UNHCR: Health Care Access and Utilization Survey: Access to Health Services Among Urban Syrian Refugees in Jordan – Monitoring Report, November 2021 – Jordan

I. Executive summary

A. Characteristics of the sample

• (403) households (HH) were interviewed in the sample of the segment of Syrian refugees living in urban areas in Jordan in the HAUS 2021, compared to (400) households interviewed in 2018

• The average household size was 5.3, roughly the same size in 2018 (5.2)

• The majority of the sample lives largely in 3 governorates: Amman (35%), Irbid (23%), Mafraq (21%), while the rest is dispersed in other governorates without significant concentration, without difference major with the 2018 survey

• in 2021 & 2018, almost the entire sample has been in Jordan for more than 2 years

• While the entire sample spoke Arabic, some respondents in the sample spoke another language, (8%) English and (2%) other languages, reported in 2021

B. Knowledge of access to health

• Among the 2021 sample, a moderate level of knowledge of the nearest UNHCR-supported clinic (37%) was found

• More than half of the sample knew that all registered refugees subsidized access to government health facilities, while the percentage was higher in 2018 at (83%)

• Almost all Syrians in the 2021 and 2018 sample hold the security card; regarding where the card was issued, the highest proportion in most governorates issued the card of the governorate in which they live

• (65%) of the sample knew they can access health facilities supported by UNHCR, compared to (81%) in 2018

C. Antenatal care

• The average percentage of pregnant women of childbearing age was (47%), the percentage was slightly lower in 2018 (41%)

• In 2021, most of the women in the sample visited health centers during pregnancy and (73%) of them made more than four visits, with (20%) of them experiencing difficulties. mainly due to not being able to pay the fees (79%). Mothers who did not seek antenatal care were mainly because they could not afford the user fees, these results were somewhat close to the 2018 survey.

• The childbirth rate was (76%) in 2021. Where (58%) of them gave birth through the normal vaginal route, followed by caesarean section (40%), while only (2% ) vaginally assisted

• (52%) in the sample selected the private facility for delivery compared to (46%) in 2018. Regarding government hospitals, (43%) of Syrians gave birth there in 2021 and (48%) in 2018 (27%) of the sample paid nothing for delivery in 2021 and 2018, and also in the two years (29%) paid between 251 JOD and 750.

D. Immunization of children

• Awareness of children’s free access to vaccination is high at (96%) in 2021 and (97%) in 2018

• (95%) of the 2021 sample state that they have a vaccination record for their child, compared to (97%) in 2018

• In 2021, (6%) of Syrians reported that their child had not received the measles / MMR vaccine, and almost everyone who received the vaccine received the vaccine at government health centers.

• Similar to measles / RR, (6%) of Syrians in the 2021 survey reported that their child did not receive the polio vaccine, and for those who received the polio vaccine, almost all received it in government health centers

E. Family planning

• (40%) were aware of the availability of family planning services in Jordan in 2021

• In the 2021 survey, (49%) of the sample said they had heard information about family planning in the past year; sources of awareness came mainly from health center staff, followed by community events

• Only (29%) of the 2021 sample tried to access contraceptives, largely through the health centers of the Ministry of Health

F. Chronic diseases

• (19%) of the sample reported suffering from chronic diseases in 2021, compared to (15%) in 2018

• The most prevalent diseases among the total sample were hypertension by (36%) and diabetes by (21%), a similar trend was observed in the 2018 survey.

• (52%) of chronically ill patients in the sample could not obtain their medication during the past three months. This was mainly due to affordability issues. A significant increase was observed in the inability to obtain medication compared to the 2018 results, which was (26%)

• Regarding access to other health services, a significant increase is also observed in disability (48% in 2021 and 22% in 2018)

G. Impairment

• (7%) of the total sample registered having at least one type of impairment in 2021 compared to 8% in 2018

• The most common impairment was “Physical impairment” with (63%), followed by “Sensory impairment” with (19%), a similar trend was observed in the 2018 results.

• The highest reported cause of impairment was “Natural (birth / congenital, disease, degenerative)” with (64%), followed by “Accident (Traffic accident, Home accident)” with (26%), these 2 reasons were the highest also in the 2018 survey with the motive “Accident (Road accident, Domestic accident)” was higher in 2018 with (36%)

• In 2021, surgical treatment was the most used treatment method with (37%) of the sample altered, leaving the other treatment methods with fairly close divisions.

H. Access to health facilities

• (38%) of the sample needed health services in the last month in 2021, compared to (49%) in 2018

• (84%) sought health services in 2021 with a strong increase compared to 2018 (45%), with the most sought-after health establishments of Clinic / Private Hospital (at 35%) compared to (15% ) for the same type of establishment

• While the majority were able to obtain health care services (89% of the 2021 sample), some of the respondents said they encountered difficulties, mainly on access to the health center and affordability of fees. of use

• Overall, around (86%) who requested the service paid for it in 2021, this percentage was lower in 2018 (77%). The maximum amount paid by was JD 1,500 versus JD 5,000 in 2018, while the average payout in 2021 was JD 37 and JD 47 in 2018

• (14%) of those who requested health services in 2021 had to go to a second health facility to meet their health care needs, while in 2018 (5%) sought a second health facility

• In 2021, (31%) of the sample noticed an increase in the costs of health services over the past year, this impact led to the inability to pay for required medical services, to pay for necessary drugs, or to visit doctors or hospitals

• Most of the 2021 sample was affected by the increase in healthcare costs with (88%) reporting it. This has led to fewer visits to health facilities and a decrease in the intake of certain medications.

• A significant percentage in the 2021 and 2018 samples (77% and 78%, respectively) spent money on health services; Taking the last month for the 2021 sample, health expenditure over monthly income was at the ratio of (44%)

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