Jordan’s healthcare system is considered one of the more modern in the Middle East, and many patients travel from neighboring countries to access its medical offerings. However, Jordan struggles with rising healthcare costs, an aging population with a changing disease burden, and meeting high demand from around the region.

Expanding home healthcare options is a promising solution to these challenges. Patients can save time and money by taking care of routine procedures and check-ups at home, and those receiving palliative care can benefit from receiving services in a comfortable, familiar environment. Hospitals, in turn, free up space and resources for additional patients.

Until recently, Jordan had no formalized home healthcare system. The King Hussein Cancer Foundation (KHCF) and King Hussein Cancer Center (KHCC)—one of the region’s premier palliative care providers— worked with the U.S. Agency for International Development (USAID) Jordan Competitiveness Program (JCP) to establish the National Home Healthcare Initiative Project in 2015. The KHCC-led effort aims to advance the country’s home healthcare system by scaling up home and palliative care offerings, serving as a center of excellence to improve practice, and providing education and training to healthcare workers.

Since 2017, the project has trained more than 300 health professionals and expanded participation to 28 public, private, and academic medical facilities. JCP’s support in creating a diploma certification program and advocating for a new national strategic framework will help the sector continue to grow.

Jordanian home care patient Zuhdiyyah, age 76, receives a visit from her care team--no hospital trip required. Photo: USAID

Improving Care While Decreasing Costs

Evidence suggests that home care promotes patient healing, reduces infection risks, and allows patients more freedom and independence.  Increased home care access can also free up vital resources for more critically ill patients in hospitals.

In late 2016, Jordan’s National Home Care Initiative launched a pilot within KHCC, expanding the hospital’s number of home healthcare teams from two to four. External experts evaluated the expansion process and compared outcomes from 2016 (before the pilot) and 2017 (after the pilot). While further research and evaluation is needed to draw long-term conclusions about the impact of home care on patient and family outcomes, the initial results are promising.

KHCC increased home care visits by 66 percent between 2016 and 2017. Patients participating in the service also received more frequent visits. During this time, emergency room visits and hospital admissions—which can be stressful, expensive, and risky—decreased among home care patients. Fewer admissions among this group of patients also meant that KHCC had more beds available to meet high demand.

The World Health Organization identifies palliative care as a central component of integrated, people-centered health services, and the Jordan pilot study also showed improvement in this area. Many palliative care patients state they would like to pass away at home and avoid a hospital death. While almost 72 percent of KHCC deaths took place in the hospital in the first half of 2016, this number fell to just 57 percent in the same period of 2017.

Average per-patient spending at KHCC decreased from 5,436 JD in 2016 to 5,220 JD in 2017. This reduction was due in part to the shift toward lower-cost, community-based services such as home care and outpatient visits. These findings are in keeping with research from high-income countries, which has established a link between palliative and homecare services and reduced costs in the wider health sector.

The experience of one patient, Zuhdiyyah, demonstrates the personal impact of home care. Doctors advised the 76-year-old to join the home care program after she received treatment at the KHCC. She was delighted. “When I was told I would be sent home for the remainder of my treatment followup, I was a completely different person,” said Zuhdiyyah.

Having to travel to the hospital for routine procedures was physically difficult for Zuhdiyyah, and could have hindered her recovery. Now, she says, “Every time I see the homecare nurses coming through the door, it feels as if I was never ill!”

Training Promises Long-Term Job Creation

“At its core, home care is about human-centered medicine and about preserving people’s dignity during treatment,” says Wissam Rabadi, Chief of Party for JCP. “But it also can benefit even more people by creating jobs for professional Jordanians.”

When the National Home Healthcare Initiative launched, skills development was a top priority. Jordan has a strong nursing workforce, but empowering nurses to manage patient care at home takes specialized training based on international best practices. The initiative provided an opportunity to train men and women for these high-demand medical jobs.

Until 2016, Jordan had no training programs in home and palliative care. With JCP support, KHCC worked with local and international experts and Jordan University to develop a curriculum and diploma in home and palliative care, which is now backed by the Jordan Nursing Council. This partnership also helps address the liability issues health providers may face when treating patients at home.

One nurse who received training is Ahmad, who said that the program taught him how to conduct a wide range of procedures—“lab tests, medication reviews, clinical examinations, you name it!”—in home settings. More than 70 percent of his work takes place in patients’ homes.

The initiative expects to help establish 18 new healthcare units at different governmental and private Jordanian hospitals, staffed by newly trained home care professionals. These units will create 1,800 new jobs to meet current home healthcare needs.

So far, 321 health professionals have participated in home and palliative care training with support from JCP. Seventy trainers received certification to teach the program.

JCP supported a range of job skills programs, including home and palliative care training for health professionals. Photo: USAID

Home Care Embedded in Policy

Through a grant from JCP, KHCC further supported the national palliative care committee. Technical assistance from JCP allowed the committee to lobby policy makers to add home healthcare services to existing government healthcare insurance plans. JCP also helped the committee make the business case for home healthcare to insurance providers.

Thanks to these efforts, Jordan’s Ministry of Health has now endorsed the country’s first-ever national strategy for palliative and home healthcare. As home care continues to professionalize as a sector, and as demand for these services continues to grow, Jordan’s National Home Healthcare Initiative will help the country’s healthcare providers improve care, serve more patients, and address healthcare costs.

Mirna Fakhoury is a project manager for DAI.

Dr. Omar Shamieh is Chairman of the Department of Palliative Care and Director of the Psychosocial Oncology Program at King Hussein Cancer Center in Amman, Jordan, which helped found the Jordanian Home Care Initiative.

Dr. Bridget Johnston is a Research Fellow in Public Health and Primary Care at the Trinity College Dublin School of Medicine.

Dr. Shamieh and Dr. Johnston co-authored a report on the economics of palliative and home care services in Jordan for the National Home Care Initiative.