Pdacr 627

MINISTRY OF HEALTH
INSTITUTIONAL
DEVELOPMENT PLAN
PALESTINIAN HEALTH SECTOR REFORM AND DEVELOPMENT
PROJECT: “THE FLAGSHIP PROJECT”
MARCH 2009
MINISTRY OF HEALTH
INSTITUTIONAL
DEVELOPMENT PLAN
PALESTINIAN HEALTH SECTOR REFORM AND DEVELOPMENT
PROJECT: “THE FLAGSHIP PROJECT”
MARCH 2009
CONTRACT NO. 294-C-00-08-00225-00
This publication was produced by Chemonics International, Inc and partners for review by the United
States Agency for International Development.
The author’s views expressed in this publication do not necessarily reflect the views of the United
States Agency for International Development nor the United States Government.
Ministry of Health Institutional Development Plan 2

CONTENTS
Section I: Introduction…….. ......................................................................................5
Section II: Institutional Development Plan Approach .................................................6
Section III: Challenges to Implementing Institutional Development… ...................…9
Section IV: Institutional Development Plan………… ...……………………………11
Annexes:
Annex A: Priority Reforms and Interventions… ...………………………….87

Annex B: Linkages between the Institutional Development Plan and the
National Strategic Health Plan………………………………........89
Annex C: MoH IDP Focal Teams……….………………………………........101
Annex D: Institutional Development Plan Workshop Working Group
Composition……..........................................................................103

ACRONYMS
BCC Behavior Change Communication

BPH Bahraini Pediatric Hospital
BZU Bir Zeit University
CE Continuing Education
CHW Community Health Worker
CME Continuing Medical Education
CQI Continuous Quality Improvement
CSR Corporate Social Responsibility
CVA Cerebrovascular Accident
EMS Emergency Medical Services
ER Emergency Room
EWAS Emergency Water and Sanitation Project
GP General Practitioner
HIS Health Information System
HMIS Health Management Information System
HR Human Resources
ID Institutional Development
IDP Institutional Development Plan
IT Information Technology
JCI Joint Commission International
LLU Loma Linda University
M&E Monitoring and Evaluation
MoH Ministry of Health
NHI National Health Insurance
NHPSPC National Health Policy and Strategic Planning Council
NICU Neonatal Intensive Care Unit
NSHP National Strategic Health Plan
OJT On-the-Job Training
OPD Outpatient Department
PHC Primary Health Care
PI Performance Improvement
PICU Pediatric Intensive Care Unit
PMC Palestine Medical Complex
PRDP Palestinian Reform and Development Plan
QI Quality Improvement
RFA Request for Application
RFP Request for Proposal
SOP Standard Operating Procedure
SOW Scope of Work
TA Technical Assistance
TOP Training of Practitioners
TOT Training of Trainers
TRG Training Resources Group
UNRWA United Nations Relief and Works Agency
UPL Unified Procurement Law
USAID United States Agency for International Development

SECTION I: INTRODUCTION
The Flagship Project is a five-year initiative funded by the U.S. Agency of International
Development (USAID), and designed in close collaboration with the Palestinian Ministry of
Health (MoH). The Project’s main objective is to support the MoH, select non-governmental
organizations (NGOs), and select educational and professional institutions in strengthening
their institutional capacities and performance to support a functional and democratic
Palestinian health sector able to meet priority public health needs. The Project works to
achieve this goal through three components: (1) supporting health sector reform and
management, (2) strengthening clinical and community-based health, and (3) supporting
procurement of health and humanitarian assistance commodities.
One of the Project’s priorities is to support the MoH in implementing reforms needed for
quality, sustainability, and equity in the health sector. To initiate this process, the Project
supported the MoH in conducting a rapid and comprehensive needs assessment of the health
sector1. The purpose of the assessment was to identify the strengths and weaknesses of the
health system, and prioritize areas for intervention that support the Palestinian National
Strategic Health Plan. See Annex A for the list of technical areas and key interventions
identified by the assessment.
The results of the assessment were organized into 18 priority areas for reform. The Ministry
of Health team used these priority areas as the basis for drafting a comprehensive Institutional
Development Plan (IDP) for Palestinian health sector reform and development. During a
workshop in Jericho on March 5 and 6, 2009, forty MoH staff worked together to further
develop and refine the action plans, and to prioritize activities for completion over the initial
six-month period. Each team presented the revised plans to the Minister, Deputy Minister,
and other MoH staff. The IDP is presented in Section IV.
The IDP translates the recommendations of the needs assessment into implementable action
to be managed by the Ministry of Health. It also serves as a reference of all the priority areas
that the Flagship Project will focus on during the lifetime of the project and can be a useful
tool for donor coordination as well.
1
USAID/Flagship Project, Health System Assessment Report, (December 2008).

SECTION II: INSTITUTIONAL DEVELOPMENT PLAN APPROACH
The Institutional Development Plan (IDP), presented in Section IV, outlines the institutional
development and technical assistance interventions that will be supported by the Flagship
Project over a five-year period, in coordination with other donors as appropriate, to
strengthen the capacity of the MoH. The IDP is based on the findings of the needs
assessment2 carried out by the MoH in November and December of 2008. The health system
assessment revealed a number of priority areas for reform by the Ministry of Health. During a
workshop chaired by the Minister and Deputy Minister of Health on November 25, 2008, the
MoH assessment team discussed the health system’s needs and priorities as a whole,
identified areas of mutual concern, and developed a more targeted list of priority areas for
reform. During subsequent discussions of that list, the MoH assessment team highlighted the
following key areas for reform:
3
Module Priority Area
1 Create a center of excellence at the Palestine Medical Complex
2 Develop a health information system
3 Support implementation of the new Health Insurance Program
4 Design and implement a continuous education program for health professionals
5 Create and implement a relicensing system for health professionals
6 Design and implement a health facility accreditation program
7 Improve performance management
8 Strengthen service delivery and clinical guidelines
9 Improve coordination of stakeholders.
10 Support passing and implementation of the Health Commodities Procurement By-laws
11 Improve clinical MoH primary care system
12 Improve the quality of clinical services in the Palestinian MoH hospital system
13 Improve health communications services
14 Support MoH emergency departments and emergency preparedness
15 Training and fellowship program in health administration and management for the public sector
16 Improve community-based health services
17 Improve medical waste management
18 Introduce and implement a comprehensive M&E approach and system
The Institutional Development Plan highlights the most tangible and realistic interventions
needed to respond to the above-mentioned eighteen areas.
To develop the plan, the Flagship team designed a template to illustrate the overall
framework, and helped compile needed information for the planning process to support a
coherent approach in presenting the IDP. The template was organized around planning
elements such as strategic objectives, the Project’s results framework, linkages between the
priority area and health sector reform process, anticipated results, intervention strategy, and
timeframe.
The MoH adopted a holistic approach to the planning process that focused on developing a
comprehensive and well-integrated IDP which links to priorities in the National Strategic
Health Plan (NSHP) and the Palestinian Reform and Development Plan (PRDP), especially
those priorities under the health quality improvement program. The IDP interventions are
complementary and supportive of the objectives of both the NSHP and the PRDP. (See
Annex B for linkages between the IDP and the NSHP).
2
USAID/Flagship Project, Health System Assessment Report, (December 2008).
3
The number assigned to each Module does not reflect a prioritized order.

In addition to ensuring consistency with other MoH planning documents, linkages between
IDP Modules are highlighted in order to pinpoint areas where coordinated interventions are
most useful. This avoids duplication of interventions and maximizes utilization of human,
financial, and material resources.
Since both the framework and Institutional Development Plan promote a comprehensive and
well-integrated approach to reform, the IDP also highlights several cross-cutting issues that
impact implementation in each programmatic area. These include promoting good
governance, institutionalizing reform, and strengthening public confidence in health services
through improved communication, private sector involvement, and gender equity — all
which affect quality of care.
Good governance is critical to ensuring meaningful and sustained reform and entails having
the political will and commitment to encourage, promote and take practical decisions to bring
about change. In addition, the reform process cannot be sustainable without an institutional
framework that has broad-based support and ownership within the Ministry at all levels.
Strengthening communication between the Ministry of Health and the general public is
critical to building trust in the health system. Another aim of the IDP is to institutionalize a
transparent and open process by which the MoH communicates its reforms, progress, and
impact on the quality of care to the public. Likewise, feedback mechanisms by which the
public communicates its needs to the MoH should be institutionalized.
The private sector will be involved through corporate social responsibility (CSR) and creating
partnerships with non-governmental organizations (NGOs), professional groups, educational
facilities, private health care providers, and businesses. Examples of partnerships with the
private sector could include working with private companies to develop innovative and cost
efficient strategies (for e.g. new services that remove and effectively decontaminate waste
materials from the health facilities), donations towards the health care fee subsidies, and with
professional associations to develop innovative ways to train health care providers and
monitor the quality of services delivered. The importance and promotion of gender equity as
a human resource requirement will be addressed to ensure that women and men have equal
access to employment (recruitment, deployment), training, continuing education
opportunities, and equitable reimbursement, to respond to the needs of the Palestinian people
with sensitivity and respect.
The Deputy Minister of Health appointed ID focal teams from within the different
departments of the MoH to facilitate and lead the implementation of the IDP (see Annex C
with the list of focal team members and corresponding priority areas). The Flagship Project
worked closely with the MoH staff to further refine the draft IDP during a two-day workshop
on March 5 and 6, 2009. The focal teams were arranged into seven working groups (see
Annex D for the working groups). The working groups reviewed and modified the IDP to
prioritize activities for implementation in the following six months. The IDP presented in
Section IV of this document is the result of the workshop and represents the commitment of
the MoH to implement the reform activities outlined.
The composition of the working groups at the IDP workshop, which brought together diverse
MoH staff, expertise, and opinions, resulted in an integrated MoH Institutional Development
Plan that addresses the totality of health system reform. It also emphasized the importance of
cooperation and coordination within the MoH and with stakeholders, and promoted a culture

of transparency and openness. The process also provided an important opportunity for district
and clinical level staff to be actively involved in the planning process and decision making.
The IDP will be reviewed on an annual basis to track progress and to make adjustments when
needed to ensure timely and realistic achievement of the anticipated milestones and results.

SECTION III: CHALLENGES TO IMPLEMENTING THE
INSTITUTIONAL DEVELOPMENT PLAN
This section highlights some of the challenges anticipated by the Ministry of Health in
implementing institutional development.
1. Resistance to change. The Ministry has been very supportive of reform efforts to date.
However, as the reform process moves forward, resistance to the needed changes may arise.
Some of the factors that may affect acceptance of change include perceived shifts in power or
authority, particularly, in the context of centralized decision-making in the Ministry. Political
instability may also cause many staff to take a “wait and see” approach before fully
committing to the health reform agenda.
Successful implementation of the IDP will require continued engagement with and active
participation from district and clinical level staff, as well as personnel from the central MoH,
during the reform process. Approaches will be developed to encourage those in senior
positions to trust and allow staff at all levels to be given a share of responsibility and
authority in the health reform process.
2. Capacity of supporting institutions. It became evident during the health system assessment
and preliminary discussions regarding the IDP that some institutions that play a central role to
health reform may not share the commitment, vision, or priorities for reform that the MoH is
interested in pursuing. This poses a challenge to the MoH which needs to work with these
institutions in order to fully implement the reforms.
3. Uncertainty of MoH financial resources over the next few years. Without solid assurances
that the needed resources will be available on a timely basis, MoH staff may not be willing or
able to commit long-term to the interventions required by the health reform process to
improve and sustain quality of services.
4. Timeframe Constraints. The capability of the Ministry to undertake multiple, significant,

and simultaneous reforms of this magnitude should be taken into consideration. Even when
MoH staff are willing to make changes, additional training and technical assistance may be
needed to develop the skills and capacities to implement reform. There are high expectations,
and the timeframe may be ambitious for a nascent system that needs strong oversight and a
detailed implementation plan to make broad institutional changes. The MoH will need to
carefully review the priorities identified in the IDP and consider adjusting and developing a
schedule to phase in health reforms over time.
5. Restrictions on mobility. Due to closures and roadblocks in the West Bank, mobility is a
challenge for Ministry staff. This factor can impact the timeliness of the IDP interventions.
6. Skepticism of the public towards the quality of MoH services. Discussions have indicated
that the public is skeptical about the commitment and capacity of the MoH to improve the
quality of care. It is critical to engage in effective communication between the MoH and the
Palestinian public to demonstrate progress achieved through successful implementation of the
IDP in the effort to change the public’s opinion about quality of health care.

7. The humanitarian crisis in Gaza. As mentioned above, the Ministry of Health and health
sector operates within an environment of chronic uncertainty and conflict, and emergencies
such as the current crisis in Gaza are unfortunately not uncommon. These frequent
emergencies test the resilience of the health system. When an emergency occurs, the
tendency among the MoH and donors alike is to refocus all resources to humanitarian and
emergency response, setting aside the longer-term development and reform initiatives and
goals. This can contribute to the stagnation of the health system reform process.

SECTION IV: INSTITUTIONAL DEVELOPMENT PLAN
This section presents the eighteen modules of the Institutional Development Plan.
Module 1: Develop a Center of Excellence at the Palestine Medical Complex
Linkages with the National Strategic Health Plan: Strategic Objectives: 1.9, 3.2, 3.3, and
4.2.
Why: The long-term objective of the Palestine Medical Complex (PMC) is to serve as a
“Center of Excellence” in the West Bank that will inspire the rest of the Palestinian health
system to provide the highest quality service in a complementary fashion. The MoH will
operationalize the PMC in a manner that promotes good governance and transparency in
health, equitable and quality services in care, social participation, and cost-effectiveness.
Elements in the Reform Process Addressed: By providing technical assistance and

capacity-building support to the PMC, the MoH can then guarantee improvements in equity,
access, efficiency, quality, and sustainability, which can then be emulated across the West
Bank and Gaza.
Results of Intervention: The establishment of a health center of excellence at the PMC.
Component & Deliverable4:

Component 1: Health Sector Management and Reform.
Component 2: Clinical and Community-Based Health.
Workplan Objective5:
Objective 1: Improve Good Governance and Management Practice in the Palestinian health
sector . Task 1.1.1: Strengthen the capacity of the MoH to implement reforms needed for
improved quality, sustainability, and equity in the Palestinian Health Sector.
Objective 2.1: Improve the quality of essential clinical services for the Palestinians. Task
2.1.2: Strengthen Quality Improvement systems within Palestinian institutions to deliver
better secondary care.
Expected Result: Strengthen capacity and performance of Palestinian health sector

institutions (this priority area is a cross-cutting activity that will respond to several results in
the framework across the three components).
4
Components and deliverables for each Module were derived from the Flagship Project Annual Draft Workplan.
5 Please refer to the Flagship Project Draft Workplan.

Module 1: Develop a Center of Excellence at the Palestine Medical Complex (PMC)
Time Frame Responsibility Comments

Activity
Month Year
1. Create and promote a mission/vision March-September 2009 Minister of Health/Flagship
statement for the PMC and each individual /Loma Linda University
institution within the PMC (LLU)
2. Form an activation team March-September 2009 Minister of Health/Flagship

/LLU
3. Develop a detailed plan that the activation March-September 2009 LLU/Minister of LLU will develop the plan
team will follow: Health/Flagship
- Identify systems, policies, guidelines
- Recruitment
- Procuring
- Renovating
4. Evaluate and assess Joint Commission June-July 2009 Minister of Health/ Link to Module #6: Design &
International (JCI) accreditation standards Flagship/LLU implement a health facility
for the PMC institutions (decide whether to accreditation program
use them as the gold standard)
5. Establish and develop governance and September 2009 Minister of Health/ Link to Module #15: Training
leadership for the PMC (education for a Flagship/LLU & fellowship program in
functioning board, hiring the right people, health administration &
mentoring process) management program for the
public sector
5.1 Board of Trustees:
- Develop criteria for board members
- Establish term limit
- Develop roles and responsibilities, including
fundraising duties

- Form the board
5.2 Develop by-laws for the PMC
6. Establish an appropriate and transparent TBD Minister of Health/ Link to Module #3: Support
cost-recovery system for the PMC to Flagship/LLU implementation of the new
include: patient fees, donor support and Health Insurance Program
hospital expenses
7. Develop a master plan for patient flow for TBD Minister of Health/
the PMC including: assessment and Flagship/LLU
evaluation of length of stay, appropriateness
of admissions, tertiary care outside of
Palestinian and PMC hospital services
8. Develop and establish a transparent HR TBD Minister of Health/ Link to Module #15: Training
management system for the PMC (system of Flagship/LLU & fellowship program in
employment, job descriptions for key health administration &
positions) management program for the
public sector
Link to Module #7: Improve

performance management
9. Develop and acquire appropriate medical Ongoing Minister of Health/ Link to Flagship Project
technology and equipment for the PMC Flagship/LLU Component 3 (Procurement)
10. Develop and establish a pharmaceutical and TBD Minister of Health/ Link to Flagship Project
medical supply system for the PMC Flagship/LLU Component 3 (Procurement)
11. Develop and integrate the following PMC TBD Minister of Health/ Link to Module #2: Develop a
support services: Flagship/LLU health information system
- Pharmaceutical services
- Radiology Link to Module #4: Design &
- Clinical laboratory implement a continuous
- Health information management/medical education program for health
records professionals
- Information systems (computers, staff) Link to Module #5: Create &
- Nutritional services implement a relicensing

- Facilities management & engineering system for health professionals
- Biomedical engineering
- Medical library and learning resource center Link to Module #8: Strengthen
service delivery & clinical
guidelines
12. Staff development and education training TBD Minister of Health/ Link to Module #4: Design &
Flagship/LLU implement a continuous
education program for health
professionals
Link to Module #5: Create &

implement a relicensing
system for health professionals
13. Continuous Quality Improvement (CQI) TBD Minister of Health/ Link to Module #7: Improve
Flagship/LLU performance management
14. Review and assess current medical waste TBD Minister of Health/ Link to Module #18: Improve
management program Flagship/LLU medical waste management

Bahrain Pediatric Hospital (BPH) & Sheikh
Zayed Emergency
1. Establish a realistic opening date for the BPH TBD Minister of Health/
Flagship/LLU
2. Identify and meet MoH standards for hospital TBD Minister of Health/ Review in light of #6: Design
licensure Flagship/LLU & implement a health facility
accreditation program
3. Establish a hospital activation and TBD Minister of Health/
implementation team Flagship/LLU
4. Conduct a “mock” hospital patient care day with TBD Minister of Health/
actors as patients to test and verify all processes Flagship/LLU
and systems
5. Submit for consideration BPH clinical services: TBD Minister of Health/
NICU, PICU, maternity, and general pediatrics Flagship/LLU
6. Establish appropriate physician and nurse to TBD Minister of

patient ratios Health/Flagship/LLU
7. Identify and collaborate with existing pediatric TBD Minister of Link with Module #15:
residency training program Health/Flagship/LLU Training & fellowship program
in health administration &
management program for the
public sector
8. Assess and evaluate current nursing staff TBD Minister of
educational level Health/Flagship/LLU
9. Integrate and implement appropriate TBD Minister of Link with Module #2: Develop
telemedicine systems in the following areas: Health/Flagship/LLU a health information system
- Patient consultations Link with Module #4: Design

- Continuing professional medical education & implement a continuous
- On-site in-service orientation and training education program for health
- Administrative leadership & development professionals
- Flagship Project management
Link with Module #7: Improve
Link with Module #15:

Training & fellowship program
in health administration &
management program

Module 2: Develop a Health Information System
Linkages to the National Strategic Health Plan: Strategic Objective 1.10, 2.3, 5.3, and 5.4.
Why: Developing a health information system is a cross-cutting issue that affects the entire
health system. However, developing a health information system goes beyond just the
procurement and installation of software and equipment. MoH staff stressed the importance
of building its capacity to utilize data for management, planning, and informed policy
formulation. Establishing a comprehensive and integrated health information system will
allow this to happen.
Elements in the Reform Process Addressed: The development of a comprehensive health

information system will address the various elements of efficiency, equity, access, highest
quality, and sustainability.
Results of Intervention: A health information system is in place and utilized by the MoH
and health sector at large to aid in the management, planning, and informed policy
formulation that will lead to better service delivery and public satisfaction.
Component & Deliverable:

Component 1: Health Sector Management and Reform. Deliverable 3: Health Administration
and Management Program for the Public Sector.
Workplan Objective:
Objective 1: Improve good governance and management practices in the Palestinian health
sector.
Expected Result: Improve management practices within the MoH network.

Module 2: Develop a Health Information System (HIS)
Activity Time Frame Responsibility Comments
Month Year
1. Review of the current status at the March 2009 Director of Health Information This should include carrying out
MoH in the following areas: Center/Director of Health workshops with the staff at the
Information-Insurance/MoH IT MoH (decision makers and end
- Patient Medical Records Department/Flagship users) to decide on what
- Available Hardware and software indicators they need to be
- Computer literacy among MoH staff incorporated in the data
collection process
2. Create draft feature list for HIS, March 2009 Director of Health Information
system specifications and Center/Director of Health
infrastructure Information-Insurance/MoH IT
Department/Flagship
3. Issue the HIS RFP April 2009 Director of Health Information The RFP will outline the detailed
Center/ Director of Health deliverables and exact
Information-Insurance/MoH IT implementation time frame
Department /Flagship
4. Evaluation of submitted proposals August 2009 Director of Health Information
and selection of firm Center/Director of Health
Information-Insurance/MoH IT
Department/Flagship
5. Implementation of HIS September 2009 Director of Health Information
development Center/Director of Health
Department/Flagship/HIS
subcontractor
6. Developing project coordination December 2009 Director of Health Information
mechanisms and architecture Center/Director of Health
Department/Flagship

Time Frame
7. Develop requirements, and March 2010 Director of Health Information

detailed design and testing Center/Director of Health
Department/Flagship
8. Data conversion and integration, June 2010 Director of Health Information
and acceptance testing Center/Director of Health
Department/Flagship
9. Documentation and training, pilot September 2010 Director of Health Information
test and implementation Center/Director of Health
Department/Flagship
10. Roll out of HIS in phases December 2010 Director of Health Information
Center/Director of Health
Department/Flagship
11. Support and maintain new system December 2011 Director of Health Information
Center/Director of Health
Department/Flagship

Module 3: Support Implementation of the New Health Insurance Program
Linkages to the National Strategic Health Plan: Strategic Objectives 1.8, and 2.2
Why: The development of an efficient and modern Health Insurance Program (HIP) will
strengthen the MoH’s ability to generate much-needed revenues to sustain the program and
finance health services. It will also help the MoH to ensure that enrolled citizens receive
better quality health services. This task constitutes an integral part of the MoH three-year
strategic plan.
Elements in the Reform Process Addressed: The lack of an efficient and transparent HIP
is undermining the task of creating a vibrant health financing system, a key determinant of
health system performance in terms of equity, efficiency, and quality. In addition, reforming
the health insurance system will improve cost recovery thereby advancing sustainability of
the health finance system. Moreover, the reform should advance better health conditions for
the enrolled population.
Results of Intervention: Strengthened financial viability of the HIP will foster the MoH’s
ability to generate revenues to sustain the program. Better quality and efficiency in services
will be provided to the enrolled population.

Workplan Objective:
sector.
Expected Result: Improved governance in the Palestinian health sector.

Module 3: Support Implementation of the Health Insurance Program (HIP)
Month Year
1. Analysis of cost of services by the March-April 2009 General Directorate of Health
MoH and other health service Insurance/Flagship/Consultant
providers
2. Specify the package of services to June 2009 General Directorate of Health The activities outlined in this plan
be included/excluded in the HIP Insurance contribute to develop a service
(basic package of health services) provision/purchasing strategy,
which is a crucial step to drafting
the by-laws and implementing the
HIP
3. Develop actuarial link between August 2009 General Directorate of Health
contributions, covered risks, and the Insurance
cost of the health benefits package
4. Identify and develop the HIP TBD General Directorate of Health The MoH team committed to
network of service providers Insurance completing these activities in the
upcoming six months; however
actual implementation of the
following activities will be linked
to the passing of the health
insurance law
5. Support the development of core TBD General Directorate of Health
business functions, including Insurance
beneficiary relations and provider
relations
6. Set up HIP transparent and TBD General Directorate of Health

accountable management and Insurance
financial system

Time Frame
7. Develop claim system and TBD General Directorate of Health

processing Insurance
8. Support development of system for TBD General Directorate of Health

fees collection, beneficiary Insurance
enrollment, and management
9. Conduct willingness to pay study TBD General Directorate of Health

based on formulated Health Insurance/Flagship/Consultant
Insurance Program
10. Test the HIP for sustainability TBD General Directorate of Health
Insurance/Flagship/Consultant
11. Draft and implement HIP by-laws TBD General Directorate of Health
Insurance
12. Establish rules and lines of TBD General Directorate of Health
responsibilities between MoH, HIP Insurance
and health service providers
13. Develop contracting system with TBD General Directorate of Health
service providers based on Insurance
performance and standard set of
criteria
14. Contract service providers based on TBD General Directorate of Health MoH may need to renegotiate
performance and standard set of Insurance current contracts based on the
criteria revised costing
15. Implement the Health Insurance TBD General Directorate of Health Link with communications and
Program Insurance determine education/awareness
campaign on new HIP

Module 4: Design and Implement a Continuous Education Program for Health
Professionals
Linkages to the National Strategic Health Plan: Strategic Objective: 4.3
Why: It is essential that the workforce (including both health professionals and care providers)
have opportunities to access resources and programs in order to continuously update their
knowledge and skills so as to remain technically competent to perform the jobs/tasks that they
are assigned to perform. This priority area is a prerequisite and linked to the priority area of
creating a system to relicense health professionals. It is also linked to the priority area of
performance improvement.
Elements in the Reform Process Addressed: Establishing a system that provides opportunities
for continuous learning/updating of knowledge and skills that addresses issues of access and
equity of providers to continuous learning, efficiency in accessing the continuous learning
opportunities, improved quality of care, and putting in place a sustainable system to provide
continuous learning
Results of Intervention: Organizational structures in place to offer different kinds of

continuous learning opportunities, processes to motivate and enable health professionals and care
providers to engage in continuous learning resulting in technically competent work force.

Component 2: Clinical and Community-based Health. Deliverable 5: Continuing Education
Program for Primary Health Care providers.6
Workplan Objective:
Objective 2.1: Improve the quality of essential clinical services for Palestinians with application
to both primary and secondary care settings. Task 2.1.1: Strengthen the capacity of Palestinian
health institutions to deliver a quality package of essential primary care services. Task 2.2.2:
Strengthen the capacity of Palestinian health institutions to effectively use communication
strategies to promote healthier and safer behaviors.
Expected Result: Strengthened capacity of health institutions to deliver clinical services.
6
No deliverable specified for professionals and health care workers in secondary care settings- have reworded
deliverable to include both primary and secondary settings.

Module 4: Design and Implement a Continuous Education (CE) Program for Health Professionals
Month Year
1. Establish a database for March-September 2009 General Directorate of Higher and Linked to Module #5: Create &
recording all health cadres Continuing Health Education/ implement a relicensing system
including their qualifications, Directorate of Human Resources and for health professionals
training received and related Development/Flagship
activities Linked to Module #15: Training
& fellowship program in health
administration & management for
the public sector
2. Design and implement the April 2009 General Directorate of Higher and A training passport is a booklet in
“training passport” Continuing Health Education/ which trainees document their
Directorate of Human Resources and completed trainings
Development/Flagship
3. Identify appropriate March-April 2009 General Directorate of Higher and Important to establish
professional associations, Continuing Health Education/ communication link between
universities, organizations to Directorate of Human Resources and 1) counterpart General
engage in offering CE Development/Flagship Directorate of Higher and
programs for health Continuing Health Education and
professionals and care 2) Licensing and Accreditation
workers Unit
4. Design the CE program July 2009 General Directorate of Higher and This will include selecting target
building on successful Continuing Health Education/ populations and topics for CE
experiences in country and in Directorate of Human Resources and training
other countries Development/Flagship/Partners
5. Release RFA/RFP to solicit August-September 2009 General Directorate of Higher and Refer to Annex: CE Framework
the services of local Continuing Health Education/ for details of RFA/RFP. Provide
organizations to provide CE Directorate of Human Resources and guidance to organizations
training Development/Flagship responding to the RFP

Time Frame
6. Evaluate proposals and October-November 2009 General Directorate of Higher and

award grant to successful Continuing Health Education/
bidder Directorate of Human Resources and
Development/Flagship/Partners
7. Work with selected December-January 2009/2010 General Directorate of Higher and
organization to build the Continuing Health Education/Directorate
capacity of their trainers, of Human Resources and
faculty members, tutors, and Development/Flagship/Partners
clinical professionals to plan,
manage, and evaluate
training programs

Annex: Continuing Education Framework
Assessment Process:
• Develop a base-line assessment tool to identify gaps in knowledge, attitude, skills, and
practice among all health professionals and care providers.
• Prioritize CE needs for all cadres of health professionals and care providers identified by
the assessment.
• Identify and assess the MoH’s existing CE programs to determine if programs respond to
the needs of the health care system and the learner.
• Contact local universities to review and determine the availability and progress in
developing e-learning and distance learning programs for health professionals and other
groups as well as reviewing the quality of existing CE programs for health professionals.
• Identify available local trainers, their specialties and contact information to determine
who could offer CE training.
Planning:
• Identify purpose and objectives of the needed programs for CE.
• Define content areas of CE programs based on the needs assessment.
• Identify target audience (e.g., health professionals physicians (GP and Specialists),
Nurses, Midwives, Pharmacists, Lab Technicians, X-Ray Technicians, Physiotherapists,
Community Health Workers, etc).
• Identify the needed type of learning activities including courses/workshops/seminars/e-
Modules for all health cadres.
• Identify expected outcomes of the CE programs that will affect performance of health
care system and patient outcomes.
• Develop a HIS system to document participation in training activities by learner and by
facility/by health directorate. Include information in both a paper system (trainer record)
and electronically including training topic, duration of course/workshop offering,
performance achieved, whether or not a course is accredited, original copy of the course
completion certificate, number of training courses attended, etc.
• Liaise with the MoH and Minister of Higher Education to recognize/accredit programs as
needed to respond to the requirements of the health care system and update the health
professionals’ knowledge.
• Develop the capacity of MoH staff to take the lead in conducting CE training programs
• Develop in-service training framework to be implemented in MoH health facilities.
• Consider ways of involving health care professionals and care providers from the NGOs
and the private sector in CE program organized by MoH.
• Utilize prerequisites for trainees to enroll in CE program offerings:
- Licensed health professionals or care provider
- Working in the department where upgrading of skill is needed and will return to the same
department
- History of working in the department and achievement of a certain level of competency
and motivation to continue study in this particular area related to the work

Implementation:
• Implement CE program for all health cadres and care providers based on the designed
schedule.
• Identify pre-approved local and international universities, professional associations,
private sector groups to address and contact to implement CE programs in MoH health
facilities.
• Implement in-service on-the-job training within the MoH facilities using different
accredited and approved CE programs.
• MoH and implementing institutions will monitor the quality of the programs that are
offered and follow up the implementation of the CE programs in the departments and
participating organizations.
Evaluation:
• Set guidance for MoH to support and follow up with health professionals and care
providers who have participated in CE programs to ensure return to the MoH facility and
application of knowledge gained through training.
• Review performance and determine if person can be promoted based on the new
knowledge and new skills acquired during the training.
• Ensure that the MoH provides incentives to trainees who have successfully completed the
training.
• Design e-learning Modules/new courses/workshops/seminars Modules to respond to the
health care system needs.
• Support research or survey activities to measure the impact of the training on the health
facilities’ performance and responsiveness to the health system needs.
• Evaluation (post-training requirements and guidance) for trainees who participated in CE
programs.
• Review requests for transfer and/or resignation from the department that sent the
participants after 6 months (period of time needs to be determined depending length of
the training).
• Train other staff on new knowledge and skills gained during training.
• Conduct workshop or sessions on gained knowledge to transfer knowledge to other
departments.
• Disseminate knowledge/skills acquired by writing papers or updating or developing job
aides related to the skills participants have acquired.

Module 5: Create and Implement a Relicensing System for Health Professionals
Linkages to the National Strategic Health Plan: Strategic Objective 5.2.
Why: The development of an objective, credible, practical and sustainable system that both
supports the continuous professional development and relicensure of all Palestinian health
professionals is critical to ensure that a technically competent workforce is maintained to provide
quality care according to international best practices.
Elements in the Reform Process Addressed: Establishing a system to relicense health

professionals addresses issues of quality of services provided by technically competent staff,
efficiency, and sustainability of a system for continuous learning.
Results of Intervention: Organizational structure to implement relicensure program, and

process developed to enable health professionals to engage in professional development. Process
developed to review documentation submitted by health professionals to apply for relicensure.
Health workforce engaged in a process of continuous professional development.

Component 1: Health Sector Management and Reform. Deliverable 4: Palestinian Health Facility
Accreditation Program.
Workplan Objective:
Objective 1: Improve Good Governance and Management Practices in the Palestinian Health
Sector. Task 1.1.1: Strengthen the capacity of the MoH to implement reforms needed for
improved quality, sustainability, and equity in the Palestinian health sector.
Expected Result: Improved management practices within the MoH network.

Module 5: Create and Implement a Relicensing System for Health Professionals
Month Year
1. MoH relevant departments: Ministry March 2009 General Directorate of Higher This priority should be linked to
of Education and Higher Education, and Continuing Health areas related to training and
Civil Service Diwan– discuss Education/Directorate of Human continuous education
Resources and Development/
purpose of program, determine scope
Licensing and Accreditation
of relicensure program (cadres to be Unit/Flagship
included: Physicians, Specialized
doctors, General Practitioners;
Dentists, Pharmacists, Nurses &
Midwives, Health workers, and Para-
medicals) and incentives to
participate (both financial and non-
financial) and whether a phased
process of voluntary relicensing that
eventually transitions to mandatory
requirements might be useful
2. Come to consensus on a strategy to April 2009 General Directorate of Higher Link with communications and
promote awareness about the need for and Continuing Health determine when to promote
such a program with all relevant Education/Directorate of Human awareness
parties
Unit/Flagship

Time Frame
3. Discuss and define the roles and May-June 2009 General Directorate of Higher Follow up on work being done
responsibilities of the Palestinian and Continuing Health with Bir Zeit University (BZU)
Health Council and the different Education/Directorate of Human to compile and review the
Resources and Development/ current legislation related to
professional associations in reviewing
Licensing and Accreditation licensing and relicensing
and approving CE courses and report Unit/Flagship procedures and requirements
recommendations to MoH/Licensing
& Accreditation Unit
4. Design the licensing and relicensing January 2010 General Directorate of Higher Based on the results of the
system in coordination with the CE and Continuing Health assessment being conducted by
program and in cooperation with Education/Directorate of Human BZU
relevant ministries and institutions
Unit/Flagship
5. Establish selection criteria for the February 2010 General Directorate of Higher
institutions that will participate in the and Continuing Health
new system Education/Directorate of Human
Unit/Flagship
6. Develop a Health Management April 2010 General Directorate of Higher Link with Module #2: Develop
Information system (HMIS) to track and Continuing Health a health information system
licensure/relincensure of participating Education/Directorate of Human
Resources and Development/ – identify categories for
health professionals
Licensing and Accreditation inclusion
Unit/Flagship/Partners – Contact IntraHealth for
system that might be available
to adapt

Time Frame
7. Develop a promotion strategy by the February-March 2010 General Directorate of Higher Link with Module #13: Improve
MoH with the various professional and Continuing Health health communication services
associations to disseminate standards Education/
Directorate of Human Resources
for each organization
and Development/Licensing and
Accreditation
Unit/Flagship/Partners
8. Disseminate information on the new June-July 2010 General Directorate of Higher
system for health professionals and all and Continuing Health
relevant parties Education/
Directorate of Human Resources
and Development/Licensing and
Accreditation
Unit/Flagship/Partners
9. Form a committee that will review the January-September 2010 General Directorate of Higher
selected options: and Continuing Health
course/seminar/workshop offerings Education/Directorate of Human
(objectives, content, instructor, and
teaching/learning process) for each Unit/Flagship/Partners
cadre and validate (accredit) that the
course offering meets preset standards

Time Frame
10. Implement the options agreed upon January 2011 General Directorate of Higher Work closely with participating
in order to have the CE options and Continuing Health MoH departments and
accessible for all health professionals Education/Directorate of Human determine contributions from
Resources and Development/ each to implement this activity
- Identify and develop learning Licensing and Accreditation
Modules with tests that are Unit/Flagship/Partners
appropriate for the needs of the
different cadres of health
professionals
- Establish a series of learning centers

with 4-5 computers, internet
connections and guidance about the
websites to access the e-learning
Modules and how to use the
computers (1 for each health
directorate and hospital)
11. Identify and encourage hospitals, January 2011 General Directorate of Higher
professional associations, and and Continuing Health
universities to offer courses that meet Education/Directorate of Human
the standards set by the approving
body for the different health cadres Unit/Flagship/Partners
and cost recovery plans

Time Frame
12. Identify international organizations Ongoing General Directorate of Higher Twinning between international
that will “twin” with Palestinian and Continuing Health organizations and Palestinian
institutions who could offer Education/Directorate of Human institutions will encourage
Resources and Development/ exchange of expertise, lessons
continuing education opportunities for
Licensing and Accreditation learned, and best practices in
health professionals Unit/Flagship/Partners continuing education. It will
provide an opportunity for
international experiences to be
adopted within the Palestinian
context
13. Recognize/acknowledge and Ongoing General Directorate of Higher
disseminate a list using a variety of and Continuing Health
channels (media, newspapers) of Education/Directorate of Human
those professionals who have
participated in the process of updating Unit/Flagship/Partners
their knowledge and have met
requirements for relicensure

Module 6: Design and Implement a Health Facility Accreditation Program
Why: The development of an objective, externally validated, transparent accreditation process

represents a commitment to quality care by all stakeholders (MoH, management and staff of
health facilities) and informs the community that quality care is provided at a particular facility.
Elements in the Reform Process Addressed: Developing a health facility accreditation

program addresses the elements of efficiency (institutions identified as providing quality care),
assures that minimum standards of quality are adhered to; enhances access (expands the reach of
quality programs; and supports sustainability (develops policy, human and financial resources,
and the technical capability to continue the accreditation program).
Results of Intervention: An organizational structure in place to implement accreditation

program, standards adapted, process to prepare staff and institutions to participate, surveyors
trained. Accredited health facilities and a system are in place to continue this process.

Component 1: Health Sector Management and Reform. Deliverable 4: Palestinian Health Facility
Accreditation Program.
Workplan Objective:
Objective 1: Improve Good Governance and Management Practices in the Palestinian Health
Sector. Task1.1.1: Strengthen the capacity of the MoH to implement reforms needed for

Module 6: Design and Implement a Health Facility Accreditation Program
Month Year
1. Interview the Licensing and March 2009 MoH/Licensing & Flagship will share a draft
Accreditation Unit to understand current Accreditation Unit/Flagship assessment tool with the MoH to
mandate, system and future directions, review
scope of program, financial and non-
financial incentives, and structure.
Review the accreditation readiness tool
with the unit.
2. Identify key MoH staff, and March 2009 MoH/Licensing &
representatives from NGO health Accreditation Unit /Flagship
service providers, UNRWA, and the
private health sector to participate in
developing the accreditation system
3. Ensure that the review being done by March 2009 MoH/Licensing &
BZU (of regulations, laws, procedures) Accreditation Unit
reveals any legislation related to
accreditation and licensing
4. Review existing standards of care from March 2009 MoH/Licensing &
accreditation institutions (consider Accreditation Unit/Flagship
adopting JCI standards for
accreditation)
5. Conduct study tour to Jordan and June 2009 MoH/Licensing & Establish clear and transparent
Lebanon to compare and contrast two Accreditation Unit/Flagship/ selection criteria for the staff visiting
different accreditation approaches in Flagship Consultant to ensure that what they learn will be
Jordan and Lebanon: one using JCI transferred to their peers
standards to accredit the King Hussein
Hospital and the other developing in- Study tours should include private
country processes for accrediting and public accredited institutions
hospitals

Time Frame
6. Develop and pilot test standards to July 2009 MoH/Licensing &

conduct accreditation of facilities and Accreditation Unit/Flagship
agree on passing scores (critical
standards)
7. Test the pilot accreditation program at June-July 2009 Link with Module #1: Create a
the PMC center of excellence at the
Palestine Medical Complex
8. Prepare a report on the findings from July-August 2009 MoH/Flagship/Consultant
the accreditation readiness assessment
9. Establish consensus on process to September 2009 MoH/Flagship/Consultant
accredit institutions (with inputs,
timeline, and commitments) from MoH
& other stakeholders including who is
responsible
10. Define the structure (roles and TBD MoH/Flagship
responsibilities) of entity to conduct
accreditation process: a) standards for
accreditation; b) surveyor training; c)
data analysis and report preparation
11. Identify and begin preparing facilities to TBD MoH/Flagship/Consultant Need to have two paths
participate in accreditation process simultaneously occurring: preparing
(Establish teams, review standards) institutions for accreditation and
developing process for accreditation

12. Prepare surveyors to conduct TBD MoH/Flagship/Consultant Workshop
accreditation
13. Conduct institutional accreditation TBD MoH/Flagship/Consultant Cost: prepare surveys,
surveys transportation, consultant
14. Analyze data from institutional TBD MoH/Flagship
surveys

Time Frame
15. Prepare institutional feedback plan TBD MoH/Flagship

based on collected data
16. Conduct awards ceremony for facility TBD MoH/Flagship Link with communications and
staff and promote awareness to public awareness
community of the quality of care
provided at the “recognized” facility

Module 7: Improve Performance Management
Linkages to the National Strategic Health Plan: Strategic Objectives 2.1, 2.3, 4.1, 4.2, 4.5,
5.1, 5.2, and 5.6.
Why: Performance management is fundamental to ensuring high quality health services. The
provision of new performance management approaches and tools will result in a more motivated
staff with a clear understanding of their jobs, establishment of peer support at the clinical
practice level, and trained supportive supervisory staff to provide clinicians the guidance that
they need to perform their jobs. The focus of performance management will be introduced at the
central, district, and facility levels.
Elements in the Reform Process Addressed: Strengthening performance management

practices at both the central and district level will address issues of efficiency of the system,
quality of services provided, and sustainability of the changes introduced.
Results of Intervention: System change from audit/inspection to supportive supervision,

motivated staff, decentralization of responsibility from central level to strengthened facility
responsibility; establishment of a sustainable process to continuously review and improve care
provided, and improved clinical services.
Components & Deliverables:

Component 1: Health Sector Management and Reform. Deliverable 3: Health Administration and
Management Program for the Public Sector.
Component 2: Clinical and Community-Based Health. Deliverable 4: and Component 2/Task

2.1.2, Deliverable 3: Integrated Quality Improvement (QI) programs for delivery of PHC and
hospital services.
Workplan Objectives:
Component 1.1: Strengthen the capacity of the MoH to implement reform needed for improved
quality, sustainability, and equity in the Palestinian Health Sector.
Component 2.1: Improve the quality of essential clinical services for Palestinians.
Expected Results: Improved management practices within the MoH network of facilities and
improved clinical and community-based health services.

Module 7: Improve Performance Management
Month Year
1. Review and update the March-September 2009 General Directorate for Planning The General Directorate for
mandates for all directorates, Planning will conduct this review in
departments, and units within coordination with all relevant parties
the Ministry within the Ministry
2. Develop a financial and non- March-September 2009 General Directorate for
financial performance-based Continuing Education
incentive system for MoH staff
3. Develop and implement March-September 2009 General Directorate for Link with Module #15: Training &
leadership training and Continuing Education fellowship program in health
capacity building program for administration & management for
all management levels the public sector
4. Develop staff performance March-September 2009 General Directorate for Finance Link with Module #18: Introduce &
evaluation for the Ministry and Administration/General implement a comprehensive M&E
staff Directorate for Continuing approach & system
Education
5. Activate/implement new March-September 2009 General Directorate for PHC and Link with Module #11: Improve
referral system between the hospitals clinical MoH primary care system
PHC facilities and hospitals
Link with Module #12: Improve the
quality of clinical services in the
Palestinian MoH hospital system
6. Determine feasibility to TBD MoH/Flagship
introduce improved
practices using a top-down and
bottom up approach
(simultaneously)

Time Frame
7. Central Level: confirm with TBD MoH/Flagship Link with Module #15: Training &
the MoH which concepts of fellowship program in health
performance management and administration & management
new approaches and tools to be program for the public sector
included in the leadership
program: Ensure that key issues to strengthen
- supportive supervision performance management are
- job descriptions included and appropriate
- feedback about performance representation at central, district and
- Quality Improvement (QI) teams at facility level are included in the
facilities Management Leadership Program
- cycle of continuous performance
review
- rewarding of staff
- update training of staff
- identification of performance gaps
- tools to resolve problems at facility
level
8. Develop and implement series TBD MoH/Flagship/Partner TRG Equipment: web-based instruction,
of workshops for Health workshop training equipment, and
Administration & Management workshop materials
training
9. Develop practical assignments TBD MoH/Flagship/Partner TRG
for central and district level
staff to support improved
performance management at
central, district, and facility
level

Time Frame
10. Facility level approach: TBD MoH/Flagship Identify department unit and lead
Conduct preparatory meetings counterpart(s) to work with on
with MoH/Quality Directorate performance management and
and Performance Improvement improvement at district and facility
(PI) staff and other level for both PHCs and hospitals
stakeholders to understand
their process and approaches to
improving quality at the
facility level
11. Identify examples of TBD MoH/Flagship
successful QI and PI
methods/approaches to build a
QI process at the facility level
(e.g. decentralizing
responsibility to facility level
to review quality of services
provided). Summarize positive
experience and lessons learned
from applying the
methods/approaches to
improve quality/performance
improvement
12. Develop training materials to TBD MoH/Flagship/Consultant
support supervisory teams at
district level to introduce
different methods of
performance review and
improvement

Time Frame
13. Implement training of TBD MoH/Flagship/Consultant Confirm initial districts and facilities
supportive supervisory teams to participate in training (determine
at district level to introduce criteria for introducing in phases (for
different methods of example, a PHC with large volume
performance review and of utilization or one hospital/district)
supportive supervision.
Examples of training methodology
include:
- self assessment (access to care,
physical environment, client-
provider-community relationships,
management (facility review), and
technical competency of the
providers (individual review)
- medical chart review by provider
and peers for accuracy and
completeness
-seeking client feedback about care
received
- coaching/mentoring and
establishment/fostering effective
team functioning
14. Establish supportive TBD MoH/Flagship
supervision teams at district
level and facility teams and
provide support to facility
teams

Time Frame
15. Link PI at facility to training TBD MoH/Flagship Link with Module #8: Strengthen
and monitoring the application service delivery & clinical
of standards and protocols by guidelines
staff following development of
primary, secondary and OPD
clinical operational protocols –
(post-training follow up at the
site)
16. Determine if feasible to TBD MoH/Flagship Examples might include:
organize review of clinical
care to achieve particular - maintaining/improving
indicators using QI methods immunization coverage
- decreasing anemia for children and
pregnant women
- increasing the use and effectiveness
of postpartum care
- early detection/management of
diabetes
- early detection/screening and
management of hypertension/CVA
- early detection/screening for
specific kinds of cancer (breast and
cervical)
17. Analyze and summarize TBD MoH/Flagship
identified performance gaps Consultant
from the health facility
improvement plans quarterly
(once the process has been
established).

Time Frame
18. Identify the type of TBD MoH/Flagship Classify performance gaps

interventions to respond to the
identified performance
management gaps (e.g.,
training (OJT and formal),
mobilization of resources,
clear job descriptions, and
incentives (non-financial and
financial)
19. Present categorized TBD MoH/Flagship Link with Module #9: Improve
performance gaps that have coordination of stakeholders
been categorized to donor
coordination committee to seek
consensus on who can provide
TA and other resources to
resolve problems. Assign
responsibility to monitor
implementation of TA
20. Develop monitoring plan to TBD MoH/Flagship/partner Link with Module #18: Introduce &
track improvements in facility implement a comprehensive M&E
performance approach & system
21. Evaluate changes in TBD MoH/Flagship/partner/consultant Link with Module #18: Introduce &
performance management at implement a comprehensive M&E
central, district, and facility approach & system
level
22. Recognize facilities that have TBD MoH/Flagship Link with Module #6: Design and
achieved certain criteria for implement a health facility
improved performance accreditation program
23. Continue roll out of TBD MoH/Flagship
strengthened performance
management to other facilities

Module 8: Strengthen Service Delivery and Clinical Guidelines
Linkages to the National Strategic Health Plan: Strategic Objectives 1.4, 1.7, 4.1, and 5.3.
Why: It is extremely important to strengthen service delivery and clinical guidelines because
one of the MoH’s principle objectives is improving quality of services and this can be
achieved by evidence-based practices and compliance with the protocols by well-trained
health professionals.
Elements in the reform process Improvements in this area will positively impact access,
efficiency, quality, and sustainability.
Results of Intervention: Standardization of practices and applied evidence-based health

actions which will lead to improve the quality of services provided.

Component 2: Clinical and Community-Based Health. Deliverable 3: Develop package of
essential primary care services for each level at the MoH.
Work plan Objective:

2.1.1: Strengthen the capacity of Palestinian health institutions to deliver a quality package of
essential primary care services.

Module 8: Strengthen Service Delivery and Clinical Guidelines
Month Year
1. Form committees from MoH, March 2009 General directors of MOH Link with Module #9: Improve
NGOs, UNRWA and the coordination with stakeholders
representatives of private sector to
review, update and adapt Link with Module #13: Improve
protocols and guidelines, health communication services
including related patient
education materials
2. Develop chart/framework that March 2009 General directors of MOH
identifies the protocols that are
needed, the availability and
quality of existing protocols, and
current staff preparedness to use
the necessary protocols
December 2009 General directors of MOH This should include establishing
3. Develop process and timeframe standardized policies and
for updating protocols procedures to explain how
national clinical guidelines are
developed, formatted, officially
approved, revised, updated, and
disseminated
December 2009 General directors of MOH Recommended to be in one-page
4. Develop a simple guide to use to format
simplify and standardize the
protocols
5. Printing of new and reprinting of March 2010 General directors of MOH
old protocols

6. Protocols should be distributed March 2010 General directors of MOH Link with Module #11: Improve
both to MoH clinics and hospitals clinical MoH primary care system
as well as to NGOs, UNRWA and
private sector Link with Module #12: Improve
the quality of clinical services in
the Palestinian MoH hospital
system

coordination of stakeholders
7. Conduct training on all agreed upon March 2010 General directors of MOH Link with Module #11: Improve
protocols, including the private clinical MoH primary care system
sector
system

coordination of stakeholders

Module 9: Improve Coordination of Stakeholders
Linkages to the National Strategic Health Plan: Strategic Objectives 2.4 and 5.5.
Why: Strengthening the capacity of the MoH to coordinate stakeholders (citizens, NGOs,
private sector, international agencies, and the donor community) will ensure that long-term
health sector priorities are addressed, that the regulatory role of the MoH is strengthened, and
that there is greater predictability of resources to finance MoH development goals.
Elements in the Reform Process Addressed: Support the MoH to be more responsive in
terms of creating a better health system as this function touches all of the health system
performance indicators of equity, access, efficiency, quality and sustainability.
Results of Intervention: Strengthened coordination among health sector stakeholders

including health care recipients, providers and financers.

and Management Program for the public sector.
Workplan Objective:
sector.

Module 9: Improve Coordination of Stakeholders
Month Year
1. Strengthen the capacity of the National March 2009 International Cooperation Link with Module #3:
Health Policy and Strategic Planning Department/Minister’s Office/Health Support to the new Health
Council (NHPSPC) as a mechanism to Policy and Planning Department/ Insurance Program
enhance the MoH capacity to engage and Flagship/Consultant
integrate NGOs, private sector partners,
and stakeholders in policy formulation,
planning, and service provision. (To be
checked with the Minister for proper
instruments)
2. Establish mechanisms to engage and March-May 2009 MoH/Flagship/NGOs This would entail
solicit public participation in health establishing cooperation
policy formulation and decision-making with NGOs advocating for
citizen participation and
organizations with large
representation (unions and
syndicates)
Link to Module #16:

Improve community-based
health services

Time Frame
3. Strengthen the capacity of the March-August 2009 International Cooperation

International Cooperation Department Department/ Health Policy and
and Health Policy and Planning Planning Department/MoH/
Department at the MoH to coordinate Flagship/Consultant
donor interventions in the health sector
3.1 Develop the existing database in

the International Cooperation
Department to include all data about
international assistance
3.2 Link the database with the

Ministry of Planning’s database to
increase cooperation and increase the
access to information
3.3 Collect information from other

Ministries’ departments regarding
other projects funded and provide to
Department
3.4 Establish a specialized unit within

Department to collect data and
information about NGO-funded
projects

Time Frame
4. Strengthen the role of the health sector March-August 2009 International Cooperation
working group in supporting Ministry of Department/Minister Office/Health
Health strategies at the Health Sector Policy and Planning Dept/Flagship
Working Group.
4.1 Review the mechanism of health

sector working group work to
recommend improvements.
4.2 Set up mechanisms to establish

funding baskets to finance
comprehensive projects (joint
projects)
4.3 Improve the Ministry’s

capacities for direct implementation
of international funds including the
funds management

Module 10: Support Passing and Implementation of the Health Commodities
Procurement By-laws
Linkages to the National Strategic Health Plan: Strategic Objectives 2.3, 2.4, and 5.2.
Why: The Health Commodities Procurement By-laws will be specific to the procurement of
health commodities for MoH. The current General Supplies Law is problematic because it
does not accept international competitive bidding and delays responses in case of emergency
situations. As a result, there is no public procurement entity, no standard bidding documents,
and no consistent record keeping or archiving of procurement documentation. These factors
contribute to high prices for procurements which lead to frequent shortages in stocks and lack
of competitive bidding which affects accountability and good management and financial
practices.
Elements in the Reform Process Addressed: These by-laws will ensure equity due to the
competitive bidding which gives local and international companies equal opportunities to
participate in the bidding process. They will also ensure access and quality through the
availability of health commodities in all health facilities with high quality and best prices,
which supports the right of the patients to receive the services without breaking the treatment
cycle. The implementation of these by-laws will also ensure the efficiency and
sustainability of the procurement process. These by-laws will support comprehensive health
commodities management (clear specifications, precise estimation of needs, goods receiving,
and storage and distribution practices, etc).
Results of Intervention: The implementation of this Module and training the relevant staff
working in departments related to these by-laws will result in: reduced health commodities
shortages, better estimation of quantities procured, having best and reasonable and
competitive prices, efficient and high quality procurements, better management of the drug
cycle which at the end will result in patient trust, convenience, and satisfaction.

and Management Program for the public sector.

sector. Task 1.1.1: Strengthen the capacity of the MoH to implement reforms needed for
Expected result: Improve management practices within the MoH network.

Module 10: Support Passing and Implementation of the Health Commodities Procurement By-laws
Month
Year
1. Form a joint MoH/Flagship health March 2009 MoH/Flagship
commodities procurement
legislation committee
2. Develop terms of reference for this March-April 2009 MoH Committee/Flagship Preparing a national
committee, including review and policy on
comment on the existing manuals pharmaceuticals that
promotes protection of
taking into consideration the
public health will
strengths and weaknesses, using the facilitate the
General Supplies Law (1998) as a development of new
main reference by-laws
3. Review other NGO/international May 2009 MoH Committee/Flagship

manuals such as WHO, World Bank
or other manuals in neighboring
countries recommended by the
committee in order to incorporate
previous best practices into the
Health Commodities Procurement
By-laws
4. Draft the new by-laws. May-September 2009 MoH Committee/Flagship/

Consultant/Legal Affairs Unit
5. Conduct workshop to review the September-October 2009 MoH/Flagship/other stakeholders Link to Module #9:
new by-laws with other stakeholders Improve coordination
of stakeholders

Time Frame
6. Submit the final draft of the Health November 2009 Minister’s Office
Commodities Procurement By-laws
for final review. Incorporate
comments and obtain final approval
from the cabinet.
7. Design training for the newly TBD MoH/Flagship

approved procurement by-laws.
8. Establish regulations, procedures TBD MoH/Flagship

and SOP’s to implement the
procurement by-laws
9. Develop a training plan on how to TBD MoH/Flagship

implement the new legislation
10. Conduct training sessions (TOT and TBD MoH/Flagship

TOP) for the relevant procurement
staff as designated by the MoH

Module 11: Improve Clinical MoH Primary Health Care System
Linkages to the National Strategic Health Plan: Strategic Objectives: 1.4, 1.7, 1.9, and 3.1.
Why: Improving clinical PHC services results in better quality of initial and preventive
health care, prevents inappropriate use of secondary care resulting in increased client
satisfaction, a healthier population, and decreased health care costs.
Elements in the Reform Process Addressed: Improving clinical PHC services will increase
accountability and leadership by the MoH, showing a commitment to respond to
community needs and the need to improve the quality of services provided. The MoH will be
implementing evidence-based standards that are internationally accepted, thereby improving
their credibility. These standards should apply to all primary health care, private, MoH,
UNRWA, and NGO clinics and facilities. The MoH will ensure financial sustainability
because it will designate part of it’s budget to support and sustain PHC programs.
Results of Intervention: Providing a package of quality services at the primary care level
that comply with national standards and respond to community needs.

Component 2.1: Improve the quality of essential clinical services for the Palestinians.
Deliverable 3: Develop package of essential primary care services for each level at the MoH.
Deliverable 4: Integrated Quality Improvement program for the delivery of essential package
of PHC services.
Deliverable 5: Continuing education program for PHC providers.
Deliverable 6: Other deliverables as specified in the MoH development plan for PHC.

2.1.1: Strengthen the capacity of Palestinian health institutions to deliver a quality package of
essential primary care services.

Module 11: Improve Clinical MoH Primary Health Care (PHC) System
Month Year
1. Select between 15-20 PHC clinics March 2009 PHC General Directorate Clinics could be from all the
to be upgraded from level I to districts or from some of them
Level II clinics; from Level II - III
clinics; and improving level III
clinics
2. Review human resource needs for October 2009 PHC General Directorate
reclassified and upgraded PHCs
(i.e. hiring more GPs, specialized
doctors, nurses, laboratory
technicians, pharmacists, and
others)
3. Provide the needed clinical December 2009 PHC General Directorate
equipment for the selected PHC
clinics and train the staff how to
use them, including emergency
equipment
4. Create a maintenance system at the January 2010 PHC General Directorate
PHC directorate and train engineers
on equipment maintenance
5. Provision of guidelines, protocols March 2010 PHC General Directorate Link with Module #8: Strengthen
and job aids service delivery & clinical
guidelines
6. Provide training on use of May 2009 PHC General Directorate
guidelines, protocols and job aids
7. Develop orientation protocol for December 2009 PHC General Directorate
the new employed staff
8. Train the new staff on PHC March 2010 PHC General Directorate Link with Module #15: Training &
services and rotate them to various fellowship program in health
departments administration & management
program for the public sector

Time Frame
9. Strengthen the health information September 2009 PHC General Directorate Link with Module #2: Develop a
system, including referrals and health information system
counter-referrals
10. Develop and implement a May 2009 PHC General Directorate Link with Module #7: Improve
performance improvement system performance management
to continuously review and
improve quality of services
11. Improve supportive supervision September 2009 PHC General Directorate Link with Module #7: Improve
approach including supervisory performance management
tools
12. Improve community participation March-April 2009 PHC General Directorate Link with Module #16: Improve
and strengthen the relationship with community-based health services
the community to identify health
problems, develop creative
solutions, and mobilize resources
13. Renovation and/or physical PHC General Directorate MOH with other USAID funded
expansion of clinics project (EWAS Program)

Module 12: Improve the Quality of Clinical Services in the Palestinian MoH
Hospital System
Linkages to the National Strategic Health Plan: Strategic Objectives: 1.7, 1.9, 3.2, and 5.6.
Why: Effective and appropriate care at each level results in increased patient satisfaction,
better health outcomes, and efficient use of MoH financial resources.
Elements in the Reform Process Addressed: The MoH’s accountability and leadership
will be strengthened through increased commitment to respond to community needs and to
improve the quality of services provided. The MoH will be implementing credible evidence-
based standards that are internationally accepted. These standards will be applicable to all
secondary health care, private hospitals MoH, UNRWA and NGOs. This will also include the
re-rationalization of bed distribution throughout the country. The MoH should designate part
of its budget to support and sustain the program.
Results of Intervention: A package of quality services at the secondary care level is

provided which complies with standards and supports an effective network that is responsive
to the community needs

Deliverable 3: Integrated Quality Improvement program for the delivery of hospital services.
Deliverable 4: Fellowship training and visiting professors program to support improved
quality of MoH hospitals.

2.1.2: Strengthen Quality Improvement systems within Palestinian institutions to deliver
better secondary care.
Expected Result: Strengthened capacity of health institutions to deliver better secondary

care.

Module 12: Improve the Quality of Clinical Services in the Palestinian MoH Hospital System
Month Year
1. Revise the existing Master April 2009 Hospital General Recommendation external consultant to initiate
Plan and draft new ones for Directorate discussions in April
hospitals where needed
2. Strengthen capacity of March 2009 Hospital General Link with Module #7: Improve performance
human resources (trained Ongoing Directorate Management
staff: GPs, nurses and
supportive staff) Link with Module #5: Create & implement a
relicensing system for health professionals
Link with Module #4: Design & implement a

continuous education program for health
professionals
Link with Module #15: Training & fellowship

program in health administration &
management program for the public sector
3. Update and develop March 2010 Hospital General Link with Module #8: Strengthen service
guidelines, protocols, and job Directorate delivery & clinical guidelines
aids
Link with Module #11: Improve clinical MoH
primary care system

Time Frame
4. Provide training on protocols March 2010 Hospital General Link with Module #8: Strengthen service
Directorate delivery & clinical guidelines
Link with Module #15: Training & fellowship

program in health administration &
management program for the public sector
Recommended long term and short term

subspecialties training courses
5. Provide training in hospital September 2009 Hospital General Link with Module #15: Training & fellowship
management and Directorate program in health administration &
administration management program for the public sector
6. Introduce Performance September 2009 Hospital General Link with Module #7: Improve performance
Improvement approach in Directorate management
each hospital to identify
problems and match them
with local solutions
7. Develop work plan for each April 2009 Hospital General
facility (initiation of activity) Directorate
8. Provide needed equipment, Ongoing Hospital General
and train staff how to use it Directorate
9. Create a maintenance system January 2010 Hospital General
at the hospital directorate and Directorate
train engineers on equipment
maintenance
10. Provide needed furniture December 2009 Hospital General Furniture lists will be provided by May 2009
Directorate
11. Improve the health TBD Hospital General Link with Module #2: Develop a health
information system, including Directorate information system
referrals and counter referrals

Time Frame
12. Establish and strengthen TBD Hospital General

referral and discharge follow- Directorate
up systems for better
continuity of care
13. Improve supportive September 2009 Hospital General Link to Module #7: Improve performance
supervision approach Directorate management
including supervisory tools
14. Improve medical waste TBD Hospital General Link to Module #17: Improve medical waste
management and personal Directorate management
safety procedures and
practices
15. Renovation and/or physical June 2009 Hospital General Coordinate with the USAID EWAS Program
expansion Directorate
16. Re-rationalization of bed March 2010 Hospital General Also see Activity 1, developing a Master Plan
distribution according to Directorate for hospitals
population needs

Module 13: Improve Health Communications Services
Linkages to the National Strategic Health Plan: Strategic Objectives 1.1, 1.2, 1.3, 1.4, and
1.5.
Why: Behavior change communication (BCC) strategies using interpersonal, mass media,
and other methodologies can enhance the impact of clinical and community-based health
service delivery. Knowledge, beliefs, attitudes, and skills at the community and household
levels shape behavior which can have a profound influence, whether positive or negative, on
the health status of individuals.
Elements in the Reform Process Addressed: Accountability and responsibility for

population health will be promoted. In addition, transparency and equity elements will be
addressed because all community personnel will receive health awareness knowledge. The
community will participate in identifying health needs and in changing behavior.
Results of Intervention: A sustainable BCC program will be operating at the MoH health
facilities. Institutional capacity will be strengthened in the health education and promotion
department of the MoH to create tangible, measurable, and sustainable health outcomes
through an effective BCC program.

Deliverable 3: Fifteen BCC Modules targeting key health knowledge and behaviors of the
Palestinian population developed.
Workplan Objective:
Objective 2.2: Support delivery of a quality package of community-based health promotion
and disease/injury prevention services.
Expected Result: Strengthen communication capacities of health institutions.

Module 13: Improve Health Communications Services
Month Year
1. Review and update existing April-May 2009 MoH Health Education
MoH and national BCC Department/Flagship
programs in coordination with
the National Committee of
Health Education
2. Develop 15 BCC (3-4 per year) Ongoing MoH Health Education Link with Module #7: Improve
Modules targeting key health Department/Flagship performance management
knowledge and behaviors of the
Palestinian population while Link with Module #8:
taking into consideration the Strengthen service delivery &
MoH health system assessment clinical guidelines
findings
clinical MoH primary care
system

system
3. Finalize the selection of 3-4 March 2009 MoH Health Education The list of Modules identified
BCC Modules for 2009 Department/Flagship
4. Introduce the appropriate April-June 2009 MoH Health Education Link to Module #18: Introduce
indicators for each of the Department/Flagship & implement a comprehensive
Modules selected for monitoring M&E approach & system
and evaluation purposes

Time Frame
5. Build the capacity of related Ongoing MoH Health Education Link to Module #16: Improve
professionals in community Department/Flagship community-based health
health education skills, as needed services
Link to Module #15: Training &

fellowship program in health
administration & management
program for the public sector
6. Produce and procure public August-December 2009 MoH Health Education
awareness campaigns and Department/Flagship
materials such as posters, boards,
TV spots production
7. Launch BCC Modules activities, Ongoing MoH Health Education
using media to transfer Department/Flagship
knowledge to public
8. Follow up and supervise the August 2009 MoH Health Education
implementation of the BCC on-going Department/Flagship
activities
9. Follow up and evaluate the BCC January 2010 MoH Health Education To measure the effectiveness
activities implementation on-going Department/Flagship and the impact of the BCC
activities on quality
improvement
10. Conduct a survey or research to TBD MoH Health Education
measure the impact of the public Department/Consulting firm/
awareness activities on Flagship
community health status

Module 14: Support MOH Emergency Departments and Emergency Preparedness
Linkages to the National Strategic Health Plan: Strategic Objectives: 1.10, 3.3, 4.6, 5.3, and
5.7.
Why: The strengthening of the MoH emergency departments and emergency preparedness will
enhance the MoH’s capacity to respond to the emergency health needs of the population. This
will also improve survival rates and decrease the risk of long-term disability following injuries
and other medical emergencies. All interventions at this level should be coordinated with other
service providers who deliver most of the pre-clinical and pre-hospital emergency services.
Elements in the Reform Process Addressed: This intervention will increase access to health
services to more segments of the population and make high quality emergency services available
to all clients. Emergency care provided to all citizens will be more equitably dispersed. In
addition, health professionals will be held accountable in implementing standards of care and
applicable guidelines.
Results of Intervention: Patient satisfaction from emergency health services will be increased.
An injury surveillance system will be operating in all MoH emergency rooms. New standards
and guidelines of emergency care will be implemented at the clinical practice level. Quality of
care in emergency rooms will be improved. A trainer Network will provide new knowledge and
skills to emergency room staff to keep the standards of care at the highest level.

Component 2: Clinical and Community-Based Health.
Deliverable 3: Fellowship training and visiting professors program to support improved quality
of MOH emergency services.
Deliverable 4: Other deliverables as specified in the MOH IDP for emergency services.
Workplan Objective:
Objective 2.1: Improve the quality of essential clinical services for Palestinians. Task 2.1.3:
Strengthen the capacity of Palestinian health institutions to provide quality emergency care
services.

Module 14: Support MOH Emergency Departments and Emergency Preparedness
Month Year
1. Conduct a national situational March 2009 Flagship/MOH Emergency Involve all service providers
analysis and needs assessment for Directorate
the existing activities in Link with Module #1: Create
emergency rooms for MoH and center of excellence at the
other stakeholders. (building Palestine Medical Complex
infrastructure, equipment,
documents such as practice Link with Module #9: Improve
guidelines, emergency coordination with stakeholders
management health information
system and triage system)
2. Unify all protocols and guidelines March-May 2009 Flagship/MOH Emergency Link with Module #8: Strengthen
for emergency care Directorate service delivery & clinical
guidelines
All stakeholders’ existing

protocols to be adjusted and
unified
Integrating the PHC, ER, and

EMS
3. Develop mandatory training July 2009 Flagship/MoH Emergency Link with Module #15: Training
prerequisites for all emergency Ongoing Directorate/PHC & fellowship program in health
room professionals, and other Directorate administration & management
positions (technicians, community program for the public sector
health workers, etc)
Mandating training prerequisites
for all stakeholders

Time Frame
4. Unify and implement the National October 2009 Flagship/MoH Emergency Building on the existing
Emergency Preparedness Plan Ongoing Directorate independent emergency plan in
with stakeholders coordination with relevant
stakeholders
5. Procure emergency equipment March 2009 Flagship/MoH emergency All equipment must be unified
based on the needs and unify Ongoing directorate/PHC directorate according to the services provider
nationally at a national level. Training on
maintenance, application, results
and interventions should be
consistent with established
protocols
6. Introduce fellowship training and August 2009 Flagship/MoH Emergency Link with Module #4: Design and
visiting rotations Directorate implement a continuous
education program for health
professionals
Fellowship should be considered

for neighboring countries (Jordan,
Dubai, Egypt). Visiting should
also be done as rotations to other
districts in the West Bank
7. Develop supervision and January 2010 Flagship/MoH Emergency Link with Module #18: Introduce
monitoring system and provide Ongoing Directorate & implement a comprehensive
continuous technical support M&E approach & system
External body to audit and follow

up on quality assurance, control,
and improvement

Time Frame
8. Revitalize the emergency health January 2010 Flagship/MoH Emergency Link with Module #2: Develop a
information system in MoH Ongoing Directorate/PHC health information system
hospitals. Nationally implement Directorate
proper documentation for Patient Standardize and unify templates
Care Report for patient care documentation
templates
Implement Patient confidentiality

HIS

Module 15: Training and Fellowship Program in Health Administration and
Management for the Public Sector
Linkages to the National Strategic Health Plan: Strategic Objectives: 4.1 and 4.2.
Why: Health administration and management are fundamental to ensuring high quality health
services. Training and system reform to introduce new standards and approaches are critical
to address issues affecting the work force such as poor motivation, emigration of highly
trained personnel, sporadic updates of professional knowledge, and heterogeneous
educational preparation of senior professionals at all levels (central, district, facility).
Elements in the Reform Process Addressed: Strengthening performance management

practices at all levels addresses issues of efficiency of the system, quality of services
provided, sustainability of the changes introduced by capacity-building for staff, equity of
services by assuring that patients are treated with respect and competently, and access to
services.
Results of Intervention: Trained and motivated staff that are applying new approaches to
manage, motivate and retain MoH personnel and standardize care practices.

Workplan Objective:
Objective 1: Improve Good Governance & Management Practices in the Palestinian Health
Sector. Task 1.1.1: Strengthen the capacity of the MoH to implement reforms needed for
improved quality, sustainability, and equity in the Palestinian health sector.
Expected Result: Improved management practices within the MoH network.

Module 15: Training and Fellowship Program in Health Administration and Management for the Public Sector
Month Year
1. Confirm who in the MoH is the March 2009 General Directorate of Higher Identify other priority areas in the
designated department/employees and Continuing Health IDP that need to be included in
responsible and committed to Education/Directorate of the Leadership Management
Human Resources and Program (e.g. performance
improving health administration and
Development/Licensing and improvement, finance, supportive
management Accreditation Unit/Flagship supervision, health facility
management, etc.)
2. Identify and review the April-May 2009 General Directorate of Higher
administrative guidelines at the MoH and Continuing Health
and update if needed Education/Directorate of
Human Resources and
Development/Licensing and
Accreditation Unit/Flagship

Time Frame
3. Convene a group to discuss the key March-April 2009 General Directorate of Higher Link to Module #1: Create a
management issues to be addressed and Continuing Health center of excellence at the
and develop an overall training Education/Directorate of Palestine Medical Complex
Human Resources and
program with a defined purpose, key
Development/Licensing and Link with Module #7: Improve
issues to be addressed, expected Accreditation Unit/Flagship performance management
outcomes of the program and criteria
for participation. Consider such Link with Module #11: Improve
criteria that foster participation of a clinical MoH primary care system
diverse range of personnel to support
decentralization –e.g., representation Link with Module #12: Improve
of central, district, and facility level
leaders, different departments within system
the MoH, different disciplines
(medicine, nursing, community
health). Explore the possibility of
having a recognized academic or
professional institution provide
certificate of learning.
4. Identify the essential attitudes, April-May 2009 General Directorate of Higher

knowledge and skills needed to and Continuing Health
implement and sustain effective Education/Directorate of
management practice (incentives, Human Resources and
knowledge and skills update, need for Development/Licensing and
feedback and appraisal of Accreditation Unit/Flagship
performance, team building, job
descriptions)

Time Frame
5. Draft and approve the final selection April-May 2009 General Directorate of Higher
criteria for trainers and trainees and Continuing Health
Education/Directorate of
Human Resources and
Accreditation Unit/Flagship
6. Prepare a final training plan that May 2009 General Directorate of Higher
supports the MoH training plan and Continuing Health
Human Resources and
Accreditation Unit/
Flagship/Partners(TRG)
7. Design a ToT training package May-June 2009 General Directorate of Higher
and Continuing Health
Human Resources and
Accreditation Unit/
8. Implement the ToT training package July-August 2009 General Directorate of Higher The idea of the ToT is to create a
and Continuing Health training capacity at the MoH that
Education/Directorate of will continue to exist beyond the
Human Resources and project period
Accreditation Unit/

Time Frame
9. Trainees who successfully passed the September 2009 General Directorate of Higher
ToT implement the training for other and Continuing Health
MoH staff Education/Directorate of
Human Resources and
Accreditation Unit/
10. Provide technical assistance on Ongoing General Directorate of Higher
assignments through a process of and Continuing Health
mentoring (using techniques such as e- Education/Directorate of
Human Resources and
mail and a web-site for posting
questions/comments), review progress Accreditation Unit/
on completing assignments, and brain- Flagship/Partners(TRG)
storming about challenges encountered
11. Evaluate the impact of the staff Ongoing General Directorate of Higher
leadership program on health care and Continuing Health
management practices Education/Directorate of
Human Resources and
Accreditation Unit/

Module 16: Improve Community-Based Health Services
Linkages to the National Strategic Health Plan: Strategic Objectives 1.1 and 1.2.
Why: Optimal health outcomes can only be achieved through a combination of clinical and
community-based interventions. Establishing a dynamic and continuous interaction between
health facilities and the communities they serve assures relevant and responsive health
programs and actively mobilizes the participation and resources of the community.
Elements in the Reform Process Addressed: Strengthening community health services

through a creative and dynamic process of working with both the MoH and the community
will address issues of equity, access, efficiency, quality, and sustainability.
Results of Intervention: Strengthened capacity of the MoH to work with communities (staff
trained, equipment procured), new processes in place (Champion Communities), increased
community satisfaction and participation in resolving health and other factors affecting the
health of the community, strengthened technical and professional capacities of Community
Health Workers in community mobilization, basic clinical services, and patient education.

Component 2: Clinical and Community-Based Health. Deliverable 2: 5-year ID Workplan for
improved community health services.
Workplan Objective:
Objective 2.2: Support delivery of a quality package of community-based health promotion
and disease/injury prevention services. Task 2.2.1: Strengthen the capacity of Palestinian
health institutions to provide effective outreach services in partnership with local
communities for improved health and safety outcomes.
Expected Result: Improved community outreach services.

Module 16: Improve Community-Based Health Services
Month Year
1. Confirm who in the MoH is the March 2009 PHC department’s units/ Explore if there is an interest or
designated department/counterpart MOH/Flagship need to establish a technical
responsible and committed to working sub-committee
improving community health services (thematic committee) for this
through conducting meetings and area
interview with relevant departments
2. Identify and assess existing models in March-April 2009 PHC department’s units/
WB/G for Community Health Worker MOH/Flagship
(CHW) programs and other types of
dynamic community-health facility
partnerships through:
2.1 Review current programs (including

training, certification, standards and
protocols, scope of practice, etc.) by
visiting and interviewing different
health providers
2.2 Review local studies and research
about the topic

Time Frame
3. Introduce the model of the April-June 2009 MOH/ PHC departments’ unit This activity should be linked
“Champion Communities” approach with standards, training, and
to strengthen the participation of certification programs
members of communities including
CHWs to work together with health
care institutions (address priority
health concerns and mobilize
community participation) through the
following sub-activities:
3.1 Prepare training package about

community – based health programs
including the trainer’s handbook and
participants guide
3.2 Conduct TOT targeting MOH
identified trainers (health educators,
nurses, physicians, senior CHWs)
3.3 Conduct training for the field staff in
the targeted communities
4. Start implementing the community – March-September 2009 PHC/MoH/Flagship Suggested name for committee:
based health program through the the Local Health Parliament
following sub-activities:
4.1 Identify communities based on the

selection criteria developed by the
MOH / PHC department
4.2 Conduct participatory rapid
assessment for communities and the
health facilities
4.3 Form local clinic-community
committees in the targeted
communities

Time Frame
5. Monitor and evaluate the March 2009 MOH/Flagship

implementation of the “Champion
Communities” process and determine
how to extend the model to other
communities through the following
sub-activities:
5.1 Client satisfaction improvement (to

be measured by client exit interview
5.2 Clinic–community linkages (to be
measured by health facility
assessment tool)
6. Identify and document success stories TBD
to promote awareness of “healthy”
communities through stories,
communicating through media,
working with journalists, and
conducting workshops.
7. Institutionalize the process of TBD MoH/Flagship
“Champion Communities” through
the following sub-activities:
7.1 Developing training package on

community-based health program
7.2 Training a cadre in the MOH on
“Champion Communities”

Module 17: Improve Medical Waste Management
Why: There is not a clear and well-developed medical waste management system nor a
comprehensive medical waste strategy at the national level. Roles and responsibilities of
various authorities are not defined. There is an absence of specific legislation, regulation,
and standards, coupled with a lack of coordination among different authorities and
stakeholders. All of this contributes to pollution and alack of safety for patients and staff in
health facilities. Establishing an organized medical waste management system, as well as
having well-trained and qualified staff, will improve both the quality of services and the
safety of personnel, patients and the environment.
Elements in the Reform Process Addressed: Medical Waste Management contributes to

improving the clinical and community –based health services at the primary and secondary
levels. This will tackle quality of the services, sustainability of the good work, and equity
between all the beneficiaries receiving high-level and safe services.
Results of Intervention: A well functioning medical waste management system with clear
and strict rules and regulations and qualified, trained staff that adhere to the protocols will
result in a better quality of services in the Palestinian health facilities with less hazard and
better protection of both patients and staff. This will also help to maintain a clean
environment and reduce the number of people including children whose health and safety
might be negatively impacted due to poor disposal methods of medical equipment, supplies,
and medicines.

Component 2: Clinical and Community-Based Health. Deliverable 3: Develop package of
essential primary care services for each level at the MoH and Integrated Quality
Improvement program for the delivery of hospital services.
Component 3: Procurement Support for Health and Humanitarian Assistance. Deliverable 3:

Medical waste management assessments for the MoH and each beneficiary NGO. Deliverable
4: Medical waste management technical assistance and mitigation plans for the MoH and
each beneficiary NGO. Deliverable 5: Annual medical waste management monitoring report
for each organization.
Workplan Objective:
Objective 2.1: Improve the quality of essential clinical services for Palestinians. Task 2.1.2:
Strengthen Quality Improvement systems within Palestinian institutions to deliver better
secondary care. Task 3.1.1: Provide essential health commodity inputs to support successful
implementation of ID work plans under the Flagship Project.
Expected Result: Improved clinical and community-based health services and strengthened
capacity of health institutions to deliver clinical services.

Module 17: Improve Medical Waste Management
Month Year
1. Establish a national working group April-May 2009 MoH/Flagship/Stakeholders/NG Link with Module #9:
(stakeholders, including private sector) under Os/ Private sector Improve coordination of
the supervision of MoH to define and stakeholders
characterize the current medical waste
management practices and situation,
including the type of waste and estimation of
risk to people and the environment. Define
better technologies for waste management
2. Analyze, review and report the findings of the April-June 2009 MoH/Flagship/Stakeholders Link with Module #9:
following: Improve coordination of
stakeholders
- Interventions from other stakeholders
- Current practices regarding medical waste
disposal and comparison of treatment
technologies. (e.g. incineration, autoclave,
microwave, chemical disinfection)
- Available protocols, guidelines, policies, and
regulations
3. Conduct short relevant studies to complement June-July 2009 MoH/Flagship/Stakeholders Link with Module #9:
existing research to design a new Improve coordination of
management system for medical waste stakeholders

Time Frame
4. Based on the findings of the previous action August-December 2009 MoH/Flagship Link with Module #8:
points: Strengthen service delivery
& clinical guidelines
- Define the geographic and technical scope of
operation (nation-wide vs. directorate, hospital vs. Link with Module #11:
clinic, etc.) Improve clinical MoH
- Define the appropriate technology for the primary care system
treatment of medical waste which that fits the
geographic and technical scope for intervention Link with Module #12:
- Work on new regulations and by-laws if needed Improve the quality of
clinical services in the
Palestinian MoH hospital
system
5. Palestine Medical Complex: find creative June-July 2009 MoH/ Flagship Link with Module #1:
solutions for some aspects of medical waste Create a center of
management that has not been addressed by excellence at the Palestine
Medical Complex
the existing system
6. Procure the new technologies for effective January-March 2010 MoH/Flagship Link with Flagship
waste management (autoclaving, micro Component on Procurement
disinfection) and other the needed equipment
and supplies to effectively segregate, handle,
collect, and treat the different types of waste
safely and effectively

Time Frame
7. Train the relevant staff during each activity Ongoing MoH/Flagship/Consultant Link with Module #7:
phase Improve performance
management

Improve clinical MoH
primary care system

Improve the quality of
clinical services in the
Palestinian MoH hospital
system

Training & Fellowship
Program in Health
Administration &
Management for the Public
Sector
8. Develop awareness campaigns and work January 2010 MoH/Flagship/NGOs Link with NGOs and
with NGOs and private sector to promote Ongoing Community
understanding and utilization of new
technologies and procedures for effective
Improve community-based
medical waste management health services

Improve health
communications services

Time Frame
9. Work with private sector to design cost TBD MoH/Flagship/Private sector Link with private sector
recovery programs to collect waste and working group
establish recycling programs
10. Institutionalize and implement the new TBD MoH/Flagship/NGOs/ Link with Reform and
legislations, by-laws, regulations, and Stakeholders Improve Clinical Services
protocols

Module 18: Introduce and Implement a Comprehensive M&E Approach and
System
Linkages to the National Strategic Health Plan: Strategic Objectives 4.1, 5.2, and 5.4.
Why: Monitoring and evaluation (M&E) plays a critical role in understanding,

demonstrating, and communicating results, using data for decision-making, and guiding
management. An efficient M&E system is fundamental to ensure successful outcomes. It is a
management tool to monitor the progress of planned activities and to strategically guide
decision-making and resource allocation.
Elements in the Reform Process Addressed: Strengthening the M&E system will address
issues of efficiency of the system and enable health service delivery to be more results-
oriented, participatory, manageable and practical by providing data that are useful for
management and linked to planning processes.
Results of Intervention: An institutionalized, effective, and sustainable monitoring and

evaluation system with the processes and tools in place to ensure improved collection and
quality of health information and data for decision-making, planning, supervision, and
management.
Components & Deliverables:

Work plan Objectives:

Objective 1.1: Strengthen the capacity of the MoH to implement reform needed for improved
quality, sustainability, and equity in the Palestinian Health Sector.
Expected Result: Improved management practices within the MoH network of facilities.

Module 18: Introduce and Implement a Comprehensive Monitoring and Evaluation (M&E) Approach and System
Month Year
1. Develop annual plan based on a March-April 2009 Department for Internal The Department for Internal
standardized M&E logical Monitoring and Inspection Monitoring and Inspection
framework/system that specifies identified certain areas where
purpose, type of data to be collected, they might need capacity
indicators, and tools needed to strengthening and technical
manage the collection, analysis and assistance, including:
use of the M&E data human resources with relevant
specialties, a computerized
M&E database, clarification of
their mandate (whether it
includes M&E for the Ministry).
This needs to be further
elaborated with the legal
department at the MoH.
Link with the Department of

Health Policy and Planning
2. Confirm the following with MoH: April 2009 MoH/Flagship Link with Module #2: Develop a
- logical framework/system for elements to health information system
include in the M&E system
- approach to M&E analysis and Link with Module #7: Improve
communication performance management
- assumptions
- indicators
- data source and collection methods
- baselines and targets
- responsibility of staff
- quality control
- analysis and reporting
- data storage and information technology

Time Frame
3. Develop and test a model of the May 2009 MoH/Flagship/Consultant Link with Module #7: Improve
system to monitor and evaluate performance management
performance of the MoH
4. Review the results of tested model to June 2009 MoH/Flagship/Consultant
determine what is missing and how
well the instructions guided users.
Revise instructions and procedures as
needed
5. Develop and implement series of July-September 2009 MoH/Flagship/Consultants
workshops/training for M&E system
and practices
6. Support Annual M&E Plan review and TBD MoH/Flagship
dissemination/communication of
results
7. Support the routine development of TBD MoH/Flagship
Annual M&E Plans beginning in 2010
8. Evaluate changes in performance TBD MoH/Flagship/partner Link with Module #7: Improve
management at central, district, and Consultant performance management
facility level
9. Continue roll out of strengthened TBD MoH/Flagship
M&E system and practices

Annex A: Priority Reforms and Interventions
Technical Areas Key Interventions

Overall • To establish and maintain a fully functional Palestine Medical Complex
in Ramallah. The complex will be receiving strong priority attention from
the Ministry of Health. The Flagship Project will provide the Ministry of
Health with needed assistance to ensure that this complex will be
transformed into a center of excellence. The center will serve as the major
national health services facility and a catalyst to emulate best practices in
management and provision of quality health services.
Governance • Finalize and issue the Public Health Law corresponding rules and
regulations.
• Raise the MoH capacity to utilize data in management, planning and
informed policy formulation by developing and maintaining a modern
information system.
• Strengthen the capacity of the National Health Policy and Strategic
Planning Council (NHPSPC) as a mechanism to enhance the MoH
capacity to engage and integrate NGOs and private sector partners and
stakeholders in policy formulation, planning and service provision.
• Establish mechanisms to engage and solicit citizens’ participation in
health policy formulation and decision-making.
• See relevant sections on the health insurance law and the pharmaceutical
procurement laws.
Finance • To issue and implement the proposed government health insurance law.
• The MoH needs to design a careful plan to finance the non-salary
operating and maintenance costs of the recurrent budget to ensure quality
service provision.
• Initiate a dialogue with national and international stakeholders to agree
on a minimum set of dependable resources over the next five years to
make effective use of the available limited resources.
• The MoH needs to adopt and implement an efficient accounting system to
monitor and track outstanding revenues and payments.
• Increase revenues through fines on health threatening products and from
hazardous behaviors to finance preventive care program.
• Allocate more resources to preventive care and primary health care to
reduce late diagnosis and future high treatment costs of diseases.
• Encourage dialogue and support initiatives demonstrating corporate
social responsibility or public/private partnerships.
• Implement rigorous criteria and guidelines for prioritizing referral
treatment including means and modes of purchase of services outside
MoH, avoid duplication and carryout cost effective analysis.
• Develop capacity within the MoH to be strategic in procurement of drugs,
equipment, and supplies.
Health Service • Foster coordination of service quality provided by NGOs, private sector,
Delivery and UNRWA.
• Standardized administrative and operational policies and procedures for
MoH hospitals and clinics which respond to new patient’s emerging
needs.
• Establish mechanisms to receive and process feedback from patients
about quality of care received.
• Upgrade primary health care clinics by shifting certain PHC clinics from
Level I to Level II in accordance with Palestinian MoH criteria.
Moreover, shifting certain Level II clinics to Level III and improvement
of Level III clinics.

• Review PHC professionals’ job descriptions and consider the feasibility
of task shifting of staff responsibilities to increase the quality of PHC
services provided at each level.
• Establishment and implementation of strengthened referral and discharge
follow-up systems for better continuity of care between primary health
care and secondary health care.
• Encourage new approaches to understand the underlying risk factors and
management interventions associated with congenital diseases and
genetic disorders.
• Review PHC programs to focus on pregnant women with anemia and
children with anemia, postpartum care and reproductive health care needs
of post-menopausal women.
• Review PHC programs to expand non-communicable and cancer
prevention awareness.
• Provide training programs in hospital management and administration.
• Installation of medical waste management systems and personnel safety
procedures and practices.
• Installation of a computerized information system with networking inside
and between hospitals and with the central management units at the MoH.
• Installation of computerized systems to manage patients’ admission,
records, appointments, external clinics, etc.
• Establishment of an integrated Quality Improvement Program for
delivery of hospital services.
Human • Update, standardize and enforce Palestinian standards for licensing,
Resources certification and accreditation of human resources and facilities in the
health sector.
• Develop and maintain a modern HR database at the MoH.
• Improve and modernize the archiving and retrieval of documents systems
at the MoH.
• Update recruitment, hiring, transfer, promotion and placement regulations
and procedures at the MoH.
• Provide supervisors with training on supportive supervision and
managing staff performance.
• Develop continuous education programs including residency schemes and
encourage the health staff to participate in and reward them for it.
• Initiate ongoing leadership training for managers in the health sectors.
Pharmaceutical • To issue the pharmaceuticals procurement law, write, and implement
Management corresponding regulations.
• Adopt and implement a drug procurement plan that includes efficient
mechanisms for drug pricing, quality assurance and distribution. The plan
should encourage national pharmaceutical production.
Health • Developing a comprehensive health information system. All MoH staff
Information participants highlighted this as essential, as it is a crosscutting issue that
Systems affects the entire health system. However, developing a health
information system goes beyond just the procurement and installation of
software and equipment. MoH staff stressed the importance of building
its capacity to utilize data for management, planning, informed policy
formulation and decision-making. Establishing a comprehensive and
integrated health information system.

Annex B: Linkages between the Institutional Development Plan and the National
Strategic Health Plan
MINISTRY OF HEALTH SYSTEM ASSESSMENT LINKAGES WITH NATIONAL

STRATEGIC HEALTH PLAN OBJECTIVES
National Health Strategic Plan Needs Assessment Module *

Strategic Objective 1 – Achievement of best Governance – 1.2
possible outcomes from health care services Finance – 1.8
Health Service Delivery – 1.1, 1.3, 1.4, 1.5, 1.7, 1.9,
1.10
Human Resources – 1.9
Pharmaceutical Management – 1.9
Health Information Systems – 1.10
Strategic Objective 2 – Ensure sustainable Governance –
financing of health care services Finance – 2.1, 2.2, 2.3, 2.4
Health Service Delivery – 2.3
Pharmaceutical Management – 2.4
Health Information Systems – 2.3
Strategic Objective 3 – Efficient and effective Governance –
infrastructure for provision of health services Finance –
Health Service Delivery – 3.1 (establish/equip PHC),
3.2 (waste management) 3.3
Human Resources –
Pharmaceutical Management –
Health Information Systems –
Strategic Objective 4 – Ensure adequate and Governance –
appropriate human resources Finance –
Health Service Delivery – 4.1, 4.2, 4.3, 4.5
Human Resources – 4.2, 4.3, 4.4, 4.5
Health Information Systems –
Strategic Objective 5 – Effective policy making, Governance – 5.1, 5.5, 5.6
planning, and management Finance – 5.3, 5.6
Health Service Delivery – 5.1, 5.2, 5.3, 5.6
Health Information Systems – 5.3, 5.4
* USAID/Flagship Project, Health System Assessment Report, (December 2008). Numbers refer to the National
Health Strategic Plan Strategic Objectives

MINISTRY OF HEALTH IDP LINKAGES WITH NATIONAL STRATEGIC HEALTH PLAN OBJECTIVES
Strategic Objective 1 – Achievement of best possible outcomes from health care services
1.1 Raised awareness toward health issues and healthy practice IDP Activity/Action Steps Responsible –
Module MoH/Donor
Advocacy and awareness campaign through mass media 13 Improve health communication services
Unified protocols for health education and health promotion for use in 13 Improve health communication services
health facilities and school health programs
Build capacities of health workers, including community volunteers 16 Improve community-based health services
1.2 Enhanced communication and public confidence in health IDP Activity/Action Steps Responsible –
system Module MoH/Donor
Improve Public Relations unit 13 Improve health communication services
Raise awareness and ownership of local community on health care 13 & 16 Improve community-based health services
system Improve health communication services
Public campaigns and customer satisfaction surveys 13 & 16 Improve community-based health services
Improve health communication services
1.3 Improved public health control programs IDP Activity/Action Steps Responsible –
Module MoH/Donor
Water control
Drivers safety thru medical check ups
Prohibit smoking in public and private institutions 13 Improve health communication services
medical waste management 17 Improve medical waste management
food control program
Vectors control program
Supervise industries to prevent occupational risks, consumer
protection, environmental hazards
Molecular biology program
Quality assurance of pesticides, poisons, hygiene, pharmaceuticals,
water, food
Screening genetic diseases; continuing PKU and TSH programs
1.4 Comprehensive primary health care IDP Activity/Action Steps Responsible –

Module MoH/Donor
Immunize children 11 Improve clinical MoH primary care system
Ensure PHC services with personnel and equipment needed 11 Improve clinical MoH primary care system

Implement MCH clinical protocols 11 Improve clinical MoH primary care system
8 Strengthen service delivery and clinical
guidelines
Improve cervical cancer screening 13 Improve health communication services
Improve breast cancer screening 13 Improve health communication services
Expand clinics providing Reproductive Health services 11 Improve clinical MoH primary care system
Rehabilitate delivery rooms in 6 hospitals
control sexually transmitted diseases 13 Improve health communication services
control avian flu
control tuberculosis
control zoonoses
1.5 School Health program IDP Activity/Action Steps Responsible –

Module MoH/Donor
Improve school health program 13 Improve health communication services
1.6 Community mental health program IDP Activity/Action Steps Responsible –

Module MoH/Donor
Develop community mental health program
1.7 Curative services at secondary and tertiary levels IDP Activity/Action Steps Responsible –
Module MoH/Donor
Improve diagnosis, treatment, and rehabilitation of acute and chronic 11 Improve clinical MoH primary care system
patients, including rational use of drugs and essential dug list 12 Improve the quality of clinical services in the
Implement guidelines and protocols for prevalent diseases and for 8 Strengthen service delivery and clinical
referral system and appropriate utilization of day care vs. ordinary guidelines
admissions
Rationalize beds distribution according to population needs 12 Improve the quality of clinical services in the
1.8 Control number and expenditure of services purchased out of IDP Activity/Action Steps Responsible –
MoH facilities Module MoH/Donor
Purchase of services out of MoH according to new developed priority 3 Implement the new Health Insurance Program
criteria
1.9 Efficient and effective support services IDP Activity/Action Steps Responsible –
Module MoH/Donor

Construct Maintenance workshop
Construct Central stores
Construct Central blood bank and lab
Construct Dorms for doctors/nurses (Jericho)
Extend MoH HQ (Nablus)
Equipment and furniture for central training unit (WB)
Equipment and furniture for Qalqilia hospital
Equipment and furniture upgrades (WB & G) 1 Create a center of excellence at the Palestine
Medical Complex
12 Improve the quality of clinical services in the
extend Central Public health Lab
improve dentistry services
1.10 Effective organization of emergency services IDP Activity/Action Steps Responsible –

Module MoH/Donor
Upgrade emergency services (unified protocols and MIS dispatch 2 Develop a comprehensive and integrated health
extended to all emergency stations) information system
14 Support MoH emergency departments and
emergency preparedness

Strategic Objective 2 – Ensure sustainable financing of health care system
2.1 Ensure health services receive adequate funding IDP Activity/Action Steps Responsible –
Module MoH/Donor
Advocate government and PLC to raise health share of budget 7 Improve performance management
2.2 Increase population coverage of health insurance system IDP Activity/Action Steps Responsible –
Module MoH/Donor
Develop health insurance system (health insurance package; 3 Implement the new Health Insurance Program
insurance fees payment)
Prepare blueprint for national body for health insurance 3 Implement the new Health Insurance Program
2.3 Promote managerial capacities of all units through IDP Activity/Action Steps Responsible –
decentralization and on-the-job training Module MoH/Donor
Develop decentralization of financial decision-making/planning 7 Improve performance management
Develop supervisory role of procurement and financial departments 10 Support passing and implementation of the
according to law of logistics and commodities health commodities procurement by-laws
Establish National health Account
Train employees on public financial management 7 Improve performance management
Computerize administrative units and network them 2 Develop a comprehensive and integrated health
information system
2.4 Rationale health expenditure IDP Activity/Action Steps Responsible –

Module MoH/Donor
Implement guidelines for referrals
Avoid duplication of health services 9 Improve coordination of stakeholders
Cost effectiveness analysis of services and commodities purchased
Develop drugs procurement and bidding procedures 10 Support passing and implementation of the
health commodities procurement by-laws
Encourage national pharmaceutical production and utilization,
ensuring GMP standards
2.5 Revenues from fines of on hazardous products and behaviors to IDP Activity/Action Steps Responsible –
finance preventive care programs Module MoH/Donor
Allocate to preventive care funds collected from fines

Strategic Objective 3 – Efficient and effective infrastructure for the provision of health services
3.1 Improve primary health care infrastructure IDP Activity/Action Steps Responsible –
Module MoH/Donor
(various) 11 Improve clinical MoH primary care system
3.2 Improve secondary and tertiary infrastructure IDP Activity/Action Steps Responsible –
Module MoH/Donor
(various) 12 Improve the quality of clinical services in the
MoH hospital system
1 Create a center of excellence at the Palestine

Medical Complex
3.3 Effective emergency services IDP Activity/Action Steps Responsible –

Module MoH/Donor
Upgrade emergency services (% of ambulances replaced) 1 Create a center of excellence at the Palestine
Medical Complex
14 Support MoH emergency departments and


Strategic Objective 4 – ensure adequate and appropriate human resources
4.1 Institutionalize quality improvement program IDP Activity/Action Steps Responsible
Module –
MoH/Donor
Build capacities of QID and health professionals in quality issues 15 Training and fellowship program in health
administration and management for the public
sector
Develop SOPs to improve operational procedures
Implement clinical guidelines 8 Strengthen service delivery and clinical
guidelines
Introduce performance indicators and quality of work as routine tool 18 Introduce and implement a comprehensive
for service evaluation according to HR database M&E approach and system
Build capacities of health professionals in quality management and 15 Training and fellowship program in health
knowledge of quality standards administration and management for the public
sector
Support health research on effectiveness and efficiency of health
sectors, including cost analysis
4.2 Adequate number and competencies of human resources IDP Activity/Action Steps Responsible
Module –
MoH/Donor
Review, update, and implement Human Resources Development 7 Improve performance management
Plan 15 Training and fellowship program in health
administration and management program for
the public sector
Develop training program based on HRD plan
Build capacities of Kuwaiti hospital 1 Create a center of excellence at the Palestine
Medical Complex
Train and educate 250 HR inside and outside Palestine 15 Training and fellowship program in health
the public sector
Provide scholarships 15 Training and fellowship program in health
the public sector
Construct/equip educational Al Watani Hospital
Construct Ibn-Sina college

4.3 Improve standards of health training and continuing education IDP Activity/Action Steps Responsible
Module –
MoH/Donor
Develop accreditation systems of health education programs 4 Design a Continuing Health Education
program.
Coordinate and cooperate with academic institutions in Total Quality
management (TQM)
4.4 Develop incentive system to attract and maintain technical IDP Activity/Action Steps Responsible
personnel in public health system Module –
MoH/Donor
Develop and implement incentives system associated with
performance
4.5 Updated and implemented job descriptions IDP Activity/Action Steps Responsible
Module –
MoH/Donor
Update and implement job descriptions for different HR identified 7 Improve performance management
4.6 Effective emergency services IDP Activity/Action Steps Responsible

Module –
MoH/Donor
Upgrade emergency services (staff of emergency services attended 14 Support MoH emergency departments and
certified upgrading courses) emergency preparedness

Strategic Objective 5 – Effective policy making, planning and management
5.1 Strengthen MoH capacity in health policy making and strategic IDP Activity/Action Steps Responsible
planning Module –
MoH/Donor
Develop capacity of health policy and planning unit 7 Improve performance management
5.2 Strengthen regulation and coordination function of MoH IDP Activity/Action Steps Responsible
Module –
MoH/Donor
Develop database which includes all health care providers and 18 Introduce and implement a comprehensive
monitors activities M&E approach and system
Improve licensing system of health services and health personnel, 5 Create a Relicensing System of Health
including drug registration process and price controls Professionals
10 Support passing and implementation of the
health commodities procurement by-laws
Create consensus on need for accreditation system for health 6 Design a Health Facility Accreditation Program
institutions
Strengthen supervisory role to minimize malpractice and introduce 7 Improve performance management
risk management system
Improve industries and workplaces with regard to prevention of
occupational risks, consumer protection, and environmental hazards
5.3 Appropriate procedures and processes implemented at all levels IDP Activity/Action Steps Responsible
of health care facilities Module –
MoH/Donor
Knowledge and practices development in health information system 2 Develop a comprehensive and integrated
and managerial skills health information system
Utilize guidelines and protocols for diagnosis and treatment of most 8 Strengthen service delivery and clinical
prevalent acute and chronic diseases guidelines
Introduction of triage system in emergency rooms 14 Support MoH emergency departments and
Develop and introduce guidelines for referral, including purchase of
services from outside MoH
Develop non-communicable disease control program thru guidelines
on diagnosis, treatment, monitoring, and rehabilitation

5.4 Provide valid, accurate, relevant, and timely data for decision IDP Activity/Action Steps Responsible
making at all levels of system Module –
MoH/Donor
Develop HIS at hospitals and PHC facilities 2 Develop a comprehensive and integrated
health information system
Develop unified national list of health indicators 18 Introduce and implement a comprehensive
M&E approach and system
Develop National health information Center for health data and 2 Develop a comprehensive and integrated
improved surveillance system, inclusive of occupational diseases health information system
18 Introduce and implement a comprehensive
M&E approach and system
5.5 Strengthened coordination and integration between different IDP Activity/Action Steps Responsible
health care providers Module –
MoH/Donor
Develop the cooperation and integration mechanisms between 9 Improve coordination of stakeholders
different health care providers
5.6 Master plan for hospital beds and facility distribution and IDP Activity/Action Steps Responsible
utilization Module –
MoH/Donor
Planning and financing according to services utilization 7 Improve performance management
Plan for maintenance, upgrading, and replacing main equipment 12 Improve the quality of clinical services in the
according to priority criteria Palestinian MoH hospital system
5.7 Disaster preparedness and contingency plan IDP Activity/Action Steps Responsible
Module –
MoH/Donor
Update disaster preparedness and management plan 14 Support MoH emergency departments and

MoH Institutional Development Plan
List of Modules
# Priority Area
1 Create a center of excellence at the Palestine Medical Complex.
2 Develop a comprehensive and integrated health information system.
3 Implement the new Health Insurance Program.
4 Design a Continuing Health Education program
5 Create a Relicensing System of Health Professionals
6 Design a Health Facility Accreditation Program
8 Strengthen service delivery and clinical guidelines
9 Improve coordination of stakeholders
10 Support passing and implementation of the health commodities procurement by-laws
12 Improve the quality of clinical services in the Palestinian MoH hospital system
13 Improve health communications services
14 Support MoH emergency departments and emergency preparedness
15 Training and fellowship program in health administration and management for the public
sector
16 Improve community-based health services
17 Improve medical waste management
18 Introduce and implement a comprehensive M&E approach and system

ANNEX C: MoH IDP FOCAL TEAMS
Module Name(s) Post Title

1. Create a center of 1. Dr. Anan Masri Deputy Minister
excellence at the Palestine 2. Ms. Aisha Mansour Minister’s Office
Medical Complex 3. Dr. Fathi Abumoghli Minister of Health
1. Mr. Omar Abu Arquob Director of Health Information
2. Develop a health 2. Mr. Ali Helew Director of Health Information -
information system Insurance
3. Ms. Omaya Abu Shanab Director, I. T. Department
1. Mr. Samer Jaber Director of Health Economics
3. Support implementation
2. Mr. Nabeel Idrees Deputy General Director of
of the new Health Insurance
Insurance
Program
3. Dr. Waddah Ba’ba Director General
4. Design and implement a 1. Dr. Said Hammouz Director General of Continuous
Continuous Education Health Education
Program for Health 2. Dr. Khaled Masri Director of Human Resources
Professionals Development
1. Dr. Kamal Al-Wazani Director of Licensing and
Accreditation Unit
2. Mr. Moheb Abo Zant Director – Licensing and
5. Create and implement a Accreditation Unit
Relicensing System for 3. Ms. Tasbeeh Nori Director – Licensing and
Health Professionals Accreditation Unit
4. Dr. Rania Shahin Director General of
Pharmaceuticals
5. Ms. Najat Dweikat Head of the Nursing Unit
6. Create and implement a 1. Dr. Husam Jouhari Director of Al Watani Hospital
health facility accreditation 2. Dr. Said Sarahneh Director of Hebron Hospital
program 3. Dr. Husam Tanib Director of Tulkarem Hospital
1. Dr. Ghaleb Abu Baker Director General of Health Policy
and Planning
7. Improve performance 2. Dr. Khaled Masri Director of Human Resources
management Development
3. Dr. Samer Hamidi Director of Pharmaceutical
Policies
1. Dr. Asad Ramlawi Director General of PHC/Public
8. Strengthen service
Health
delivery and clinical
2. Dr. Intisar Alem Director of Health Research
guidelines
3. Dr. Mahmoud Slayyeh Tulkarem Hospital
1. Dr. Qasem Maani Director of International
9. Improve coordination of Cooperation Unit
stakeholders 2. Ms. Maria Aqra Director of International
Relations

Module Name(s) Post Title
10. Support passing and 1. Mr. Rezeq Othman Director of Procurement Unit
implementation of the 2. Ms. Razan Hindeyi Director of Contracts and
Health Commodities Tenders
Procurement By-laws 3. Mr. Ibrahim E’lian Director of Medical Equipment
1. Dr. Bassam Abo Madi Director of Salfit Primary Health
Directorate
2. Dr. Mohammad Rizeq Health Director of Bethlehem
11. Improve clinical MoH
District
primary care system
3. Ms. Ilham Shamasneh Director of Nursing in the
Directorate of the Primary Health
Care
1. Dr. Naim Sabra Director General, West Bank
12. Improve the quality of Hospitals
clinical services in the 2. Mr. Ammar Sbouh General Directorate of Hospitals
Palestinian MOH hospital 3. Dr. Husam Jouhari Director of Al Watani Hospital
system 4. Mr. Imad Zaki Director of Nursing in the
Directorate of Hospitals
13. Improve health 1. Ms. Lubna Sawalha Director of Health Education
communications services 2. Mr. Fakhri Ali Director of Public Relations
14. Support MoH 1. Dr. Mohamed Eideh Director General of Emergency
emergency departments 2. Dr. Khaled Qadri Director of Nablus Primary
and emergency Health Directorate
preparedness
15. Training and fellowship 1. Dr. Said Hammouz Director General of Continuous
program in health Health Education
administration and 2. Dr. Khaled Masri Director of Human Resources
management for the public Development
sector
1. Dr. Hatem Jaber Head of Occupational Health
16. Improve community-
Division
based health services
2. Dr. Jawad Betar Director of Chronic Diseases
17. Improve medical waste Mr. Ibrahim Ateya Director of Environmental Health
management
18. Introduce and 1. Dr. Samer Hamidi Director of Pharmaceutical
implement a comprehensive Policies
M&E approach and system 2. Dr. Jihad Bedawi Director of Investigation Unit

Annex D: MoH Institutional Development Plan Jericho Workshop Team Composition
Group Priority Area & Module # Project team MoH Team

# members Members
1 • Create a center of excellence at the Taroub, Fadi, Bashir Dr. Fathi
Palestine Medical Complex. (Module 1) and Hadeel Abumoghli
Dr. Anan Masri
Ms. Aisha Mansour
2 • Develop a health information system. (2) Nadera, Faisal, Mr. Omar Abu
• Support implementation of the new Health Yasir, Imad, and Arquob
Insurance Program. (3) Ra'ed Mr. Ali Helew
• Support passing and implementation of Mr. Samer Jaber
the health commodities procurement by- Mr. Nabeel Idrees
laws. (10) Mr. Rezeq Othman
Ms. Razan Hindeyi
Mr. Ibrahim E’lian
Ms. Omaya Abu
Shanab
Dr. Waddah Ba’ba
3 • Design and implement a Continuous Nasser, Wafa, Dr. Said Hammouz
Education Program for Health Thar'a, and Dr. Khaled Masri
Professionals. (4) Waseem Dr. Kamal Al-
• Create and implement a Re-licensing Wazani
System of Health Professionals. (5) Mr. Moheb Abo
• Training and fellowship program in health Zant Ms.Tasbeeh
administration and management for the Nori
public sector. (15) Dr. Rania Shahin
Ms. Najat Dweikat
4 • Design and implement a Health Facility Ziad, Tasneem and Dr. Husam Jouhari
Accreditation Program. (6) Maha Dr. Said Sarahneh
• Improve performance management. (7) Dr. Husam Tanib
• Introduce and implement a Dr. Ghaleb Abo
comprehensive M&E approach and Baker
system. (18) Dr. Samer Hamidi
Dr. Jihad Bedawi

Group Priority Area & Module # Project team MoH Team Members
# members
5 • Strengthen service delivery and clinical Daoud, Damianos, Dr. Asad Ramlawi
guidelines. (8) Dina, Fadiah and Dr. Intisar Alem
• Improve clinical MoH primary care system. Crissy Dr. Mahmoud
(11) Slayyeh
• Improve the quality of clinical services in the Dr. Bassam Abo Madi
Palestinian MOH hospital system. (12) Dr. Mohammad Rizeq
Ms. Ilham
Shamasneh
Dr. Naim Sabra
Mr. Ammar Sbouh
Mr. Imad Zaki
6 • Improve health communications services. (13) Hazem, Hanna and Ms. Lubna Sawalha
• Support MoH emergency departments and Noor Mr. Fakhari Ali
emergency preparedness. (14) Dr. Mohamed Eideh
• Improve medical waste management. (17) Dr. Khalid Qadri
Mr. Ibrahim Ateya
7 • Improve coordination of stakeholders. (9) Randa, Wafa S. and Dr. Qasem Maani
• Improve community-based health services. Nisreen Ms. Maria Aqra
(16) Dr. Hatem Jaber
Dr. Jawad Betar

Clearance page for the Palestinian Health Sector and Reform and Development Project:
“The Flagship Project” Ministry of Health Institutional Development Plan (IDP) prepared by
Chemonics International Inc. and the MoH.
USAID
WBG Mission Health E. Drabant Clear _______________ Date __________
WBG Desk S. Borodin Clear _______________ Date __________
ME LPA R. Marshall Clear _______________ Date __________
ME TS Health J. Mason Clear _______________ Date __________
Cc: P. Stephenson, USAID/W GH/PRH/RTU

Cc: M. Matthews, USAID/W GH/PRH/RTU

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MINISTRY OF HEALTH

CONTRACT NO. 294-C-00-08-00225-00

Ministry of Health Institutional Development Plan 2

Section II: Institutional Development Plan Approach .................................................6

Section III: Challenges to Implementing Institutional Development… ...................…9

Section IV: Institutional Development Plan………… ...……………………………11

Annex A: Priority Reforms and Interventions… ...………………………….87

Ministry of Health Institutional Development Plan 3

BCC Behavior Change Communication

Ministry of Health Institutional Development Plan 4

Ministry of Health Institutional Development Plan 5

Ministry of Health Institutional Development Plan 6

Ministry of Health Institutional Development Plan 7

Ministry of Health Institutional Development Plan 8

4. Timeframe Constraints. The capability of the Ministry to undertake multiple, significant,

Ministry of Health Institutional Development Plan 9

Ministry of Health Institutional Development Plan 10

Module 1: Develop a Center of Excellence at the Palestine Medical Complex

Elements in the Reform Process Addressed: By providing technical assistance and

Results of Intervention: The establishment of a health center of excellence at the PMC.

Component & Deliverable4:

Expected Result: Strengthen capacity and performance of Palestinian health sector

Ministry of Health Institutional Development Plan 11

Time Frame Responsibility Comments

2. Form an activation team March-September 2009 Minister of Health/Flagship

Ministry of Health Institutional Development Plan 12

5.2 Develop by-laws for the PMC

Link to Module #7: Improve

Ministry of Health Institutional Development Plan 13

Link to Module #5: Create &

Ministry of Health Institutional Development Plan 14

6. Establish appropriate physician and nurse to TBD Minister of

- Patient consultations Link with Module #4: Design

Ministry of Health Institutional Development Plan 15

Link with Module #15:

Ministry of Health Institutional Development Plan 16

Elements in the Reform Process Addressed: The development of a comprehensive health

Component & Deliverable:

Expected Result: Improve management practices within the MoH network.

Ministry of Health Institutional Development Plan 17

Activity Time Frame Responsibility Comments

Ministry of Health Institutional Development Plan 18

7. Develop requirements, and March 2010 Director of Health Information

Ministry of Health Institutional Development Plan 19

Component & Deliverable:

Expected Result: Improved governance in the Palestinian health sector.

Ministry of Health Institutional Development Plan 20

Activity Time Frame Responsibility Comments

6. Set up HIP transparent and TBD General Directorate of Health

Ministry of Health Institutional Development Plan 21

7. Develop claim system and TBD General Directorate of Health

8. Support development of system for TBD General Directorate of Health

9. Conduct willingness to pay study TBD General Directorate of Health

Ministry of Health Institutional Development Plan 22

Linkages to the National Strategic Health Plan: Strategic Objective: 4.3

Results of Intervention: Organizational structures in place to offer different kinds of

Component & Deliverable:

Expected Result: Strengthened capacity of health institutions to deliver clinical services.

Ministry of Health Institutional Development Plan 23