Service Availability and Health Facilities Functionality ... 16 Govn final report.pdf · 2 Abbreviations BeMOC Basic Emergency Obstetric Care DHIS District Health Information System

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Ministry of Public Health & Population

Service Availability and Health Facilities Functionality in

16 Governorates

Final report

Using HeRAMS

(Health Services and Resources Availability Mapping System)

October 2016

1

Table of contents 1

Acronyms and Acknowledgements 2

Introduction and Methodology 3

Process and timeline 4

Snapshot of HeRAMS main results 5

Health facilities functionality

1 Overview on health facilities and staff 6 2 Functionality of health facilities 7 3 Damages to health facilities 8 4 Human resources availability 9 5 Availability of midwives and doctors 10 6 Population coverage by health units 11 7 Population coverage by health centers 12 8 Population coverage by hospitals 13 9 HF utilities and functions; beds 14 10 HF utilities and functions; BeMOC, ambulances 15

Services availability

1 Overall service availability 16 2 Availability of services in governorates 17 – 19 3 Availability of services in provision level 20 4 Specific services availability 21 – 24

Governorate summaries

1 Abyan 25 9 Hajjah 33 2 Aden 26 10 Ibb 34 3 Al Baydha 27 11 Lahaj 35 4 Al Dhalae 28 12 Marib 36 5 Al Hodeida 29 13 Sada’a 37 6 Al Jawf 30 14 Sana’a 38 7 Amant Al Asama 31 15 Shabwa 39 8 Amran 32 16 Taiz 40

Annex 41

Table of

contents

2

Abbreviations

BeMOC Basic Emergency Obstetric Care

DHIS District Health Information System

DHS Demographic and Health Survey

Dist District

Doc Doctors

Gen Prac. General Practitioner

HC Health Centre

HeRAMS Health Resource Availability Mapping System

HF Health Facility

HMIS Health Management Information System

HNO Health Needs Overview

Hosp Hospital

HU Health Unit

IDP Internally Displaced Person

MoPHP Ministry of Public Health and Population

NCD Non-communicable diseases

OCHA United Nation's Office for the Coordination of Humanitarian Affairs

PHC Primary health care

Pop Population

Spec Specialist

TB Tuberculosis

WHO World Health Organization

YHRP Yemen Humanitarian Response Plan

Acknowledgement

The Ministry of Public Health & Population (MoPHP) and WHO country office – Yemen would like to express

their gratitude to all those whom contributed to the collection of data, data entry, its analysis and synthesis of

information towards the production of this report. Appreciation is due to staff of the MoPHP and WHO whom

organized the functions and workshops and provided logistical support which has resulted in the successful

accomplishment of the assessment. A word of gratitude is due to all district health officers and governorate

health offices whom have participated in the workshops and interviews, without their cooperation the whole

process could not have been possible.

Disclaimer

Neither the MoPHP nor the WHO are responsible for the validity and reliability of the information included in

this report. The information is based on data that has been deliberately revealed through interviews with

national health authority officials at different levels to the best of their knowledge and evidence they possess.

In some cases the information has been integrated or validated with phone interviews with health staff and

field visits to selected health facilities.

For further information or electronic copies of this report or separate governorate reports; kindly

send your request to the WHO country office – on the following email: [email protected]

Abbreviations &

Acknowledgments

mailto:[email protected]

3

Introduction

HeRAMS (Health Resources and Services Availability Mapping System) is an approach that aims at collection and

analysis of information on the availability of health services and functionality of health facilities in humanitarian

emergencies. The tool has was developed in 2008 and has since been used in several emergency contexts; Sudan

(2008), Haiti (2009), Pakistan (2010) and Central African Republic (2014). Information revealed has been used

extensively by the national health authorities, health cluster members and relevant coordination mechanisms.

Planning for HeRAMS in Yemen began in the second half of 2015, which was agreed upon by the health cluster in

October 2015, as a unified tool for gathering information. By January of 2016, the generic HeRAMS tool was adapted

to the local context after extensive discussions with relevant health sector stakeholders. In February, the tool was

piloted in Amant Asama (capital Sana’a) with a plan of action to further conduct the assessment in 16 priority

governorates during quarter one, two and three of the current year.

The undertaking of HeRAMS in the emergency context of Yemen aims at a rapid revelation of key information on the

availability of health services and functionality of those providing facilities at all levels of provision. The generated

information will greatly support the decision making bodies and health cluster members in planning, monitoring,

measuring gaps, coordination of inputs, as well as responding to urgent needs of the health sector. The overall aim is

to maximize the use of resources towards the provision of relevant, equitable and efficient health services.

This report “Service availability and health facility functionality based on HeRAMS (16 governorates) – Final report”

presents the findings of the 16 governorate assessments under the following headings: 1) Introduction, 2) Health

facilities functionality, 3) Service Availability, and finally 4) Governorate summaries.

Each of the surveyed governorates has a separate detailed report which examines functionality and service

availability on all levels of provision in relation to its districts.

Methodology & Process

After the piloting of the assessment tool in February 2016 in Amant Al Asama (the capital Sana’a), HeRAMS has been

conducted in fifteen additional governorates (Feb – Jul 2016); Ibb, Sada’a, Amran, Aden, Hodeida, Taiz, Sana’a,

Abyan, Al Dhalae and Hajjah governorates during March and April of 2016. The MoPHP jointly with the WHO have

covered further the governorates; Lahaj, Marib, Al Jawf, Al Baydha, and Shabwa during May and June of 2016 to

reach to a total of 16 governorates prioritized in the humanitarian emergency response framework. Before the end

of the current year 2016, HeRAMS will cover the remaining 6 governorates; Thamar, Hadaramout, Raima, Al Mahra,

Mahweit, Socotra and a similar final report will be available for all the governorates.

The assessment tool has two components; a) Information Sheet as well as b) the Services checklist. The information

sheet includes basic information on the health facility status including functionality, damages, available utilities and

human resources. This is intended to build upon and to update the national HMIS ‘Health Analyzer - 2008’. The

Services Checklist – includes information on services availability based on the list of services provided at all level of

service provision. Tools are completed through interviews with the district health officer’s in the governorates with

the assistance of trained surveyors. Validation of information has been through on-site visits to randomly selected

health facilities. Data entry was carried out by the MoPHP and WHO (two stages) and analyzed using EpiInfo.

Geolocation of new health facilities is planned and ongoing to enable their plotting on maps despite the security

challenges in some governorates.

.

Introduction &

Methodology

4

Process and timeline

Process and

timeline

Quarter 4 of 2015: preparations;

End of Jan / Beginning of Feb

2016: piloting in Amant Al

Asama;

Mar – Jun 2016; field work,

conducting HeRAMS workshops

and interviews (16 governorates),

correspondent entry of data and

analysis

Jul – Aug 2016; finalizing analysis

and governorate report writing;

Sept 2016; preliminary 16

governorate findings

Oct 2016; finalization of the final

16 governorate report

5

1. Health

facilities

functionality

2. Health facilities

damages

3. Human resources availability

4. Population coverage with services

33,312; total health staff in 16 governorates

Average for 16 governorates

National standard / Int benchmark

Pop coverage with HU 9,885

One unit at least 5,000 pop

Pop coverage with HC 36,340

One center at least 20,000 pop

Pop coverage with Hosp 150,190

One Dist Hosp (60 – 150,000) pop

Health staff in emer context 17.03

Equal or more than 22 / 10,000 pop

Beds per population 6.2

Equal or more than 10 / 10,000 pop

5. Service

availability

Snapshot of HeRAMS

main results

3,507 health facilities were assessed in 16 governorates

6

No Governorate Population % out of

total

1 Taiz 3,155,736 11.3%

2 Al Amana 3,113,889 11.2%

3 Hodeida 3,079,241 11.1%

4 Ibb 2,804,609 10.1%

5 Hajah 2,060,867 7.4%

6 Amran 1,322,455 4.8%

7 Sana'a 1,150,494 4.1%

8 Sa'adah 1,027,237 3.7%

9 Lahj 973,720 3.5%

10 Aden 888,148 3.2%

11 Al Baydha 733,473 2.6%

12 Al Dhalae 689,630 2.5%

13 Al Jawf 622,878 2.2%

14 Shabwah 609,935 2.2%

15 Abyan 573,656 2.1%

16 Ma'areb 329,231 1.2%

o The map below outlines the total number of health facilities in the governorates (functional + partially functional +

non-functioinal) followed by its percentage from the total health facilites across the country.

o It addionally shows the number of available health staff (all categories) based on HeRAMS followed by their

percentage compared to the total number of health staff countrywide.

1. Overview on health

facilities & staff

7

No Governorate Fully

functional Partially

functional Total

% out of total HF

1 Hodeida 178 192 370 96.9%

2 Lahaj 176 30 206 88.0%

3 Hajah 196 87 283 86.8%

4 Ibb 156 153 309 86.6%

5 Al Dhalae 32 100 132 85.7%

6 Taiz 124 238 362 85.2%

7 Amran 187 68 255 83.9%

8 Shabwa 106 48 154 83.7%

9 Sana’a 167 70 237 83.5%

10 Al Amana 54 18 72 81.8%

11 Abyan 73 61 134 79.8%

12 Aden 34 3 37 77.1%

13 Al Baydha 33 102 135 76.3%

14 Ma'areb 17 64 81 67.5%

15 Sa'adah 38 66 104 64.2%

16 Al Jawf 8 34 42 44.7%

2. Functionality of

health facilities

o Functionality of health facilities is categorized / defined as follows: Fully functional: the health faclity is open and provides healthcare services at full

capacity. Partially functional: health facility is operational but with partial capacity due to shortages in staffing, supplies, equipments or due to

damages to infrastructure. Not functional; the health facility is not providing any services due to any of the following reasons: damages, lack of

essenital operational inputs of staff and funds, inaccessibility due to insecurity or the facility is not yet operational.

o Out of total 3507 health facilities; 1,579 (554%) were reported to be fully functional and accessible, 1,343 (38%) were partially functional and 504

(17%) not functional. The map below shows the number of non-functional health facilities in each governorate followed by its % out of the total HF.

8

No Governorate Total

HF Totally

Damaged Partially

Damaged Total

% out of total

1 Sa'adah 163 24 36 60 37.0%

2 Al Amana 86 1 24 25 28.4%

3 Aden 45 1 11 12 25.0%

4 Abyan 168 8 17 25 14.9%

5 Ma'areb 120 5 9 14 11.7%

6 Al Jawf 94 1 7 8 8.5%

7 Al Baydha 177 4 8 12 6.8%

8 Hajah 326 6 16 22 6.7%

9 Taiz 425 7 18 25 5.9%

10 Shabwa 184 2 7 9 4.9%

11 Lahaj 234 4 7 11 4.7%

12 Sana’a 285 2 11 13 4.6%

13 Amran 304 1 12 13 4.0%

14 Al Dhalae 155 1 5 6 3.9%

15 Hodeida 384 2 12 14 3.7%

16 Ibb 365 0 5 5 1.4%

o The level of damage to the health faclitlies has been measured in terms of either; fully damaged, partially damaged (parts of the

infrastucture have been damaged) and not damaged (building is intact).

o The total number of totally damaged health facilities is 69 whereas those that are partially damaged are 205 HF.

o Damages in each governorate are shown in the map below; the color gradient changes based on their percentage from the total HF.

o

3. Damages to

health facilities

9

4. Availability of

human resources

No Govern H staff (10,000 pop

1 Aden 42.7

2 Ma'areb 34

3 Abyan 27

4 Shabwa 24.5

5 Lahaj 22

6 Al Amana 20

7 Sana’a 13.1

8 Taiz 13.1

9 Al Dhalae 11.8

10 Amran 11.7

11 Al Baydha 11.2

12 Ibb 10.7

13 Hajah 10

14 Hodiedah 8

15 Sa'adah 6.3

16 Al Jawf 6

o The benchmark implies that in a context of humanitrian crises, the minimum is the availablity of at least 22 health workers

for every 10,000 population. The map oulines the total number of health staff in each governorate, the table outlines the

number of staff per 10,000 population. The small box highlights the differential distribution of staff in 16 governorates. o Apparently, five governorates are above the benchmark hightlighted in yellow. The national aveage is 17.03 which is

below the recommended threshold.

10

No Governorate No of

District

Districts with 2 or

less doctors

1 Hajah 31 5

2 Hodiedah 26 2

3 Taiz 23 10

4 Al Baydha 20 15

5 Amran 20 15

6 Ibb 20 9

7 Shabwa 17 10

8 Sana’a 16 7

9 Lahaj 15 5

10 Sa'adah 15 12

11 Ma'areb 14 10

12 Al Jawf 12 5

13 Abyan 11 3

14 Al Amana 10 0

15 Al Dhalae 9 6

16 Aden 8 0

5. Availability of

midwives, nurses &

doctors o The map outlines the availabilty of nurses and midwives in the 16 surveyed govenroartes.

o Number of districts for eacg govenorate which have 2 or less doctors are highlighted in the table below.

o The highest number of nurses and midwives is in Amant Al Asama followed by Aden, Al Jawf has the least

o In 267 districts surveyed, 49 have no doctors. In 42% of these districts less than 2 doctors exist.

11

No Governorate Health Units

Pop per HU

1 Al Amana 5 518,981

2 Aden 2 460,905

3 Al Jawf 29 155,719

4 Ibb 180 15,882

5 Taiz 221 14,637

6 Sa'adah 77 13,341

7 Hodiedah 289 10,655

8 Hajah 235 9,037

9 Al Baydha 86 8,724

10 Sana’a 145 7,934

11 Al Dhalae 97 7,110

12 Amran 205 6,451

13 Ma'areb 52 6,331

14 Lahaj 169 5,917

15 Abyan 107 5,494

16 Shabwa 113 5,398

o Health Units (1 per 1,000 to 5,000 population) with 4 health staff is the first contact level between the service provider and the client

(preventive services and health education, very basic curative care) and refers most complicated cases to the next level. Health Centers /

Co,pleses replace health unitsd as the first contact level (thus excluded in analysis).

o HUs in each governorate is shown on the map below with the gradient colours denoting the population covergae per health units.

The national average for the health unit coverage (16 surveyed governorates exculding Aden and Al Amana) is 9,885 which is above

the benchmark. In fact coverage in all govenorates exceeds the national standard of 1 unit per 5,000 population.

6. Population

coverage by

Health Units

12

No Governorate Health Centers

Pop per HC

1 Al Jawf 10 622,878

2 Hajah 36 58,992

3 Sa'adah 18 57,069

4 Al Amana 56 53,688

5 Hodiedah 67 45,959

6 Lahaj 22 45,451

7 Amran 35 37,784

8 Abyan 19 30,938

9 Ma'areb 11 29,930

10 Aden 32 28,807

11 Taiz 116 27,887

12 Ibb 115 24,782

13 Shabwa 26 23,459

14 Al Dhalae 31 22,246

15 Al Baydha 41 18,299

16 Sana’a 83 13,861

o Health Centre (1 per 5,000-20,000 population) with 17 staff, second level of the health system, provides the same PHC

services as the health unit, plus basic laboratory diagnostic (laboratory) and a wider range of curative services. It refers

complicated cases to the District Hospital. In Aden and Sana’a cities, health centres are called health complexes.

o The number of health centers is shown on the map below with the gradient colours denoting the population covergae per

each health center. The national average for the health center coverage (16 surveyed governorates) is 36,340 population

exceeding the national benchmark. Two govenorates are within the standard range of coverage as shown in the table.

7. Population

coverage by

Health Centers

13

No Governorate Hospitals Pop per Hospital

1 Al Amana 9 389,236

2 Al Jawf 3 311,439

3 Hajah 11 193,066

4 Hodiedah 16 192,453

5 Aden 5 184,362

6 Sa'adah 6 171,206

7 Ibb 16 169,101

8 Sana’a 8 143,812

9 Al Dhalae 5 137,926

10 Taiz 25 129,397

11 Al Baydha 8 93,783

12 Amran 15 88,164

13 Abyan 8 73,478

14 Lahaj 15 66,661

15 Shabwa 15 40,662

16 Ma'areb 18 18,291

o The District Hospital (1 per 60,000-150,000) with 30 – 70 beds and the Governorate Hospital with more than 100 beds (1 per 300,000) is the

third and forth level of the health care, providing life-saving emergency surgical operations, blood transfusion services, and inpatient services

(departments of internal medicine, paediatrics, gynaecology-obstetrics and surgery).

o Hospitals are shown on the map below with the gradient colours denoting the population covergae per each hospital. The national average

for the hospitals coverage (16 surveyed governorates) is 150,190 population which is identical with the national benchmark. Two

govenorates are below the standard range of coverage and 7 other governorates are above the minumum thresold as shown in the table.

8. Population

coverage by

Hospitals

14

No Governorate No of beds per

10,000 pop

1 Ma'areb 24.7

2 Aden 14

3 Shabwa 12.4

4 Lahaj 7.45

5 Al Amana 6.9

6 Abyan 6.8

7 Taiz 4.5

8 Ibb 4.16

9 Al Dhalae 3.2

10 Amran 2.9

11 Al Baydha 2.4

12 Sa'adah 2.3

13 Hodiedah 2.1

14 Sana’a 2

15 Hajah 1.8

16 Al Jawf 1.6

o The benchmark implies that in a context of humanitrian crises, the minimum is the availablity of at least 10 beds or more for

every 10,000 population. o The map oulines the number of functional beds in each governorate based on HeRAMS, the table oulines the ratio of how

many beds are avaiable for every per 10,000 population. The national average for beds (16 surveyed governorates) is 6.2 for

every 10,00 population which is below the benchmark. Three govenorates are above the recommnded ratio (the table).

9. HF utilities &

functions; beds

15

o Based on the benchmark (4 BeMOC for

every 500,00o population), the adjacent map

outlines the ratio in each govenorate.

o Six govenorates are below the thresold; Taiz,

Hodeidah, Marib, Al Jawf, Sada’a, Amant Al

Asama.

o The adjacent map shows the number of

ambulances across the surveyed

governorates.

10. HF utilities &

functions; BeMOC &

Ambulances

16

o Availability of services is

an indicator of the level

of provision of services;

o Services are Fully

Available; all expected

interventions in addition

to required inputs are in

place to provide the

services. Partial

availability indicates that

the services are not

provided completely

(based on the service checklist for each found in annex 1) or with the lack of any of its elements. Non-

availability denotes that the service is lacking or absent in a functional HF (non-functional HF are excluded);

o The table outlines the status of availability of services (full services) in the 6 main domains in the full

functional and partially functional health facilities in 16 governorates; the highest being “Child Health &

Nutrition” services and the lowest being “General Services & Trauma Management” and “Maternal and

Newborn Health”;

o The figure below show the extent of lack of services (100% - full + partial availability). Those health facilities

which are non-functional in the 16 surveyed governorates have been excluded from the analysis. The extent of

lack is the highest in “General Services & Trauma Management” and the least lacking was “Child Health &

Nutrition” services.

Full availability of services

General Services and Trauma management

37 % Maternal and Newborn

Health 37 %

Child Health & Nutrition 63 % Non-communicable

diseases & Mental Health 21 %

Communicable Diseases 43 % Environmental Health 50 %

Proportion of health facilities lacking services

1. Overall service

availability

17

The tables below outlines the availability of services (fully, partial and non-available) in an order of highest to

lowest in each of the 6 services domains across the 16 surveyed governorates. The analysis includes fully and

partially functional health facilities (those non-functional have been excluded).

1- General Services and Trauma management

Governorate Full

availability Partial

availability Total Non-

available Governorate

Full availability

Partial availability Total

Non- available

Lahj 29 % 63 % 92 % 8 % Sanaa 33 % 42 % 75 % 25 %

Hajah 54 % 28 % 82 % 18 % Hodeida 38 % 24 % 62 % 39 %

Abyan 39 % 42 % 81 % 19 % Al Dhalae 30 % 31 % 61 % 39 %

Ibb 42 % 39 % 81 % 19 % Amran 35 % 22 % 57 % 43 %

Taiz 49 % 31 % 80 % 20 % Al Amana 44 % 11 % 55 % 45 %

Al Baydha 38 % 40 % 78 % 22 % Aden 41 % 13 % 54 % 45 %

Sa'adah 44 % 34 % 78 % 22 % Ma'areb 30 % 12 % 42 % 58 %

Shabwa 41 % 36 % 77 % 23 % Al Jawf 7 % 4 % 29 % 72 %

2- Child Health and Nutrition

Governorate Full



available Governorate

Full availability


Non- available

Hajah 89 % 4 % 93 % 7 Al Amana 42 % 13 % 74 % 26 %

Sanaa 80 % 13 % 93 % 7 Al Baydha 67 % 7 % 74 % 26 %

Hodiedah 77 % 12 % 89 % 11 Lahj 42 % 32 % 74 % 26 %

Taiz 79 % 9 % 88 % 12 Amran 67 % 4 % 71 % 29 %

Ibb 84 % 3 % 87 % 13 Al Dhalae 51 % 9 % 60 % 40 %

Sa'adah 67 % 18 % 85 % 15 Aden 51 % 1 % 52 % 48 %

Shabwa 64 % 12 % 76 % 24 Ma'areb 45 % 2 % 47 % 53 %

Abyan 52 % 22 % 74 % 26 % Al Jawf 11 % 0 % 11 % 89 %

2. Availability of services in

governorates

18

3- Communicable Diseases

Governorate Full



available

Governorate

Full availability


Non- available

Hajah 68 % 11 % 79 % 21 % Abyan 45 % 16 % 61 % 39 %

Al Amana 46 % 31 % 77 % 23 % Al Baydha 45 % 13 % 58 % 42 %

Ibb 60 % 14 % 74 % 26 % Sanaa 37 % 21 % 58 % 42 %

Hodiedah 54 % 15 % 69 % 31 % Amran 43 % 13 % 56 % 44 %

Taiz 43 % 25 % 68 % 32 % Aden 49 % 4 % 53 % 47 %

Lahj 44 % 23 % 67 % 33 % Al Dhalae 28 % 9 % 37 % 63 %

Sa'adah 45 % 22 % 67 % 33 % Ma'areb 23 % 9 % 32 % 68 %

Shabwa 34 % 33 % 67 % 33 % Al Jawf 10 % 7 % 17 % 83 %

4- Maternal and Newborn Health

Governorate Full



available

Governorate

Full availability


Non- available

Ibb 60 % 16 % 76 % 24 % Al Dhalae 31 % 23 % 54 % 47 %

Lahj 33 % 40 % 73 % 27 % Hodiedah 25 % 29 % 54 % 46 %

Taiz 49 % 24 % 73 % 27 % Amran 37 % 16 % 53 % 47 %

Hajah 47 % 18 % 65 % 35 % Al Baydha 39 % 12 % 51 % 49 %

Sa'adah 37 % 27 % 64 % 36 % Aden 40 % 2 % 42 % 58 %

Sanaa 35 % 27 % 62 % 38 % Shabwa 25 % 15 % 40 % 59 %

Abyan 43 % 12 % 55 % 45 % Ma'areb 34 % 3 % 37 % 63 %

Al Amana 42 % 13 % 55 % 45 % Al Jawf 17 % 6 % 23 % 77 %

19

5- Non-communicable diseases & Mental Health

Governorate Full



available

Governorate

Full availability


Non- available

Lahj 20 % 68 % 88 % 12 % Hajah 19 % 32 % 51 % 49 %

Al Amana 40 % 26 % 66 % 34 % Sanaa 12 % 38 % 50 % 51 %

Sa'adah 28 % 34 % 62 % 38 % Hodiedah 12 % 32 % 44 % 56 %

Ibb 21 % 40 % 61 % 39 % Al Baydha 12 % 27 % 39 % 61 %

Shabwa 25 % 34 % 59 % 42 % Al Dhalae 9 % 28 % 37 % 63 %

Abyan 36 % 22 % 58 % 43 % Amran 10 % 13 % 23 % 77 %

Taiz 22 % 31 % 53 % 46 % Ma'areb 19 % 4 % 23 % 77 %

Aden 39 % 13 % 52 % 49 % Al Jawf 6 % 11 % 17 % 83 %

6- Environmental Health

Governorate Full



available

Governorate

Full availability


Non- available

Hajah 69 % 23 % 92 % 8 % Al Baydha 59 % 21 % 80 % 20 %

Al Amana 82 % 8 % 90 % 10 % Lahj 26 % 54 % 80 % 20 %

Shabwa 64 % 26 % 90 % 10 % Abyan 45 % 30 % 75 % 25 %

Ibb 54 % 33 % 87 % 13 % Amran 50 % 25 % 75 % 25 %

Sanaa 55 % 31 % 86 % 14 % Hodiedah 36 % 34 % 70 % 30 %

Taiz 56 % 29 % 85 % 15 % Ma'areb 64 % 4 % 68 % 32 %

Al Dhalae 42 % 41 % 83 % 17 % Aden 63 % 0 % 63 % 37 %

Sa'adah 29 % 53 % 82 % 18 % Al Jawf 13 % 17 % 30 % 70 %

20

o For each level of care (Health Units, Health Centers, Hospitals) the level of availability of each of the six

domains of services differs from a governorate to another. This shows how well is a health facility (e.g.

health unit) performing in terms of the availability of a service (e.g. maternal and new child health) at a

specific governorate (e.g. Al Hodeida); as outlined in the figure below.

o The following are three examples of availability of services in a chosen level of provision in three selected

governorates: (governorate reports provide more information on the service availability on each

level). Colors donate; Green – Fully available, Yellow – Partially available and Red – Non-available).

: Abyan Al Hodeida Ibb

Health Unit Health Centers Hospitals

Child Health and Nutrition (P2)

Non-communicable diseases

& Mental Health (P5)

Maternal and Newborn

Health (P4)

-

3. Availability of services on

provision level

21

o Availability of services is an indicator of the level of provision of services which could be fully available; all

expected interventions in addition to required inputs are in place to provide the services. Partial available

indicates that the services are provided with lack of any of the elements. This is based on the service

checklist for each found in annex 1.

o Eight services have been selected from a total 39 services on the primary care level and 19 additional

services on the secondary level. Colors in the figures below donate the following; Dark Green – Fully

available, Medium Green – Partially available and Light Green – Non-available).

o The governorate reports provide full information on the availability of these services on each

level of care / provision.

FIRST AID AND LIFE SUPPORT (P12)

• Full levels of availabilty in the hospitals level was in Al Dhalae

followed by Shabwa and Hajjah;

• The lowest level of

availability on the health units level was in Sana’a followed by

Hodeida and Al Dhalae;

• Among the level of health centers the lowest levels were

in Hodeida and the highest level was in Shabwa.

Marib - Health Centers

Sada’a - Health Centers Taiz - Health Units

OUTPATIENT SERVICES WITH AVAILABILITY OF ALL ESSENTIAL DRUGS (P13)

• Services availability was the

highest in hospitals in Al Dhalae. However the lowest

availability levels were in Aden followed by Abyan, Hodeida

and Lahaj;

• Availability of services in health centers was very low

(less than 10%) in the governorates of Abyan, Marib,

Sana’a and Amran;

• Similarly, availablity was low on health unit’s level not

exceeding the level of 40% in all

governorates.

Aden – Hospitals Al Amana – Health

Centers Al Baydha – Health

Centers

4. Specific services

availability

22

UNDER – 5 CLINIC (P23)

• Lowest levels of availability

were in Aden hospital whereas hospitals in Shabwa, Amran,

Sadaa and Ibb levels were high;

• Health Centers in Shabwah and Hodeida showed the

highest levels of availability;

• Availability of services in health units was variable

among the governorates, lahaj being the lowest.

Al Dhalae - Health Centers

Hodeidah - Health Units

Lahaj - Health Units

MANAGEMENT OF COMMON AND ENDEMIC DISEASES (P34)

• Best performers in terms of availability of services on the level of hospitals were Hajjah

followed by Baydha. The lowest availability was in Al

Dhala and Lahaj;

• Availability of services was variable on both the health

center and health unit levels, the lowest levels were in

Marib, Shabwa, Sadaa, Sana’a, Amran and Hodeida;

• Additionally, levels of

availability in health units in Al Dhalae, Taiz, Hajjah, Lahaj

were low. The highest availability was in Health

centers in Al Amana.

Al Hodeidah - Hospitals

Al Dhalae - Hospitals Hajjah - Health Units

23

ANTENATAL CARE (P422)

• Highest availability was in

hospitals in Sana’a, Al Dhalae, followed by Hajjah and Ibb. The

availability was low in Aden hospitals;

• Highest availability in terms of

health centers was in Abyan compared to the lowest in

Shabwa and Sana’a;

• Availability in Health units was low in all governorates especially

Marib, Sana’a, Shabwa, Lahaj, Hodeida (extremely low; 4%), Al Dhalae. The highest being in Ibb;

55% and Hajjah 44%.

Al Jawaf – All levels Amran - Health Units Lahaj - Health

Centers

SKILLED CHILDBIRTH CARE & EARLY ESSENTIAL NEWBORN CARE (P423)

• Lowest levels of availability was

in Aden hospital whereas hospitals in Sana’a 100% followed by Ibb; 86% were high in addition

to Shabwa; 86%;

• Levels of availability on health unit and health center levels was

low in all governorates; • HU (above 30% availability; Ibb

and Abyan), HC (above 40% availability Ibb, Abyan, Taiz,

Lahaj);

• Level of availability in Al Hodeida are low in HU; 1% and

HC; 16%.

Sana’a - Health Centers

Abyan - Hospitals Sada’a - Hospitals

24

NON-COMMUNICABLE DISEASES CLINIC (P51) - FULL + PARTIAL PROVISION

• Availability of services on the level of hospitals was

highest in Sada’a followed by Ibb. The lowest was in Marib

and Hodeida;

• The levels of availability on the health unit and health

center levels were low in all governorates;

• Those exceeding the 50%

threshold were health centers in Abyan and Amant

Al Asama.

Hajjah - Hospitals Ibb - Health Centers Aden - Hospitals

PSYCHOLOGICAL FIRST AID (P57) – FULL + PARTIAL PROVISION

• Availability of services on the level of hospitals was highest

in Sada’a followed by Taiz, Sana’a, Lahaj, Hodeida, Ibb,

Shabwa and Aden;.

• The levels of availability on the health unit and health

center levels were low in all governorates;

• Those exceeding the 50%

threshold were health centers in Abyan, Amant Al Asama and

Sada’a in addition to health units in Sada’a.

Amran - Hospitals Abyan - Hospitals Taiz - Health Centers

25

Fully


functional Non –

functional Total

Physical status

Hospital 3 5 1 9 Totally damaged 8

Health Center 12 7 3 22 Partially damaged 17

Health Unit 58 49 30 137 Not damaged 138 + (5)

Total 73 (43%) 61 (37%) 34 (20%) 168 Total 168

Functional health facilities Coverage per population

Total HU HC Hosp HU (≤ 5,000) HC (≤ 20,000) Hosp (≤ 150,000)

134 107 19 8 5,494 30,938 73,478

Total no of staff 1,589 No of health staff per 10,000 pop (equal or more than 22)

27

No of nurses & midwifes

782 No of districts without doctors

(no of districts = 11 ) 3

Total no of beds

394 No of beds per 10,000 pop

(equal or more than 10) 6.8

No of operating ambulances

3 No of BEmOC per 500,000 pop


Gen Services & Trauma management 39% Maternal and Newborn Health 43%

Child Health and Nutrition 52% Non-communicable & Mental Health 36%

Communicable Diseases 45% Environmental Health 45%

Full service provided Health Unit Health Center Hospital

First Aid and Life support (P12) 32% 28% 63%

Outpatient services with availability of all essential drugs (P13) 3% 8% 25%

Under-5 clinic (P23) 57% 75% 43%

Management of common and endemic diseases (P34) 22% 40% 38%

Skilled childbirth care & early essential newborn care (P423) 32% 73% 57%

Noncommunicable diseases clinic (P51) - full + partial provision 8% 71% 43%

Abyan

26

Fully


functional Non –

functional Total

Physical status

Hospital 5 - 1 6 Totally damaged 2


Health Unit 2 - - 2 Not damaged 32

Total 35 (78%) 4 (7%) 6 (13%) 45 Total 45



39 2 32 5 460,905 28,807 184,362


42.7


1,571 No of districts without doctors


Total no of beds

1,252 No of beds per 10,000 pop

(equal or more than 10) 14








First Aid and Life support (P12) n/a 41% 60%

Outpatient services with availability of all essential drugs (P13) n/a 41% 20%

Under-5 clinic (P23) n/a 60% 25%

Management of common and endemic diseases (P34) n/a 57% 40%

Skilled childbirth care & early essential newborn care (P423) n/a 24% 25%

Noncommunicable diseases clinic (P51) - full + partial provision n/a 31% 40%

Aden

27

Fully


functional Non –

functional Total

Physical status



Health Unit 21 65 29 115 Not damaged 165

Total 33 (19%) 102 (58%) 42 (23%) 177 Total 177



135 86 41 8 8,724 18,299 93,783

Total no of staff 838 No of health staff per 10,000 pop (equal or more than 22)

11.2




Total no of beds












Under-5 clinic (P23) 53% 76% 86%




Al Baydha

28

Fully


functional Non –

functional Total

Physical status




Total 32 (21%) 101 (65%) 22 (12%) 155 Total 155



133 97 31 5 7,110 22,246 137,926


11.8




Total no of beds












Under-5 clinic (P23) 37% 50% 60%




Al Dhalae

29

Fully


functional Non –

functional Total

Physical status




Total 180 (47%) 192 (50%) 10 (3%) 382 Total 384



372 289 67 16 10,655 45,959 192,453


8.0




Total no of beds












Under-5 clinic (P23) 41% 80% 67%




Al Hodeida

30

Fully


functional Non –

functional Total

Physical status




Total 8 (9%) 34 (36%) 52 (55%) 94 Total 94


Total HU HC Hosp HU (++ 5,000) HC (≤ 20,000) Hosp (≤ 150,000)

42 29 10 3 21,479 62,288 311,439


6.0




Total no of beds




? No of BEmOC per 500,000 pop





Full service provided Fully Available Partially Available

Total

Availablity



Under-5 clinic (P23) 12% 31% 43%




Al Jawf

31

Fully


functional Non –

functional Total

Physical status




Total 56 (65%) 14 (16%) 16 (19%) 86 Total 86



70 5 56 9 518,981 53,688 389,236


20.0




Total no of beds










First Aid and Life support (P12) n/a 31% n/a

Outpatient services with availability of all essential drugs (P13) n/a 36% n/a

Under-5 clinic (P23) n/a 66% n/a

Management of common and endemic diseases (P34) n/a 81% * n/a

Skilled childbirth care & early essential newborn care (P423) n/a 33% n/a

Noncommunicable diseases clinic (P51) - full + partial provision n/a 53% n/a

Amant Al Asama

32

Fully


functional Non –

functional Total

Physical status




Total 186 (61%) 69 (23%) 49 (16%) 304 Total 304



255 205 35 15 6,451 37,784 88,164


11.7




Total no of beds












Under-5 clinic (P23) 54% 56% 80%




Amran

33

Fully


functional Non –

functional Total

Physical status




Total 195 (60%) 87 (27%) 44 (13%) 326 Total 326



282 235 36 11 9,037 58,992 193,066


10.0




Total no of beds












Under-5 clinic (P23) 71% 77% 75%




Hajjah

34

Fully


functional Non –

functional Total

Physical status




Total 157 (43%) 154 (42%) 54 (15%) 365 Total 365



311 180 115 16 15,882 24,782 169,101


10.7




Total no of beds 1,203 No of beds per 10,000 pop











Under-5 clinic (P23) 88% 77% 100%




Ibb

35

Fully


functional Non –

functional Total

Physical status




Total 176 (75%) 30 (13%) 28 (12%) 234 Total 234



206 169 22 15 5,917 45,451 66,661


21.9




Total no of beds












Under-5 clinic (P23) 8% 26% 50%



Noncommunicable diseases clinic (P51) - full + partial provision 0 0 60%

Lahaj

36

Fully


functional Non –

functional Total

Physical status




Total 17 (14%) 64 (53%) 39 (33%) 120 Total 120



81 52 11 18 6,331 29,930 18,291


34




Total no of beds












Under-5 clinic (P23) 33% 64% 78%




Marib

37

Fully


functional Non –

functional Total

Physical status




Total 35 (21%) 66 (41%) 62 (38%) 163 Total 163



101 77 18 6 13,341 57,069 171,206


6.3




Total no of beds












Under-5 clinic (P23) 49% 63% 80%




Sada’a

38

Fully


functional Non –

functional Total

Physical status




Total 168 (59%) 68 (24%) 49 (17%) 285 Total 285



236 145 83 8 7,934 13,861 143,812


13.1




Total no of beds












Under-5 clinic (P23) 58% 54% 71%




Sana’a

39

Fully


functional Non –

functional Total

Physical status




Total 106 (58%) 48 (26%) 30 (16%) 184 Total 184



154 113 26 15 5,398 23,459 40,662


24.5




Total no of beds












Under-5 clinic (P23) 75% 81% 100%




Shabwa

40

Fully


functional Non –

functional Total

Physical status




Total 124 (29%) 238 (56%) 63 (15%) 425 Total 425



362 221 116 25 14,637 27,887 129,397


13.1




Total no of beds












Under-5 clinic (P23) 61% 67% 58%




Taiz

41

Service Checklist

Annex

Documents

Service Availability and Health Facilities Functionality ... 16 Govn final report.pdf · 2 Abbreviations BeMOC Basic Emergency Obstetric Care DHIS District Health Information System