In view of the current conditions in Syria, AKDN is presently focused on responding to the humanitarian crisis. As in all countries in which it works, AKDN takes, a long-term view and remains committed to assisting the peoples of Syria to improve the quality of their lives.
Since 2003 AKDN has worked in Syria to improve the quality of care and health management in 28 public primary health care facilities and the public hospital in Salamieh District. The AKDN Health Programme introduced community-based health initiatives that had been defined as priorities by the local community, including child care and development, women’s health and non-communicable diseases.
Many of these initiatives have had to be suspended given the current situation, but the AKDN health response has had to consider the ongoing need to increase the capacity to cope during the crisis.
At the same time, AKDN has worked to sustain gains in three areas: one for health systems strengthening (HSS), another one for health promotion and disease prevention and a third one for mass casualty management (MCM). Its objectives are as follows:
- Support the public health systems to ensure the functioning of essential public health services in the crisis, the provision of good quality public health care and the sustained improvement in the health systems. AKDN can complement health care service delivery where public primary and secondary health care services are not available.
- Continue the community health programme of health promotion and disease prevention, but adapted to the current situation. This calls for focusing on building capacity of communities to cope with emerging health problems, participate effectively in community health initiatives and adopt the healthy life style for the long term.
- Build capacity of local communities to appropriately perform search, rescue and basic first aid, and ensure a continuum of care and adequate capacity to deal with mass casualties within the district health system, including Salamieh hospital.
The HSS plan for Salamieh district incorporates the World Health Organization’s six building blocks for health systems at three levels: community, primary health care and secondary health care. It includes strengthening the public health system, principally the still-operational 23 primary/basic health centres (BHCs) and the district hospital. Eight strategically located primary healthcare centres are being improved to provide a “Basic Package of Essential Health Services”.
In areas of the district that are secure but where there are access problems, AKDN has introduced mobile health services, especially for critical services such as immunisation, growth monitoring and antenatal and postnatal care.
The AKDN Health Programme trained around 1,200 community members in different health topics, enabling them to disseminate the health messages to the families and contribute to many community health activities, such as home visits, awareness sessions, interactive activities, distribution of health kits and educational materials. These programmes reached more than 30,000 families, including the participation of thousands of mothers, parents, children and community members.
AKDN has supported the development of maternal and child mortality capacity reduction in the District of Salamieh through the following measures:
- Renovation of Salamieh Hospital’s Emergency Department, increasing its capacity to 10 + 6 beds, providing emergency power, equipment, and essential medicines and supplies;
- Renovation and upgrading of Salamieh Hospital’s Operating Theatres Unit increasing the capacity from four to seven operating rooms plus provision of surgical and anaesthesia equipment, medicines and supplies;
- Repair of the existing CT scanner, provision of a new CT scanner and new X-Ray machine.
- Training of Salamieh Hospital and other emergency health care workers;
- Formation of 11 CERTs, including the provision of emergency supplies and kits, along with regular training of the in total 141 members, simulations, and evaluations;
- Establishment of an alternative make-shift AKDN managed Trauma Unit to divert, accommodate, and treat triaged cases away from the Salamieh Hospital if needed;
- Provision of five ambulances to Salamieh district;
- Development of a MCM response plan, including the establishment of an EOC, in partnership with health and emergency authorities.
The AKDN health interventions were designed to address the gaps in care brought about by the crisis, which have led in some cases to excess mortality and morbidity in terms of injuries, child health, maternal and reproductive health, communicable diseases, non-communicable diseases and mental health. AKDN technical and material assistance was also included in the provision of essential and advanced medical equipment, renovation of health facilities, and training of more than 500 health workers in different health topics to improve the diagnostic and therapeutic capacity. AKDN also added to stockpiles of equipment and supplies.
To fill the gap with non-communicable disease (NCD) services, particularly for vulnerable patients, an AKDN-managed clinic established a patient registry in Salamieh in 2015. The registry now has 5,769 NCD patients. Patients come for diagnosis, treatment, awareness and counselling sessions. Most common diagnoses are hypertension, cardiovascular disease, diabetes and cancer.
Through the training of general practitioners and health workers in mental health disorders, and many more community workers in basic psycho-social support and trauma counselling, much more attention is being given to this area of work - despite there being a large unmet need as more individuals (including AKDN/AKF staff) have been directly affected by violence. The new AKDN NCD/mental health clinic with a consultant psychiatrist has so far treated 1,031 patients with mental health care problems.
The AKDN assistance to provide the essential health services was complemented by a number of actions to strengthen the health system, in terms of the way health interventions were planned, organised and delivered in response to the crisis, with a special focus on enhancing the existing health systems and their future recovery and development. The statistics of public health services have shown that the capacity of public health facilities to deliver health services has improved.
For example, Salamieh Hospital provided 606,973 health services in 2016 compared to 287,635 health services in 2010 (increased by 111%); public health centres provided 267,244 health services in 2016 compared to 182,876 health services in 2010 (increased by 46%).
The outreach health activities increased the coverage of immunisation and MNCRH services by providing these reproductive health services to 2,796 women and children, including immunisation to 1,700 children in (64) small communities who have difficulty accessing fixed health services.
Good progress continues to be made under very difficult circumstances. All the AKDN health interventions in support of health services and health promotion at community levels contributed to an increase in the coverage of MCH services (antenatal care coverage increased from 20 % in 2010 to 50% in 2016). Perhaps most remarkable has been immunisation coverage, which rose to 95% in children in the accessible parts of the district (it was 72% in 2013).
A unique community health programme is training over 200 health workers and 2,000 volunteers to reach over 20,000 families with essential messaging about communicable disease care and prevention, maternal and child health, and healthy living. The programme’s success can be measured by the absence of major outbreaks of communicable diseases in 2016 and a stabilisation reported in the number of cases of typhoid, hepatitis A and cutaneous leishmaniosis. There is also a relatively high level of exclusive breastfeeding (56% compared to the national level, which is below 30%) and child growth monitoring. The prevalence of undernutrition remains low with 8.7% and 7.1% of children under the age of five being stunted or wasted, respectively.
