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Rebuilding of the Lebanese Health Care System: Health Sector Reforms
Abstract
The civil war in Lebanon from 1975 to 1992 had a significant negative impact on the public health care system. This paper describes the health care system in Lebanon and its financing as of 2001. The efforts that have been made and are being made to rehabilitate and reform this sector since the end of the war are outlined.
... Lebanon, like many countries in the Middle East such as Syria is experiencing an epidemiological transition with an increasingly ageing population suffering from chronic and non-communicable diseases [22]. Lebanon has a fragmented and uncoordinated health care system, which is highly privatized and based on user fees [17]. This expenditure is concentrated in high cost curative technological interventions, and the number of Lebanese individuals making use of primary health care centers remains limited and the quality of services varies by region and provider [17]. ...
... Lebanon has a fragmented and uncoordinated health care system, which is highly privatized and based on user fees [17]. This expenditure is concentrated in high cost curative technological interventions, and the number of Lebanese individuals making use of primary health care centers remains limited and the quality of services varies by region and provider [17]. One of the structural weaknesses in the Lebanese health care system is related to the fact that the role of the Ministry of Health has focused almost exclusively on the provision of services, while its role in prevention, planning and regulation remains limited. ...
... For uninsured Lebanese citizens accounting for 50 % of the Lebanese population [21], the Ministry of Public Health provides services as the last resort, either through public hospitals or contracted private hospitals, and covers 95 and 85 % of hospital care costs consecutively and 100 % of medication costs for chronic and high-risk diseases [1,10]. Primary health care is provided through a network of centres, supported by the Ministry of Public Health and the Ministry of Social Affairs [16,17]. The centres are predominately run by NGOs through contractual agreements between the Ministry of Public Health and the NGO. ...
The crisis in Syria has forced more than 4 million people to find refuge outside Syria. In Lebanon, in 2015, the refugee population represented 30 % of the total population. International health assistance has been provided to refugee populations in Lebanon. However, the current humanitarian system has also contributed to increase fragmentation of the Lebanese health system. Ensuring universal health coverage to vulnerable Lebanese, Syrian and Palestinian refugees will require in Lebanon to redistribute the key functions and responsibilities of the Ministry of Health and its partners to generate more coherence and efficiency.
... The civil war destroyed much of its beauty and the accompanying peace for which it was known (Abyad, 2001). The war has also destroyed the country's economic health after it was considered ''the banking centre of The Middle East'' (Kronfol, 2006). The long years of war have caused an increase in the migration patterns from and inside Lebanon where the latter has caused crowded living conditions in the capital city Beirut and the surrounding regions. ...
... Political unrest damaged services and planning across the public and private sectors, including the health care system. Over the last two decades social, political and economic changes have taken place in Lebanon, increasing the need for understanding of the burden of cardiovascular diseases and specifically data to inform health services delivery and planning (Kronfol, 2006). Regional issues affecting the health sector are addressed below. ...
... This group accounts for almost 42% of the Lebanese population (Ammar, Wakim, & Hajj, 2007). The rest are covered by other parties as follows: (NSSF) National Social Security Fund (30%), private insurance (12%), Army (11%), and civil servants (5%) (Kronfol, 2006). These groups have no emergency department funding unless it is followed by hospitalization (Bayram, 2007). ...
Introduction
Lebanon is a small country located at the western boundary of the Middle East. Approximately 40% of health care in Lebanon is financed by the public sector. Cardiovascular diseases in Lebanon are scarcely addressed in the literature raising the need for baseline data on these health condition to be better treated.
Aim
To (1) aggregate and define the burden of cardiovascular disease in Lebanon and (2) describe implications for policy, practice and research to improve health outcomes in Lebanon.
Method
An integrative review was conducted of both peer-reviewed papers and unpublished reports. CINAHL, Medline, Google Scholar and Academic Search Complete were searched along with the websites of The World Health Organization, Ministry of Public Health Lebanon and Central Intelligence Agency of Lebanon. No year limit was applied to our search.
Results
The search yielded 28 peer-reviewed articles and 15 reports. Cardiovascular diseases are the leading cause of morbidity and mortality in Lebanon and is also the primary cause of hospital admission. A range of social, political, economic and cultural factors explain the burden of cardiovascular diseases, some of these risks are culture specific such as the arghile smoking and the high rates of familial hypercholesterolemia. Workforce shortage produced by high rates of migrating nurses also has an implication on the patients’ outcomes.
Conclusion
Much of the presented data are sourced from the gray literature; more research, using systematic and prospective data collection methods, are needed to inform health services planning, delivery and evaluation. Primary care needs to be enhanced to produce better outcomes for a population with high profile of cardiovascular risk factors.
... Lebanon is a developing country with a population estimated at 4 million, with 80% to 90% living in urban areas and a gross domestic product (GDP) of $18 billion. 1,2 The 17-year civil war in Lebanon from 1975 to 1992 and the relentless instability since then majorly impacted the infrastructure of Lebanon, altering it from a robust economy to one that is barely thriving and in debt. However, Lebanon has been striving to recover from the long-term effects of the war both economically and socially. ...
... Furthermore, because the provision of NICUs is not regulated by the Lebanese government, there is a lack of standardized care. 1,4 In terms of health care providers, there are approximately 10 000 physicians practicing in Lebanon (3.2 physicians per 1000 individuals, compared with 1.6 per 1000 in the United States); most are specialists, with a dearth of family and general practitioners. 1,8 This inefficiency translates to pricey specialists providing many of the services that should be provided by family/general practitioners at a lower cost. ...
... 1,4 In terms of health care providers, there are approximately 10 000 physicians practicing in Lebanon (3.2 physicians per 1000 individuals, compared with 1.6 per 1000 in the United States); most are specialists, with a dearth of family and general practitioners. 1,8 This inefficiency translates to pricey specialists providing many of the services that should be provided by family/general practitioners at a lower cost. There is also a shortage of nurses and midwives. ...
This article describes nursing care of high-risk infants in Lebanon based on the actual observation of nine neonatal intensive care units. Observations are based on key drivers of quality-of-care initiatives encouraged for infants requiring care in the neonatal intensive care unit and their families. Discussion of quality of care described is based on national and international research leading to gold standards set forth in policies, procedures, and guidelines. The presence or lack of specific key drivers of high-level quality care is compared with evidence-based benchmarks for performance improvement in a variety of categories provided herein.
... The Lebanese older person is prescribed around 8 to 9 drug per year (8). Moreover, this person requires hospitalization more than twice the average population with 4.5 % being hospitalised more than one time per year (9). ...
... The availability of research on the quality of life of older adults in Lebanon is limited, and is restricted to the hospitalization phase. Since many older adults spend their last days in hospitals (9), it is important to explore how their quality of life is perceived. The study aims to describe the self-reported quality of life of hospitalized older Lebanese adults, aged 65 and above, and investigate its association with the four World Health Organization Quality of Life (WHOQOL) domain predictors (physical, psychological, social and environmental domains). ...
Background:
The older adult population in Lebanon is anticipated to double by year 2030. The health care resources available for the geriatric population is limited and there is much reliance on the social support of family caregivers. Older adults have double the rate of hospital utilization in comparison to the regular Lebanese population where 4.5% are hospitalized more than once per year. This study aims to describe self-reported quality of life among hospitalized patients "with palliative care needs" and investigate the relationship with its four health domains.
Methods:
An observational survey design with a convenience sample of 203 hospitalized patients with palliative care needs above 65 years of age were recruited from three hospitals. Descriptive statistics and regression analysis were used to describe and determine the association between health domains and quality of life.
Results:
Mean age of participants was 78.5 years with the majority being male and married. Participants reported low overall quality of life with a mean score of 35.43 (SD =23.45). Anxiety and depression were common findings. "Worrying" (83%), "Feeling nervous" (80%), "Feeling sad" (76%) were dominant psychological symptoms. Low scores were also observed for physical, role and social functioning. Participants suffered from lack of energy (94%), pain (72%), difficulty sleeping (73%) and shortness of breath (64%).
Conclusions:
The findings suggest that quality of life in the aging Lebanese population is burdened with physical and psychological symptoms. A comprehensive approach that attends to the psychosocial as well as the physical problems in older adults with early integration of symptom management and palliation could improve quality of life.
... Lebanon is a middle-income country with a population estimated at around 4 million, of which more than 90% live in urban areas (Kronfol, 2006). Lebanon has 165 hospitals and a ratio of 3.73 beds per 1,000 population (Harb, 2016). ...
... The scheme enhanced quality on the one hand, but increased expenses on all hospitals on the other hand (Saleh et al., 2013). Ad-ditional challenges relate to controlling the quality and quantity of physicians as well as increasing the retention of nurses, who are increasingly leaving Lebanon for better job offers in the Gulf region (see Kronfol, 2006). Additionally, since 2011, and due to the conflict in neighbouring Syria, there has been an influx of an estimated 1.5 million Syrian refugees to Lebanon, corresponding to a 30% increase in Lebanon's population (United Nations High Commissioner for Refugees, 2019). ...
Evidence-based management (EBMgt), which refers to using the best-quality evidence from different sources in decision-making, is becoming an imperative for managers in both profit and non-profit sectors. Yet, the competencies underlying EBMgt have not yet received much attention. Therefore, the aim of this study is to identify the foundational and functional competencies of evidence-driven managers working in hospital settings and develop an empirically based competency model for evidence-driven managers. We collected qualitative data using semi-structured interviews and the critical incident technique from 36 executive managers from 11 hospitals in Lebanon about the competencies of managers who use EBMgt when approaching problems and making decisions. Using inductive coding, we identified 13 competencies that we grouped into four dimensions: technical, cognitive, interpersonal and intrapersonal. We further classified the specific competencies underlying each of the dimensions into foundational and functional, and highlighted those that are critical for the practice of EBMgt in hospital settings, including open mindedness, research knowledge and skills, ethicality in research, resourcefulness and relationship management.
... Third, Lebanon itself offers compelling evidence of what can be done to implement a data-driven package of basic health services, with alignment of donors' efforts within a National Health Plan that directs resources to where they are most needed. In 1992, following the Lebanese Civil War, a weak MoPH was able to develop a health sector strategy that emphasized its governance and stewardship roles (19). The MoPH strengthened its managerial and administrative capacity and developed a comprehensive package of curative and preventive services at all primary healthcare facilities. ...
... The MoPH strengthened its managerial and administrative capacity and developed a comprehensive package of curative and preventive services at all primary healthcare facilities. The lessons learnt highlighting the need for the MoPH to be the central player in a pluralistic system (19). ...
Lebanon is providing sanctuary to an estimated 1.5 million Syrian refugees, with potential consequences for its health system. Here, we analyse how it has responded to this challenge, identify sensitive areas where a strong national governance system is needed and explore how it might be implemented. An effective response to the Syrian refugee crisis requires concerted international action. Nonetheless, geography dictates that the Lebanese health system must play a central role. We identify some areas where a strengthened stewardship role of the Ministry of Public Health is urgently required. We argue that the Ministry is well placed to take a lead, with its detailed knowledge of the Lebanese health system and its legitimacy to formulate a national health response. Finally, we suggest that this crisis could be a catalyst for the strengthening of the Lebanese health system, based on evidence-informed policies that would benefit refugees and the Lebanese population alike.
... Lebanon as a developing, upper-middle income country had a gross domestic product (GDP) at market prices of $45.73 billion in 2014 [35]. Total health expenditure as percentage of GDP in 2012 was estimated at 7.5 % [36]; this is due to the high dependence on the private sector for healthcare services [37,38]. The public share of total health expenditure was estimated at 46.30 % in 2012, while the private share of total health expenditure was estimated to be 53.70 % in 2012, entailing a heavy burden on household income with the highest burden falling on those households in the lowest income category [36,37]. ...
... Total health expenditure as percentage of GDP in 2012 was estimated at 7.5 % [36]; this is due to the high dependence on the private sector for healthcare services [37,38]. The public share of total health expenditure was estimated at 46.30 % in 2012, while the private share of total health expenditure was estimated to be 53.70 % in 2012, entailing a heavy burden on household income with the highest burden falling on those households in the lowest income category [36,37]. Reflecting on this current challenge encountered by the Lebanese healthcare system, the Ministry of Public Health (MoPH) has expanded its focus to strengthening the primary care sector [38]. ...
Background:
eHealth can positively impact the efficiency and quality of healthcare services. Its potential benefits extend to the patient, healthcare provider, and organization. Primary healthcare (PHC) settings may particularly benefit from eHealth. In these settings, healthcare provider readiness is key to successful eHealth implementation. Accordingly, it is necessary to explore the potential readiness of providers to use eHealth tools. Therefore, the purpose of this study was to assess the readiness of healthcare providers working in PHC centers in Lebanon to use eHealth tools.
Methods:
A self-administered questionnaire was used to assess participants' socio-demographics, computer use, literacy, and access, and participants' readiness for eHealth implementation (appropriateness, management support, change efficacy, personal beneficence). The study included primary healthcare providers (physicians, nurses, other providers) working in 22 PHC centers distributed across Lebanon. Descriptive and bivariate analyses (ANOVA, independent t-test, Kruskal Wallis, Tamhane's T2) were used to compare participant characteristics to the level of readiness for the implementation of eHealth.
Results:
Of the 541 questionnaires, 213 were completed (response rate: 39.4 %). The majority of participants were physicians (46.9 %), and nurses (26.8 %). Most physicians (54.0 %), nurses (61.4 %), and other providers (50.9 %) felt comfortable using computers, and had access to computers at their PHC center (physicians: 77.0 %, nurses: 87.7 %, others: 92.5 %). Frequency of computer use varied. The study found a significant difference for personal beneficence, management support, and change efficacy among different healthcare providers, and relative to participants' level of comfort using computers. There was a significant difference by level of comfort using computers and appropriateness. A significant difference was also found between those with access to computers in relation to personal beneficence and change efficacy; and between frequency of computer use and change efficacy.
Conclusion:
The implementation of eHealth cannot be achieved without the readiness of healthcare providers. This study demonstrates that the majority of healthcare providers at PHC centers across Lebanon are ready for eHealth implementation. The findings of this study can be considered by decision makers to enhance and scale-up the use of eHealth in PHC centers nationally. Efforts should be directed towards capacity building for healthcare providers.
... While older persons constitute less than 10 percent of the Lebanese population, they consume over 60 percent of health care resources [15]. Compared to a national average of 3.4 outpatient visits and 4 prescriptions per person per year, older adults aged 60 years and over make 6.2 visits and are prescribed between 8 to 9 drugs per person per year [16]. Similarly, hospitalization rates among older people exceed 28 percent per person per year, and this is more than double the national average (12.5 percent) [16]. ...
... Compared to a national average of 3.4 outpatient visits and 4 prescriptions per person per year, older adults aged 60 years and over make 6.2 visits and are prescribed between 8 to 9 drugs per person per year [16]. Similarly, hospitalization rates among older people exceed 28 percent per person per year, and this is more than double the national average (12.5 percent) [16]. Healthcare access and utilization is central for older adults. ...
Lebanon is currently experiencing unique and dynamic demographic shifts towards an aging population: past and present fertility are among the lowest in the Arab region and crude mortality rates have decreased in the past few decades from 9.1 to 7.1 per thousand. Increased waves of emigration of youthful adults seeking better work opportunities elsewhere, as well as counter-waves of 'return migration' of older Lebanese workers from neighboring host countries contribute further to the 'rectangularization' of the population pyramid. These trends are accompanied by an epidemiological transition towards non-communicable diseases, mental disorders and degenerative diseases as the leading causes of mortality and morbidity in lieu of communicable diseases. We examine in this paper the implications of these transformations on the health profile of older persons and on the social and health care available to them. Findings are discussed within the prevailing conflicts and political strife in the country, family transformations and structural settings including pension systems, health coverage, family support channels and social fabric, and nursing home-care. The paper ends with recommendations and options for.reforms.
... The physician density in Lebanon is twice the nurse density [8]. Furthermore, there is a geographical maldistribution of nurses as the majority work in urban areas like Mount Lebanon (34%) and Beirut (27%), making the shortage more pronounced in smaller villages and towns particularly in rural areas [27,28]. According to the records of the Order of Nurses in Lebanon (ONL), there are approximately 11,621 registered in the ONL [29]. ...
... The tangible sources of power of these groups were their ownership of major organizations (hospitals and vocational schools) mobilizing thousands of people and millions of dollars in equity [36]. Private hospitals in Lebanon were almost mainly responsible for secondary healthcare delivery in Lebanon, and vocational schools were responsible for graduating over half of the nursing workforce [26,28]. As for the intangible sources of political power, these groups had valuable information and knowledge on the problem and options as they were on the implementing end of this policy which gave them legitimacy [36]. ...
Background
Evidence-informed decisions can strengthen health systems, improve health, and reduce health inequities. Despite the Beijing, Montreux, and Bamako calls for action, literature shows that research evidence is underemployed in policymaking, especially in the East Mediterranean region (EMR). Selecting the draft nursing practice law as a case study, this policy analysis exercise aims at generating in-depth insights on the public policymaking process, identifying the factors that influence policymaking and assessing to what extent evidence is used in this process.
Methods
This study utilized a qualitative research design using a case study approach and was conducted in two phases: data collection and analysis, and validation. In the first phase, data was collected through key informant interviews that covered 17 stakeholders. In the second phase, a panel discussion was organized to validate the findings, identify any gaps, and gain insights and feedback of the panelists. Thematic analysis was conducted and guided by the Walt & Gilson’s “Policy Triangle Framework” as themes were categorized into content, actors, process, and context.
Results
Findings shed light on the complex nature of health policymaking and the unstructured approach of decision making. This study uncovered the barriers that hindered the progress of the draft nursing law and the main barriers against the use of evidence in policymaking. Findings also uncovered the risk involved in the use of international recommendations without the involvement of stakeholders and without accounting for contextual factors and implementation barriers. Findings were interpreted within the context of the Lebanese political environment and the power play between stakeholders, taking into account equity considerations.
Conclusions
This policy analysis exercise presents findings that are helpful for policymakers and all other stakeholders and can feed into revising the draft nursing law to reach an effective alternative that is feasible in Lebanon. Our findings are relevant in local and regional context as policymakers and other stakeholders can benefit from this experience when drafting laws and at the global context, as international organizations can consider this case study when developing global guidance and recommendations.
... Although increased interest in the PHC sector in Lebanon has instigated the writing of a number of research reports over the last two decades [26,27], none have systematically examined factors significantly associated with retention in this vital sector. ...
... Public PHC centers were excluded from this study for several reasons, mainly due to private PHC centers providing the majority of PHC services in Lebanon [26] and the minimal variability in recruitment and retention policies across public PHC centers. Indeed, there has been a freeze on HHR recruitment and very little turnover with respect to current staff at public PHC centers, whereby all staff are salaried governmental employees. ...
Background
Critical shortages of health human resources (HHR), associated with high turnover rates, have been a concern in many countries around the globe. Of particular interest is the effect of such a trend on the primary healthcare (PHC) sector; considered a cornerstone in any effective healthcare system. This study is a rare attempt to investigate PHC HHR work characteristics, level of burnout and likelihood to quit as well as the factors significantly associated with staff retention at PHC centers in Lebanon.
Methods
A cross-sectional design was utilized to survey all health providers at 81 PHC centers dispersed in all districts of Lebanon. The questionnaire consisted of four sections: socio-demographic/ professional background, organizational/institutional characteristics, likelihood to quit and level of professional burnout (using the Maslach-Burnout Inventory). A total of 755 providers completed the questionnaire (60.5% response rate). Bivariate analyses and multinomial logistic regression were used to determine factors associated with likelihood to quit.
Results
Two out of five respondents indicated likelihood to quit their jobs within the next 1–3 years and an additional 13.4% were not sure about quitting. The top three reasons behind likelihood to quit were poor salary (54.4%), better job opportunities outside the country (35.1%) and lack of professional development (33.7%). A U-shaped relationship was observed between age and likelihood to quit. Regression analysis revealed that high levels of burnout, lower level of education and low tenure were all associated with increased likelihood to quit.
Conclusions
The study findings reflect an unstable workforce and are not conducive to supporting an expanded role for PHC in the Lebanese healthcare system. While strategies aiming at improving staff retention would be important to develop and implement for all PHC HHR; targeted retention initiatives should focus on the young-new recruits and allied health professionals. Particular attention should be dedicated to enhancing providers’ role satisfaction and sense of job security. Such initiatives are of pivotal importance to stabilize the workforce and ensure its longevity.
... [33][34][35][36][37] Furthermore, these countries show a trend toward the privatization of health services, a punitive culture toward the free exercise of sexuality, and the criminalization of sex work. [38][39][40][41][42][43] In some instances, the countries that temporarily host migrants or refugees are neighboring states to those in conflict and are susceptible to forced migration implications (e.g., Ghana, Lebanon, and Pakistan). These unstable circumstances directly affect the implementation of interventions and the collection of data required for research and evaluation. ...
Objective:
Limited evidence exists on interventions aimed at enabling reproductive health (RH) services access for undocumented female migrants and refugee women. We aimed to identify intervention characteristics and impacts on RH outcomes among migrants and refugee women in protracted situations.
Methods:
We conducted a systematic literature review of RH intervention studies that reported on migrants and refugee women in protracted situations. We applied 2 search strategies across 6 databases to identify peer-reviewed articles in English, Spanish, and Portuguese. Eligible studies were assessed for content and quality.
Results:
Of the 21,453 screened studies, we included 10 (all observational) for final data extraction. Interventions implemented among migrant and refugee women included financial support (n=2), health service delivery structure strengthening (n=4), and educational interventions (n=4). Financial support intervention studies showed that enabling women to obtain RH services for free or at a low cost promoted utilization (e.g., increased use of contraception). Interventions that established or strengthened health service delivery structures and linkage demonstrated increased prenatal visits, decreased maternal mortality, and facilitated access to safe abortion through referral services or access to medical abortion. Educational interventions indicated positive effects on RH knowledge and the importance of involving peers and meeting the unique needs of a mobile population. All intervention studies emphasized the need to accommodate migrant security concerns and cultural and linguistic needs.
Conclusion:
Interventions in protracted situations reported positive outcomes when they were migrant or refugee-centered and complementary, culturally acceptable, geographically proximate, and cost-sensitive, as well as recognized the concerns around legality and involved opportunities for peer learning. Free or low-cost RH services and greater availability of basic and emergency maternal and neonatal care showed the most promise but required further community outreach, education, and stronger referral mechanisms. We recommend further participatory implementation research linked to policy and programming.
... Health expenditure is high in Lebanon accounting for 8.4% of the total gross domestic product (GDP) with an annual increase of expenditure per capita of 4.7% (atlas, 2021). Table 1 describes the healthcare insurance systems in Lebanon: three governmental coverage schemes (47.6% of total healthcare expenditure); four private coverage schemes (16%); out-of-pocket individual payments for health services (36.4%) (Hallit et al., 2020;Kronfol, 2006). Treatment in public hospitals is free of charge for Lebanese citizens aged above 64 years old and emergency treatment is provided in those hospitals at a low cost for low-income citizens or citizens without any type of medical coverage. ...
Lebanon is facing many problems that can cause several long-term threats to the overall public health such as an increasing poverty rate, and an economic crisis induced by the devaluation of the Lebanese currency. The healthcare system is affected in terms of quality and availability of services in addition due to the pandemic, a lot of public health campaigns were paused. Consequently, Lebanon is losing its frontline healthcare workers coupled with the fact that the government budget for healthcare has dwindled. This report addresses the evolution of some health indicators in Lebanon throughout the years and presents the rights and ethical considerations and dilemmas faced by the frontline healthcare professionals during the COVID-19 outbreak. The findings of this report showed that the average life expectancy at birth was almost 80 years for both sexes in 2020. The infant mortality rate has positively been reduced to 9.2 cases per 1000 live births and despite its position compared to some Arab countries mostly adjoining Lebanon, this rate in 2019 is considered three times higher compared to some European countries. A decrease in the food and waterborne diseases rate in Lebanon was noted, however, a higher rate is presented in Bekaa. A sustainable health system is required in Lebanon focusing on people and based on public health evidence. Many ethical challenges are faced particularly in the degree of freedom and medical choices. Nevertheless, most notably the long-term impact of these measures will preserve the well-being of society.
... Beneficiary employees are permanent workers in agriculture, public institutions not subject to civil service, public school teachers, taxi drivers, newspaper sellers, and university students. in 2003, NSSF was extended to physicians and their dependents (Kronfol 2006). Foreign employee rights to benefit from NSSF services, on the other hand, are based on the principle of reciprocity that gives access to foreigners to the NSSF services if their country of origin offers similar treatment to Lebanese workers. ...
The Prosperity Report - El Mina, Tripoli is the third major report led by the Institute for Global Prosperity (IGP, presenting key findings on prosperity in urban research sites across Lebanon. The Prosperity Report – El Mina, Tripoli is the result of a collaborative effort between the IGP-led RELIEF Centre (PROCOL Lebanon), the charity CatalyticAction, and locally-based citizen scientist researchers who are committed to making a positive difference in El Mina and beyond. The report presents data on prosperity and quality of life for a site (El Mina) whose residents are diverse in terms of socioeconomic status, religious identity, and housing tenure whereby both informal settlement housing and privately owned and rented accommodation are present in the area. The report is about prosperity in two significant ways: in terms of content and in terms of practice. With regard to content, the report is organised in accordance with the IGP’s five-domain holistic and context specific prosperity model. In terms of practice, the report is only one milestone in a much bigger programme of collaborative research and action over many years. Prosperity, as conceptualised at the IGP, is a collaborative process in which stakeholders with different kinds of knowledge and expertise come together in order to identify local problems, build collective resources within the community, and envision and create solutions that contribute to meeting needs and alleviating pressing challenges. The report is also a rare study presenting detailed quantitative data for a research site in Lebanon that is outside of Beirut – something that is much-needed in a Lebanese research landscape that is disproportionately focused on the country’s capital at the expense of other cities and towns.
... With the fragile, highly privatized, and under-resourced healthcare system available in Lebanon, providing care to the local population is already a challenge that is exacerbated by the refugee crisis (34). This under-resourced healthcare system, particularly in refugee areas, coupled with refugees' increased need for healthcare services beyond that of the local population, worsens the economic burden of refugee communities on the host healthcare system (35,36). ...
Background: Refugees are prone to injury due to often austere living conditions, social and economic disadvantages, and limited access to health care services in host countries. This study aims to systematically quantify the prevalence of physical injuries and burns among the refugee community in Western Lebanon and examine injury characteristics, risk factors, and outcomes.
Methods: We conducted a cluster-based population survey across 21 camps in the Beqaa region of Lebanon from February to April 2019. A modified version of the ‘Surgeons Overseas Assessment of Surgical Need (SOSAS)’ tool (Version 3.0) was administered to the head of the refugee households and documented all injuries sustained by family members over the last 12 months. Descriptive and univariate regression analyses were performed to understand the association between variables.
Results: 750 heads of households were surveyed. 112 (14.9%) households sustained injuries in the past 12 months, 39 of which (34.9%) reported disabling injuries that affected their work and daily living. Injuries primarily occurred inside the tent (29.9%). Burns were sustained by at least one household member in 136 (18.1%) households in total. The majority (63.7%) of burns affected children under 5 years and were mainly due to boiling liquid (50%). Significantly more burns were reported in households where caregivers cannot lock children outside the kitchen while cooking (25.6% vs 14.9%, p-value=0.001). Similarly, households with unemployed heads had significantly more reported burns (19.7% vs 13.3%, p-value=0.05). Nearly 16.1% of the injured refugees were unable to seek health care due to the lack of health insurance coverage and financial liability.
Conclusions: Refugees severely suffer from injuries and burns, causing substantial human and economic repercussions on the affected individuals, their families, and the host healthcare system. Resources should be allocated toward designing safe camps as well as implementing educational awareness campaigns specifically focusing on teaching heating and cooking safety practices.
... However, the current humanitarian system has also contributed to the increase in fragmentation of the Lebanese health system [35]. Lebanon has a fragmented and uncoordinated healthcare system, which is highly privatised and based on user fees [36]. However, infectious disease tracing and diagnosis among the Lebanese population, as well as refugees, has been developed within the country through centres, predominately run by non-government organisations (NGOs) through contractual agreements between the Ministry of Public Health and the NGO [37], but this is not similar for non-communicable diseases and cancerous pathologies. ...
Purpose:
Over the last decade, Lebanon has experienced an increase in the rate of cancer patients. The aim of this study is to investigate the incidence rates of ovarian cancer in Lebanese women over a period of 12 years and to compare them to other countries.
Methods:
Data were collected from the Lebanese National Cancer Registry for the time period 2005-2016 (inclusive). Data from other countries were retrieved from an online database 'Cancer Incidence in Five Continents'. The age-specific and age-standardised incidence rates (ASIR) were calculated and analysed using Joinpoint regression.
Results:
Ovarian cancer ranked seventh among the commonest cancers in Lebanese women in the studied time frame. Approximately 189 new cases were reported every year, with an average age-standardised incidence rate of 7.88 (per 100,000 women). Ovarian cancer showed a significantly decreasing trend in the 12 years of study. Lebanon had one of the highest ASIR for ovarian cancer among regional countries and randomly selected countries.
Conclusion:
Lebanon presented a high ASIR for ovarian cancer compared to regional countries, and was placed among the top ASIRs compared to countries worldwide. However, with the decreasing ovarian cancer trends, it is important to implement efficacious awareness in order to detect all OC cases.
... The armed conflict in Syria, which continues since 2011, did not only create a public health catastrophe within the country, but also critical public health challenges in the neighboring countries which received refugees [9]. The Lebanese healthcare system is inequitable, in large shares privatized, and is based on out-of-pocket payments [10,11]. ...
Since data on the sexual and reproductive health (SRH) of young refugee women living in urban settings in Lebanon are particularly scarce, we aim through this exploratory study to assess the SRH knowledge and access to services of Arab and Kurdish Syrian refugee young women living in Bourj Hammoud. From January to March 2020, a cross-sectional survey was conducted among 297 Syrian Arab and Kurdish participants and aged 18–30 years old. It was found that participants coming from Syrian urban areas or who completed an education above secondary level have higher overall knowledge on SRH issues. Only a total of 148 out of the 297 participants (49.8%) knew a health facility in Bourj Hammoud that provides SRH services and among them 36.4% did not know which type of services are available there. The Syrian refugee young women’s access to SRH services is inadequate due to different obstacles. The overall knowledge level on different SRH topics is limited. The context of multiple crises in Lebanon should be taken into consideration when delivering future SRH services.
... This was shown by the proportion of the budget of the Ministry of Public Health (MOPH) that was spent on the private sector, increasing drastically from 10% in 1970 to 80% in the late 1990s; therefore, forcing the private sector to record a growth of almost 60% after the war. 5 Currently, the public sector is formed of 28 hospitals all over Lebanon with more than 2,500 beds, whereas the private sector is formed of more than 100 hospitals representing more than 70% of the health care force in Lebanon. 6 Together, both public and private components of the Lebanese health care sector sum up to a rate of 2.7 beds per 1,000 population. ...
Introduction: The use of technology in the medical field has been rising rapidly and offering, in many cases, an alternative to traditional ways of practicing medicine, especially when remote medical services are required. This background has laid the foundation for telemedicine to play a role in controlling the current coronavirus disease 2019 (COVID-19) pandemic. Telemedicine has the potential to allow the facilitation of providing the necessary medical care to patients without exposing them to contact with other patients or the general population. Objective: The aim of this study was to investigate the utilization of telemedicine by the Lebanese physicians during the COVID-19 pandemic. Methods: This cross-sectional online study was conducted using LimeSurvey® through an e-mail-based questionnaire sent to physicians currently enrolled in both Beirut and Tripoli Lebanese Order of Physicians. Results: Four hundred one physicians completed the survey resulting in a response rate of 5.85%. Most of the respondents (N = 401, 75.8%) reported using telemedicine to provide health care services to patients without in-person visits during the pandemic. Among those using telemedicine (N = 304), around 40% reported that they started using it during COVID-19 pandemic. Discussion: Literature states that the average time of an in-person clinic consultation is more than 15 min. This implies that telemedicine can play a role in saving physicians' time; this conclusion is supported by other studies that consider telemedicine a time-saving method of providing health care services. Conclusions: Our study indicated that telemedicine is used by the majority of Lebanese physicians and that this use has been accelerated by the COVID-19 pandemic. Our results showed that telemedicine does have a potential that can allow it to be integrated in the health care system and implemented on a national organized level.
... The Security Forces Coverage is the most generous public service with more than 350,000 beneficiaries (Lebanese Army, 2020). Primarily funded by the Ministry of Defense, it covers all medical fees for members of the Lebanese army and internal security forces, 75% of their direct family's medical fees, and an additional 50% of their parents' medical fees (Kronfol, 2006). For the employed Lebanese, the National Social Security Fund covers 90% of hospitalization costs and 80% of medical consultations and pharmaceuticals in return for a percentage of the employee's income. ...
Background: To date, there has been a dearth of research on health literacy in the Eastern Mediterranean Region and in particular Lebanon.
Objectives: This cross-sectional study assessed the levels and correlates of health literacy in Lebanese adults. Methods: A total of 587 participants (54.5% women) were recruited from the outpatient clinics of five health facilities in Beirut. The questionnaire consisted of the Arabic version of the Functional Health literacy Scale, the Arabic short version of the European Health Literacy Survey, and questions on sociodemographic and health-related factors. Descriptive and inferential statistics were performed to assess the association of these factors with functional health literacy (FHL) and comprehensive health literacy (CHL) levels.
Key Results: About 65.8% had inadequate or problematic FHL and 43.8% had inadequate or
problematic CHL. Although FHL was negatively correlated with long-term illness, it was positively correlated with ability to pay and health status. CHL was positively correlated with education, income, ability to pay for treatment, health status, and FHL level, whereas it was negatively correlated with long-term illness. Binary logistic regression showed that low education, low socioeconomic status, and being a widow were predictive of inadequate FHL. Moreover, having inadequate FHL and low income increased the likelihood of having
inadequate CHL. Conclusion: This study has identified those with risk factors for inadequate health literacy and unfavorable health outcomes. A national action plan can guide the promotion of health literacy and its embeddedness in society to instill competencies and the environment that would eliminate health inequities and sustain health in Lebanon.
... In Lebanon, the primary healthsystem is usually provided through a single or network of Primary Health Care (PHC) centers or even medical centers.Primary Health Care(PHC) centers across Lebanon have become a great importance for affording the Syrian refugees with basic healthcare. The (PHC) centers are mostly run by NGOs and are supported by renewable yearly contract basis from both the Ministry of Social Affairs (MSA) and the Ministry of Public Health (MPH) ( Kassak et al. 2006; Kronfol 2006). ...
Based on the review of the literature, the researcher in this study found an imperative need to predict NGOs' performance in Lebanon.The importance of this study is recommended by experts in Lebanon because of the increasing role of community services and the growing awareness of corporate social responsibilities (CSR) in Lebanon.The need for community services has been growing because of the increase the Lebanese population and the sudden influx of Syrian refugees into Lebanon.It was evident in this research that this increasing role of NGOs services was a must and highly related to the decreasing role of the governmental services.The researcher in this study collected primary data via questionnaire from 180 valid responses to test the relationship importance of age, civil status, and religion, number of family members, internet usage and economic activity on NGOs' performance in Lebanon.The findings of the study using econometric approach provided implications for policy making, decision making, and further research.The construction of the instrument (questionnaire) was based on the review of the literature, experts' opinion and this researcher's experience with NGOs, corporate social responsibility and community services.
... Lebanese hospitals, most of which are privatized and function on a true fee-for-service payment model, arguably lack the appropriate coordination, interfacility communication, infrastructure, and financial incentive to provide care to the refugees; as such, they are likely illprepared to handle this sudden and recent rise in demand for primary surgical services. [5][6][7][8] To mitigate this predictable mismatch between the need for and the ability to provide safe primary surgical care, several regional and international aid agencies have initiated relief missions targeted at the vulnerable refugee populations in Lebanon. 9,10 In particular, the United Nations Refugee Agency (UNHCR) has made Lebanon its largest single-country operation with five offices countrywide and is leveraging several national and international partnerships to provide health care including surgical services to refugees. ...
Background:
Lebanon hosts an estimated one million Syrian refugees registered with the United Nations High Commissioner for Refugees (UNHCR). The UNHCR contracts with select Lebanese hospitals to provide affordable primary and emergency care to refugees. We aimed to assess the surgical capabilities of UNHCR-affiliated hospitals in Lebanon.
Methods:
Cross-sectional data from the Surgical Capacity in Areas with Refugees study were combined with hospital affiliation data obtained from the UNHCR. The Surgical Capacity in Areas with Refugees study evaluated surgical capacity in Lebanon by mapping all acute care hospitals and administering the five domain Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) tool to each hospital. Mean PIPES indices and mean numbers of hospital beds, surgeons, and anesthesiologists were compared between UNHCR-affiliated and nonaffiliated hospitals. Geographically, the distribution of UNHCR-affiliated hospitals was cross-referenced with refugee population distributions.
Results:
One hundred and twenty nine hospitals were included, 35 (27.1%) of which were affiliated with the UNHCR. The PIPES tool was administered across all hospitals. Mean PIPES indices and mean number of hospital beds, general surgeons, and anesthesiologists were similar between UNHCR-affiliated and nonaffiliated hospitals. Geographical mapping of hospitals and refugee populations across Lebanon revealed a disparity in the Northeastern region of the country: that region had the highest number of refugees but lacked sufficient UNHCR coverage.
Conclusions:
Hospitals covered by the UNHCR performed similarly to nonaffiliated hospitals with respect to all aspects of the PIPES surgical capacity tool. However, there is a concerning geographic mismatch between UNHCR coverage and refugee density, specifically in the governorates of Akkar, Bekaa, and Baalbek-Hermel.
... [23,24] Nonetheless, it was able to regain its strength in the past few years, but this come back did not reflect on the weak, sectarian health system. [25,26] One of the major health challenges that are currently being faced include the under estimated injury rates owing to these wars and their longterm consequences, and in particular TBI rates. [27] Recently, there has been an increased interest in assessing the neuropsychological outcomes, such as PTSD and depression, following traumas in the Lebanese population; however, these studies have not attempted to investigate the upstream instigators that lead to the occurrence of these disorders, such as TBI in specific. ...
Background: Traumatic brain injury (TBI) is a debilitating medical and emerging public health problem that is affecting people worldwide due to a multitude of factors including both domestic and war-related acts. The objective of this paper is to systematically review the status of TBI in Lebanon – a Middle Eastern country with a weak health system that was chartered by several wars and intermittent outbursts of violence - in order to identify the present gaps in knowledge, direct future research initiatives and to assist policy makers in planning progressive and rehabilitative policies.
Methods: OVID/Medline, PubMed, Scopus databases and Google Scholar were lastly searched on April 15th, 2016 to identify all published research studies on TBI in Lebanon. Studies published in English, Arabic or French that assessed Lebanese patients afflicted by TBI in Lebanon were warranting inclusion in this review. Case reports, reviews, biographies and abstracts were excluded. Throughout the whole review process, reviewers worked independently and in duplicate during study selection, data abstraction and methodological assessment using the Downs and Black Checklist.
Results: In total, 11 studies were recognized eligible as they assessed Lebanese patients afflicted by TBI on Lebanese soils. Considerable methodological variation was found among the identified studies. All studies, except for two that evaluated domestic causes such as falls, reported TBI due to war-related injuries. Age distribution of TBI victims revealed two peaks, young adults between 18 and 40 years, and older adults aged 60 years and above, where males constituted the majority. Only three studies reported rates of mild TBI. Mortality, rehabilitation and systemic injury rates were rarely reported and so were the complications involved; infections were an exception.
Conclusion: Apparently, status of TBI in Lebanon suffers from several gaps which need to be bridged through implementing more basic, epidemiological, clinical and translational research in this field in the future.
... In addition coordination between the Ministry of Industry and Trade, which is responsible for VHI regulation, and the Ministry of Health has been reported to be limited [50]. In Lebanon the VHI sector boomed post 1992 due to gaps in public health insurance after the end of a 17 year civil that had left the public sector with very limited capacity and with a fragmented health system and health financing structure [51,52]. Despite improvements in the government health sector, private sector provision has still remained dominant and patients faced high user charges. ...
Background
Most low- and middle-income countries (LMIC) rely significantly on private health expenditure in the form of out-of-pocket payments (OOP) and voluntary health insurance (VHI). This paper assesses VHI expenditure trends in LMIC and explores possible explanations. This illuminates challenges deriving from changes in VHI expenditure as countries aim to progress equitably towards universal health coverage (UHC). Methods
Health expenditure data was retrieved from the WHO Global Health Expenditure Database to calculate VHI, OOP and general government health (GGHE) expenditure as a share of total health expenditure (THE) for the period of 1995–2012. A literature analysis offered potential reasons for trends in countries and regions. ResultsIn 2012, VHI as a percentage of THE (abbreviated as VHI%) was below 1 % in 49 out of 138 LMIC. Twenty-seven countries had no or more than five years of data missing. VHI% ranged from 1 to 5 % in 39 LMIC and was above 5 % in 23 LMIC. There is an upwards average trend in VHI% across all regions. However, increases in VHI% cannot be consistently linked with OOP falling or being redirected into private prepayment. There are various countries which exhibit rising VHI alongside a rise in OOP and fall in GGHE, which is a less desirable path in order to equitably progress towards UHC. Discussion and Conclusion
Reasons for the VHI expenditure trends across LMIC include: external influences; government policies on the role of VHI and its regulation; and willingness and ability of the population to enrol in VHI schemes. Many countries have paid insufficient attention to the potentially risky role of VHI for equitable progress towards UHC. Expanding VHI markets bear the risk of increasing fragmentation and inequities. To avoid this, health financing strategies need to be clear regarding the role given to VHI on the path towards UHC.
... 2 Affordability: the costs of services fit with users' income and ability to pay; hospitalization in Lebanon is mainly covered by the ministry of public health, followed by other sectors (Kronfol 2006). However, there is no adequate coverage for out of hospital or home care. ...
AimA discussion of the conceptual elements of an intervention tailored to the needs of Lebanese families.Background
The role of informal caregiving is strongly recommended for individuals with chronic conditions including heart failure. Although this importance is recognized, conceptual and theoretical underpinnings are not well elucidated nor are methods of intervention implementation.DesignDiscussion paper on the conceptual underpinning of the FAMILY model.Methods and data sourcesThis intervention was undertaken using linked methods: (1) Appraisal of theoretical model; (2) review of systematic reviews on educational interventions promoting self-management in chronic conditions in four databases with no year limit; (3) socio-cultural context identification from selected papers; (4) expert consultation using consensus methods; and (5) model development.ResultsTheories on self-care and behavioural change, eighteen systematic reviews on educational interventions and selected papers identifying sociocultural elements along with expert opinion were used to guide the development of The FAMILY Intervention Heart Failure Model. Theory and practice driven concepts identified include: behavioural change, linkage, partnership and self-regulation.Implications for nursingHeart failure is a common condition often requiring in-hospital and home-based care. Educational interventions targeting the socio-cultural influences of the patients and their family caregivers through a structured and well-designed program can improve outcomes.Conclusion
As the burden of chronic diseases increases globally, particularly in emerging economies, developing models of intervention that are appropriate to both the individual and the socio-cultural context are necessary.
... This increased morbidity among older adults is also leading to an increase in the consumption of health care services and costs. On average, each older adult in Lebanon makes 6.2 outpatient visits and is prescribed eight to nine drugs per year [9] . Yet, to date, the number of healthcare institutions that provide targeted care for older adults in Lebanon is insufficient and there are few geriatric physicians . ...
In Lebanon, the proportion of older adults (over 65 years) is on the rise. This rise is associated with increased morbidity rates and the need for age-specific medical and nursing care. The number of nurses specializing in geriatric care remains very small despite the increased need for this specialty. The nursing curriculum at the Hariri School of Nursing at the American University of Beirut (AUB) has integrated gerontological content in both undergraduate and graduate programs as an essential step to prepare future nurses for the care of the growing population of older adults and consequently to support the health care system. In line with the essential competencies proposed by the American Association of Colleges of Nursing (AACN), the school of nursing at AUB is preparing entry level and advanced practice nurses to care for the geriatric population. Furthermore, developing specialists in the field of gerontology and launching an interdisciplinary graduate program on 'Care of the Older Adult' is more and more becoming a desired development for the future.
... Lebanon is a small country located along the Eastern Mediterranean coast that has experienced multiple wars and civil unrests over the last three decades. These have eventually eroded public healthcare services provision, and have led to the establishment of a strong private sector that dominates the delivery of services across all sectors of care (Kronfol 2006). ...
The sustainability of primary healthcare (PHC) worldwide has been challenged by a global shortage in human resources for health (HRH). This study is a unique attempt at systematically soliciting and synthesising the voice of PHC and community stakeholders on the HRH recruitment and retention strategies at the PHC sector in Lebanon, the obstacles and challenges hindering their optimisation and the recommendations to overcome such obstacles. A qualitative design was utilised, involving 22 semi-structured interviews with PHC experts in Lebanon conducted in 2013. Nvivo qualitative data analysis software was employed for the thematic analysis of data collected from interviews. Five comprehensive themes emerged: understanding PHC scope, HRH recruitment issues, HRH retention challenges, rural areas' specific challenges and stakeholders' recommendations. Analysis of stakeholders' responses revealed a lack of a unified understanding of the PHC scope impacting the capacity for appropriate HRH planning. Identified impediments to recruitment included the suboptimal supply of HRH, financial constraints and poor management. Retention difficulties were attributed to poor working environments, financial constraints and lack of professional development. There was consensus that HRH challenges faced were aggravated in rural areas, jeopardising the equitable access to PHC services of quality. Equitable access was also jeopardised by the reported shortage of female HRH in a sociocultural context where many females prefer providers of the same gender. The study sets the path towards upscaling recruitment and retention policies and practices through the endorsement of a nationally acknowledged PHC definition and scope, the sustainable development of the PHC workforce and through the implementation of targeted recruitment and retention strategies addressing rural settings and gender equity. Decision-makers and planners are urged to identify HRH as the most important input for the success of PHC programmes and interventions, especially in the growing fields of mental health and geriatric care.
© 2015 John Wiley & Sons Ltd.
... • En terme de ressources humaines, la main-d' oeuvre qualifiée est drainée en raison de l' émigration massive des professionnels de santé. • En terme de régime de financement et de dépenses de santé, la fragmentation et le cloisonnement existants entre les nombreuses caisses publiques, parapubliques et privées (environ 100) (Kronfol, 2006), ainsi que l'absence de mécanismes de contrôle efficaces résultent en un pouvoir d'achat affaibli et des coûts administratifs très élevés ainsi qu' en des comportements pervers visant l'augmentation des revenus (Ammar, 2003). Par ailleurs, l' escalade continue des coûts place le pays à un niveau proche des pays industrialisés et constitue un poids financier très lourd sur les dépenses des ménages. ...
... Accordingly, the private sector's involvement in the provision of health care has witnessed a rapid expansion. The number of private hospitals has increased by 60% during the war [10] and this is mainly due to unrestricted financing by the Ministry of Public Health (MoPH). The WHO World Health Statistics report published in 2010 shows that the number of hospital beds in Lebanon sums up to 34 per 10 000 population scoring among the highest indicators in the EMR (average number of beds is 12 per 10 000 population) [11]. ...
Objective:
This study explores the views of Lebanese hospitals on the worthiness of accreditation vis-à-vis its associated expenses in addition to examining the type and source of financial investments incurred during the accreditation process.
Design:
Observational cross-sectional design.
Participants:
All private short-stay hospitals registered with the Syndicate of Private Hospitals in Lebanon (110 hospitals).
Main outcome measure:
Hospital's views on the worthiness of accreditation in lieu of its associated expenses. Other measures explored included areas of expenditure increase and sources of expenses coverage for accreditation.
Results:
Three-fifths of responding hospitals (63% response rate) considered accreditation as a worthy investment. Favorable views on accreditation were mostly related to its effect on enhanced quality and safety culture. Unfavorable views regarding the worthiness of accreditation investment were justified by absence of link with enhanced tariffs from payers (25.7%). All hospitals incurred increased expenses due to accreditation. Areas of highest increase included training of staff (95.7%), consultants' costs (80.0%) and infrastructure maintenance (77.1%). Most of the hospitals covered expenses through internal absorption (52%) or bank loans (45.7%).
Conclusions:
The financial burden of accreditation on hospitals has to be factored in the decision of its adoption at a national level, especially in developing countries.
... Net patient RPB, which is calculated by dividing the net patient revenue for a hospital by the number of beds, has been cited as indicative of an institution's competitive power in attracting patients and staffing its beds (Smith et al., 2006). In relation to OR concern (see preceding discussions) and the fact that most hospitals e38 have a present revenue ceiling from the MoPH (the predominant payer of hospital services in Lebanon) (Kronfol, 2006), RPB became a key financial performance indicator for the financial wellbeing and survival of many hospitals especially in light of the decrease in number of contracts of hospitals with MoPH and limits on the yearly ceiling (Ammar, 2009). It is worth noting that outlier values on both financial performance measures were removed from the analysis. ...
Background:
Strategic planning has been presented as a valuable management tool. However, evidence of its deployment in healthcare and its effect on organizational performance is limited in low-income and middle-income countries (LMICs). The study aimed to explore the use of strategic planning processes in Lebanese hospitals and to investigate its association with financial performance.
Methods:
The study comprised 79 hospitals and assessed occupancy rate (OR) and revenue-per-bed (RPB) as performance measures. The strategic planning process included six domains: having a plan, plan development, plan implementation, responsibility of planning activities, governing board involvement, and physicians' involvement.
Results:
Approximately 90% of hospitals have strategic plans that are moderately developed (mean score of 4.9 on a 1-7 scale) and implemented (score of 4.8). In 46% of the hospitals, the CEO has the responsibility for the plan. The level of governing board involvement in the process is moderate to high (score of 5.1), whereas physician involvement is lower (score of 4.1). The OR and RPB amounted to respectively 70% and 59 304 among hospitals with a strategic plan as compared with 62% and 33 564 for those lacking such a plan. No statistical association between having a strategic plan and either of the two measures was detected. However, the findings revealed that among hospitals that had a strategic plan, higher implementation levels were associated with lower OR (p < 0.05).
Conclusions:
In an LMIC healthcare environment characterized by resource limitation, complexity, and political and economic volatility, flexibility rather than rigid plans allow organizations to better cope with environmental turbulence.
... The reason we are able to use the presence of any health related expense as an indicator of use is that no health care financing plans in Lebanon involves complete coverage of health expenses, with the exception of the government provided insurance plan for military and security personnel. For all other Lebanese citizens, even the most generous coverage involves some out-of-pocket expenditures, so we take the presence of health-related spending as an indicator of the use of healthcare services [9]. ...
The health sector in Lebanon suffers from high levels of spending and is acknowledged to be a source of fiscal waste. Lebanon initiated a series of health sector reforms which aim at containing the fiscal waste caused by high and inefficient public health expenditures. Yet these reforms do not address the issues of health equity in use and coverage of healthcare services, which appear to be acute. This paper takes a closer look at the micro-level inequities in the use of healthcare, in access, in ability to pay, and in some health outcomes.
We use data from the 2004/2005 Multi Purpose Survey of Households in Lebanon to conduct health equity analysis, including equity in need, access and outcomes. We briefly describe the data and explain some of its limitations. We examine, in turn, and using standardization techniques, the equity in health care utilization, the impact of catastrophic health payments on household wellbeing, the effect of health payment on household impoverishment, the equity implications of existing health financing methods, and health characteristics by geographical region.
We find that the incidence of disability decreases steadily across expenditure quintiles, whereas the incidence of chronic disease shows the opposite pattern, which may be an indication of better diagnostics for higher quintiles. The presence of any health-related expenditure is regressive while the magnitude of out-of-pocket expenditures on health is progressive. Spending on health is found to be "normal" and income-elastic. Catastrophic health payments are likelier among disadvantaged groups (in terms of income, geography and gender). However, the cash amounts of catastrophic payments are progressive. Poverty is associated with lower insurance coverage for both private and public insurance. While the insured seem to spend an average of almost LL93,000 ($62) on health a year in excess of the uninsured, they devote a smaller proportion of their expenditures to health.
The lowest quintiles of expenditures per adult have less of an ability to pay out-of-pocket for healthcare, and yet incur healthcare expenditures more often than the wealthy. They have lower rates of insurance coverage, causing them to spend a larger proportion of their expenditures on health, and further confirming our results on the vulnerability of the bottom quintiles.
... In addition to that, Lebanese physicians may prefer not to diagnose allergies in order not to alarm the children's parents (17). Moreover, given the fact that less than half of the Lebanese population has some sort of health care insurance and that 69% of the Lebanese health expenditure is contributed by household out-of-pocket expenses (18), children of low income families are possibly less likely to seek physicians and hence less likely to be diagnosed with these diseases. ...
Studies on allergic diseases remain scarce in Lebanon. The aim of the present study was to determine prevalence and characteristics of asthma, allergic rhinitis and eczema among Lebanese school children.
The study was cross-sectional in design performed on a convenient sample of 3,115 students (13-14 yr) selected from 13 schools in 5 Lebanese provinces. Students were asked to complete the Arabic version of the International Study of Asthma and Allergies in Childhood questionnaire. Logistic regression was performed to assess the characteristics of having asthma, allergic rhinitis and eczema in the past year.
The prevalence of ever having asthma, rhinitis and eczema was 8.3%, 45.2% and 12.8% respectively, while the prevalence of the symptoms of these diseases in the past year was 24.1%, 38.6% and 20.9%, respectively. Residing in the South and the North provinces of Lebanon and living in a busy area increased the likelihood of developing asthma and rhinitis. Higher rates of asthma and eczema, however, was noted among students going to private schools (Odds Ratio (OR) = 1.6, 95% confidence interval (CI): 1.3-2.1 and OR = 1.3, 95% CI: 1.0-1.7, respectively). Passive smoking was significantly associated with asthma only (OR = 1.3, 95% CI: 1.1-1.7). In addition to the above, the odds of having any of the three outcomes increases to at least 2.4-fold when accompanied by another allergic disease.
Allergic diseases are highly prevalent in Lebanon and are catching up with the rates of developed countries. Moreover, the role of each of the three diseases in the existence of the other two had the greatest impact on their prevalence.
Purpose
The purpose of this paper was first to gain an in-depth understanding of the barriers and facilitators to implementing the BPS model and pain neuroscience education in the current Lebanese physical therapy health care approach and explore its acceptability.
Method
A qualitative semi-structured interview using purposive sampling was conducted with eight Lebanese physical therapists practising in different governorates. The transcribed text from the interviews was analyzed using inductive thematic analysis.
Results
Two topics were generated and constructed by the researchers: (1) “barriers to the implementation of pain neuroscience education, with subthemes including (a) “current health care approach,” (b) “basic curriculum and continuing education,” (c) “patients’ barriers”; (2) “facilitators to the implementation of pain neuroscience education,” with subthemes containing (a) “interest in the BPS model, (b) “therapeutic alliance,” and (c) “motivation for future training on BPS approach.”
Conclusion
The analysis of the results showed that Lebanese physical therapists currently hold a strong biomedical view of chronic pain, assessment, and treatment. However, despite the presence of barriers and challenges, they are aware and open to consider the implementation and future training about the BPS model and pain neuroscience education in their approach.
•
IMPLICATIONS FOR REHABILITATION
• The exploration of potential barriers and facilitators to the bio-psychosocial model and pain neuroscience education implementation may provide an opportunity for better development and design of a culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists.
• The exploration of barriers and facilitators to the implementation of pain neuroscience education will help to improve pain education and ensure better clinical pain management.
• The most important barriers were the dominant characteristic of the Lebanese physical therapist’s health approach, which is focused on a biomechanically oriented model, and their lack of knowledge to approach chronic pain from a biopsychosocial perspective.
Migration has always been a feature of human populations, with people migrating and crisscrossing the globe for a wide range of reasons. During the 21st century [1], there have been substantial increases and changes in international migration and resettlement patterns due to factors including: people’s ability to travel, ease of communication and technology, civil unrest and conflicts, seeking opportunities for greater equality and freedom, and career progression and achievement. As a result of these factors, global populations have increased and integrated across settings, challenging the differentiation between types of migrants such as refugees and economic migrants.
As part of this exploration, up to 15 April 2022, a special topic of the International Journal of Environmental Research and Public Health (IJERPH) entitled “Migration, Resilience, Vulnerability and Migrants’ Health” was opened, and a dedicated team of scholars managed the editorial work as guest editors to facilitate the timely peer-review and publication of relevant manuscripts from multiple studies [2]. Between 20 February 2020 and 15 April 2022, a total of 44 manuscripts were submitted to the Special Issue, of which 14 were rejected and 29 published. A total of 128 authors from across the globe including Europe, Australia, China, and Malaysia contributed to the published articles. The published studies were conducted using different methodological approaches including mixed methods, qualitative, quantitative, and review studies. These studies involved participants whose migration involved both internal and international journeys, and they were both economic migrants and people with a refugee background. The published studies involved a wide range of population groups including men and women, children, young people, and people
in different settings—such as aged care facilities, refugee camps, and in general community dwellings. By August 2022, the Special Issue had achieved 37,208 views.
In the Special Issue, a number of thematic areas were discussed including, but not
limited to:
A. Health literacy and communication—For example, Klingberg et al. [3] identified
disparities in the use of emergency care between asylum seekers and Swiss nationals with non-urgent complaints, and Patel et al. [4] synthesized evidence on communication/interaction in the primary health care consultation setting with refugees or asylum seekers in western host countries.
B. Mental health and resilience—For example, Hynek et al. [5] developed a system
model of post-migration risk factors for mental health and their interactions, and
Mwanri et al. [6] discussed how individual and community resilience factors supported the successful resettlement of Africans in Australia.
C. Sexual and reproductive health services—For example, Loganathan et al. [7] explored the provision of sexual and reproductive health education, contraception, abortion, antenatal, and delivery, as well as the management of gender-based violence.
D. Identity and belongingness—For example, Mude et al. [8] explored the identity and belonging of refugees in a host country.
E. Policy for disability among migrants in Europe—For example, Martin-Cano et al. [9] critically reviewed the structure of social and professional intervention policies, at the international level, towards refugees with disabilities in Europe.
Conclusion: It is evident from these research activities that migrants, being internal
or international and migrating for opportunities or as forced migrants (refugees), face a number of challenges, but opportunities do exist as well. Despite their vulnerability, especially for those migrating with a refugee background, through their resilience and adaptation to whatever adversity they face, they do survive and continue to contribute to their new place of residence.
Objective
: Injuries account for a large portion of the global burden of disease, representing over 10% of all disability adjusted life years (DALYs). This study analyzes the economic impact of injury for those experiencing moderate-to-severe injury in Beirut, Lebanon. It further examines the impact of different demographic and socioeconomic factors on trauma-specific quality of life 1-2 years following injury.
Methods
: This was a prospective cohort study following patients 1-2 years after being treated for injury at one of three hospitals in Beirut, Lebanon. Patients interviewed by phone. In addition to questions on financial impact, access to healthcare, and socioeconomic status, the Trauma-specific Quality of Life (TQoL) Questionnaire was used to assess quality of life following injury. Multivariable linear models were constructed to examine TQoL and demographics among institutes.
Results
: 116 patients completed interviews. The average out-of-pocket cost of injury was 2975.42 USD, 65% of which was borrowed. 21% of people lost employment due to injury. Patients at Geitawi Hospital and the Rafic Hariri Governmental Hospital borrowed more on average and had higher reductions in employment than patients at the American University of Beirut Medical Center (AUBMC). There was a loss of income for those employed at the time of injury, with a mean monthly loss of 261.6 USD. The economic impact of injury was 10,329.00 USD. 25% of patients reported difficulty with accessing follow-up care, predominantly due to cost. Mean-adjusted Trauma-specific Quality of life (TQoL) was highest at AUBMC. Education was associated with functional recovery in the TQoL questionnaire; for every additional year of education there was an increase in the functional recovery domain of 0.03.
Conclusion
: Individuals that experienced moderate-to-severe injury in Beirut, Lebanon, suffered financial repercussions, including reductions in income, less employment, or unemployment. Across all patients surveyed, higher level of education was associated with better functional quality of life. More study into the intricacies of accessing healthcare care in Lebanon, especially given the current economic and political climate, are crucial to maintain the health of those experiencing injury and can help inform targeted interventions.
Neonatal intensive care has evolved drastically over the last few decades with babies surviving and thriving when born at 22 or 23 weeks gestation. However, in many parts of the world resources are scant and premature babies often do not survive and if they do, they suffer long-term negative consequences and developmental delays. This chapter describes neonatal care in Lebanon, a middle-income Middle Eastern country.KeywordsLebanonNeonatal nursingNeonatal researchNeonatal education
LGBT people face significant discrimination, social pressures, and legal challenges in Lebanon, yet little is known about their experiences with the healthcare system. We conducted a secondary data analysis study using a qualitative descriptive design and data from the parent project, LebGuide (2016 2017). The data consisted of de-identified one-on-one interviews with 13 LGBT individuals and seven community-based organizations (CBOs). Data were analyzed using content analysis. Themes related to LGBT individuals' healthcare experiences overlapped between the two groups of participants (LGBT participants and CBO participants) and centered around: anticipation of discrimination, experiences with healthcare providers, experiences with healthcare systems, transgender-specific experiences, and role of CBOs. This study highlights the need for LGBT-inclusive curricula in healthcare educational and training programs. Since most positive healthcare experiences reported by participants were at CBOs, it is important for CBOs to partner with healthcare institutions to introduce an LGBT-affirming culture into the healthcare workplace and the institutional culture of healthcare facilities and systems. Given the reported experiences of LGBT individuals, training of healthcare providers on LGBT health is important to address such challenges and change attitudes and behaviors. Healthcare entities in Lebanon need to take actions to prevent discrimination within their systems and train their providers to ensure safe and optimal healthcare.
Background
Health care workers (HCWs) are essential for the delivery of health care services in conflict areas and in rebuilding health systems post-conflict.
Objective
The aim of this study was to systematically identify and map the published evidence on HCWs in conflict and post-conflict settings. Our ultimate aim is to inform researchers and funders on research gap on this subject and support relevant stakeholders by providing them with a comprehensive resource of evidence about HCWs in conflict and post-conflict settings on a global scale.
Methods
We conducted a systematic mapping of the literature. We included a wide range of study designs, addressing any type of personnel providing health services in either conflict or post-conflict settings. We conducted a descriptive analysis of the general characteristics of the included papers and built two interactive systematic maps organized by country, study design and theme.
Results
Out of 13,863 identified citations, we included a total of 474 studies: 304 on conflict settings, 149 on post-conflict settings, and 21 on both conflict and post-conflict settings. For conflict settings, the most studied counties were Iraq (15%), Syria (15%), Israel (10%), and the State of Palestine (9%). The most common types of publication were opinion pieces in conflict settings (39%), and primary studies (33%) in post-conflict settings. In addition, most of the first and corresponding authors were affiliated with countries different from the country focus of the paper. Violence against health workers was the most tackled theme of papers reporting on conflict settings, while workforce performance was the most addressed theme by papers reporting on post-conflict settings. The majority of papers in both conflict and post-conflict settings did not report funding sources (81% and 53%) or conflicts of interest of authors (73% and 62%), and around half of primary studies did not report on ethical approvals (45% and 41%).
Conclusions
This systematic mapping provides a comprehensive database of evidence about HCWs in conflict and post-conflict settings on a global scale that is often needed to inform policies and strategies on effective workforce planning and management and in reducing emigration. It can also be used to identify evidence for policy-relevant questions, knowledge gaps to direct future primary research, and knowledge clusters.
Introduction:
The World Health Organization's general assembly, in its last meeting of May 2019, has approved the suggested changes to the International Classification of Diseases manual, 11th version (ICD-11). Some of the proposed recommendations include the revision of "Disorders of Sexual Preference", now called Paraphilic Disorders, currently listed under the International Classification of Diseases-10 Mental and Behavioural Disorders.
Aim:
This article presents findings on the analysis of the existing laws and policies that are relevant to paraphilic disorders in Lebanon.
Methods:
A literature review of all official and unofficial documents, reports, and articles published on laws and health policies relevant to paraphilic disorders in Lebanon was conducted, including a thorough review on Lebanese laws on that matter. Moreover, interviews with government representatives, including the Ministry of Public Health, the Ministry of Justice, the Ministry of Social Affairs, representatives of Non-Governmental Organizations working in child protection, and mental health professionals from the private and public sector, were conducted.
Main outcome measure:
Covered are (i) the health system in Lebanon including policies and laws related to mental health care provision and relevance to paraphilic disorders, (ii) the legal framework and the mental health evaluation and treatment in the Lebanese criminal justice system: the case of paraphilic disorders, (iii) adjudication of sex offenders in Lebanon, (iv) criminal responsibility relevant to paraphilic disorders, and (v) the relationship between legal and clinical issues for non-forensic health professionals.
Results:
The treatment of paraphilic disorders would follow the treatment of all mental health conditions in Lebanon as no specific services for paraphilic disorders are available within these health-care systems. Legally, sexual crimes in Lebanon are not judged according to the individual's urges, fantasies, or state of mind, rather are assessed according to the acts committed by the individual. Therefore, an individual diagnosed with a paraphilic disorder is not culpable of any crime should he not act on this disorder by committing acts that fall under the scope of the penal code. An analysis of sexual acts that qualify as crimes reveals that the element of consent is rarely taken into consideration as most sexual crimes are defined as such with reference to violation of social norms, primarily "morals and public morality." Therefore, a change in the diagnostic classification of mental and behavioral disorders (ICD or Diagnostic and Statistical Manual of Mental Disorders) should not be a factor in their definition. Furthermore, in the course of enforcing criminal sanctions on individuals diagnosed with a mental disorder, the determining factor will be the individual's state of awareness at the time of the act. Psychiatric expertise initiated in that context lacks standardized criteria for diagnosis and is not bound by law to rely on international classifications; it is usually based on nonstructured interviews. Should it be assessed that the individual was fully aware of the consequences of his or her act, the paraphilic disorder diagnosis should not play any role in the sentencing.
Clinical implications:
Clinicians in Lebanon can now be aware of the legal sanctions that patients with paraphilic disorders may fall under, should criminal acts be committed. Clinicians can also be familiar with the role of mental health disorders in the legal system, specifically with relevance to "awareness" at the time of the criminal act. Moreover, clinicians can freely use the updated diagnoses of paraphilic disorders in the ICD-11, as they form no legal detriments in Lebanon.
Strength & limitations:
The interviewing technique used in this study ensured that participants spoke about issues pertinent to their experience and expertise and helped achieve data saturation. Nonetheless, although this is a review, a quality and bias screening tool was not used because of the search mostly pertaining to legal laws and cases instead of research articles. furthermore, no software was used to analyze the qualitative data from the interviews. In addition, some of the documents reviewed were in Arabic, and therefore, some nuances, while translating the essential findings to English, might have been lost in translation.
Conclusion:
Compared with the ICD-10, the categories and definitions in ICD-11 should not create any additional obstacles nor offer any direct positive consideration, as the diagnostic classifications of mental disorders (ICD or Diagnostic and Statistical Manual of Mental Disorders) are not relevant to the definition of criminal sexual acts in Lebanon. Makhlouf Y, Kerbage H, Khauli N, et al. Legal and Policy Considerations in Lebanon Related to Proposals for Paraphilic Disorders in World Health Organization's International Classification of Diseases Manual, 11th Version. J Sex Med 2019;XX:XXX-XXX.
Homosexuality is illegal in Lebanon and men who have sex with men (MSM) may experience discrimination. Displaced Syrians, who currently comprise approximately 20% of Lebanon’s population, also face discrimination. Individuals who are members of both groups may experience heightened levels of discrimination and abuse. In partnership with local nongovernmental organizations serving the community, we recruited N = 292 MSM in Beirut, Lebanon. Participants were interviewed about experiences of violence and discrimination in the context of a larger health behavior survey, and all were offered anonymous HIV testing. Responses were analyzed using the framework of intersectionality, combining regression, geographical mapping of reported experiences, and network analysis of the participant recruitment pattern. MSM, born outside of Lebanon, who are primarily from Syria, face higher levels of discrimination and violence than native-born MSM (71% vs. 32% reporting at least one type of discrimination or violence). Socioeconomic status is also associated with discrimination and violence overall, and among native- and foreign-born MSM. Experiences vary by town and neighborhood, and are highly correlated between recruiting and recruited participants.These results highlight health risks faced by foreign-born MSM in Lebanon.
Based on the review of literature, the researchers in this study found an imperative need to predict NGOs' performance in Lebanon. The importance of this study is recommended by experts in Lebanon because of the increasing role of community services and the growing awareness of corporate social responsibilities (CSR) in Lebanon. The need for community services has been growing because of the increase the Lebanese population and the sudden influx of Syrian refugees into Lebanon. It was evident in this research that this increasing role of NGOs services was a must and highly related to the decreasing role of the governmental services. The researchers in this study collected primary data via questionnaire from 180 valid responses to test the relationship importance of age, civil status, religion, number of family members, internet usage and economic activity on NGOs' performance in Lebanon. The findings of the study using econometric approach provided implications for policy making, decision making and further research. The construction of the instrument (questionnaire) was based on review of literature, experts' opinion and this researchers' experience with NGOs, corporate social responsibility and community services.
Armed conflicts in the Middle East during the past decade have forced people to flee in vast numbers to neighboring countries, and this has added substantial strains to existing resources. In this context, the needs of displaced children with noncommunicable diseases such as cancer can unfortunately be overlooked because of the complexities of coordinating multidisciplinary care and a lack of resources for managing the acute toxicities of therapy. Innovative transnational collaborations in countries such as Lebanon can serve as models for the delivery of equitable cancer care during times of geopolitical turmoil.
See also pages 1464‐72.
The proliferation of conflicts across borders of Middle Eastern States has transformed the landscapes of health and healthcare across the region. In the case of Iraq, state healthcare has collapsed under the strain of protracted conflicts. Meanwhile, Lebanon’s post-war healthcare system is booming, and becoming more privatised. In this paper, we build on an ethnographic study on the movements and experiences of Iraqi patients in Lebanon to show how one of the consequences of war is the rise of alternative forms of healthcare–seeking practices and survival strategies – a therapeutic geography that is embedded in regional economies and geopolitical relations and reconfigurations. We argue for the need to reimagine the disconnectivity and connectivity of healthcare systems under war and conflict as grounded in the empirical realities and experiences of mobility in the Middle East.
Lebanon has unique socio-demographic features that render the ageing of its population a complex challenge. Past and present fertility levels are among the lowest in the region, crude mortality rates have decreased dramatically during the past few decades and non-communicable diseases have been considered to be the leading causes of death since the 1960s. Furthermore, Lebanon has currently the highest evidence percentage of older persons aged 65 years and above (7.5 per cent) among Arab countries. Yet, changes to the governance, structure and composition of the population remain unmatched by any corresponding increase in support measures. Lebanon lacks policies towards ageing, as well as a lack of reliable data on older people. This paper examines the public health, social and economic implications of demographic changes in Lebanon and explores their impact upon the expanding population of older persons.
Providing health services at affordable prices while balancing quality with cost has been a major challenge for health managers as well as policy makers particularly in the developing world in an era of major constraints on financial and human resources. This balance has been difficult to sustain especially in the public sector, often criticized for low levels of efficiency. On the other hand, the private sector has made strides in management efficiency and cost control. Research efforts have been focusing on financial incentives and its impact on the decision making process of the provider in terms of quantity and quality of services. This study assessed the impact of ownership, on the practice patterns of providers under different physician payment mechanisms in primary care centers in Lebanon. The results support the notion that not only payment mechanisms, but also type of ownership affects physicians' behavior. Government health centers exhibited a lower mean duration of visit and less referral patterns. In governmental centers, fee-for-service physicians reported the highest referral rate compared with salaried physicians. A mixed payment mechanism that would provide a prospective payment coupled with some risk adjustment, pay for performance, to reward value added services might be a viable alternative to current practices.
This study aimed to examine the association between the payer mix and the financial performance of public and private hospitals in Lebanon. The sample comprised 24 hospitals, representing the variety of hospital characteristics in Lebanon. The distribution of the payer mix revealed that the main sources of revenue were public sources (61.1%), out-of-pocket (18.4%) and private insurance (18.2%). Increases in the percentage of revenue from public sources were associated with lower total costs and revenues, but not profit margins. An inverse association was noted between increased revenue from private insurance and profitability, attributed to increased costs. Increased percentage of outof- pocket payments was associated with lower costs and higher profitability. The study provides evidence that payer mix is associated with hospital costs, revenues and profitability. This should initiate/inform discussions between public and private payers and hospitals about the level of payment and its association with hospital sector financial viability.
Palliative care focuses on relieving suffering in patients with serious illness. Patients who receive palliative care have better control of distressing symptoms, are less likely to suffer from depression and have a better quality of life. Although palliative care has become an integral component of health care systems in many developed countries it has yet to be established in most developing countries. In Lebanon, Palliative care was only recently recognized as a specialty and there are not enough palliative care providers to cover the needs of the population. This article describes the opportunities and barriers to the development of palliative care in the Lebanese context.
This article describes a pluralistic regime of oral health provision in a rural part of northern Lebanon, where dental care came from two main sources: professionally trained dentists and "informal" Dom dentists with Syrian nationality. Relying on a combination of interviews and ethnography, I offer a multivocal view of oral health services that incorporates data from patients and formal and informal providers. I argue that informal dentistry constituted an interstitial and translocal mode of dental care. In the northern Lebanese Biqa Valley, close to the Syrian border, the local articulation of neoliberal health governance created opportunities for heterodox practices in oral health. The organization of informality was predicated on the presence of the open border between Syria and Lebanon, which favored patterns of flexible cross-border mobility. In this context, informal dentistry was not alternative, but supplementary and lateral in relation to official forms of oral health provision.
LA COLLABORATION INTERPROFESSIONNELLE : CAS D’UN SERVICE DE PÉDIATRIE D’UN HÔPITAL UNIVERSITAIRE AU LIBAN
La collaboration interprofessionnelle (CIP) est un concept novateur qui émerge en sciences de gestion qui est appliqué surtout dans le secteur de la santé. Face au constat de l’absence de définitions précises de la CIP et aux nombreux concepts sous-jacents qui existent dans la littérature contribuant à la difficulté de son opérationnalisation, nous proposons une définition générique et trois définitions contextualisées du concept de CIP basées sur l’étude empirique menée dans trois unités de soins d’un service de pédiatrie d’un hôpital universitaire au Liban.
La démarche par étude de cas utilisée dans ce travail nous permet de réaliser des comparaisons intra-unités, de proposer des modèles de CIP qui tiennent compte de l’environnement spécifique de chaque unité et de développer un modèle générique. La grille d’entretien unique sur laquelle se base ce travail permet de limiter les biais émanant du chercheur et de la subjectivité des acteurs. Cet outil nous permet de faire ressortir la perception des acteurs de la CIP, les situations potentielles de CIP, les formes de CIP, les conditions pré-requises, les facteurs facilitants et contraignants de la CIP ainsi que les résultats.
Mots-clés : Collaboration, interprofessionnelle, hôpital universitaire, pédiatrie, étude de cas, démarche abductive
INTERPROFESSIONAL COLLABORATION: CASE OF A PAEDIATRICS UNIT IN A UNIVERSITY HOSPITAL IN LEBANON
Interprofessional collaboration (IPC) is an innovating concept which emerges in organization and management theory and is mostly applied to the health sector. As a response to the evidence found in the literature as to the lack of precise definitions of IPC and to the existence of many underlying concepts which renders its applicability difficult, we propose a generic definition and three contextualized definitions of IPC based on the empirical study conducted in three wards of a pediatric unit of a university hospital in Lebanon.
The case study approach used in this research allows us to compare between the three units, to propose models of IPC which take into consideration the specific environment of each unit and to develop a generic model of IPC. The unique interview grid on which is based this work limits bias from the researcher and subjectivity of the actors. This tool allows us to highlight the perception of actors of the IPC, the potential situations of IPC, forms of IPC, prerequisites of IPC, facilitating and restrictive factors of IPC and the outcomes.
Keywords: Collaboration, interprofessional, university hospital, paediatrics, case study, abductive reasoning
Prehospital emergency medical services in Lebanon are based on volunteer systems with multiple agencies. In this article, a brief history of the development of prehospital care in Lebanon is presented with a description of existing services. Also explored are the different aspects of prehospital care in Lebanon, including funding, public access and dispatch, equipment and supplies, provider training and certification, medical direction, and associated hospital-based emergency care.
El Sayed MJ, Bayram JD. Prehospital Emergency Medical Services in Lebanon: overview and prospects . Prehosp Disaster Med . 2013 ; 28 ( 2 ): 1 - 3 .
badr l., rizk u. & farha r. (2010) Journal of Nursing Management18, 182–193 The divergent opinions of nurses, nurse managers and nurse directors: the case in Lebanon
Aim The present study provides an overview of the status of the nursing profession in Lebanon and compares and contrasts the opinions of directors, nurse supervisors/managers and nurses regarding the nursing profession and the workplace.
Background There are limited publications concerning the working conditions of nurses in Lebanon, and no studies on the views of directors, supervisors/managers and nurses regarding the priorities of the nursing profession. Such data are necessary to build a sound theoretical basis on which recommendations for improving the nursing profession in Lebanon are made as well as to compare and contrast cross cultural findings.
Method Data were collected from 45 hospitals using a mixed methods design. Qualitative data was obtained from 45 nursing directors whereas quantitative data were collected from 64 nursing supervisors and 624 nurses.
Results Similarities and differences in the opinions of nurses, nurse supervisors/managers and nurse directors regarding critical issues for the nursing profession are discussed and contrasted.
Conclusions/implications Nurses are more likely to be satisfied and committed to their profession when they feel that their opinions are being heard and that their work environment promotes professional advancement.
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