutrition knowledge, attitudes and practices of nurses and physicians with their sociodemographic factors, in addition to questions about nutrition education, training and general nutrition care given.205 questionnaires were returned with 79% response rate. The validity of the questionnaire were ensured by both content and face validity; Reliability of questionnaire was also ensured and Cronbach’s alpha results showed (α=0.812, 0.725, 0.901 for Knowledge, Attitude and practice questions respectively. Data analysis was done with the help of (SPSS version 27) Results: Most of the participants were nurses (76.1%) aged from 26-30 years old. Participants showed moderate knowledge towards Nutrition in hospitals. Most of them agreed about the importance of care, either in terms of its priority (42.9% agree and 35.6% strongly agree), the importance of nutrition in fostering health recovery (44.4% agree and 47.8% strongly agree) and the need for individualized nutritional care for patients by the nutritionist (40.5% agree and 47.3% strongly agree). The study shows neutral attitudes towards nutrition among the participants. However, results found poor practices toward nutrition, 50% of them never check patients when eating to ensure they are eating well. Female health care professions tend to practice more supporting nutritional practices than males while age was significantly correlated to better attitudes and practice in both genders. Conclusion: The study shows good nutritional knowledge and attitudes among nurses and physicians, while their practice in daily routines are not enough. The study also shows that most of the participants didn’t receive any in-work training and they also agree that they need such continuous training during their work life. Adding nutrition curriculum to medical and nursing schools is recommended in addition to effective and efficient training and education programs in all hospitals to target all nurses and physicians who have direct contact with patients.
Performance Evaluation of the Multi-disciplinary Team Members Committee for Cancer Management at Al-Shifa Medical Complex - Gaza
(Al-Quds University, 2016-01-02) Mohammed Mahmoud Jaber; محمد محمود جبر
Background and Aim. It is becoming a standard practice worldwide for cancer cases to be discussed by multidisciplinary team cancer committee members (MDTs or MDCM ) in order to formulate an expert-derived management plan with international patients safety lines on the level of medical responsibility and accountability by better efficient and effective cancer care. The MDTs cancer committee just was newly established in Al-Shifa Medical Complex five years ago. That was the first experience and only one at all MOH hospitals in Palestine. The study explores the performance evaluation of the MDT Cancer Members Committee for Cancer Management Al-Shifa Medical Complex in the Gaza Strip, to improve outcomes of cancer patient care and to provide supportive elements, mechanisms of process that enhanced formal environment and sharing the best practices. Design and methods. The methodology of study employed a descriptive, analytical and cross sectional design. I developed interview and questionnaire that used for data collection. A systematic sample was selected from three hospitals at Al-Shifa Medical Complex. Of the 116 specialists were selected from all doctors specialties from 47 departments, 115 responded and completed the questionnaires, with a response rate of 99.1% . The most majority of managerial positions were head of departments (41.7%). The overall reliability was 0.982 Cronbach' Alpha. Key measures for performance evaluation MDTs cancer performance indicators, included: attendance rate, cancer waiting time management CWTM, dynamics of case presentation process, preparation process, structure leadership, administration, organization, communication, coordination, case management and clinical decision making, barriers and challenges that effected MDTs cancer committee work. Result findings revealed that the overall status of performance of MDTs cancer committee members work for cancer management was good, with an average score of 67% reflecting perceptions of specialists towards the current status of performance of MDTs cancer committee. The results preparation of MDT cancer committee in (Pre-meeting stage) was the poorest domain and lowest result (60.2%), in (during-meeting stage) result was 67.6%, in post-meeting stage was 69.4%, the structure found 61.6%, organization, administration and leadership was 69.4%, communication and coordination was 68.8%, MDTs cancer case management and clinical decision making was the first domain and highest percentage 71.8%. On the other hand, availability and shortage of diagnostic and treatment resources became more limited, there was a greater urgency for technological solutions to be identified that would enable the MDTs cancer services to be delivered more effectively. There is limited training and research opportunities in cancer care for specialists as 75% had not received training courses related to cancer care at the last 5 years. M & E of performance indicators regularly had been lacking 90%of participants stated there were poor except attendance rate that was 2.3 times per month. In otherwise, the dynamics of cases presentation process shown as; the average case presentation by the member himself in your department was 3 cases, the average case presentation in MDTs cancer committee monthly was 10.73, the average leakage of cases without presentation in monthly was 7.55, the average delayed case presentation after the end of diagnosis monthly was around 4 cases, the total average delay of intervention more than two weeks after presentation monthly was 3 cases, the average expected time implementation of decisions after case discussion was very well around 9 days, the total average of time preparation case was 26 minutes, the average of time for weekly MDTs cancer meeting was 2.30 hours and the average of each case discussion during meeting was 15.5 minutes. Conclusion. This study developed and validated an evidence-based to support the quality of MDTs cancer committee members work. They felt positively about the evaluation that may help work effectively, improve inclusively, patient care and outcomes. There were major obstacles and barriers that threatened the sustainability and effectiveness of this model, improving the availability of resources and that could give them an opportunity to develop the required additional skills and contribute to improved MDTs cancer performance and ultimately cancer care.
Perspectives of the MOH Hospitals' Nurses about the Impact of Training Programs on their Performance
(Al-Quds University, 2011-04-18) Nayef Ibrahim Ouda; نايف ابراهيم عودة
Universally, the area of health care delivery is highly affected by training. The need for training programs for hospitals' nurses is greater today than ever before in order to keep them exposed for the state-of-the art techniques in this field. The overall objective of this study is exploring the impact of nursing training programs on nurse's performance in Gaza hospitals in order to assess the effectiveness of these programs. This study is a descriptive, analytical cross-sectional one, conducted on a sample of 258 nurses selected from the three major general MOH hospitals in the Gaza Strip. The participants were selected through a systematic stratified sampling method in proportional to the total number of nurses in each of these three hospitals. The study covered nurses who had participated and those who did not participate in training programs to assess the impacts of the provided training programs. Also, the performance appraisal forms were reviewed and total scores were obtained. Data was collected through a self-administered questionnaire which was developed by the researcher. The research was conducted during the period from June through September 2010. Response rate was 81.5%. Data was entered and analyzed using the SPSS program. The study revealed that males constituted 58.6 % while females constituted 41.4 % of the sample. More than half of the respondents were less than 35 years old, 26.7% of them aged between 40-50 years. Half of the respondents were holding bachelor degree in nursing; 5.2% of the respondents were holding Master degree. The study findings revealed that respondents who participated in training course/s represented 39.0% of the total respondents. The general reactions of the trainees who participated in the provided training programs were positive (p-value less than 0.05). Around 70 % of the respondents reported having training programs at their hospitals while the remaining did not have. The Performance of those who participated in training programs did not improve at significant level (Mean in 2008 was 81.4, Mean in 2009 was 82.2), while the performance of those who did not participate in training programs has improved at significant level training (Mean in 2008 was 81.1, Mean in 2009 82.3). This implies that the provided training didn t improve trainees performance. There were no statistically significant variations in perceptions about the impact of training in reference to a particular hospital. Results showed statistically significant differences in gender as males showed more willingness to participate in training programs than their females counterparts (P value 0.01). Similarly, nurses aged less than 30 years were more motivated to take training than their older colleagues with statistically significant differences among the two groups (P value 0.01). Findings also showed inverse relationship between level of education and the desire to undertake further training courses. The majority of participants were uncertain about the appropriateness of the selection process for the training program (54%). The study recommended that policy makers at MOH should design more effective training programs and to pay more attention to follow up and monitoring the impact of training programs. Evaluation of the impact of the training programs should be given a priority and training should be assessed in reference to performance.
prevalence of wasting and stunting among governmental primary school children in gaza governorates
(Al-Quds University, 2003-04-15) Adly Bahjat Skeik; عدلي بهجت عطا سكيك

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