Supporting the Provision of Healthcare in North-West Syria

In November 2021, Levante completed a mid-term evaluation of a German Federal Funding Office (GFFO) funded project that sought to increase access to humanitarian life-saving health services for conflict-affected internally displaced and host populations in North-West Syria. The team’s assignment was to examine the project that supported two hospitals in Idleb serving large displaced and host populations using the OECD-DAC criteria for relevance, effectiveness, impact, and efficiency. Levante also conducted a further assessment of cross-cutting themes including the extent to which the project had incorporated gender and disability inclusion during the implementation.

While the project was a lot similar to our previously conducted projects, this mid-term evaluation provided a unique opportunity for the team to further solidify our experience in the health sector within humanitarian assistance. The project also strengthened our understanding of the complexity of running a hospital on the ground in the Syrian context. Drawing from our previous experience conducting third-party monitoring of the health component within an emergency response project in the same location, the team assessed the running of the two hospitals from both the patients’ and staff perspectives. A particular focus was placed on the administrative aspects of the hospital with staff being examined on the issues that they encountered in the course of delivering their duties in such a fragile context.

The project that was implemented from across the border in Turkey through a local partner focused on the provision of wholesome assistance to the two hospitals serving vulnerable persons in Idleb. This posed a challenge as there was a wide scope of activities to be assessed including a full infrastructural inspection that we conducted using a structured inspection tool with a checklist. To address this challenge, the team lay emphasis on the key areas that had previously been identified as points of weakness in the running of the hospitals and examined if and how these areas had improved.

Another challenge that the team encountered was the gaps in health information systems in the Syrian context with only so much information available on healthcare, more so in North-West Syria. To address this, Levante included, within the data collection tools, questions that sought to quantify and describe the impact of supporting the two hospitals on the overall health landscape in North-West Syria.

Some key areas of assessment included the availability of medicines and medical supplies, accessibility of the hospital to people with disabilities and the elderly, the satisfaction of hospital staff with their working conditions, and the satisfaction of patients with the services that they had received. We also examined the patients on the ease of access to the healthcare services from the two hospitals as well as on limitations of the feedback mechanisms.

Levante used a mixed-method approach that included a thorough desk review and surveys with patients, healthcare staff, hospital administrators, and project staff. At the end of the study, we produced a report that included recommendations that included exploring using qualitative discussions some of the reasons why patients were reluctant to provide feedback.