Warren Garner, MD
We believe that local stakeholders can and should determine both the overall development process and the details of the health system menopause length 20mg fluoxetine for sale, particularly given the exper tise that already exists in Palestine and among Palestinians living abroad menstruation japan buy fluoxetine 20mg otc. At the same Health 225 time breast cancer 1 in discount fluoxetine express, we recognize that successful health system development in Palestine will require considerable outside resources pregnancy x medications buy fluoxetine 10mg cheap, including technical and nancial assistance. We esti mate that the Palestinian health system would require between $125 million and $160 million per year in external support over the rst decade of an independent state. Successful development of the Palestinian health system is worthwhile in its own right, and it may be a relatively cost-e ective way to help demonstrate the tangible bene ts of independence and peaceful relations with neighboring countries. Moreover, health system development is an area where Israel, other neighboring countries, and the larger international community could play a constructive role, especially in areas such as health system planning, licensing and accreditation, development of informa tion systems, and research. Introduction Envisioning a successful Palestinian health system is a broad and challenging mandate. Tese include policies and programs covering health system planning and coordination across regions and stakeholders; licensing and accreditation of health professionals, facilities, and educa tional programs; human resource development; health insurance and health care nancing programs; pharmaceutical policy; research and evaluation programs; health information systems; disease prevention and health promotion; and public health. Sample objectives from the 1999 national strategic health plan and the 2001 national plan for human resource development are included in Appendix 7. Although we regard the micro-level targets as generally appropriate, it is beyond the scope of this project to a rm their validity. Similarly, we did not perform detailed assessments of prevailing standards of care or quality of care, conduct salary surveys for health care workers in the government sector, assess the suitability of various pilot sys tems or programs as national models, or conduct similar analyses of particular health system details. Tese include a relatively healthy population, compared with other countries in the region with similar levels of economic development; many highly quali ed, experienced, and motivated health professionals, including clinicians, planners, administrators, techni cians, researchers, and public health workers; and a strong base of local institutions. At the same time, there are a number of opportunities to strengthen the Palestinian health system to achieve speci c health targets and nancial sustainability over time. Successful development of the Palestinian health system is worthwhile in its own right. It may also be a relatively cost-e ective way to help demonstrate tangible bene ts of peace. Historically, the health sector has bene ted from considerable and ongoing cooperation between Palestinian and Israeli institutions and individuals, in areas such as policy formation and human resource development. Despite the current tensions in the region, we found high levels of support on both sides for continuing and strength ening such cooperation as circumstances permit. We describe our methods for conducting the health system analysis and provide brief background information on health and health care in the 1 One of the authors of this chapter, Adel A, was overall project coordinator for the development of the National Plan for Human Resource Development and Education in Health. The remainder of the chapter presents speci c recommenda tions for strengthening (and, in some cases, establishing) institutions and programs to promote the current and future success of the Palestinian health system. In our discussion, we refer frequently to primary, secondary, and tertiary health care. Primary care refers to basic health care that is traditionally provided by physicians trained in family practice, internal medicine, or pediatrics, or by nonphysician provid ers such as nurses. Tere are many ways to achieve these broad goals, ranging from incremental reform to radical redesign. The two national health plans (1994 and 1999) and the 228 Building a Successful Palestinian State National Plan for Human Resource Development and Education in Health (2001) ar ticulate a vision of how the health system should develop over time, based mainly on incremental rather than radical change. The public and primary care systems would be complemented by high-quality secondary and tertiary care systems, but these systems would be developed very carefully, and in a coordinated fashion, to ensure both clinical e cacy and economic e ciency. In our view, this general vision conforms to the economic realities facing Palestine and to the available evidence from other settings regarding cost-e ective health system development. In particu lar, we assume that the government will continue to be responsible for public health; a major provider of health care services; and a major, if not the primary, sponsor of health insurance over at least the rst decade of an independent state. For this analysis, we therefore consider several possible scenarios for the characteristics of a future state, and we discuss how our policy recommendations might change for each scenario. Health 229 to help meet the acute needs of patients who would have traveled for care under less restrictive conditions. This scenario assumes free movement within the West Bank and within Gaza in a future independent Palestinian state. In general, it also assumes that patients would be able to travel between the West Bank and Gaza. Because these areas are relatively distant from each other, primary and sec ondary care would probably be handled within each area; travel to another area would become important if the patient is referred to a tertiary care center. Simi larly, although the status of East Jerusalem is uncertain, we assume that Palestin ians will have relatively open access to health care facilities in East Jerusalem. This scenario assumes that movement within and between the territories of a future Palestinian state will be restricted (or, in the extreme case, prevented). Various factors could limit mobility, including the de gree of territorial contiguity and Palestinian and Israeli security policies. Except as noted, health system development strategies do not depend on the speci c cause of mobility restrictions, only on their scope and duration. In practice, we regard free movement of patients, health professionals, and supplies within Palestine as prerequisites for successful health system development and operation. Restricted mobility would perpetuate and magnify the problems of sta ng, supply, and patient access that have prevailed in the Palestinian health system during the second in tifada. Moreover, strategies to mitigate these problems would be clinically and economi cally ine cient, relative to development under free mobility, particularly because the problems inhibit the development and operation of regional referral centers. As a result, we consider unrestricted domestic mobility to be the default scenario for our analyses. However, at the end of each substantive subsection, we discuss how our recommendations would change under conditions of restricted mobility. International Access5 The extent to which travel is restricted between an independent Palestinian state and other countries, particularly Israel and Jordan, may also signi cantly a ect the future health system. We consider two possible scenarios: 4 Tere has also been some damage to relevant infrastructure, particularly in conjunction with Israeli military opera tions in the West Bank during and after March 2002. As with domestic mobility, interna tional access is likely to be contingent on successful security arrangements. This scenario assumes that Palestinians face no categorical re strictions on travel to Israel, Jordan, or elsewhere for purposes of receiving health care or for professional training. This scenario assumes that access for Palestinians to Israel, Jor dan, and elsewhere for purposes of receiving health care or professional training is signi cantly restricted. Unrestricted access is clearly preferable for health system development, because it provides additional options for meeting clinical and educational needs. As a result, we consider unrestricted access to be the default scenario for our analyses. However, at the end of each substantive subsection, we discuss how our recommendations would change under conditions of restricted international access. Other Crosscutting Issues Other characteristics of a future independent state will also a ect health system devel opment in important ways.
Anatomically womens health facebook buy fluoxetine canada, it is clear that more cortical modules are involved in the two streams than was initially thought women's health clinic kalgoorlie buy fluoxetine 20mg low cost. It is therefore possible that this route would be important in the integration of perceptual information about stimuli arising from di erent sensory inputs pregnancy vs period fluoxetine 10 mg with mastercard, such as hearing and touch (Boussaoud menstruation with large fleshy clots order fluoxetine 20mg otc, Ungerleider, & Desimone, 1990). Conceptually, the main challenge to the model has concerned the nature of information processing in the dorsal stream. Originally, Ungerleider and Mishkin proposed that this stream was dedicated to the identi cation of object location in space. In other words, while knowing about the location of objects is an important component, some neurons in this pathway become particularly active only when a visual stimulus prompts a motor response, such as reaching for an object. The guidance that cannot be inferior parietal lobule, on the other hand, is known to be associated with a range explained by motor, somatosensory, or primary of visuospatial skills (some of which we describe later in this chapter) not directly visual de cits. Creem and Polysensory: Responsive to Pro tt have characterised these as involving the manipulation of non-egocentric input from several modalities. While debates about, and re nements of, the model are likely to continue for some time, the basic principle of separable dorsal and ventral processing streams for visual perception, specialised for what and where (or how), has become accepted as a tenet of brain organisation. In fact, recent evidence suggests that the same what/where segregation may be an organisational principle that extends to other perceptual domains such as audition (Alain et al. However, many neuropsychologists anticipate further revisions to the model as more is learned about the nuances of visual perception. We return to consider spatial processing in the dorsal stream later in this chapter. For the time being, we need to consider some of the characteristics of the ventral stream, and the effects that damage to different components of it can have on object recognition. For example, 3D objects in our eld of vision are projected onto our retinas, which only work in 2D. Second, objects must be recognised as such irrespective of where their image falls on the retina, their distance from the viewer, and their orientation. For example, a tree is still usually perceived as a tree whether it is close to you or on the distant horizon. Third, you must also be able to recognise objects when they are moving in 182 Chapter 8 Visual object recognition and spatial processing di erent directions. A horse moving across your line of vision projects a quite di erent image from one galloping directly towards you. Finally, your brain must be able to link the percept (of the horse for example) with stored representations of horses in order for you to make the semantic leap towards recognition of the object as a horse. The ventral stream runs bilaterally from area V1 of the occipital lobes via areas V2 and V4 into the inferior regions of the temporal lobes (see Figure 8. If we examine the response characteristics of neurons in this stream, three clear trends emerge. First, neurons in posterior regions (at the beginning of the stream) re in response to relatively simple stimulus characteristics such as width, shading, and texture, whereas neurons later on in the stream only respond to much more complex visual stimuli. Remarkably, some cells in anterior temporal regions only respond to very speci c shapes of stimuli such as a hand, or even particular faces (Gross, Rocha-Miranda, & Bender, 1972). A second feature is that neurons further forward along the stream are less concerned with the physical position of objects in the visual eld. We could describe cells in these forward regions as having large receptive elds, and in the case of some anterior temporal neurons almost the entire retina appears to be covered. So, no matter where the object falls on the retina, cortical cells will respond to an object to which they are tuned. This attribute is tremendously important for object recognition, not least because it often allows us to distinguish gure from ground, providing additional clues about the edges (and thus the shape) of objects (Zeki, 1980). In the 1890s, on the basis of a small number of detailed case studies, Lissauer described two forms of object recognition failure which he called apperceptive and associative agnosia. Today, we think that the two disorders are linked to damage at di erent stages in the ventral stream, and re ect di erent types of perceptual disturbance. However, the distinction at least provides a useful starting point for our consideration of visual agnosia. Typically, for example, cells in your fovea When shown a photograph of a cup, someone with this type of agnosia will (central eld of vision) have probably be able to describe some of the physical features of it such as its size, much smaller receptive elds colour, the presence of a handle, and so on. People with apperceptive agnosia are described as being unable to put individual parts of a visual stimulus together to form what psychologists call a percept. Associative agnosia Individuals with this form of agnosia can copy objects relatively well, and detect similar items from a visual display. In some cases they may even be able to sort items into groupings (animals, items of cutlery, tools, etc. The problem in associative agnosia is an inability to identify (and name) speci c objects. This shows that percep tion of the item is relatively complete, and therefore that the individual does not have apperceptive agnosia. Moreover, if later asked to draw the object from memory, he might be unable to do so, although if actually asked to draw a fork, he probably could. Even at this point, he might not realise that the object he was holding and the drawing he has just made were of the same item. This problem is not necessarily related to general de cits in semantic memory because individuals with this form of agnosia can sometimes describe in great detail functional (or other semantic) information about objects from memory. On the other hand, some people with associative agnosia do have problems with their semantic memory. He could determine whether photographs depicted animals or objects, but he was unable to name or distinguish between di erent types of animal, suggesting some form of semantic memory de cit. Insight into the nature of the cognitive de cit found in associative agnosia is provided by McCarthy and Warrington (1986). However, he was unable to name any of them, and could provide only partial semantic information (at best) about just a few of them. Apperceptive agnosia occurs because of damage at an early stage in the ventral stream, and although many people with this form of agnosia have bilateral damage, cases of people with unilateral damage suggest that it is the right hemisphere that is most critical. People with this form of agnosia have only the most rudimentary visual perceptual functions, and damage to the occipital lobes and adjacent cortical regions such as the occipitotemporal border is often apparent.
The differential diagnosis is usually from delusional Schizophrenia can be classi ed into several subtypes (or paranoid) disorders and paranoid personality dis (Table 5 menstrual headaches cheap 20 mg fluoxetine visa. Marked thought disorder menstrual incontinence cheap 20mg fluoxetine with mastercard, incoherence and severe Paranoid schizophrenia is characterised by the fol loosening of associations breast cancer volleyball t-shirts purchase fluoxetine without prescription. Delusions and halluci lowing clinical features women's health clinic alaska buy line fluoxetine, in addition to the general nations are fragmentary and changeable. The hallucinations usually have a persecutory or functioning, extreme social withdrawal and other grandiose content. Undifferentiated schizophrenia deterioration, without any signi cant remissions, 6. Mutism: Complete absence of speech behaviour, in addition to the general guidelines of 2. Rigidity: Maintenance of a rigid posture against ef schizophrenia described earlier. Negativism: An apparently motiveless resistance to all commands and attempts to be moved, or doing tonia, stuporous catatonia, and catatonia alternating just the opposite between excitement and stupor. Posturing: Voluntary assumption of an inappropriate Excited Catatonia and often bizarre posture for long periods of time 5. Stupor: Akinesis (no movement) with mutism but this is characterised by the following features: with evidence of relative preservation of conscious 1. Increase in psychomotor activity, ranging from awareness restlessness, agitation, excitement, aggressiveness 6. Echolalia: Repetition, echo or mimicking of phrases to , at times, violent behaviour (furore). Echopraxia: Repetition, echo or mimicking of actions spontaneity, pressure of speech, loosening of as observed sociations and frank incoherence. Waxy exibility: Parts of body can be placed in the excitement has no apparent relationship with positions that will be maintained for long periods of the external environment; instead inner stimuli. Ambitendency: Due to ambivalence, con icting im So, the excitement is not goal-directed. Fortunately, with the availability of new and behavioural), automatic obedience (commands treatment choices, and early diagnosis and treatment, are followed automatically, irrespective of their lethal catatonia has become increasingly rare in most nature) and verbigeration (incomprehensible speech). The onset of catatonic schizophrenia is usually Stuporous (or Retarded) Catatonia acute, usually in the late 2nd and early 3rd decade. The this is characterised by extreme retardation of course is often episodic and recovery from the episode psychomotor function. Differential di hallucinations may be present but are usually not agnosis is from other causes of stupor and catatonia. Not all the features are present at the (This is discussed in further detail in Chapter 19). Residual and Latent Schizophrenia Catatonia Alternating between Residual schizophrenia is similar to latent schizo Excitement and Stupor phrenia and symptoms are similar to prodromal this clinical picture is very common with features symptoms of schizophrenia. The only difference is of both excited catatonia and stuporous catatonia that residual schizophrenia is diagnosed after at least alternatingly present. It is important to rule out antipsychotic-induced would easily t in one of the above-mentioned seven negative symptoms as well as negative symptoms subtypes. A few are brie y mentioned due to their secondary to associated depression, organic brain historical interest and their popular names; though disease or institutionalisation. Undifferentiated Schizophrenia Pseudoneurotic Schizophrenia this is a very common type of schizophrenia and is Pseudoneurotic schizophrenia was rst described by diagnosed either: Hoch and Polatin. When features of no subtype are fully present, or nant neurotic symptoms that last for years and show 2. It is characterised Nowadays, this subtype is subsumed under bor by an early onset (early 2nd decade), very insidious derline personality disorder. This term was originally introduced by if present they are short lasting and poorly syste Langfeldt (1961) to designate good prognosis cases, matised. Post-Schizophrenic Depression Oneiroid Schizophrenia Some schizophrenic patients develop depressive features within 12 months of an acute episode of Described rst by Mayer-Gross, this is a subtype of schizophrenia. The depressive features develop in the schizophrenia with an acute onset, clouding of con presence of residual or active features of schizophrenia sciousness, disorientation, dream-like states (oneiroid and are associated with an increased risk of suicide. Van Gogh Syndrome It is important to distinguish the depressive features from negative symptoms of schizophrenia and extrapy Dramatic self-mutilation occurring in schizophrenia ramidal side-effects of antipsychotic medication. It is phrenia with enumeration of positive, negative and more common in women, especially unmarried or disorganised symptoms. The rst step in the differential diagnosis is to ex Hallucinations of all kinds (visual, auditory, tactile, clude psychoses with known organic causes, such gustatory and olfactory) can be present. Intelligence as complex partial seizures, drug-induced psychoses and social judgement outside the arena of persecutory (such as amphetamine-induced psychoses), metabolic delusions are usually normal. There would often be clinical features suggestive of At present, this syndrome is placed under paranoid underlying disorders in these conditions. The second step is to rule out a possibility of mood disorder (such as mania, depression, or mixed affective Pfropf Schizophrenia disorder) or schizo-affective disorder. This is a syndrome of schizophrenia occurring in the the third step is to exclude the possibility of other presence of mental retardation. In addition to the main diagnosis, it is also impor Therefore, behavioural disturbances are much more tant to look for co-morbid medical (such as diabetes, prominent than delusions and hallucinations. Catatonic subtype (paranoid subtype has an Disorganised, simple, undifferentiated, or chronic intermediate prognosis) catatonic subtypes 6. Presence of confusion, perplexity, or disorientation Flat or blunted affect in the acute phase 15. Proper treatment, good treatment concordance, Absence of proper treatment or poor response to and good response to treatment treatment 16. Schizophrenia 63 So, about two-thirds (67%) of the patients had help-seeking behaviour, decreased activity levels, a favourable outcome as compared to 50% in Luc higher incidence of suicide, and metabolic syndrome. It was apparent that the course and prognosis of schizophrenia was better in Biological Theories the developing countries such as Nigeria and India, Genetic Hypothesis as compared to the developed countries (Fig. There is an increased However, environmental factors and stress are prob mortality in patients with schizophrenia by almost one ably also important in precipitating an episode in and half times. Schizophrenia is presently thought to be probably due There is also a higher prevalence of metabolic to a functional increase of dopamine at the postsyn syndrome (characterised by abdominal obesity, athero genic dyslipidaemia, hypertension, raised fasting blood glucose, and insulin resistance) in schizophrenia which can be worsened by administration of antipsy chotic medication. Patients with schizophrenia can die 10-15 years prematurely as compared to general population. There are several factors responsible for this increased morbidity and mortality, including high prevalence of smoking, caffeine, alcohol and drug Fig. At present brain imaging does not have a role in Stress con rming a diagnosis of schizophrenia though it Increased number of stressful life events before can be used to rule out an organic basis of psychotic the onset or relapse probably has a triggering ef symptoms where clinically appropriate. According to this hypothesis, higher the the following ndings also point towards a biological genetic vulnerability in a person, lesser the environ basis of schizophrenia. In the cal anomalies, and impaired eye tracking (smooth research conducted in the last 30 years, these ndings pursuit eye movements) are more often seen in have been replicated all over the globe, though the patients with schizophrenia than in persons without period of 35 hours/weeks has not been found to be the disease. Viral and autoimmune factors have also been Family Theories implicated by some, while others. Weinberger) have suggested a neurodevelopmental hypothesis for Several theories have been propounded in the past schizophrenia. These include Schizophrenia 65 loss of ego-boundaries (described by Federn), with a loss of touch with reality. Sociocultural Theories Although the prevalence of schizophrenia is quite uniform across cultures, it was found to be more com mon in lower socioeconomic status in some studies. Higher rates of schizophrenia have been found among some migrants, not only among the first generation migrants but also among the second gen eration. The rst drug to be used with bene cial effect in schizophrenia was probably reserpine (Rauwol a Information Processing Hypothesis serpentina extract), in India by Sen and Bose (1931). Disturbances in attention, inability to maintain a set, Reserpine is no longer used for the treatment of and inability to assimilate and integrate percepts are schizophrenia for a variety of reasons, including its common ndings in schizophrenia.
Syndromes
In Closing Our analysis is intended to inform the health system development e orts of a future independent Palestinian state women's health veggie burger buy fluoxetine canada. However menopause 46 buy fluoxetine 10mg low cost, we believe that successful health system development in Palestine requires that local stakeholders be committed to and in control of both the overall development process and its substantive details pregnancy fashion buy generic fluoxetine line. B: Methods The analyses underlying this chapter were mainly conducted between December 2002 and July 2003 menstrual gush buy cheap fluoxetine. First, we reviewed previously published academic research and policy analyses regarding health and health care in Palestine to understand the history of the Palestin ian health system and the current status of health and health care in Palestine. We reviewed all such information that we could obtain, with the goal of identifying priorities for health system development in Palestine over the next decade. Second, we identi ed and contacted local stakeholders in Palestine and Israel whose input we wanted regarding this analysis, based on their expertise in the organi zation, operation, and nancing of the Palestinian health system. Given our project mandate, each person was asked to identify priorities for health system development in Palestine over the next decade. We discussed these issues iteratively with each expert, along with issues we identi ed from our literature review. In addition, we asked each expert to recommend additional people whom we could ask for information regarding the Palestinian health system and our analysis. We speci cally asked to be referred to people in all sectors of the Palestinian health system; relevant Palestinian and Israeli academics; and people from relevant interna tional organizations, particularly key donors to the Palestinian health system. In addition, we decided that it was important to interview certain categories of stakeholders to whom we had not already been referred. They fell into two broad categories: international organizations, particularly donors, and Palestinian women active in health care delivery and health policy. We identi ed people in these categories through a combination of referral and independent research. Health 295 In March and April, 2003, we contacted the people to whom we had been re ferred by fax, mail, email, and/or telephone. We provided materials describing this project, including its background and aims, along with a preliminary list of health system development priorities and a general set of questions we wanted to discuss with them (a sample letter of introduction is included as Appendix 7. We asked people to meet with us during a visit to Palestine and Israel in May 2003. No person whom we approached about this project explicitly refused to meet with us, although some people were unavailable for various reasons. During that meeting, we discussed the information in the written materials we had reviewed, and we discussed our analysis plans and the strategy for our upcoming trip with several Palestinian and Israeli experts. Because Gaza was closed to foreigners during the entire period of this visit, meetings with the Palestinian Ministry of Health in Gaza, and with other relevant stakeholders of that area, had to be postponed or canceled. Where pos sible, these interviews were conducted by telephone instead, and we were subsequently able to meet with one Gaza contact in Washington, D. In each interview, the questions listed in the letter of introduction served as a general interview guide (see Appendix 7. Interview questions were open-ended, so as not to constrain the scope of the information that people provided. Interview par ticipants were asked to base their responses on their own expertise and experience. Interview participants were asked to allow themselves to be identi ed in this chap ter. However, to help ensure that people felt free to express their views fully, interview participants were assured that no comments would be quoted directly or attributed to them in an identi able way. All interview participants received a draft version of this chapter and were invited to submit comments prior to publication. They were told that we would seriously con sider all comments but not necessarily implement them in the nal book. Husseini, Birzeit University University Ra q Husseini, Welfare Association Fathi Abumoghli, Palestine Ministry Ajay Mahal, Harvard University of Health (in association with the Faris Massoud World Bank) Rashad Massoud, University Research Zeid M. Carlin, United States Agency University for International Development Tou k Shakhshir Ellan Coates, Maram Munther Al Sharif, Palestine Ministry of Khuloud Dajani, Al-Quds University Health Nahil Dajani, Dajani Maternity Hospital Hossam K. Sharkawi, Palestine Red Rajai Dajani, Dajani Maternity Hospital Crescent Society Anwar Dudin, Al-Quds University Raghda Shawa Rita Giacaman, Birzeit University Husam E. Gregg Greenough, Johns Hopkins Ricardo Sole Arques, World Health University Organization Arafat S. Hidmi, Makassed Charitable Suzy Srouji, United States Agency for Society International Development Rafaella Iodice, European Union Teodore Tulchinsky, Hebrew University Emil Jarjoui, Palestine Liberation School of Public Health Organization Henrik Wahlberg, World Health Anne Johansen, World Bank Organization Salam Kanaan, World Bank Laura Wick, Birzeit University Health 297 Appendix 7. As part of this larger project, our working group is leading an analysis of the Palestinian health system. Our goals are: 1) to understand the strengths and gaps of the current system, with respect to organization, human and physical infrastructure, and nanc ing; 2) to identify major priorities for future development and investment, over ap proximately the next ten years; and 3) to estimate the nancial cost of reaching various development goals. We are currently planning to visit the region in May to meet with key Palestinian, Is raeli and international stakeholders. The analysis includes consideration of economic, demographic, governance, education, health, public safety, security, and natural resource issues. Where appropriate, the analysis includes consideration of policy alternatives that re ect choices that might face the key participants in the process of creating such a state. This study adopts a long-term perspective, recognizing that many short-term prob lems will also have to be solved in the process. It assumes that a successful Palestinian state should ultimately bring stability for Palestinians, Israelis and the region. It also assumes that substantial resources will be required from various sources in order to establish and support the institutions and infrastructure necessary for a successful independent Pales tine, and it seeks to estimate the necessary resources associated with key policy alterna tives. By identifying the needs for a viable state and quantifying the costs of such a develop ment, the parties will have a realistic appraisal of what is possible and what it will cost. Kenneth Shine and Jerrold Green (co-Project Directors), Michael Schoenbaum (leader, Health working group), Glenn Robinson (leader, Governance working group), Robert Hunter (leader, Security working group), Jack Riley (leader, Pub lic Safety working group), Mark Bernstein (leader, Natural Resources working group), Cheryl Benard (leader, Education working group), Brian Nichiporuk (leader, Demo graphics working group), and David Gompert and Richard Neu (senior advisors). The overall goals of our analysis of the Palestinian health system are: 1) to un derstand the strengths and gaps of the current system, with respect to organization, human and physical infrastructure, and nancing; 2) to identify major priorities for future development and investment, over approximately the next ten years; and 3) to estimate the nancial cost of reaching various development goals. We recognize that there is a well-established Palestinian national health planning process. This process has led to several National Health Plans that contain detailed targets for improving health status and for developing health manpower and physical infrastructure. Our project therefore focuses on key institutions and programs that are necessary for the Palestinian health system to operate successfully, and options for strengthening these institutions. As above, however, the overall focus of this project is on fostering the success of a future independent Palestinian state. For purposes of this project, we therefore do not focus on short-term strategies for operat ing the health system under the current conditions. Instead, we focus on longer-term health system development, under the assumption of unrestricted travel within the West Bank and Gaza. Planned Trip to the Region We are preparing for a trip to Palestine and Israel in May, during which we will meet with key Palestinian, Israeli and international stakeholders regarding the Palestinian health system. Based on your knowledge of the institutions described above, how well do those institutions currently function in the Palestinian health system Have we left out any key institutions that need to be strengthened in the Palestin ian health system What are the major barriers that a ect successful development of the Palestinian health system Finally, we will want to collect information on the potential costs of implementing various policy options. Although our mission is to conduct in dependent analyses, we will coordinate with these other projects as much as possible. If you have questions about this project or would like additional information, please feel free to contact any of us directly using the contact information listed above; or through our representative in Jerusalem, Ms. We interviewed representatives from several of the participating organizations during our visit to Palestine and Israel in May, as listed in Appendix 7. We recognize that most or all of the issues we address here have been addressed in previous plans and analyses. Order fluoxetine cheap online. Vanessa Hudgens Ranks Keto Snacks | Food Fight | Women's Health. |
