Assessment of the Strengths and Challenges in the Implementation of the Mental Health and Psychosocial Support (MHPSS) for Palestine Refugees in Jordan from the Perspective of Healthcare Providers Open Access

Abstract

The United Nations Relief and Works Agency for Palestine Refugees (UNRWA) reported that 19.3% of Palestine refugees needed mental health support. In response, the UNRWA has conducted the Mental Health and Psychosocial Support (MHPSS) program since 2017. As Jordan hosts the largest Palestinian refugee population, addressing these needs is critical. Therefore, this evaluation aims to identify the strengths and challenges of implementing the MHPSS program for Palestine refugees in Jordan from healthcare providers’ perspectives.  This evaluation utilized mixed methods, including online surveys and interviews administered to healthcare providers, including doctors, nurses, and midwives in the UNRWA health center in Jordan. The survey was conducted across all health centers, and interviews were carried out at 10 of the 25 centers in Jordan. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed thematically with MAXQDA. Eighty survey responses were analyzed from 20 out of 25 health centers (23.1% response rate). Additionally, 38 healthcare providers from 10 health centers participated in the interviews. Both qualitative and quantitative findings demonstrated that integrating the MHPSS program into primary healthcare is beneficial in terms of enhancing access to mental health services, reducing stigma, preserving the privacy of patients, and using the guidelines to deliver mental health care. However, there were challenges with the need for ongoing staff training, an enduring mental health stigma, time constraints, difficulty maintaining privacy, lack of presence of mental health specialists, and sociopolitical situations.  Based on the findings, recommendations include enhancing awareness of mental health among Palestinian refugees, ongoing training for healthcare providers, and improving access to limited resources. Further research is needed to support comprehensive evaluations, cost-effectiveness analyses, and investigations into stigma. These insights inform future policy and program development to improve refugee mental health care in humanitarian settings. 

Table of Contents

Chapter 1: Introduction 1 

Background of Mental Health Among Refugees. 1 

Addressing the Mental Health Issues for Palestine Refugees 2 

Theoretical Framework 3 

Evaluation Questions 4 

Significance of the Thesis Project 5 

Chapter 2: Review of the Literature 5 

Introductory Paragraph 5 

Literature Review 6 

Conceptual Framework for Evaluating the MHPSS Implementation at UNRWA 19 

Summary of the Challenges and Strengths of Current Implementation of the MHPSS Program among Refugees 21 

Chapter 3: Methodology 23 

Introduction 23 

Study Design 23 

Sampling and recruitment 24 

Measures 25 

Data Collection Procedures 26 

Data Analysis Methodology 27 

Positionality 27 

Chapter 4: Results 29 

Introduction 29 

Key Findings of Quantitative and Qualitative Data 32 

Overarched Evaluation Questions 32 

Sub Evaluation Question1 39 

Sub Evaluation Question 2 55 

Sub Evaluation Question 3 63 

Summary of Findings 65 

Chapter 5: Discussion, Public Health Implications, and Conclusions 68 

Introduction and Summary of Study 68 

Discussion of Key Results 68 

Strengths of Implementing the MHPSS 68 

Challenges of Implementing the MHPSS 72 

Strengths and Limitations 77 

Implications for Public Health Research and Practice 80 

Conclusions 84 

References 86 

Appendix A: Survey 96 

Appendix B: Interview Guide 107 

Appendix C: Table 10. 118 

Table 10: Distribution of the Responses from Healthcare Providers in the Online Survey 118 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Mental Health
Keyword	UNRWA Mental health MHPSS Palestine refugees Evaluation
Committee Chair / Thesis Advisor	Walker, Elizabeth , Emory University
Committee Members	Waford, Rachel , Emory University Thapa, Aradhana , Emory University

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