Conflict Reduction through Improving Healthcare Services for the Vulnerable Population in Lebanon
Project funded by the European Union
Lebanon is experiencing unprecedented increase in population from neighboring Syria. Primary Healthcare Centers (PHCs) are currently overstretched and the Ministry of Public Health’s (MoPH) communicable disease surveillance and response system is being put under stress.
Led by MoPH and funded by the European Union(EU), the main goal of the IFS/EU project ‘Conflict Reduction through Improving Healthcare Services for the vulnerable population in Lebanon’, is for the MoPH to better respond to the challenge of serving and protecting the residents of Lebanon through strategic institutional support using a conflict sensitive approach and leading to enhanced access to primary health services and increased capacity to monitor and respond to communicable disease outbreaks.
Through the IfS/EU project, the MoPH, with the support of the European Union and implementing partners, intends to
increase the PHC centers resources to ensure that local population including all vulnerable Lebanese have enhanced access to quality primary health care, ensuring adequate provision of vaccines and essential medications (especially the chronic medications), and increasing the capacity of these PHC centers to implement its programmes using a conflict sensitive approach
strengthen its capacity to undertake early warning and response to communicable diseases outbreaks
The IFS/EU project is implemented by United Nations High Commission for Refugees (UNHCR), in partnership with the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the International Relief and Development (IRD) and the International Alert (Alert)
Project in Focus
A-Primary Health Care (PHC) Centers
(Mainly MoPH PHC network)
In Lebanon, the primary health care system offers a multitude of services including preventive programs, reproductive health programs (including family planning, prenatal and postnatal care), child vaccination and care, non-communicable diseases program and mental health program. The number of people benefiting from these services and the quality of the services varies by region and provider. The utilization of primary healthcare centers has increased by four folds between 2002 and 2010. And this is accentuated with the advent of the Syrian crisis and the increased displacement to Lebanon.
In order to standardize the quality of care in PHCs, the MoPH has developed various guidebooks such as Diabetes Mellitus type II (2006), Reproductive health (2008), and mental health (2008). The American University of Beirut has also contributed to that by updating the “Primary Care Clinical Guide” developed in 2000 into its second edition of 2011. The guide encompasses evidence-based recommendations for diseases mostly encountered at PHC level. Each chapter covers the definition and epidemiology of the disease, history, physical examination, diagnosis, management of the disease, references used, and other relevant sections.
Under IfS/EU project, many of these guidelines are being updated, other guidelines are being developed, and staff are being trained accordingly. Medical equipment and sufficient quantities of essential medications (for chronic and non chornic patients) and vaccines are also being supplemented to prevent any gaps in the medical services at PHC level. Additional staff to MoPH and to PHCs in overstretched areas were also provided.
The intended impact is that MoPH increases the capacity of the PHC centers under its network to deliver quality PHC services, including reproductive and child health, for the vulnerable community, using a conflict sensitive approach, thus decreasing tension linked with access to healthcare.
1. General PHC Centers Support
The general support to PHC centers include the update of the Primary Heathcare Clinical Guidelines, the provision of basic medical equipment and supplies and the increase of essential medication and vaccines stock.
Primary Healthcare(PHC) Clinical Guidelines
The MoPH is focusing on strengthening the capacity of PHCs in the area of clinical case management including acute and chronic conditions. With the support of the WHO, the MoPH has already initiated a plan to integrate non-communicable diseases at the level of primary healthcare in terms of early detection, risk assessment and provision of treatment.
Under IfS/EU project, WHO in collaboration with the Lebanese Society of Family Medicine has conducted a major review of the primary care management guidelines (previously set with the support of AUB-MC). The updated guidelines provide evidence-based recommendations for preventive services that should be provided at primary healthcare level and services that are intended to improve health outcomes such as heart diseases, cancer, metabolic diseases, infectious diseases, and other conditions and events that impact the health of children, adolescents, adults, and pregnant women.
Capacity building trainings took place in 2015 to ensure that these updated guidelines are properly implemented.
Medical Equipment and Medications
IfS/EU project supported the provision of basic medical equipment for consultation rooms at the PHC centers, in addition to some advanced maternal and child health equipment and supplies with the support of WHO and UNHCR. It also increased the level of medications stock with the support of WHO (in collaboration with YMCA for the procurement of essential chronic medications) and UNICEF (for the procurement of vaccines and essential non chronic medications) to ensure that all beneficiaries enrolled in PHC program have sufficient supply of medications in line with the MoPH guidelines and list of essential medications.
3. Mother and Child Health
A particular focus in the project’s support for PHC centers’ capacities is on maternal and child health care which constitutes 50-75% of consultations at the level of PHC centers. Existing primary health care programmes are being revitalized by strengthening reproductive/maternal & child health services, the introduction of IMCI guidelines, the duplication of Wadi Khaled initiative model, the strengthening of the routine vaccinations and outreach campaigns.
Under the IfS/EU project, the World Health Organization (WHO), in collaboration with La Sagesse University, has completed the adaptation to the Lebanese context of a WHO guidelines, the “Integrated Management of Childhood Illnesses” (IMCI), with the aim to offer effective and simple means to prevent and manage the leading causes of serious illness and mortality in young children. The clinical guidelines promote evidence-based assessment and treatment, using a syndromic approach that supports the rational, effective and affordable use of drugs.
The guidelines is in line with the national Lebanese treatment guidelines and other policies and include:
Methods for checking a child’s immunization and nutrition status;
Teaching parents how to give treatments at home;
Assessing a child’s feeding and counseling to solve feeding problems; and
Advising parents about when to return to a health facility.
The approach is designed for use in outpatient clinical settings with limited diagnostic tools, limited medications and limited opportunities to practice complicated clinical procedures. During 2015, WHO with the support of MoPH led training workshops on IMCI guidelines in PHC settings targeting 2 nurses and 2 doctors per PHC.
Vaccines and Cold Chain
In its policy to ensure the safe access of free-of-charge vaccines to all children living in Lebanon based on National Calendar, MoPH is ensuring the provision of these vaccines to all PHC centers and dispensaries as needed. It is also ensuring the needed training for a safe preservation of vaccine. In 2008, MoPH received the “International Cold Chain Certificate” from WHO and UNICEF, becoming between the 5 countries worldwide to get this certification.
Under the IfS/EU project and in response to the increased population due to the Syrian crisis, additional stock of vaccines were procured with the support of UNICEF and made available in all PHC centers and dispensaries. Vaccines fridges were also procured.
Routine Vaccination and Outreach Campaign:
Under the execution of the MoPH and as part of its Expanded Program on Immunization (EPI ),UNICEF has secured in 2014 enough vaccinations via IfS/EU support, to cover all children under the age of five in vulnerable areas across Lebanon, regardless of nationality. Routine vaccination is provided in PHC centers, dispensaries and informal settlements through Mobile Medical Units free of charge according to the National Calendar of Vaccines.
Under EPI, vaccination mop-up campaigns (Jul-Aug-Sept 2014) and national immunization campaigns against Polio (Oct-Nov 2014) have been executed by the MoPH and UNICEF reaching out to the most vulnerable and at-risk (low vaccination coverage) caza.