title: Health service access and utilization among Syrian refugees in Jordan.
abstract: The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system. Changing lifestyles and aging populations are shifting the global disease burden towards increased non-infectious diseases including chronic conditions, co-morbidities, and injuries which are more complicated and costly to manage. The strain placed on health systems threatens the ability to ensure the health needs of both refugees and host country populations are adequately addressed. In light of the increasing challenges facing host governments and humanitarian actors to meet health needs of Syrian refugees and affected host communities, this study was undertaken to assess utilization of health services among Syrian refugees in non-camp settings.
  
  
  
  A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. Differences in household characteristics by geographic region, facility type, and sector utilized were examined using chi-square and t-test methods.
  
  
  
  Care-seeking was high with 86.1 % of households reporting an adult sought medical care the last time it was needed. Approximately half (51.5 %) of services were sought from public sector facilities, 38.7 % in private facilities, and 9.8 % in charity/NGO facilities. Among adult care seekers, 87.4 % were prescribed medication during the most recent visit, 89.8 % of which obtained the medication. Overall, 51.8 % of households reported out-of-pocket expenditures for the consultation or medications at the most recent visit (mean US$39.9, median US$4.2).
  
  
  
  Despite high levels of care-seeking, cost was an important barrier to health service access for Syrian refugees in Jordan. The cessation of free access to health care since the time of the survey is likely to have worsened health equity for refugees. Dependence of refugees on the public facilities for primary and specialist care has placed a great burden on the Jordanian health system. To improve accessibility and affordability of health services in an equitable manner for both refugees and Jordanian host communities, strategies that should be considered going forward include shifting resources for non-communicable diseases and other traditional hospital services to the primary level and creating strong health promotion programs emphasizing prevention and self-care are strategies.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Suite E8132, Baltimore, MD, 21205, USA. doocy1@jhu.edu.
authors.forename: Shannon
authors.initials: S
authors.lastname: Doocy
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Suite E8132, Baltimore, MD, 21205, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Lyles
authors.affiliation: Jordan University of Science and Technology School of Nursing, Irbid, Jordan.
authors.forename: Laila
authors.initials: L
authors.lastname: Akhu-Zaheya
authors.affiliation: United Nations High Commissioner for Refugees, Amman, Jordan.
authors.forename: Ann
authors.initials: A
authors.lastname: Burton
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Suite E8132, Baltimore, MD, 21205, USA.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Burnham
mesh_terms: D000328:Adult; D002608:Charities; D005191:Family Characteristics; D005102:Health Expenditures; D006297:Health Services Accessibility; D006801:Humans; D007597:Jordan; D009938:Organizations; D010342:Patient Acceptance of Health Care; D004364:Pharmaceutical Preparations; D017149:Private Sector; D017150:Public Sector; D012036:Refugees; D011795:Surveys and Questionnaires; D013593:Syria
chemical_list: D004364:Pharmaceutical Preparations
keywords: Health services; Humanitarian assistance; Jordan; Refugee; Syria