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Date: 24/02/2020
Source: MOPH
Health System Resilience in Lebanon: A Consistent Progress amidst Political Instability- June 2019

Despite the ongoing insecurity climate and socio-political instability for decades, the Lebanese healthcare system has been able to sustain achievements among which, controlling and preventing outbreaks, ensuring universal accessibility to essential quality care, decreasing out of pocket expenditures and lowering of maternal and child mortality (achievement of MDGs 4 and 5)[1]. Five years into the Syrian crisis, the Lebanese health system is still showing considerable resilience, despite the unprecedented increase of demand and strain on the healthcare system. The continuous focus on non-emergency reforms in the health sector shows that progress in achieving strategic goals has been maintained against all odds. It is, hence, noteworthy to look at the main historical stages of the health system development following the 1975-1989 civil war.
The after civil-war years of the 90s represented a period of assessment and planning, while setting basic administrative systems and reorganizing the MOPH. During this period, important studies were conducted including the Households’ Health Utilization and Expenditures Survey, the PAPFAM and PAPChild surveys, the National Health Accounts and many others. This endeavor led to identifying problems and setting priorities, of which:
  • Improving quality of health services.
  • Containing cost of health care and reducing its financial burden on households.
  • Reorienting health services towards promotion and prevention and ensuring universal access to Primary Health Care.
  • Reducing price and improving quality of pharmaceuticals. 
On the other hand, the political system based on power-sharing among political forces and distribution of benefits on a confessional basis, resulted in a widespread practice of favoritism and clientelism in government institutions. This required a professional response paying particular attention to improving governance while focusing on:
  • Building a well trained team of health professionals among MOPH staff and find ways for motivation and protecting them from political interferences.
  • Introducing innovative governance mechanisms to overcome fragmentation of health financing and provision
  • Promoting scientific approach for impartial assessment and performance contracting to face political and confessional favoritism. 
The 2000-2010 denoted the era of innovative institutional arrangements, through the involvement of all stakeholders in the execution of the national strategy and programmes implementation. The post 2000 period brought meaningful achievements, such as:
  • Enhancing Transparency through Website and Mobile Application development.
  • Simplification of procedures through automation of the administrative transactions and implementation of the e-Services platform.
  • Improving Accountability using a unified mechanism to receive and follow up on complaints.
  • Strengthening primary healthcare and promoting essential drugs
  • Scaling up Epidemiological Surveillance and Response.
  • Enforcement of public hospitals autonomy.
  • Execution of human resources strategy, that focused on yielding production of nursing graduates. And post-graduate training of health controllers, medical inspectors and PHC physicians.
  • Upgrading the registration of pharmaceuticals and revisiting the pricing structure.
  • Implementation of the WHO Good Governance for Medicines Programme (GGM) and The Quality Assurance of Pharmaceutical Products Programme (QAPPP).
  • The accreditation of hospitals and PHC centers.
  • The performance contracting with hospitals and containing cost of hospital care, including[2]:
    • The creation of a Unified Beneficiaries Database, its maintenance & updating
    • Development of the visa system, its decentralization and linkage to database.
    • Setting of a financial ceiling in every contract between hospitals and the MOPH.
    • Utilization review and introducing incentives through new payment mechanisms.
Since 2010, studies have been consistently providing evidence on the significant positive impact of health reform policies, and tangible achievements became more and more recognized.
In the WHO World Health Report 2010, the case of Lebanon was documented as a success story in how to decrease total health spending in % of GDP by lowering, mainly, out of pocket spending, while at the same time improving health indicators. This validates the sound health policy of strengthening PHC and rationalizing the cost of hospital services, while promoting the MOPH regulatory capacity. 
Box 4.2. Lebanon’s reforms: improving health system efficiency, increasing coverage and lowering out-of-pocket spending[3]
In 1998 Lebanon spent 12.4% of its GDP on health, more than any other country in the Eastern Mediterranean Region. Out-of-pocket payments, at 60% of total health spending, were also among the highest in the region, constituting a significant obstacle to low-income people. Since then, a series of reforms has been implemented by the Ministry of Health to improve equity and efficiency.
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