Lebanon's essential health care benefit package: A gateway for universal health coverage

Abstract

Summary Recent years have demonstrated the resurgence of a global commitment toward universal health coverage (UHC). The first step toward developing a sustainable primary health care (PHC)‐oriented UHC program is the creation and service delivery of an explicit essential health care benefit package (EHCP). This paper aims to describe the development, features, and progress of the EHCP in Lebanon, in addition to outlining barriers, facilitators, and next steps. Building on the investments made in the PHC network, the ministry of public health in Lebanon piloted an essential PHC package program in 2016 targeting vulnerable Lebanese and was able to enroll over 87% of targeted population to date. In order to scale up the EHCP to the national level and achieve UHC, modifications need to be made to the package entitlements, provider payment mechanisms, and implementation arrangements. The paper also notes that further advocacy and lobbying are needed in order to place UHC and the EHCP on the national agenda and stimulate public demand.

Can Primary Healthcare be Protected as a Public Good in Lebanon Today?

“…The shock of the Lebanese civil war (1975)(1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990) The Lebanese civil war resulted in numerous deaths, injuries, and economic losses as it succeeded to "put an end to the prosperity and economic growth witnessed in Lebanon since the 1950s, and had a catastrophic impact on both the private and the public sectors" [1]. The civil war seriously affected the capacity of the Ministry of Public Health (MoPH) and increased its reliance on disparate non-state actors and private providers [4,5,10,11]. The war disrupted previous efforts to establish an integrated healthcare system and forced upon Lebanon a social organisation of health care based on sectarian lines [1,3,10].…”

“…The war disrupted previous efforts to establish an integrated healthcare system and forced upon Lebanon a social organisation of health care based on sectarian lines [1,3,10]. The war also created in each region substantial opportunity for an increasing number of non-governmental and private actors in the health care sector, who continue to play an important role in providing primary health care [4,5]. The current overall health system remains very hospital centred and the private system has become the key service provider [4,5,11].…”

“…The war also created in each region substantial opportunity for an increasing number of non-governmental and private actors in the health care sector, who continue to play an important role in providing primary health care [4,5]. The current overall health system remains very hospital centred and the private system has become the key service provider [4,5,11]. The result of the post-civil war arrangement is that the provision of health care has devolved to fragmented sub-systems, most of them private but including the public system as well.…”

“…The result of the post-civil war arrangement is that the provision of health care has devolved to fragmented sub-systems, most of them private but including the public system as well. These arrangements deliver health care through separate mechanisms to various populations of interest, relying on the 70 plus years of support from the United Nations Relief and Works Agency (UNRWA) to cover the health needs of the chronically impoverished Palestinian refugees [4,5,11]. Consequently, a people-centred and patient-centred approach has proved di cult to build --especially at the level of primary care [4,5,11].…”

“…The country now faces severe threats to its survival from impending economic collapse and hyper-in ation, factors brought on by grave failures in governance to protect public goods. The Covid-19 pandemic is challenging the frailties of the public health system, chronically underfunded by the Lebanese government for its routine obligations to care for the populations of poor Lebanese and of 1.5 million Syrian refugees who ed Syria from 2011 through 2014 [4,5].…”