West Bank & Gaza: Service Delivery Survey, 1998

This survey was intended as a contribution towards achieving high quality basic services for the population of West Bank and Gaza and, in particular, effective integration of services from different providers. The sample consisted of 25 sites of 100-120 households per site. 2,988 households were interviewed; 107 schools and 42 primary care clinics serving the sites were reviewed; 51 (virtually all) secondary health care facilities in West Bank and Gaza were reviewed; 48 focus group discussions were held in the survey sites (24 groups of women discussing health services and 24 groups of men discussing basic education issues); a key informant was interviewed in each of the 25 communities.
Overall, 35% of household heads were registered refugees, 2% non-registered refugees and 63%  non-refugees. People made heavy use of secondary health care facilities. The choices between primary and secondary facilities were often on the basis of access: some people would visit a hospital during the day for a child with fever, but more would do so after the clinics were closed in the evening. Some people chose hospital care over primary care because they perceive they would get better care in a hospital. In general, people rated their experience more positively after a visit to NGO/charity and private hospitals than to government and UNRWA hospitals. On the other hand, the costs to the service users were greater with NGO/charity and private hospitals. Rural dwellers rated their experience of hospitals more positively than the urban population and people from Gaza rated it more positively than those from West Bank. A common complaint about both primary health services and hospitals was a perceived lack of medicines needed to treat the condition. Basic education was nearly universal in this survey. Figures for basic literacy (87% of household heads literate), net school enrolment (92%), dropout and class repetition compared favourably with many other countries. Problems with basic education were less with parental perceptions of quality of education than with physical concerns. Class sizes were higher and parental satisfaction lower in government and UNRWA schools than in charity and private schools, but costs to households of education in government and UNRWA schools were less than in charity or private schools.
Financial support for the work was provided by the World Bank. The Palestinian Central Bureau of Statistics played a key role in data collection and data entry and the Health, Development, Information and Policy Institute in West Bank undertook the reviews of secondary care facilities.