Jordan hosts one of the largest refugee populations per capita in the world, primarily Syrians, alongside tens of thousands from other countries and over 2.39 million registered Palestine refugees. These populations are largely concentrated in urban areas. Jordan’s healthcare system, which serves citizens, refugees, and foreign residents, is delivered through a combination of public facilities operated by the Ministry of Health (MOH) and other government entities, private hospitals and clinics, as well as UN agencies and NGOs providing targeted support. Despite this broad network, population health coverage remains fragmented, with some groups entirely uninsured.
The Jordan Health Fund for Refugees (JHFR) was established in 2018 to help the government offset the additional costs of providing healthcare to Syrian refugees and later expanded to cover all UNHCR-registered refugees. It is a collaborative multi-donor fund, supported by Canada, the USA, Denmark, Qatar, Germany, Italy, and the World Bank, with contributions managed by the Ministry of Planning and International Cooperation (MoPIC) and implemented by MOH. By 2025, the fund had mobilized over 76 million Jordanian Dinars, supporting a range of health interventions. The evaluation was undertaken to assess the Fund’s outcomes, effectiveness, relevance, and sustainability, and to inform future health programming for refugees in Jordan.
The evaluation focused on the Fund’s performance from 2018 to 2024, with particular attention to JHFR II (FY 2022–23 onwards). It assessed how well the Fund improved access to subsidized primary and secondary healthcare for refugees, strengthened national health infrastructure, and addressed gender and environmental considerations. The evaluation was participatory, engaging donors, MOH staff, implementing partners, and primary beneficiaries, and covered five governorates with significant refugee populations: Amman, Zarqa, Irbid, Mafraq, and Balqa.
The Fund’s work includes policy advocacy to ensure refugees pay no more than 20% of healthcare costs, infrastructure upgrades, capacity building, and the provision of equipment and specialized services in high-density refugee areas. Canada’s contributions specifically supported the establishment of a Gender Unit at MOH and initiatives to promote environmentally sustainable healthcare delivery. A Performance Measurement Framework (PMF) tracks outcomes and results, though limitations exist in attributing system-wide changes directly to JHFR interventions.
The evaluation used a mixed-methods approach, including desk review, key informant interviews with 21 stakeholders, and 11 focus group discussions with 58 refugees and NGO representatives. Key limitations included low participation in FGDs, limited baseline data, and challenges isolating Canada’s specific impact from other donors.
Findings indicate that JHFR contributed to measurable improvements in equitable access to healthcare for refugees, particularly women and children, through reduced financial barriers and strengthened infrastructure. Positive unintended outcomes included enhanced donor engagement, expanded coverage to all UNHCR-registered refugees, and support for national COVID-19 response efforts. Challenges included concentration of investments in central governorates, limited visibility of donor contributions, and gaps in participatory planning for refugees.
The Fund’s design enabled strategic alignment with national priorities, strong coordination, and operational flexibility, which supported effective delivery of outcomes. JHFR remains relevant to the needs of refugees and MOH priorities, improving access, affordability, awareness, and quality of care. Investments have contributed to the sustainability of the public health system, including institutional capacity building, gender mainstreaming efforts, and environmentally conscious planning, though long-term sustainability is threatened by donor fatigue, an evolving funding landscape, and lack of a predictable financial plan.
Data systems currently support routine monitoring of refugee healthcare utilization but lack sufficient analytical capacity to fully assess long-term impact or attribute changes solely to JHFR interventions. The evaluation concludes that while JHFR has strengthened equitable access to healthcare and laid the groundwork for sustainable health system improvements, ongoing efforts are needed to align services with refugee needs, ensure chronic and specialized care access, and improve monitoring and evidence-based decision-making.
