|
ACKNOWLEDGEMENTS |
vi |
|
|
|
|
PREFACE |
vii |
|
|
|
|
I- THE CONTINUING CHALLENGES |
1 |
|
1- OVERVIEW |
3 |
|
2- THE POLITICAL DEADLOCK |
4 |
|
3- MILITARY CONFLICTS |
7 |
|
4- THE ECONOMIC CRISIS |
12 |
|
5- GLOBALIZATION CHALLENGES |
18 |
|
6- THE INCREASING BURDEN OF DISEASE |
22 |
|
7- HEALTH SYSTEM ADJUSTMENTS |
24 |
|
|
|
|
II- PROVISION AND PROVIDERS OF HEALTH SERVICES |
27 |
|
1- HOSPITAL CARE |
27 |
|
1.1 Public Hospitals Development |
28 |
|
1.2 Private Hospitals |
30 |
|
2- AMBULATORY CARE |
35 |
|
3- COMMUNITY BASED HEALTH SERVICES |
38 |
|
3.1 The Role of NGOs |
38 |
|
3.2 The Primary Health Care Network |
39 |
|
4- VERTICAL HEALTH PROGRAMS |
40 |
|
4.1 Expanded Immunization Program |
40 |
|
4.2 Tuberculosis Control Program |
44 |
|
4.3 Reproductive Health Program |
44 |
|
4.4 National AIDS Control Program |
45 |
|
4.5 Medication for Chronic Illnesses Program |
47 |
|
4.6 School Health Program |
48 |
|
4.7 School-based Oral Health Program |
49 |
|
4.8 Non Communicable Disease Program |
49 |
|
5- HUMAN RESOURCES FOR HEALTH |
50 |
|
5.1 Physicians |
51 |
|
5.2 Dentists |
54 |
|
5.3 Pharmacists |
55 |
|
5.4 Nurses |
56 |
|
6- CONCLUSION |
60 |
|
III- HEALTH SYSTEM FINANCING |
63 |
|
1- THE NATIONAL SOCIAL SECURITY FUND |
64 |
|
2- THE CIVIL SERVANTS COOPERATIVE |
68 |
|
3- MILITARY SCHEMES |
69 |
|
4- THE MOPH COVERAGE |
75 |
|
5- PUBLIC FUNDS COORDINATION AND DUPLICATION |
81 |
|
6- PRIVATE INSURANCE |
85 |
|
7- MUTUAL SOCIETIES AND SELF FUNDED SCHEMES |
89 |
|
8- NATIONAL HEALTH ACCOUNTS |
91 |
|
8.1 Sources of Funds |
91 |
|
8.2 Distribution of Health Expenditures |
96 |
|
9- CONCLUSION |
98 |
|
|
|
|
IV- PHARMACEUTICALS |
101 |
|
1- THE PHARMACEUTICAL MARKET |
102 |
|
2- REGISTRATION AND QUALITY OF DRUGS |
106 |
|
3- COST CONTAINMENT |
109 |
|
3.1 Modifying the price structure |
110 |
|
3.2 Promoting generic drugs |
113 |
|
3.3 Reforming legislations to enhance competitiveness |
114 |
|
4- THE NEED FOR A MULTIDIMENSIONAL APPROACH |
117 |
|
|
|
|
V- ACCREDITATION OF HOSPITALS |
121 |
|
1- THE CLASSIFICATION SYSTEM |
122 |
|
2- THE ACCREDITATION SYSTEM |
123 |
|
2.1 Developing the first version of Standards |
123 |
|
2.2 The Survey and Accreditation Award |
124 |
|
2.3 Revision of standards and comprehensive re-auditing survey |
126 |
|
2.4 Accreditations of public hospitals |
128 |
|
3- THE NEW ACCREDITATION SYSTEM |
129 |
|
4- LEBANESE PARTICULARITIES AND CHALLENGES |
130 |
|
4.1 From A Quality Management Perspective |
130 |
|
4.2 From A Health System Perspective |
132 |
|
4.3 From Social and Political Perspectives |
134 |
|
5- CONCLUSION |
136 |
|
VI- ASSESSMENT AND PROSPECTS OF HEALTH STRATEGIES |
139 |
|
Containing Households Direct Spending On Health For Equity, Sustainability And Poverty Alleviation |
140 |
|
|
|
|
Capitalizing On Existing Resources |
143 |
|
|
|
|
Towards A More Credible And Attractive Alternative For Outpatient Care |
143 |
|
|
|
|
Towards Achieving The Millennium Development Goals |
147 |
|
|
|
|
Intervention I: The Capitation Based Pregnant And Infant Package |
150 |
|
|
|
|
Intervention II: Reach Every Child In Immunization |
152 |
|
|
|
|
Intervention III: Neonatal Resuscitation Training |
153 |
|
|
|
|
Sustaining The MOPH Role As An Insurer Of Last Resort And Developing Performance Contracting Capabilities |
153 |
|
|
|
|
Public Hospitals Contribution To Equitable Accessibility And Lightening The Households’ Financial Burdens |
156 |
|
|
|
|
The Contribution Of The MOPH Drugs Dispensing Center, In Alleviating The Financial Burden Of Disease |
162 |
|
|
|
|
The Overall Impact On Households Out-Of-Pocket |
163 |
|
|
|
|
Medicines Remain Beyond Remedy |
165 |
|
|
|
|
Generic Drugs Are The Cure |
169 |
|
|
|
|
Conclusion |
171 |
|
|
|
|
ACRONYMS |
176 |
|
LIST OF TABLES |
181 |
|
LIST OF FIGURES |
185 |
|
LIST OF BOXES |
187 |
|
BIBLIOGRAPHY |
188 |
