Hospital Strategic Plan (March 2020– February 2024)

To view the plan in pdf format click here. 

Hospital Strategic Plan (March 2020– February 2024)

Prepared by

Dr. Youssef Abd Al-Hamid Al-Takrouri 

General Director 


Dear respected Board of Trustees of Patient Friends Society 

Subject: What has been achieved from the hospital’s second strategic plan. 


I am presenting to you the second strategic plan, which lasts for (4) years from March.2020 to February.2024, comes as a continuation of the first strategic plan from March.2016 to March.2020, which adopted a vision based on the philosophy of improvement and development of medical services in addition to expanding the variety of the medical services and procedures, and the goal is to fully improve the Palestinian health system in cooperation with the Palestinian Ministry of Health, despite the serious obstacles, the most important of which are the Corona pandemic, the state of emergency we are going through , and the last war on Gaza Strip. 

Allow me to present to you a description of what has been accomplished in the strategic plan through an insightful vision and a clear mission to achieve the goals and objectives set through an integrated action plan built on the following five main directions: 

The plan of developing medical, nursing and technical staff. 


The plan of developing the infrastructure of the hospital. 


The plan of the proposed expansion of Hospital departments and creation new services. 


The relationship with service providers such as the Ministry of Health, Military Medical Services, UNRWA and insurance companies. 


Scientific Research. 


             Before talking about the plan’s directions, I will talk first about our role in the governance's medical  emergency plan during the Corona pandemic and the last war on Gaza and their impact on the hospital.


Corona pandemic (Covid-19) - the Emergency plan: 

Let's start with the Corona pandemic, as it is the most prominent event in our lives and it had the greatest impact on the development plan. 

     The Corona pandemic has affected the entire world, paralyzing most aspects of human life, and all indicators of economic growth declined, but medical teams and supporting medical services teams (nursing, laboratories, radiology) were in the eye of the storm, and all teams were mobilized to participate in confronting this pandemic, and the greatest weight fell on the responsibility of hospitals... 

       Here was the challenge, and the question posed was, “What can Al-Ahli Hospital provide in this pandemic?”? And your esteemed council’s quick response to the emergency plan was a cornerstone of the success of this plan, in which we integrated with the governorate’s hospitals, whether governmental, private, or public. 

      We have been involved in the Supreme Emergency Committee in the governorate from the first moment and formed a specialized work team within the hospital. The most important things we have done were: 

1-Stock of medical consumables and supplies: 

       We worked within an emergency plan, inventorying the assets, and supplying the warehouses with materials for which demand is expected to increase, the most important of which are sterilization materials, masks, hand gloves... 

         The summary of the work is that we have overcome the pandemic and, thank God, no type of supplies or medicines were cut off, in addition to that we were not forced to buy anything at a high price due to scarcity or interruption. 

2- Protecting staff inside the hospital: 

     All protection means were provided, in accordance with the requirements of the Palestinian Ministry of Health and the requirements of the World Health Organization, and we applied the global protocol for quarantine and staff leave and the mechanism for collecting samples. Sick leave and treatment for employees were considered at the expense of the hospital, in addition to an emergency plan for the mechanism of work and attendance of the staff in the hospital, aiming to protect the staff and maintain the workflow in the hospital. 

3- With the pandemic spread and the increase in numbers of infections and the increasing need for hospital beds, we opened ten intensive care beds within a separate department for Covid patients. The situation quickly developed and our response was rapid, so we added ten more beds, followed by another ten, and we now have an intensive care department that can accommodate thirty patients, equipped with the latest ventilators and devices. ECMO monitoring and pulmonary support. The number of patients admitted to the department reached (335). 

4- Home care for patients: 

      We participated in the “Good Breath” or “Healthy Breath” campaign with the Palestinian Red Crescent and the Royal Trading Foundation, and the base of this campaign was voluntary work... The goal is to reduce pressure on emergency departments by responding to patients through (free of charge) home visits for medical examination, conducting the necessary laboratory tests, and developing a diagnosis and treatment plan, and in case of need Providing an oxygen generator for patients at home, this work had a significant and clear impact in preventing emergency departments from being overcrowded with patients in all of Hebron governorate, Al-Ahli Hospital made its significant fingerprint in this campaign. 

5-Vaccinating the staff against the Corona virus: 

       We have developed a plan in cooperation with the Palestinian Ministry of Health, which provided vaccines to staff working in hospitals, and We gave the vaccination to the staff working in the hospital, which had a positive impact in confronting the pandemic. 

6-The biggest challenge that we faced was how to continue providing medical services to patients who are not infected with Corona, and they need medical other medical services available in Al-Ahli Hospital, or emergency cases, taking in consideration not expose them to infection with the Corona virus inside the hospital...

      In order to make this matter successful, we have developed a strict plan that prevents the movement of nurses, doctors, and staff between the different departments (coronavirus/non-coronavirus), and this doubled the burden on us. on one hand, the lack of qualified staff members going out on sick leave due to infection with Corona, on the other hand, the high financial cost for this type of services.

      With the end of the pandemic, we were able to overcome this ordeal and this difficult test, and I hope that we have reached safety...

The War on Gaza 2023 - Emergency Plan 

     In response to the reality imposed by the war on Gaza in 2023, we have developed an emergency plan based on steadfastness and continuing to provide medical services. We list for you the most important items of the emergency plan to confront the effects as well as the challenges and difficulties resulting from the war and the impacts on the hospital: 

1-Medical and general storage: With the eruption of the war against Gaza after 10/7/2023 and in accordance with the decision of the Palestinian Minister of Health in her meeting with public and private hospitals that she insisted of the great need to prepare and raise the storage in hospitals to confront any emergency for at least 4-6 months, this comes in parallel with the special emergency plan. At Al-Ahli Hospital, we communicated with the companies that supply medicine and medical and general supplies, we raised the storage within the internal procurement system and according to the established plan, but we faced a problem and difficulties in paying the supplying companies due to the general financial situation resulting from the last War on Gaza, but this dilemma was overcome by communicating with the companies and raising the debt ceiling and Payment by post-dated checks. 

Note: We are working within a plan to rationalize consumption in the departments, but it is important that the hospital warehouses must have what is needed within storage without affecting the medical service provided to patients. 

2- Employees 

a. Regarding the emergency plan taking in consideration the fact that Al-Ahli Hospital is a central hospital in the southern region, we placed all our staff in a state of extreme emergency and we arranged programs for the alternates within an exceptionally special mechanism (and we received some occupation injuries during the last months of (10th of July.2023 – 2nd of January.2024) we received more than (117) injuries, most of which are severe injuries. 

b. We have developed a plan to consume the accumulated annual leaves for all departments and according to work need. 

c. We began reducing outside nursing overtime and developed a plan to minimize the reduction. 

3- Gaza patients and their companions: 

      There are (49) Gaza patients in the hospital who were receiving treatment in the hospital and were unable to leave due to the war on Gaza. They are fully hosted by the hospital (they are currently in the housing of our people from Gaza) until they are able to return. 

4-Generators, wells and storage spaces: 

     All electrical generators were inspected and maintained, and the storage of fuel was raised to the highest possible level, and additional storage spaces were approved. 

The direct impact of the war on the hospital: 

1- Payments from the Ministry of Health Instead for purchasing the service: 

     Due to what the government is going through as a result of the occupation’s by holding the Palestinian authority funds, monthly transfers to the hospital instead of purchasing services have decreased, and the emergency payments that were transferred are barely enough to cover emergency matters. 

2-Daily income: 

      There is a decrease in daily income of up to 30%-40% compared to what was before 10/7/2023, as we are facing a problem with patients that are unable to pay medical bills, as well as the percentage owed by patients after the treatment coverage, in addition to the failure of public employees to receive their salaries, as well as the suspension of workers that used to work inside Israel. 

    Recently, we have been forced to solve these problems through Past due bills (bills of exchange), especially that some patients are forced to stay for a long time such as premature babies they have no money, this shows the importance of the Poor Patients Fund and its aid to the needy Patients that come through this fund, this comes through the decisions of the Board of Trustees and according to the recommendations of the specialized committees. 

3-Private insurance companies: 

     Due to the current situation, insurance companies were not able to commit itself to pay the Hospital dues as before, but we are working diligently with them to collect the payments. 

4We face difficulty in disbursing employee salaries, as well as difficulty in paying financial dues to companies supplying medicines and medical supplies for the above reasons, and we cannot reduce the number of employees, including doctors, nurses, etc., because we are working within a state of emergency and the patient occupancy rate in the hospital exceeds (85%)


Summary... after Four months of war: 

1-The hospital works in an integrated manner with the governmental hospitals and within the health emergency committee in the governorate. 

2- The hospital is working at maximum capacity despite the difficulties, while maintaining the quality of medical services provided to patients. 

3-We adopted a resilience plan: 

a. The warehouses were supplied for months, at the same time we rationalizing internal consumption to the highest level. 

b. The necessity of preserving the staff and maintaining their safety.

4-Maintaining the training of university students (nurses, doctors) in the hospital so that they do not lose the semester and clinical practical training for the year 2023-2024.

5- We are working hard to provide salaries to employees, the total salaries owed to the employees so far (3 and a half salaries) as a part of an emergency plan that depends on sustainability in coordination with banks and the Monetary Authority, Frankly, our employees are steadfast and appreciate the situation we are going through, but we firmly believe that their steadfastness will not last long and will not last. They are no longer able to reach the hospital or provide the minimum requirements for life.


     Despite what was mentioned previously and the great difficulties we faced as a result of the pandemic, the last war on Gaza, and the measures that were taken within the emergency plan... However, with the support of charitable people and the sincerity of the loyalty of our employees, we were able to move forward in implementing the directions of the second strategic plan, as we review in this report its most important outcomes:

The five directions of the strategic plan

  • 1st Direction: The plan of developing medical, nursing and technical staff. 

a. The doctors: 

-The number of specialty and subspecialty doctors in the hospital is (78) 

-The number of doctors residing within the specialty program in the hospital departments is (122) doctors. 

In continuation of the work that we began several years ago, which aims to improve medical services by attracting medical competencies and rare specialties, the following have joined the hospital staff since the years (2020-2023): 





Endoscopic Lung Surgery Specialist 

Dr. Youssef Abu Asaba 


Surgical Intensive Care Specialist 

Dr. Issam Al-Shammas 



Dr. Mutaz Al-Bakri 


Diagnostic Radiologist 

Dr. Ibrahim Al-Zaatari 


Pediatric Nephrology Specialis 

Dr. Basil Al-Grouz 


2- Part Time: 




Pediatric neurologist 

Dr. Bassam Al-Bashiti 


Pediatric gastroenterologist 

Dr. Mutaz Sultan 


Pediatric gastroenterologist 

Dr. Ibrahim Shamasneh 


Premature infant specialist 

Dr. Mutee Abu Awad 


Pediatric Cardiac surgery specialist 

Dr. Nizar Hajjeh 


Genetic and hereditary diseases specialist 

Dr. Nadra Daamsa 


Pediatric neurologist 

Dr. Mutaz Al-Tamimi 



We adopted a scholarship policy to obtain medical subspecialties that are not available in the hospital, and the following joined the hospital staff after completing the scholarship period for the subspecialty: 




Pediatric Intensive Care Specialist 

Dr. Tamer Quteina 


Orthopedic and Endoscopic Surgery Specialist 

Dr. Murad Natsheh 


Intensive Care Specialist 

Dr. Ashraf Al-Zughayar 


Neurosurgeon and Cerebral Therapeutic Catheterization Specialist 

Dr. Sharif Basal 



Dr. Ezz El-Din Igteit 


Infectious Diseases Specialist 

Dr. Safwat Zeidat 


4-Physicians who have recently received scholarships or have not completed their scholarship in the subspecialty: 




Subspecialty/Laparoscopic and Obesity Surgery 

Dr. Amer Abu Rmeileh 



Dr. Hamza Al-Zughayar 



Dr. Ahmed Atawneh 


Subspecialty/Plastic and Reconstructive Surgery 

Dr. Ismail Dababsa 



Dr. Hosam Al-Husseini 


Laparoscopic and Obesity Surgery 

Dr. Mohamed Emar 


Subspecialty/ Internal Neurology 

Dr. Muhammad Al-Rejei 


Subspecialty/Interventional Cardiology 

Dr. Hammam Abu Aisha 


Nuclear Medicine 

Dr. Obaida Rabai 


Subspecialty/Liver and Pancreas Surgery 

Dr. Murad Jaafra 


Subspecialty/Pediatric Anesthesia 

Dr. Yazan Al-Zaatari 


Subspecialty/Pulmonary Diseases 

Dr. Mahmoud Al-Hoor 


Subspecialty/Pediatric Surgery 

Dr. Muhammad Al-Qaymari 


5-This is in addition to the participation of doctors in many scientific conferences and training courses internally and externally.

6-Full-time medical system and evening clinics:
We made the full-time medical system (working only at Al-Ahli Hospital and not opening a clinic outside the hospital) in April 2018. We were one of the first hospitals, or even the only ones so far, to implement this system. Implementing this system had many positive impacts, the most important of which are: 

A. The presence of specialist doctors in the hospital until the evening, which reflected positively on the patients, and the level of medical services. 

B. Improving the quality of training programs for doctors. 

C. Improving daily financial income, whether from clinic income, support services, or medical procedures. 

7-Medical educational program:  

Al-Ahli Hospital is currently considered one of the most important medical teaching hospitals in Palestine within the specialty program of the Palestinian Medical Council, which is accredited by it (the Palestinian Board and the Arab Board). The number of doctors enrolled in the specialty programs in the hospital is (122) male and female doctors.

-The hospital’s current educational programs accredited by the Palestinian and Arab Medical Councils are: 

  • Specialization in general surgery
  • Pediatric specialty
  • Internal medicine specialty
  • Specialization in orthopedic surgery
  • Specialization in diagnostic radiology
  • Specialization in Obstetrics and Gynecology
  • Specialization in anesthesia and resuscitation

-We have obtained recognition for the subspecialty program from the Palestinian Medical Council as follows: 

  • Gastroenterology Fellowship Program
  • Non-interventional cardiology fellowship program
  • Fellowship program for premature infants

-We submitted applications to the Palestinian Medical Council to recognize the following programs: 

  • Fellowship program in intensive care. 
  • Specialization in cardiac surgery. 
  • Specialization in Neurosurgery. 
  • Pathology specialty.

    • Developing the nursing staff is very important, as they are in constant contact with patients and clients. This is why we have sent nurses to attend scientific conferences and specialized training courses, the most important of which are cardiac catheterization and infection control, in addition to internal training courses. 

-The results of the board exams for doctors enrolled in the hospital’s specialty programs are among the best. 

B. Nursing: 

  • Encouraging nursing staff to continue their studies at the Palestinian universities by providing scientific scholarships. 
  • Sending a number of (15-20) nurses on scholarships in order to obtain master’s degree in the field of premature infants and pediatric intensive care due to the importance of this service, especially after the expansion of the Neonate department with a capacity of (27) incubators and the expansion of the pediatric cardiac care department.

C. Various technical and administrative staff: 

  • Medical and general engineers and technicians participated in specialized training courses. 
  • Most service employees have been trained on infection control policy in special training courses. 
  • Encouraging technical and administrative staff to advance (continue their studies) to a bachelor’s degree or obtain a master’s degree.

nd direction: The plan of developing the infrastructure of the hospital2  
* Unfortunately, due to the Corona pandemic and the financial crisis resulting from the state of emergency due to the war on Gaza, progress in this direction is still progressing slowly, with my emphasis on the necessity of developing a plan to accelerate the modernization of infrastructure, especially the electricity network and the fire network.33rd Direction: The plan of the proposed expansion of Hospital departments and creation new services: 

  • We were able to increase the operational capacity of the hospital by (57%) by increasing the number of beds in the hospital by (93) beds, bringing the number of beds to (255) by the end of the year 2023, noting that the hospital operated with a capacity of (162) beds from the year 2000 until the year 2016. This increase is considered a major achievement in during these difficult circumstances and enormous challenges. 
  • In continuation of the first strategic plan, which ended in 2020, and within the second strategic plan, the following medical departments were opened: 

1-The new outpatient department: 

With a capacity of (34) specialized clinics attached to a laboratory and CT, X-ray and ECHO equipment, this department is considered the largest and most modern at the national level. A communication system has been developed to book advance appointments (No. 1700200400) and the clinics operate in two shifts, morning from 2-9 and evening from Hours (3-6( 

2-Neonate Department

The department was completely rehabilitated and expanded to operate with a capacity of (27) incubators instead of (13) incubators, equipped with the latest medical devices and equipment. 

3-Catheterization Department: 

The department was rehabilitated with modern specifications and expanded to include (3) catheterization devices, one double-headed and two single-headed, which include: 

  • Cardiac catheterization. 
  • Peripheral catheter. 
  • Cerebral catheterization. 
  • Pediatric heart catheterization. 
  • Radiological interventional catheter. 
  • Treatment of electrical heart diseases. 

4-Surgical Intensive Care Department: 

We were one of the first hospitals to separate intensive care departments (internal intensive care/surgical intensive care) and the department with a capacity of (16) beds equipped with the latest medical monitoring devices, distillation devices, and blood washing and filtration devices5-Laboratory and 5-Blood Bank Department: 

The laboratory department and the blood bank were modernized and equipped, and the infrastructure and external decoration were rehabilitated, as well as equipped with the latest equipment. The blood bank was expanded to accommodate (3000) units of blood and blood products are stored in special cooling rooms that were equipped for this purpose. A special room was also prepared to withdraw blood from donors. The laboratory and blood bank departments were connected with a computerized system to ensure quality and accuracy and to avoid human errors. 

6- Emergency Department: 

The department is equipped with a capacity of (24) beds, these beds are equipped with the latest devices and equipment. The department was designed to take into account privacy and needs. The department includes (a women’s section / a men’s section / a children’s section / a trauma section / a cardiopulmonary resuscitation unit).

7-Residents’ housing and specialists’ offices: 

A two-store building with an area of (1000 square meters). The second floor was prepared and divided into two parts, one section includes housing for female resident doctors and the other section for male resident doctors. The section is equipped with modern communication and education tools, while the first floor was prepared to be designated for specialist doctors. 

Work is underway to complete and open the following departments: 

1-Daily Cases Department: 

We are working on rehabilitating and equipping a new department that includes (14) beds for daily surgical cases, and it will begin operating within (4) months. 

2-Department of Pediatric Cardiac Surgery Intensive Care: 

This important medical service was started to be given in the year 2019, and We have distinguished ourselves in providing this medical service among all the hospitals in the West Bank. This department came in response to the urgent need for this service, especially with the stop of referrals to Israeli hospitals by a decision of President Abu Mazen. Work in the department began with (4) beds. Within two years, it increased to reach (8) families, where (421) heart surgeries were performed on children since the opening of the department. Given the need and importance of this service and its positive effects in reducing the suffering of patients, we developed a plan and began implementing it to create a modern department with a capacity of (13) additional beds. An operation theatre for pediatric heart surgery, and work in the department is expected to begin within (6) months. 

3-Central Sterilization Department: 

From the vital departments in the hospital, according to the plan, we were able to obtain funding to provide the department with the latest devices and equipment. We are currently working on preparing the basic infrastructure, and work will begin in the new department within (3-6) months. 

4-Developing the operational structure and diagnostic and therapeutic capabilities of the Nuclear Medicine Department: 

The nuclear medicine department in the hospital is one of the departments in which we have distinguished ourselves and been unique in providing therapeutic services using radioisotopes since 2013. We have equipped the department with special specifications that are in parallel with the work requirements within the conditions of licensing and the requirements of the International Atomic Energy Agency. 

At the beginning of 2023, in partnership with experts in the field of nuclear medicine, our project was approved with support from the International Atomic Energy Agency (IAEA). The project code is:

LAL6005: Establishing in Prostate and Neuroendocrine Cancer Treatment Unit using Radioisotope Techniques at the Al-Ahli Hospital Nuclear Medicine Department. 

Over the course of an entire year, we held several technical meetings via the ZOOM system during which the plan and objectives were discussed. A face-to-face meeting was not possible due to the War on Gaza. We present to you a summary of the project: 


Providing diagnosis and treatment of prostate and neuroendocrine cancer services using radio nuclear isotope technology in the nuclear medicine departments at Al-Ahli Hospital. 

- Expected outcomes after project implementation: 

1-The physical infrastructure is being created in the existing departments for the diagnosis and treatment of prostate and neuroendocrinology using radioisotope techniques in the currently functioning Department of Physical Medicine. 

2-Human resources (staff) are trained and qualified in prostate and neuroendocrine diagnosis and treatment techniques. 

3- The new plan for the new cancer treatment hospital is being formulated using linear accelerator techniques.


Activities expected to be implemented during the period 2024 - 2025 - 2026: 

1-Evaluating the current functional infrastructure of the nuclear medicine sections in terms of the physical infrastructure of spaces and equipment, human resources, radiation protection and the quality of implementation of technical and administrative services in Al-Ahli Hospital. 

2-Reconstructing the current physical infrastructure to be suitable for implementing prostate and neuroendocrine cancer treatment and diagnosis procedures using radioisotope techniques within the currently operating Department of Physical Medicine. 

3- Improving and updating functional medical procedures and programs in the department. 

4-Determine the required equipment and tools and all necessary purchases for capacity building. 

5-Training and qualifying the required staff. 

6- Approval of implementation plans for the new hospital for diagnosing and treating cancer. 

Diagnostic and therapeutic medical services proposed to be added to the services: 

1- The radioactive material LU-177 and the PSMA diagnostic examination: adding a treatment service for prostate cancer. This treatment service is not available in the country’s hospitals. 

2-The Substance of - F18-DOPA: It is used to diagnose patients with brain tumors, Parkinson’s patients, and some endocrine and neuroendocrine tumors. It is not available in national hospitals. 

3- The Substance of F18-DOTA: It is used to diagnose neuroendocrine tumors (NET) and is not available in national hospitals.

4th  Direction: The relationship with service providers such as the Ministry of Health, Military Medical Services, UNRWA and insurance companies. 

a. Ministry of Health and Military Medical Services: 

It is the largest provider of medical services, and we have expanded the medical services according to the requirements and needs of the Palestinian Ministry of Health within the vision of integration in providing medical services. 


We have a strategic relationship with our people in the camps and medical service representatives who hold the UNRWA insurance on the basis of strengthening resilience and identity. 

- 5th Direction: Scientific research:

a. Believing in the importance of scientific research, we have encouraged participation in scientific research, and many research papers by hospital doctors have been published in international scientific journals.

B. We signed a research consulting agreement with an expert in the field of practical research and presented to donors several research projects through which a laboratory would be established for scientific research purposes.

Future plan for expansion: 

1-The New Building A: 

A proposal for a building with an approximate capacity of (16,500) square meters in the front parking lot of the hospital. The building includes 3 underground floors with a capacity of (2,500) meters per floor designated for parking and services, and 6 floors above ground with an area of (1,600) meters per floor (a floor designed to be teaching halls for Medicine students and 4 floors of medical departments with high specifications. 

2- Oncology building: 

We obtained the approval of the Palestinian Ministry of Health to start giving radiotherapy services for cancer patients, and preparations have begun for this large, vital, and important project that is expected to be built within the external spaces of the hospital. We hope that this project will see the light in the near future (3-5 years), and this comes as a continuation of what we have accomplished in the department. Of the Nuclear medicine, where we were the first, and even the only one, in providing treatment services for cancer patients with radioactive materials such as radioactive iodine and technetium, as well as the positron medical imaging service, Pet Scan. 

- A proposal to build a building consisting of 3-4 floors with an approximate area of about (6000) square meters, which includes a place designated for installing a device for radiotherapy for oncology patients within special specifications, as well as a treatment service with radioactive (nuclear) materials such as radioactive iodine, technetium, lutetium... etc., and positron tomography (PET) Scan. 

- Note that radiotherapy service is not available in areas of the Palestinian National Authority, and patients suffer greatly to obtain this service due to the occupation’s measures.

Dear respected Board of Trustees: 

Once again, I extend my sincere thanks to you. Without your unlimited support, we would not be standing today to be proud of this achievement. Thanks go to all the employees (staff) of this medical institution, each in his position, and success is for all. 

As a conclusion, No one has a monopoly on success, success is for those who stick to the goal, success is for those who pay the price... and that what has been achieved in this short period of time is clearly witnessed by everyone, despite the grave obstacles and challenges, the most important of which is the Corona pandemic and the state of emergency. In this plan, we were able to combine medical development, human staff, administrative development, and urban expansion, and we have laid a foundation for introducing scientific research into the services in the hospital. 

With All respect and appreciation

Dr. Youssef Al-Takrour

General Director




A chart shows the number of employees distributed among departments.


A chart shows the number of employees over the years.

A chart shows the number of patients' beds distributed among the department.

A chart shows the number of patients' beds over the years.


A chart shows the number of patients' admissions over the years.

A chart shows the number of births over the years.

A chart shows the number of patients of the outpatient clinics over the years.