Irbid Health Centers Poor Service Harms Beneficiaries

July 9 – Ahmed Bani Hani

Umm Muhammad visits the Ibn Sina Primary Health Center, in the city of Irbid, to prescribe the monthly treatment of her 60-year-old father, who suffers from heart disease, but in many times they provide her with alternative medicines, which leave many side effects to her father, saying, “They gave us alternative medicines. They did not work with his condition”.

In this case, the family is forced to buy medicines at its own expense, even though the parent is covered by health insurance. Yet, the lack of medicines in the health center pharmacy increases the burden on them, especially since the patient needs 5 types of drugs for chronic diseases per month, which increases the cost of treatment. Umm Muhammad says that the pharmacy’s most frequent response has become “Buy it from private pharmacies”.

The problems faced by patients are not limited to the lack of medication, as Umm Muhammad asserts that clinics suffer from overcrowding, especially dental clinics.

The former director of the Directorate of Health in Irbid Governorate, Dr. Qassem Mayas, whose reply was taken before his transfer from office, acknowledges that the Health Directorate receives daily complaints about the lack of medicines and their unavailability in some health centers, but the shortage is secured from the warehouses. If the alternative is available, it shall be replaced, but when the alternative is not available, hospital specialists dispense it on the health insurance account if it is planned.

This is also confirmed by Dr. Riyadh Al-Shiyyab, Director of the Directorate of Health in Irbid Governorate, who took office on June 24. Shiyyab explained that the Health Directorate is working to fairly dispense medicines, especially monthly treatments for patients with chronic diseases, to health centers, and to ensure that they reach their beneficiaries without a waste of resources.

The reporter monitored complaints from health center services beneficiaries in the Irbid governorate areas, about poor services provided by health centers, shortage of medical equipment and human cadres, in addition to the delay in obtaining the service, which compels them to revisit the center or refer to the nearest hospital.

Comprehensive health care centers in the governorate of Irbid provide general medical services, and services for children, family, maternity, dentistry, x-rays, laboratory, dental laboratory, vaccines, women, internal, dermatological, and orthopedic. It is not a must that every center covers all those types of services. Meanwhile, primary centers provide general medical services, maternity, dentistry, laboratory, and vaccines, while the secondary centers include general medicine, maternity, and vaccines.

Low-Quality Health Services
Irbid governorate has 11 comprehensive health centers, in addition to three health centers ready to be converted into comprehensive centers, bringing the number to 14 after the decision of the Minister of Health regarding them, 78 primary centers, and 22 secondary-centers.

Health care activist Abdullah Hanatla confirms that the patient’s right to receive the service is indisputable, but the most important is the quality of health care that he gets in those health centers. There is a disparity in the quality of services provided, their availability, and proximity to patients, according to him.

Hanatla’s comment came in response to testimonies documented by the report, related to the quality of health services, as Nidal al-Masry talks about the treatment of a doctor at the Hussein Health Center: “The doctor would ask you, what do you suffer from, write you a prescription, and tell you to dispense it from the pharmacy. He does not examine the patient”. He pointed out that he stayed for 30-60 minutes waiting before it is his turn, although the center was not crowded, and that doctors do not abide by official working hours.

Although Masri usually visits the health center to dispense “thyroxin” to treat the thyroid gland and drugs for other chronic diseases, he has to buy it from abroad many times.

But Mayas clarifies the protocol that must be followed to examine the patient by the doctor in the health centers, by looking at the patient’s history, then clinical examination and deciding to transfer it to the x-ray or laboratory to perform the required examination to further clarify his situation. Finally, the patient dispenses the appropriate treatment, with the adequate time taken into account for these procedures. The large numbers that visit health centers may reduce the time granted to each patient, according to Mayas, noting that receiving 200 cases per day differs from receiving 50. Still, he believes that the diagnosis of the condition is more important than dispensing the drug as the correct diagnosis is the treatment for medical conditions. Mayas expressed his shock by the existence of these behaviors, pointing out that doctors reside in the same area and know the pathology of people, and upon reviewing them, they will dispense the appropriate treatment for them based on their condition.

The directorate did not receive any complaints about doctors who do not perform the examination, according to Mayas. In the event of complaints, the Health Directorate takes the appropriate action by sending people to the center and verifies how the doctor treats them or checks them before dispensing the appropriate medicine for their condition. If it is proven, appropriate administrative action is taken, or the doctor is summoned to the Health Directorate and verifies the complaint, indicating that the penalties range from verbal and written warnings, salary deduction and withholding incentives. Shiyyab also confirmed there were no complaints in this regard since he assumed office.

Hanatla indicates that the Ministry of Health is the largest provider of primary health care services in Jordan, and the presence of some individual practices may affect the quality of services, noting at the same time they need qualified people to provide these services per the established medical protocols. Anything less is a violation of the patient’s right to treatment.

“The Ministry of Health is sure to monitor health centers and doctors, but it is difficult to observe every doctor, and if the doctor does not examine the patient, and write the prescription before checking his condition and sending him to the laboratory, it is a crime if he does not know, and a breach of trust if he knows”, Says Hanatla.

To provide better health care to citizens, an educational program has been activated in the Health Directorate to train new doctors by specialized doctors, to give them more experience, especially concerning how to deal with and receive patients, and to examine cases and dispense appropriate treatments efficiently and competently, through lectures awareness and continuous training, Shayyab explains.

Services Overload
Muhammad Ali recounts his suffering in the primary northern Mazar health center, which is crowded always crowded, noting that patients start arriving at the center from the early morning hours for a queue.

Ali continues, “The center suffers from a shortage of drugs, except for Revanin and capsules. The doctors do not do full working hours, and the staff treats you as if you are at a police station.”

To improve services, citizens in Irbid are calling for the conversion of some primary health centers into comprehensive, extending working hours to accommodate all conditions, optimally dealing with them, merging secondary-centers close to each other to become primary, with greater services and a longer time, so that they can obtain appropriate health care being in areas far from the hospitals, especially the centers in the Bani Kinana and the Bani Ubaid. In turn, Mayas stresses that health centers in the governorate cover the needs of all regions, and contribute to relieving pressure on hospitals. They provide primary and comprehensive services in addition to dispensing medicines and are provided with cadres based on the need and pressure of work. The same applies to medical equipment and services, with easy access through transportation. As for transformation into comprehensive, there are specific criteria for conversion, and the approval of the minister is required, according to his clarification.

Unfocused Commitments
“An employee plays the role of an accountant, pharmacist, and more than one employee at the same time in the absence of the pharmacist or the accountant. There is no commitment to the official working hours, and if you go to the center at noon or before noon, you will find employees on their way home. This is how Abu Abdullah describes the scene in Barha primary health center. He also said: “I paid the center several visits after noon time; I would find it empty with only the cleaning worker there”.

The matter was repeated with Abu Abdullah when he visited the dental clinic in the same center and finds it closed, due to the doctor’s commitment to school health, which compels him to wait and revisit the clinic to find the doctor, because his financial condition does not allow him to go to a private doctor, especially since he is a beneficiary of health insurance What prompted him to file a complaint with the Ministry of Health, but no action was taken, and no one called back.

Mayas attribute the doctor’s absence in some health centers, to their commitment to work in more than one center, due to the presence of secondary centers in the Irbid governorate, where the doctors’ working hours are from two to three hours.

Shiyyab stresses the need for doctors to adhere to their time even in the secondary -health centers, pointing to the formation of 12 teams to inspect the health centers during the past week, to control working hours and ensure the commitment of the medical and administrative cadres to them, through monitoring the working hours periodically, and activating the hidden employee who works to evaluate and improve performance, to ensure the advancement of the health sector in Irbid.

As for Ammar Al-Sweiti, Ministry of Health media officer, he acknowledges the need for continuous monitoring of the working hours in health centers by the health director, stressing that there were no complaints about the doctors’ failure to abide by working hours and that the director of each health center is keen his workers follow working hours. As per complaints, they are verified and followed up by the concerned health director, and if the violation is proven, the necessary measures are taken against the violators. This has been said, Irbid, like the rest of the governorates, suffers from a shortage of rare specialists, such as the heart and nerves, and this deficiency is covered by referral to hospitals.

Budget Reduction
The director of the Irbid Governorate Council, Omar Maqablah, admits there is a lot of pressure on services in the governorate, and weak infrastructure, pointing to the need of many buildings for maintenance, modernization and construction of others in several sectors, including health.

The provincial council had approved the budget for the current year at JOD24m; before it was reduced at the beginning of the year by 64%, then by another 50% due to the Coronavirus pandemic to reach only JOD4m. This amount is not enough to pay off the debts of 2019 projects that work is still underway, describing the budget as “close to zero”.

Reducing budgets does not achieve the initial requirements and service projects in the governorate with a population of about two million, according to Maqablah who confirmed that Irbid is one of the major governorates in the Kingdom and must be viewed differently when preparing the general budget for the advancement of worn infrastructure, serving citizens and providing the necessary services to them including establishing, maintaining and modernizing health centers.

Primary health care services in Jordan are managed through 676 health centers, of which 102 are comprehensive, 380 are primary and 194 are secondary-centers, according to data from the Jordanian Ministry of Health.

In its 2018 report, the National Center for Human Rights recommended the importance of converting primary and secondary health centers into comprehensive health centers, given their importance in detecting diseases at an early stage and their contribution to relieving pressure on hospitals.

Paragraph (1) of Article 25 of the Universal Declaration of Human Rights states: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control”.

* With support from JHR

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