Ministry of Health and the Patient Waiting System in Palestine

- The existence of patient waiting lists is considered one of the most prominent challenges facing the Ministry, especially with the increased demand at public hospitals, where demand for medical services in hospitals rises sharply while increases in the resources needed to provide these services are limited.

- In the current circumstances, the health sector faces a number of challenges, particularly given the limited available resources and population growth, where the population of the West Bank reached 2,930,000 persons in 2016, and the number of hospitals reached 14 public hospitals with a capacity of 1,661 beds.!. (According to the Ministry of Health annual report for 2018)

- The importance of reducing patient waiting times in public hospitals has emerged, and verifying the efficiency and effectiveness of the procedures carried out by the Ministry of Health in particular, because of its impact on the health of the citizen and his need to seek treatment in medical centers not affiliated with the Ministry of Health.

- The audit targeted the procedures carried out by the Ministry of Health to reduce patient waiting times in terms of whether this is included in existing plans, and the setting of standards and necessary work procedures to reduce waiting time, including the departments that have waiting times in hospitals, namely outpatient clinics, surgical departments, and radiology departments, during the years 2016-2018..., and the measures taken by the competent administrations in the Ministry of Health regarding setting standards that reduce waiting time and regulate work. These include the General Administration of Hospitals, the General Administration of Planning and Health Policies, and the Internal Audit Unit.!

· The Court reached the following findings:

- First: Weak effectiveness of the planning process to organize queues in public hospitals, where:

- Clear and documented inputs are not relied upon for the planning process in hospitals, in addition to a lack of guidelines and procedures that organize work in hospitals, as well as a lack of adopted standards to reduce waiting time, in addition to weak planning to utilize the available human resources and distribute them according to actual need.

- Second: Weak effectiveness of procedures to reduce waiting times in surgical operating departments!

- Operating rooms in hospitals are not allocated based on waiting lists, in addition to poor utilization of available operating room time, disparities in waiting times, and the average number of booked surgical operations within the same specialty.

- Third: Weak effectiveness of procedures to reduce waiting times in outpatient clinics!

- There is weak adherence by physicians to being present at their posts in outpatient clinics during the hours allocated for that, weak utilization of clinic rooms and their distribution among specialists according to waiting lists, in addition to variation in the average number of patients treated in hospitals within the same specialty.

- Fourth: Weak effectiveness of procedures to reduce waiting times in radiology departments!!, where the following was shown:

- There are long waiting periods for patients to undergo radiographic imaging due to weak efficiency of CT and MRI imaging devices in some hospitals, as well as delays in issuing reports on radiological imaging results.!.

· Conclusions:

1- It appears that the mechanisms in force in operating, radiology, and outpatient departments do not convince the auditor that the Ministry of Health is working sufficiently to reduce waiting times through appropriate controls that ensure work according to a coherent, integrated, and regular institutional framework, ensure transparency in service delivery to citizens, work to reduce waiting times, and contribute to providing medical service at the required time.

2- The Ministry of Health did not develop a comprehensive plan to achieve its objective of reducing patient waiting times, nor did it adopt the foundations it assumed to reach this objective such as adopting relevant international standards, and it did not specify indicators by which achievement of the objective can be measured.

3- The issue of reducing waiting times is not taken into account when planning the management of available material and human resources and determining their needs, such as utilization of operating rooms, the number of specialists, and clinic rooms.!

4- There is a deficiency in drafting procedural guidelines in radiology, outpatient, and surgical departments so as to organize physicians’ schedules effectively, reduce waiting time, and limit the creation of an environment conducive to favoritism and conflicts of interest.!

5- There is a deficiency in the role of the administrations and units existing in the Ministry of Health regarding setting correct work foundations based on the existing reality, developing the current situation, and monitoring hospital activities.!

6- Weak control and follow-up procedures in the Ministry of Health and public hospitals regarding the reduction of patient waiting times.!

7- Weak documentation procedures necessary to reduce waiting time in a way that ensures transparency, such as the service provided to patients, and provides management with the necessary data on the length of waiting periods and enables it to identify gaps in them.!

· The following clarifies some information about the workforce in the health sector in Palestine according to the Ministry of Health report for 2018.

- The total number of the workforce in the health sector for 2018 reached 14,650 persons (Ministry of Health, UNRWA, Medical Services, non-governmental institutions...), distributed as follows:

· Ministry of Health:

- Total number of employees 10,597 employees, of whom 6,703 are in hospitals, and 1,949 employees in primary care units.

· In non-governmental health institutions:

- The total number of employees in them reached 3,199 employees, of whom 1,944 employees are in their hospitals, and 1,255 employees in primary care centers...

· Medical Services:

- The total number of employees in Medical Services reached 854 persons, of whom 402 employees work in Medical Services' hospitals, and 274 persons in primary care centers..

- In summary, the total number of employees in all hospitals reached 9,049 persons, i.e., 61.8% of the total workforce in the health sector. As for primary care centers, the total number of employees in them reached 3,478 persons, i.e., 23.7% of the total number of the workforce in the health sector.

- As for the distribution of the workforce in the health sector by specialty, the statistics were as follows:

· Physicians (at a rate of 21.2%): The number of physicians in the health sector was 3,100 physicians, of whom 2,315 physicians are in hospitals, while the number of physicians working in primary care centers reached 748 physicians.

· The number of physicians as general practitioners reached 1,932, of whom 1,422 general practitioners are in hospitals, and 478 general practitioners in primary care centers. The number of specialist physicians was 833 physicians in hospitals and 97 physicians in primary care centers.

· The number of dental physicians working in hospitals reached 60 dentists, and their number in primary care centers reached 173 dentists...

· Pharmacists (at a rate of 5.1%): The number of pharmacies in hospitals was 237 pharmacies, and in primary care centers 320 pharmacies.

· Nursing (at a rate of 25.1%): The number of nursing staff was 2,716 working in hospitals, and 773 working in the nursing sector in primary care centers.

· Midwifery (at a rate of 3.2%): The number of midwifery staff was 319 in hospitals and 149 in the nursing sector in primary care centers.

· Health workers (at a rate of 1.4%): The number of health workers was 18 in hospitals, and 120 health workers in primary care centers.

· Allied medical professions (at a rate of 10.4%): The number of allied medical professions in hospitals was 1,059, and 384 allied professions working in primary care centers. (at a rate of 10.4%)

· Administrative and services (at a rate of 33.6%): The number of the workforce in administration and services in hospitals was 2,385 individuals, and 984 in primary care centers.

- Reducing patient waiting time is important and necessary, including all departments that have waiting times in hospitals, namely outpatient clinics, surgical departments, and radiology departments. From the content of the Court's report on the work of the general administrations in the Ministry of Health for the period 2016-2018, it is clear that the Ministry of Health is still unable to solve this challenge... Why? Because there is negligence and omission by many of the responsible general administrations in the Ministry of Health, as the Court's report above explained.!.

· We hope that the Ministry of Health and its general administrations will assume their responsibilities in this regard and work diligently and responsibly to reduce patient waiting times... in all places where patients attend, whether in public hospitals or public health centers.!

·       12-11-2020