Weakening of the Lebanese health sector

Nassar, M.; Abdallah, Wael; Najib, Bernard; Khalil, Khalil; Atallah, David

doi:10.26719/emhj.23.022

Cited by 5 publications

(5 citation statements)

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“…Among the nine selected EMR countries, high-income countries such as Bahrain, Saudi Arabia and the United Arab Emirates possess robust healthcare systems underpinned by strong financial backing and effective governance [ 22 – 24 ]. In contrast, countries such as Lebanon, Tunisia and Jordan face a multitude of challenges, including political instability, economic uncertainties, a high influx of refugees and relatively less efficient healthcare systems [ 25 – 27 ]. Conflict-affected countries such as Sudan, Syria and Yemen, already burdened by other disease outbreaks, famine and malnutrition, relied heavily on humanitarian assistance from donor nations and non-governmental organizations for resources [ 28 , 29 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, after the 2009 election, no further elections were held until 2018 and then again in 2022 • Health Policymaking: Lebanon’s political system, characterized by a corrupt sectarian structure, has hindered healthcare sector development. The absence of political will and inadequate accountability mechanisms have contributed to insufficiencies in the healthcare sector, particularly during the crisis • Date of first recorded COVID-19 case: 21 February 2020 • % of COVID-19 cases out of the population : 2.66% • Total COVID-19 deaths : 1468 • Case fatality rate (% of deaths of total cases): 0.8% [ 27 , 45 – 54 ] Tunisia • Governance arrangement : The healthcare system is overseen by the Ministry of Health, which is responsible for developing and implementing national health policies, regulating the healthcare sector and planning for equitable and high-quality healthcare services. The Ministry also manages the National Health Insurance Fund (CNAM), which provides health insurance coverage to a significant portion of the population • Financing arrangement: Healthcare is financed through a combination of social health insurance, general government revenues and private spending.…”

Section: Resultsmentioning

confidence: 99%

“…On the contrary, countries with political and economic instability struggled with fragmented and often delayed responses [ 55 , 59 , 66 ]. Lebanon’s private-sector-dominated healthcare system and persistent political turmoil, exacerbated by inadequate accountability mechanisms, contributed to insufficiencies in the healthcare system and impeded a cohesive response, while Tunisia’s political transition from a representative democracy to an authoritarian state affected its healthcare response and resource allocation [ 26 , 27 , 46 ]. In countries with fragmented governance structures and weak healthcare systems such as Sudan, Syria and Yemen, the lack of coordination between government agencies and non-health sectors weakened the pandemic’s impact, particularly in terms of resource allocation and service delivery.…”

Section: Resultsmentioning

confidence: 99%

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Multi-sectoral collaborations in selected countries of the Eastern Mediterranean region: assessment, enablers and missed opportunities from the COVID-19 pandemic response

El-Jardali,

Fadlallah,

Daher

2024

Health Res Policy Sys

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Background The coronavirus disease 2019 (COVID-19) pandemic has emphasized the importance of multi-sectoral collaboration to respond effectively to public health emergencies. This study aims to generate evidence on the extent to which multi-sectoral collaborations have been employed in the macro-level responses to the COVID-19 pandemic in nine selected countries of the Eastern Mediterranean region (EMR). Methods The study employed in-depth analytical research design and was conducted in two phases. In the first phase, data were collected using a comprehensive documentation review. In the second phase, key informant interviews were conducted to validate findings from the first phase and gain additional insights into key barriers and facilitators. We analysed the macro-level pandemic responses across the following seven components of the analytical framework for multi-sectoral collaborations: (1) context and trigger; (2) leadership, institutional mechanisms and processes; (3) actors; (4) administration, funding and evaluation; (5) degree of multi-sectoral engagement; (6) impact; and (7) enabling factors. Results Governments in the EMR have responded differently to the pandemic, with variations in reaction speed and strictness of implementation. While inter-ministerial committees were identified as the primary mechanism through which multi-sectoral action was established and implemented in the selected countries, there was a lack of clarity on how they functioned, particularly regarding the closeness of the cooperation and the working methods. Coordination structures lacked a clear mandate, joint costed action plan, sufficient resources and regular reporting on commitments. Furthermore, there was no evidence of robust communication planning both internally, focused on promoting internal consensual decision-making and managing power dynamics, and externally, concerning communication with the public. Across the selected countries, there was strong representation of different ministries in the pandemic response. Conversely, the contribution of non-state actors, including non-governmental organizations, civil society organizations, the private sector, the media and citizens, was relatively modest. Their involvement was more ad hoc, fragmented and largely self-initiated, particularly within the selected middle- and low income- countries of the EMR. Moreover, none of the countries incorporated explicit accountability framework or included anti-corruption and counter-fraud measures as integral components of their multi-sectoral plans and coordination mechanisms. Key enablers for the adoption of multi-sectoral collaborations have been identified, paving the way for more efficient responses in the future. Discussion Mirroring global efforts, this study demonstrates that the selected countries in the EMR are making efforts to integrate multi-sectoral action into their pandemic responses. Nevertheless, persistent challenges and gaps remain, presenting untapped opportunities that governments can leverage to enhance the efficiency of future public health emergency responses.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Multi-sectoral collaborations in selected countries of the Eastern Mediterranean region: assessment, enablers and missed opportunities from the COVID-19 pandemic response

El-Jardali,

Fadlallah,

Daher

2024

Health Res Policy Sys

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“…In this context, although the general population was severely impacted by the above, refugees and other vulnerable groups in particular were especially affected. For example, seeking healthcare services became even more difficult for them, primarily due to financial and logistical factors (13)(14)(15). Beyond those, refugees in Lebanon usually fear mistreatment and discrimination when seeking medical attention (16) as large numbers of Syrians in Lebanon report worse treatment than others because of their nationality (17).…”

Section: Introduction 1contextmentioning

confidence: 99%

Capacity building and community of practice for women community health workers in low-resource settings: long-term evaluation of the Mobile University For Health (MUH)

Naal,

Alaeddine,

Brome

et al. 2024

Front. Glob. Womens Health

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BackgroundLebanon has been facing a series of crises, significantly increasing health challenges, and straining its healthcare infrastructure. This caused deficiencies in the system's ability to attend to population health needs, and it profoundly impacted vulnerable and refugee communities who face additional challenges accessing healthcare services. In response, the Global Health Institute at the American University of Beirut designed and implemented the Mobile University for Health (MUH), which promotes task-shifting through capacity building complemented by communities of practice (CoP). The program aimed to prepare vulnerable women to assume the role of community health workers (CHW) within their communities, and to promote positive health knowledge and behaviours.MethodsA mixed-methods approach was used to evaluate MUHs' three certificates (women's health, mental health and psychosocial support, and non-communicable diseases). Implementation took place between 2019 and 2022, with 83 CHWs graduating from the program. Short-term data including knowledge assessments, course evaluations, and community member feedback surveys were collected. 93 semi-structured interviews with CHWs and 14 focus group discussions with community members were conducted to evaluate the long-term impact of the capacity building and CoP components.ResultsData revealed multiple strengths of the initiative, including increased access to education for the community, effectiveness of blended learning modality, successful planning and delivery of CoP sessions, and improved knowledge, skills, and health behaviours over time. The supplementary CoP sessions fostered trust in CHWs, increased community empowerment, and increased leadership skills among CHWs. However, some challenges persisted, including limited access to healthcare services, implementation logistical issues, difficulties with some aspects of the learning modality, and some resistance within the communities.ConclusionMUH promoted and improved positive health knowledge and behaviours within targeted vulnerable populations in Lebanon. The supplementary CoP component proved instrumental in empowering CHWs and enhancing their impact within their communities. The study highlights the need for ongoing training and support for CHWs and underscores the importance of continued investment and adaptation of such initiatives through a gendered lens. This evaluation provides evidence on the successes of a capacity building model that has strong potential for scale and replication across health topics in conflict-affected contexts.

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“…Lebanon’s infrastructure, particularly healthcare infrastructure, has also been further strained by the impact of the COVID-19 pandemic, the financial challenges, and the catastrophic August 2020 Beirut port explosion. The healthcare crisis is multifaceted and has been characterized by staffing shortage due to the exodus of healthcare workers [ 29 ] closure of medical centers [ 7 ], shortage of medications, and shortage of instruments and lab kits [ 28 ] to name a few.…”

Section: Introductionmentioning

confidence: 99%

Building a maternal and child cohort amidst Lebanon’s socioeconomic collapse: preliminary results and navigating research challenges

Kaddoura,

Elbejjani,

Tamim

et al. 2024

Popul Health Metrics

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The impact of conflict and crisis on maternal and child health underscores the need for reliable research in vulnerable populations. Lebanon, amidst ongoing economic collapse, political instability, and healthcare system strain, offers a case study for exploring these impacts, particularly on preterm babies and their development. This study aims to assess the feasibility of establishing a prospective cohort of mothers and their full-term and preterm babies in Lebanon, examining the association between social determinants, preterm birth, and developmental outcomes amidst the nation's multifaceted crises. The planned cohort involves 50 full-term and 50 preterm mother-baby pairs recruited at birth and followed up to 9–12 months post-birth. Data collection spans social determinants, perceived stress, social support, quality of life, and developmental assessments. Challenges in recruitment, follow-up, and data collection in the context of Lebanon's socio-political and economic turmoil are evaluated, alongside ethical considerations for research in vulnerable populations. Preliminary findings highlight substantial recruitment and follow-up challenges, notably due to population mobility, economic instability, and healthcare access issues. Despite these obstacles, 113 mother-baby pairs have been recruited. Early analysis reveals significant stress and reduced quality of life among mothers, particularly those with preterm infants, against a backdrop of declining birth rates and healthcare worker exodus. Conducting research in crisis settings like Lebanon presents unique methodological and ethical challenges but remains crucial for understanding and improving health outcomes in vulnerable populations. The study underscores the importance of adaptable research designs and ethical diligence in crisis research, highlighting the need for interventions tailored to these contexts. Establishing a mother and child cohort in Lebanon's crisis-ridden setting is faced with many challenges but is essential for guiding future interventions. Research in such contexts is needed to address health disparities and supporting vulnerable populations, emphasizing the need for dedicated funding and innovative research approaches in times of crisis.

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Weakening of the Lebanese health sector

Cited by 5 publications

References 0 publications

Multi-sectoral collaborations in selected countries of the Eastern Mediterranean region: assessment, enablers and missed opportunities from the COVID-19 pandemic response

Multi-sectoral collaborations in selected countries of the Eastern Mediterranean region: assessment, enablers and missed opportunities from the COVID-19 pandemic response

Capacity building and community of practice for women community health workers in low-resource settings: long-term evaluation of the Mobile University For Health (MUH)

Building a maternal and child cohort amidst Lebanon’s socioeconomic collapse: preliminary results and navigating research challenges

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