The Crisis in Tipat Halav: An Essential Service in Danger of Collapse

The full policy paper is currently available only in Hebrew.

This policy paper presents a troubling picture of Tipat Halav services in Israel — the main public institution for child health in early childhood.

The clinics suffer from severe budget neglect, a shortage of staff, major maintenance problems, and a sharp decline in vaccination rates — 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, Prof. Nadav Davidovitch, Dr. Sarit Silverman, Efrat Sales, and Dr. Yair Sadaka, present policy alternatives to halt the deterioration.

Study findings: The challenges and failures in Tipat Halav

• 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 chickenpox), which was once among the highest in the world, is showing a worrying decline: from 73% in 2019 to just 64% in 2023. The paper shows that none of the Tipat Halav service providers — the Ministry of Health, the health funds, and the local authorities of Jerusalem and Tel Aviv — met the vaccination targets set by the Ministry of Health. Vaccination rates for other vaccines have also fallen, especially 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 paper’s authors emphasize that non-vaccination endangers not only the individual but the entire public, as it undermines the ability to achieve herd immunity, which protects the whole population, not just those vaccinated.
• A severe shortage of manpower. 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 at Tipat Halav compared to other healthcare frameworks make it difficult to recruit and retain doctors and nurses over time.
• Lack of information transfer and gaps in continuity of care. Medical care for children involves many providers and care settings. Currently, information collected about a child in hospitals and health funds is not transferred to the relevant Tipat Halav station, 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.
• Poor maintenance. The Ministry of Health, which provides services to more than half of Israel’s children, operates the Tipat Halav stations 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, damp, and neglected yards. However, the Ministry of Health struggles to allocate funding for renovations and for constructing new facilities.

• Widening gaps in language acquisition milestones. A study conducted by the Taub Center in collaboration with the KI Institute examined the link between achieving language development milestones and the mother’s education level (a proxy for 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 Tipat Halav stations.

Policy options

To ensure that Israel’s population can continue to benefit from the vital services of Tipat Halav, it is necessary to strengthen and preserve this system. To that end, the authors propose several policy alternatives. The full alternatives, with their advantages and disadvantages, are detailed in the full paper. The following is a summary:

1. Maintain the current system 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 of Health’s proven experience in emergencies: the Ministry 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, Tipat Halav’s staff have specialized training and extensive experience in prevention and health promotion.
2. Establish an Early Childhood Authority. This authority would consolidate all early childhood activities, which are currently spread across different government ministries, and secure increased funding for Tipat Halav to ensure its effectiveness and accessibility. The authority would have a broad, holistic perspective, enabling it to 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. Transfer responsibility for operating Tipat Halav 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. Moreover, this model already operates in Tel Aviv and Jerusalem. 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. Transfer responsibility for operating Tipat Halav to the health funds. The advantage of this option is that the health funds 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.