Improving Newborn Health in Countries Exposed to Political Violence: An Assessment of the Availability, Accessibility, and Distribution of Neonatal Health Services at Palestinian Hospitals

Figures & data

Table 1 Levelling Indicators and Criteria of Neonatal Units for Referral Program Guidelines, 2018

Indicator	Criteria	Level 1	Level 2	Level 2 ^▲M	Level 3	Level 4
		Criteria Satisfied
1 Neonatal Admission	Hospital accepts VLBW neonates	–	–	√	√	√
	Hospital accepts ELBW neonates	–	–	–	√	√
2 Equipment	Hospital has a c-pap and/or mechanical ventilator	–	√	√	√	√
	Hospital can keep neonate on mechanical ventilator for ≥48 hours	–	–	√	√	√
3 Staff	Hospital has neonatologists	–	–	–	√	√
	Hospital has pediatricians	√	√	√	√	√
	Hospital has pediatric medical ^◊ sub-specialties	–	±**	–	√	√
	Hospital has pediatric surgical^◊◊ sub-specialties	–	±	±	–	√

Notes: ^◊Medical pediatric sub-specialists included: pediatric ophthalmologist, cardiologist, gastroenterologist, metabolic specialist, geneticist, neurologist, endocrinologist. ^◊◊Surgical pediatric sub-specialists included: surgeon, cardiac surgeon, pediatric anesthesiologist, pediatric neurosurgeon, Modified to fit the context in Palestine where hospitals were found to be between Levels 2 and 3. ^**If available, it is a plus.

Abbreviations: VLBW, very low birth weight; ELBW, extremely low birth weight.

Figure 1 Availability of delivery units, neonatal units, and number of incubators in Palestine by region and geographic area, 2017.

Table 2 Number of Neonatal Hospitals (N) with Available Functioning Equipment to Support Neonatal Health Stratified by Region (West Bank, East Jerusalem, Gaza Strip) and Sector (Ministry of Health, Non-Governmental Hospital) (N=38), 2018

Equipment	West Bank* (n=27)		East Jerusalem (n=3)		Gaza Strip (n=8)		Palestine (N=38)
	MoH (n=9)	NGov (n=18)	MoH (n=0)	NGov (n=3)	MoH (n=7)	NGov (n=1)	MoH (n=16)	NGov (n=22)
	N^†	N	N	N	N	N	N	N
Incubators with humidifiers^#	8	17	0	3	7	0	15	20
Transport incubator	9	18	0	3	5	0	14	21
Radiant warmer or other heating system	9	18	0	3	6	1	15	22
Phototherapy lamps	9	18	0	3	7	1	16	22
Glucometers	8	18	0	3	7	1	15	22
Equipment for the delivery of oxygen	9	18	0	3	7	1	16	22
Pulse-oximeters	8	18	0	3	7	1	15	22
Multifunction monitors	8	16	0	3	7	0	15	19
Infusion pumps: peristaltic and syringe (neonatal)	9	18	0	3	7	1	16	22
Mechanical ventilators	8	17	0	3	6	0	14	20
Mechanical ventilators with humidifier sensors	7	16	0	3	3	0	10	19
Arterial blood gas analyzers^#	9	14	0	3	7	1	16	18
High frequency oscillatory ventilation (HFOV)	2	9	0	3	4	0	6	12
Echo-sonography	3	7	0	3	4	0	7	10
Portable x-ray equipment^#	6	14	0	3	7	0	13	17
Continuous positive airway pressure ^^	7	13	0	3	4	0	11	16

Notes: *West Bank excluding East Jerusalem. ^#Indicator of quality of care for very low birth weight (VLBW). ^†Number of functioning equipment reported to be in “good condition” as opposed to “functioning, but not in good condition” or “broken”. ^{^}Continuous positive airway pressure (c-pap) equipment refers to the c-pap, Si-pap, or vapotherm.

Abbreviations: MoH, Ministry of Health (governmental hospitals); NGov, non-governmental hospitals.

Figure 2 Number of neonatal beds needed and available by region, 2018.

Table 3 Total Number (N) of Neonatal Staff per Neonatal Unit (Full Time/Part Time/Upon Request) by Region (West Bank, East Jerusalem, Gaza Strip) (N=38), 2018

Health Staff	West Bank (n=27) (MoH)	East Jerusalem (n=3)	Gaza Strip (n=8) (MoH)	Palestine (N=38) (MoH)
	N	N	N	N
Neonatologist^◊	5(1)	9	1(1)	15(2)
Pediatrician	85(36)	12	38(30)	135(66)
Total nurses	385(119)	68	184(163)	637(282)
- Specialized pediatric nurse	11(7)	2	1(0)	14(7)
- Specialized neonatal nurse	55(25)	31	0	86(25)
Pediatric resident	56(37)	9	10(10)	75(47)
Pediatric anesthesiologist	8(1)	3	0	11(1)
Pediatric cardiologist	16(3)	4	4(3)	24(6)
Pediatric ophthalmologist	13(1)	3	0	16(1)
Pediatric surgeon	22(6)	4	14(10)	40(16)
Pediatric neurosurgeon,	5(1)	1	2(2)	8(3)
Pediatric cardiac surgeon	1(0)	2	0	3(0)
Infectious disease doctor^^	3(0)	1	3(3)	7(3)
Pediatric orthopedic specialist	18(2)	3	0	21(2)
Pediatric endocrinologist	9(2)	3	0	12(2)
Pediatric nephrologist	9(1)	3	0	12(1)
Pediatric metabolic specialist	7(0)	3	0	10(0)
Pediatric pulmonologist	8(1)	3	0	11(1)
Pediatric gastroenterologist	7(1)	3	0	10(1)

Notes: *Neonatologist posts; there are 11 neonatologists covering 15 full-time/part-time posts. ^The number of infectious disease doctor only included specialists who received formal training; it excluded those who received short-term training. ◊This number does not represent the absolute number of neonatologists available in Palestine as many neonatologists serve more than one hospital.

Abbreviation: MoH, Ministry of Health (governmental hospitals).

Figure 3 Geographic distribution of specialized neonatal services by proposed levelling system, 2018.