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      Health system’s response to the COVID-19 pandemic in conflict settings: Policy reflections from Palestine

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          Abstract

          <p class="first" id="d37028314e140">As the COVID-19 pandemic spreads, concerns are particularly serious in conflict and humanitarian settings. Tackling the pandemic in those countries is challenging due to the fragility of socioeconomic and health systems. Palestine is one of those countries that is facing compounding challenges, instability, fragility, living conditions, poverty, and mobility, all of which are caused by multifactorial etiology. The Pandemic shows triple tragedies; virus (COVID-19 Pandemic), ongoing Israeli occupation (Politics), and Intra-Palestinian divide (Policies). Yet, Palestine's response to the pandemic is outperforming many countries in the region. The early preventative lockdown measures in the West Bank found effective and not overwhelming the already over-stretched health system. While in the Gaza Strip, the response was slow. Prisoners, labours, besieged people, socioeconomic-disadvantaged classes, and refugees were put at additional high risk. Nonetheless, measures taken were unconsolidated in both regions largely due to the political factors. A little collaboration and inter-agency task forces in preparedness and response was observed, and the mechanisms and governance remain ambiguous. A consolidated and evidence-based nation-wide plan is required, whereby state and non-state actors have a clear and transparent exit strategy. A new thinking approach to promote the public health system and evidence-informed policies in Palestine is an urgent national priority. </p>

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          Most cited references6

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          Health status and health services in the occupied Palestinian territory

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            Operational considerations for case management of COVID-19 in health facility and community. Interim guidance

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              Is Open Access

              The Palestinian health research system: who orchestrates the system, how and based on what? A qualitative assessment

              Background In 2011, the WHO Eastern Mediterranean Region committee launched a strategy for scaling up research in the region to address the countries’ health needs through formulating and analysing the National Health Research System (HRS). Stewardship comprises three functions, namely governance, policy and priorities, and is a central pillar of this system to ensure a well-organised and functioning HRS. This study aims to examine the perceptions of the HRS performers to understand these functions and to generate insights for system strengthening. Methods The study was carried out in Palestine, targetting three sectors in the health field, including relevant governmental health institutions, schools of public health, and major local and international health agencies. The data were collected through 52 in-depth interviews (IDIs) and 6 focus group discussions (FGDs) with policy-makers, academics, directors, and experts. Participants and institutions were selected purposively based on a set of criteria and peer review. Results A total of 104 experts participated in the IDIs (52 participants) and FGDs (52 participants in 6 FGDs), highlighting that stewardship functions remain problematic and insufficiently performed, mainly due to a missing health research structural and regulatory framework and dispersed health research work. Despite the limited good practices, the majority of the participants described the Ethical Review and Clearance as weak due to the lack of an agreed-upon national committee and procedural quality and ethics guidelines for non-compliance. A policy or strategy dedicated to health research is lacking. The exercises of research priority-setting appear to be evolving despite the lack of consensus and the low levels of knowledge and experience in research prioritisation. Common gaps, such as weak political will and capacity support, the absence of a national unified regulating body, and the indirect effects of political conditions on strengthening the HRS as well as other sectors, also emerged. Conclusions The stewardship functions of the Palestinian HRS remain weak along with substantial political, structural, and resources and capacity gaps. The study emphasises the imperative need to initiate strategic efforts led by the MOH and the Palestinian National Institute of Public Health alongside with other players to strengthen a national HRS through improving the stewardship functions. To achieve this, attention and support of decision-makers, involvement, mobilisation and strategic dialogue are indispensable, in order to embark on building a well-regulated and coordinated structure, operational research policy, and prioritisation of essential research. Electronic supplementary material The online version of this article (10.1186/s12961-018-0347-4) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                (View ORCID Profile)
                (View ORCID Profile)
                Journal
                Global Public Health
                Global Public Health
                Informa UK Limited
                1744-1692
                1744-1706
                August 02 2020
                June 17 2020
                August 02 2020
                : 15
                : 8
                : 1244-1256
                Affiliations
                [1 ]Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
                [2 ]Council on Health Research for Development, Geneva, Switzerland
                [3 ]Faculty of Medicine and Health Sciences, An-Najah National University, Palestine
                [4 ]University College London UCL, London, UK
                [5 ]Gaza Community Mental Health Programme, Gaza, Palestine
                [6 ]Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
                [7 ]Women Deliver Organization, New York, NY, USA
                Article
                10.1080/17441692.2020.1781914
                32552389
                7d5ed2d4-ff20-443f-a215-65efe1ab9775
                © 2020
                History

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