Emergency Response Project

 Juzoor, in partnership with the Catholic Relief Services (CRS) is providing health care facilities and vulnerable households in the West Bank with support to respond to the COVID-19 emergency. Juzoor is supporting health care facilities to address critical needs and strengthen their infection prevention control measures while also helping households to protect themselves and others through safe behaviors.

Intermediate Result 1: Targeted health facilities effectively respond to COVID-19

Juzoor, along with CRS, mapped-out the different roles that government and non-government health care facilities were playing in the emergency response, assessed their needs in terms of material support (equipment, supplies) and systems strengthening (infection prevention controls), developed priority interventions and action plans, and began supporting targeted health care facilities to respond to those priorities in a timely way. The project team focused on 15 total health care facilities: 11 government and 4 non-government hospitals. Government hospitals were prioritized because of the full range of COVID-19 services offered (from triage to treatment) as well as their role in providing other medical services in a safe, COVID-19 responsive way; several government hospitals were also exclusively dedicated to COVID-19 treatment. Four NGO hospitals were prioritized because of their planned role in surge-support for COVID-19 treatment and/or their high-volume of services requiring safer practices. The government hospitals included: Alia, Dura, Bait Jala, Bethlehem COVID-19 Center, Palestinian Medical Complex, Hugo Chavez, Watani, Rafeedia, Jericho, Tubas, and Qalqilia and the NGO hospitals included Caritas Baby Hospital, Holy Family Hospital, Bethlehem Arab Society for Rehabilitation, and Shepherd’s Field Hospital (later replaced by Al Ahli Hospital).

The activities focused on inputs, accompaniment and technical assistance to hospitals to execute the priority interventions with a particular emphasis on items that would help hospitals to meet “minimum IPC requirements for COVID-19.” Through a participatory exercise with MoH and NGO hospital representatives, the project team defined “minimum IPC requirements” as: adequate PPE and supply management, effective identification and management of patients (patient screening and admission), increased capacity of personnel to understand and practice IPC measures, and relevant educational materials and resources available for reference. In addition to IPC investments, Juzoor also provided critical needs in the response to urgent gaps. Key interventions included:

Increasing Capacity of Personnel for Infection Prevention Control (IPC):

• Trained 129 doctors and nurses of NGO hospitals, ambulance drivers, and cooks and cleaners of government and non-government hospitals in infection prevention control (IPC). Trainings were customized to the particular role that each staff performed, emphasizing key messages and behaviors that needed strengthening based on gaps in knowledge and practices identified through assessments.
• Enhanced the capacities of hospital Quality Assurance Coordinators, who are responsible for promoting and reinforcing IPC measures at targeted hospitals, through on-the-job coaching (field visits) and organization of an international certification as Health Care Quality Practitioners. This certification includes 40 hours of intensive, specialized training on advanced IPC topics as well as standards and systems for continuous quality improvement. It also includes additional on-the-job exercises, group presentations, and ultimately exam in subsequent months. Through this certification process, MoH and NGO quality assurance staff will become experts in their field, enabling them to speak with authority at their assigned hospitals, and be empowered to make improvements in their facility’s compliance with IPC standards. 

Intermediate Result 2: Targeted households practice safe behaviors that reduce the spread of COVID-19

Juzoor is improving infection prevention at the community level by supporting households to practice safe COVID-19 behaviors. During the pandemic, Juzoor and CRS developed a targeting strategy focused on households in Hebron and Bethlehem with a COVID-19 exposure risk. Analysis at that time identified this group as those most at-risk of spreading the virus, especially as no other entity was actively providing messaging and support to individuals who had recently tested for COVID-19. Juzoor developed tailored messages relevant for this group, aligned to recommendations of the Risk Communication and Community Engagement (RCCE) working group that included: 1) stay at home for 14 days, 2) monitor your symptoms, and 3) disinfect your home and personal items properly and tested recall and self-reported adherence to those practices two-weeks after promotion. The team also developed an intake and screening procedure to identify households within this group that also needed hygiene items in order to practice the safe behaviors. Eligibility was based on socio-economic indicators such as whether household income had decreased after COVID-19 and whether the household was unable to access hygiene supplies either directly or through friends and family.

As the exposure risk targeting strategy filled a critical gap, Juzoor identified an additional targeting group in need of assistance: families with such high socio-economic vulnerability that they do not have the ability to purchase basic hygiene supplies. Juzoor, along with CRS, decided to expand the targeting strategy to include this group due to several factors. There was a decrease in the number of people getting tested due in part to a shortage of supplies and also a shift in the general population’s attitude toward testing. The geographic areas targeted continued to be areas with the highest overall infection rates justifying more outreach, messaging, and supplies to help stem spread of the virus.  Juzoor developed tailored risk communication messages for this group focused on: 1) wearing masks properly, 2) keeping physical distance, and 3) disinfecting home and personal items properly. Juzoor then began outreach to this target group within the same governorates. Under this intervention, the following interventions were also implemented: 

Equipping Community Workers:

• Developed a cloud-based application for managing beneficiary data, determining eligibility for hygiene support, and tracking services (messaging, hygiene supplies, follow-up, etc.)
• Trained 23 community workers and coordinators on community messaging, the online data management tools, beneficiary accountability, and safeguarding.
• Organized practice sessions and provided robust coaching to community workers to ensure quality of support.

Coordinating with Government & Cluster System:

Juzoor’s Community Health Workers simulate phone messaging and practice cloud-based tools

• Coordinated with the MoH centrally to establish a mechanism to receive regular lists of individuals that tested for COVID-19.
• Coordinated with the governors’ offices and Ministry of Social Development representatives of Hebron and Bethlehem to receive regular lists of individuals testing for COVID-19 – both positive and negative cases.