Henrietta Szold, the founder of the Hadassah Women’s Zionist Organization of America, would have been extremely distressed to read the new report from Jerusalem’s Taub Center for Social Policy Studies that warns about the impending collapse of Tipat Halav (“Drop of Milk”) well-baby centers around Israel.
Hadassah’s work in establishing Tipat Halav clinics was instrumental in reducing infant mortality rates in Israel. In pre-state Israel, first under the Ottoman Empire and later under the British Mandate of Palestine, the rate had been one of the highest in the world. Starting in 1913, Szold’s groundbreaking work around maternal health and the eventual establishment of mother and baby clinics helped to dramatically reverse those numbers. The project was financed by Hadassah donor and department store magnate Nathan Strauss, whose own son had died after drinking contaminated milk in New York City.
More than a century ago, before Tipat Halav, four out of five children did not live to see their first birthday as a result of poor hygienic conditions due to bathing only once a week, a shortage of medications, polluted water pits, and early marriages, and a shortage of medications. The first two nurses sent to Jerusalem back then lived in a small house near Mea Shearim and advised mothers on how to care for their babies. Pregnant women who were reluctant to go to doctors for help and advice out of fear of the “Evil Eye” were willing to listen to the nurses.
But due to ministry neglect, the whole system is in danger of being shut down, according to the Taub report. Asked several times to comment by The Jerusalem Post, the ministry spokeswoman did not respond.
WHILE HADASSAH initially ran these clinics, they were integrated into the broader national healthcare system, with the Health Ministry supervising them and even providing their services along with the four health funds, and the Jerusalem and Tel Aviv municipalities.
The clinics are community-based centers that focus on preventative care for infants and young children up to age six. Among the services they offer are growth monitoring and developmental surveillance of babies, routine childhood vaccinations, nutritional guidance and counseling, advice and support for parents, and dental checkups and fluoride treatments for young children.
Prof. Nadav Davidovitch, Taub’s Health Policy Program chairman and former dean of Ben-Gurion University’s Faculty of Public Health, was the chief researcher, working with senior researcher Sarit Silverman, Efrat Sales, and Yair Sadaka. Their policy paper presents a troubling picture of Tipat Halav services.
The clinics suffer from severe budget neglect, a shortage of staff, major maintenance problems, and a sharp decline in vaccination rates, which is a trend that could endanger public health as a whole. This is happening against a backdrop of a sharp increase in the child population in Israel. The paper’s authors present policy alternatives to halt the deterioration.
THE RESEARCHERS asserted that there is a breakdown in the vaccination system. The vaccination rate for children in Israel for the MMRV vaccine (the combined vaccine against measles, mumps, rubella, and varicella: chickenpox), which was once among the highest in the world, is showing a worrying decline from 73% in 2019 to just 64% in 2023.
Vaccination rates for other vaccines have also fallen after the COVID-19 pandemic. For example, in 2021, the chance of a child not being vaccinated against measles was seven times higher compared to the pre-pandemic period, and the chance of missing the fourth dose of the pertussis vaccine was 5.6 times higher.
The researchers stressed that not being vaccinated endangers not only the child but the entire public, as it undermines the ability to achieve herd immunity that protects the whole population.
Several years ago, it was reported that nurses in one well-baby station mistakenly injected infants with water instead of a vital vaccine; when the error was discovered, the babies had to be brought in again for another injection.
THERE IS a severe shortage of staff. The population of children aged birth to six is steadily increasing: from 1991 to 2024, the number of live births in Israel rose by 71%. Moreover, projections show that the early childhood population will grow from 1.29 million children in 2022 to 1.48 million by 2032. Despite this, staffing at Tipat Halav clinics has not significantly changed over the years and has not been adjusted to meet growing needs. In addition, the relatively low salaries offered there compared to other healthcare frameworks make it difficult to recruit and retain doctors and nurses.
There is also an inadequate transfer of information and gaps in continuity of care. Medical care for children involves many providers and care settings. At present, data collected about a child in hospitals and health funds are not transferred to the relevant Tipat Halav station, thus creating information gaps. This lack of information sharing is a serious failure that can harm continuity and quality of care for the child and may also lead to unnecessary duplication and waste of system resources.
The ministry, which provides services to more than half of Israel’s children, operates the clinics under its responsibility in buildings owned by local authorities. About a third of the clinics are housed in old, deteriorating buildings with problems such as mold, dampness, and neglected yards, but the ministry has not allocated enough money for renovations and for constructing new facilities.
A study carried out by the Taub Center in collaboration with the KI Institute examined the link between achieving language development milestones and the mother’s education level, an indication of the family’s socioeconomic status. The lower the mother’s education, the higher the share of children not reaching milestones on time.
It also found that these gaps grow with the child’s age, especially between ages two and three, and are most pronounced among children of mothers with only a primary or secondary education. These findings point to widening gaps between socioeconomic groups in Israel and highlight the critical need to monitor developmental milestones at the clinics.
<br><strong>THE TEAM offered a number of policy alternatives</strong>
1 – The current system could be maintained with essential adjustments and improvements. In this option, the organizational structure remains as it is today, while correcting budget distortions and improving cooperation among the various health providers. Preserving the current system has the advantage of the ministry’s proven experience in emergencies; it knows how to operate the Tipat Halav network for a quick response to emergencies such as disease outbreaks and is well prepared to handle them. In addition, the staff have specialized training and extensive experience in prevention and health promotion.
2 – Alternately, an Early Childhood Authority could be established to unify all early childhood activities that are currently spread among various government ministries and secure increased funding for Tipat Halav to ensure its effectiveness and accessibility. The authority would have a broad, holistic perspective, so it could identify the unique needs of young children in education, welfare, and health. It would also resolve the issue of communication and information transfer among the various health providers.
3 – Responsibility for operating the clinics could be transferred to local authorities. Although this option has been rejected several times in the past, it now seems quite feasible given that many local authorities have become active in health promotion and in related areas of education and welfare, they wrote, adding that this model already operates in Israel’s two largest cities.
The advantage of this option is that local authorities function well in emergencies. As seen during the current war, they are engaged and effective in providing health responses and strengthening community resilience. Local authorities also have strong ties to the community and a deep understanding of the challenges in each neighborhood and population group.
4 – Responsibility could be moved to the four public health funds. The advantage of this option is that they already provide medical services to the entire population, and to children in particular, so major system changes would not be needed. Bringing Tipat Halav services and other health services under the same roof would solve the problem of communication and information transfer between different agencies and help maintain continuity of care for the child.
Whichever alternative is finally implemented – by the Health Ministry, the municipalities, the health funds, or if a special authority is established, – it has to be done now before it’s too late even to pick up the pieces of the Tipot Halav system.