By Shadi Saleh and Chaitali Sinha
Nearly one in every four people in Lebanon is a refugee. This number is staggering, yet not entirely unbelievable given the protracted and emerging conflicts in the Middle East. A rapid influx of refugees from Syria has catapulted Lebanon from the 69th largest refugee-hosting country to the third largest within the past five years. The country also hosts a large proportion of the world's Palestinian refugee population, comprising nearly 10% of the country's population.
In mid-November 2016, the Honorable Marie-Claude Bibeau, Canada's Minister of International Development, announced a pledge of $20 million to the United Nations Relief and Works Agency (UNRWA): the official body mandated to deliver basic services to Palestinian refugees in a number of settings, including Lebanon. These funds will support increased access to education, health and social services.
A health research project funded by Canada's International Development Research Centre (IDRC) is showing how digital technologies - such as mobile phones and netbooks - can help to close the access and quality-of-service gaps for Palestinians in refugee camps and other vulnerable populations in Lebanon.
Many of these Palestinian refugees are raising the fourth generation of their families within these camps. They suffer from overcrowding, inadequate housing conditions and infrastructure and poor nutrition. These circumstances give rise to increased rates of non-communicable diseases (NCD), such as diabetes, hypertension and respiratory infections. They also make pregnancy and childbirth more risky for women.
Management of these types of conditions requires continuous and prolonged care, and benefits greatly from early screening and detection. Pregnant women in particular require special attention for conditions such as hypertension and diabetes (including gestational diabetes). Left undetected and untreated, they can have calamitous effects on both mothers and their newborns.
The e-Sahha project, implemented by the American University of Beirut and funded by IDRC, is working in collaboration with the Ministry of Public Health in rural areas of Lebanon and with UNRWA in Palestinian refugee camps to bring better quality care to underserved populations who are at greater risks for developing NCDs -- including women with 20 or more weeks of pregnancy.
Launched in 2014, e-Sahha is an implementation research project that was designed with a clear intention to use mobile technology, embedded in the local context, to improve the continuum of services for high-risk groups and to create the space for them to have a say in the quality of the health services they receive.
There is no one-size-fits all system to improve health. This is true for everyone -- and especially for refugee populations living in fragile and humanitarian contexts, where the right to health is far from guaranteed. Recognizing this, e-Sahha was designed not only to improve the timeliness and outreach of health monitoring, but also to gather feedback from pregnant women and other users about the perceived and actual quality of care they received.
The focus on quality of care is noteworthy because when it comes to refugees - living in registered camps and beyond -- this aspect is often diluted or ignored altogether. This is why e-Sahha invested in improving both access and quality of care through better use of mobile technology and upgrading the skills of the health professionals.
Health providers receive continuing education (clinical guidelines as well as provider-patient communication strategies) through electronic learning materials developed by the project and opportunities for peer-to-peer exchanges through online forums. In addition, community health workers are trained on how to use mobile devices during household visits to screen for diabetes and hypertension.
Once registered in the e-Sahha system, individuals and their families receive text messages on their mobile phones about healthy behaviours and reminders for their upcoming appointments.
Implemented in three of the 28 UNRWA health centres and reaching 893 people, e-Sahha results to date indicate an increased demand for and access to better quality services. The research team is now monitoring the impact of e-Sahha activities on people's health.
While the project is working with a limited population, it is setting the groundwork for a growing number of diabetic or hypertensive individuals to enjoy more accessible and better quality health care on a continuous basis. These technologies hold the potential to be a game changer in health care provision across all underserved rural populations and refugee populations in Lebanon, including Syrian refugees.
For over 10 years, IDRC has invested in research to overcome various development challenges experienced by refugees in Lebanon. Contributions from the e-Sahha project demonstrate how locally driven innovations with strong community engagement can collectively address pressing health challenges by bringing life-saving information to those most in need.
There are staggering challenges to overcome when providing quality health care to underserved and displaced populations. But, with the clever use of technology, strong relationships with leaders and the community, and a persistent focus on reducing health inequities, the potential for positive transformative change can also be staggering.
Shadi Saleh is a Professor at the American University of Beirut and the principal investigator for the e-Sahha project.
Chaitali Sinha is a Senior Program Officer at the International Development Research Centre and responsible for managing the e-Sahha project.
The views expressed are those of the authors and do not necessarily reflect the views of CCIC or its members.
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