Informal healthcare provision in Lebanon: an adaptive mechanism among displaced Syrian health professionals in a protracted crisis

Abstract

Background Syrian healthcare workers (HCWs) are among those who fled the Syrian conflict only to face further social and economic challenges in host countries. In Lebanon, this population group cannot formally practice, yet many are believed to be operating informally. These activities remain poorly documented and misunderstood by the academic, policy and humanitarian communities. This study aims to understand mechanisms of informal provision of services, the facilitators and barriers for such practices and to present policy recommendations for building on this adaptive mechanism. Method A qualitative descriptive study based on an in-depth interview approach with a sample of Syrian informal healthcare workers (IHCWs) residing in Lebanon was adopted. Known sponsor networks followed by snowball sampling approaches were used to recruit participants. Data collection occurred between September and December 2017. All interviews were audio-recorded, transcribed and translated into English. An inductive thematic analysis was used. Results Twenty-two participants were recruited. Motivational factors that led HCWs to practice informally were personal (e.g. source of income/livelihood), societal (cultural competency), and need to fulfill a gap in the formal health service sector. Being connected to a network of IHCWs facilitated initiation of the informal practice until eventually becoming part of a community of informal practice. The central challenge was the informal nature of their practice and its negative consequences. Most IHCWs were afraid of arrest by the government upon identification. Most interviewees indicated being discriminated against by host communities in the form of differential wages and tense interpersonal relationships. Almost all recommended a change in policy allowing them to practice formally under a temporary registration until their return to Syria. Conclusion Our study confirmed the presence of IHCWs operating in Lebanon. Despite its informal nature, participants perceived that this practice was filling a gap in the formal health system and was helping to alleviate the burden of IHCWs and refugee health needs. In line with interviewees’ views, we recommend that policy decision makers within humanitarian agencies and the Government of Lebanon explore the possibilities for allowing temporary registration of displaced Syrian IHCW to benefit local host communities and refugee populations. Electronic supplementary material The online version of this article (10.1186/s13031-019-0224-y) contains supplementary material, which is available to authorized users.

Voices of the vulnerable: Exploring the livelihood strategies, coping mechanisms and their impact on food insecurity, health and access to health care among Syrian refugees in the Beqaa region of Lebanon

“…Healthcare becomes a luxury and individuals resort to prioritization of medical conditions for which to seek healthcare. As a result, refugees seek alternative sources of healthcare such as homeremedies, informal healthcare providers [66], and pharmacists [63], as evidenced previously by 35% of registered Syrian refugees in the Baalbek-Hermel governorate seeking primary care from pharmacies [10]. Refugees in the present study also reported increasingly acquiring their medications from Syria [63] and occasionally travelling to Syria for surgical procedures despite associated ramifications.…”

“…Providing employment, jobskills training and investment opportunities, along with cash assistance can help alleviate many barriers experienced by refugees in securing their livelihood and provide more sustainable long-term solutions. Finally, with respect to improving access to health care, temporary policies, similarly to those adopted in Turkey [76], allowing Syrian healthcare providers to practice their professions among their refugee communities can be examined as potential approaches to relieve the high burden on the strained health care system of host communities [66]. Moreover, Syrian healthcare workers have good rapport and reputation within their own communities, thus they may be able to alleviate the financial strains and fears of social discrimination experienced among refugees when interacting with health workers from the host community.…”

Noncommunicable Disease and Health Care-Seeking Behavior Among Urban Camp-Dwelling Syrian Refugees in Lebanon: A Preliminary Investigation

“…13,27 Some SRs also visited informal SR HCWs, as has been described in other regions of Lebanon. 19,28 As described in Table 4, a notable finding of this study is that participants sometimes avoided care due to perceived discrimination by HCWs. Participants frequently cited poor treatment by HCWs because of their ethnicity, socioeconomic status, or receipt of subsidized services.…”

“To die is better for me”, social suffering among Syrian refugees at a noncommunicable disease clinic in Jordan: a qualitative study

“…No Syrian health professionals were employed by the clinic due to regulatory restrictions in Jordan. Syrian refugees in Lebanon were found to feel more comfortable receiving care from health professional staff from their own culture who have also endured displacement rather than from local staff [50]. Its is unclear how employing Syrian health professionals would impact on uptake of MHPSS services in this context.…”