Dynamics of non-communicable disease prevention, diagnosis and control in Lebanon, a fragile setting

Abstract

Background Non-communicable diseases (NCD) present an increasing global health challenge, particularly for settings affected by fragility where access to care may be disrupted, and where high-quality continuous care delivery is difficult to achieve. This study documents the complex dynamics of NCD prevention and management in the fragile setting of rural Beqaa, Lebanon. Methods Participatory system dynamics methods were used, including 30 semi-structured interviews and three Group Model Building (GMB) workshops. Participants included health care providers offering NCD care, and Lebanese host- and Syrian refugees community members affected by NCDs. Results Participants across all groups articulated a shared complex understanding of both the structural and direct determinants behind NCD onset. Lebanese and Syrian community members further identified several barriers to health seeking, including restrictions in health coverage, limited availability of services in the Beqaa and perceptions of poor-quality care. Health providers and community members described a health system overtly focused on disease control and overwhelmed by delivery of care to people living with NCD across both communities. Conclusion Participants across all groups agreed on the need for health promotion and primary prevention activities and identified priority interventions in these areas.

The role of trust in health-seeking for non-communicable disease services in fragile contexts: A cross-country comparative study

“…Incipient models were analysed by the wider research teams, inductively identifying themes related to health-seeking in each context and its relations with social and structural contextual factors. This was followed by the abstraction of key themes and mechanisms explaining health-seeking pathways for NCDs ( Idriss et al, 2020 , Witter et al, 2020 , Zablith et al, 2021 ).…”

“…These themes are posited as pre-requisites for institutional, interpersonal and social trust in the previous literature looking at trust in health systems and a wider role of social capital in help-seeking behaviour ( Anand and Kutty, 2015 ; Lewis and Weigert, 2012 ; Luhmann, 2000 ; Lyon et al, 2015 ; Mechanic and Meyer, 2000 ; Ozawa and Sripad, 2013 ; Topp and Chipukuma, 2016 ). Data were then triangulated with eight CLDs developed by a wider research team (KD, SW, AA, IBO) during GMB workshops in Sierra Leone and Lebanon ( Idriss et al, 2020 , Witter et al, 2020 , Zablith et al, 2021 )). Complemented by contextual data extracted from official reports, the findings for each context are presented in case summaries.…”

“…Some people wait until they get paid by the beginning of the month”. (Lebanese NCD patient, interview; Zablith et al, 2021 , p.7)…”

“…So, they go straight to the pharmacist and get diagnosed and tested there”. (Lebanese community member, interview; Zablith et al, 2021 , p.7) “What I hear is that refugees only go to the pharmacist. They don't go to the doctor's.…”

“…So, they go straight to the pharmacist and get diagnosed and tested there”. (Lebanese community member, interview; Zablith et al, 2021 , p.7)…”