Health & Education

Duty Bound

Health

The Lebanese healthcare system is facing a number of challenges, and it must find new sources of funding. A switch to a more domestic approach may be key to lowering costs.

HOME FRONT

While Syrian refugees present their own problems, Lebanon still has a number of domestic issues that need to be addressed. The country is going through an epidemiological change presently whereby communicable diseases common with developing nations, such as polio, remain present but are generally falling, while non-communicable diseases often associated with developed nations, such as heart disease, diabetes, and obesity, are rising. Lebanon has made great strides over the past decade combating communicable diseases through a systematic vaccination program; however, the large influx of unvaccinated refugees could jeopardize the progress that has been made and increase the risk of preventable and waterborne disease outbreaks. Having suffered through civil war in the 1970s and 1980s, Lebanon’s healthcare system was ravaged; however, the rapid growth of the 2000s led to a drastically improved private offering, but the public side somewhat lagged behind as the profits of the private sector allowed it to continue its growth.

The WHO, in partnership with the government, established five key areas to help boost the country’s health in its Country Cooperation Strategic Agenda (2010-2015). The first two strategic priorities are focused on the control of communicable and non-communicable diseases. Strategic Priority III is aimed at promoting health through life courses. These include information on reproductive, maternal, and child health, as well as courses for children on youth health. Strategic Priority IV aims to tackle some of the problems inherent in the system through reform. It hopes to introduce an integrated healthcare system centered on the people of the country through universal healthcare as well as personalized healthcare coverage. It aims to increase access to medicine and enhances the Ministry of Public Health’s regulatory capacity. It will also help to reinforce the information available to citizens on e-health services, and health financing and expenditures. This strategic area will also introduce a secondary and tertiary accreditation system for public hospitals, central public health labs, and laboratories. Part of this strategy was recently launched by the Ministry of Public Health in its Second Emergency Social Protection Implementation Support Project (ESPISP II). The main aim of the project is to improve administration, delivery, financial sustainability, and target social services through the implementation of new systems and policies in the Ministry of Public Health. Part of this system has included a scoring system on the performance of all hospitals. Patients can now look up all private and public hospitals split into price brackets and examine key statistics such as admissions, deduction rates, patient satisfaction scores, and contracting, among others, which all go together to give each hospital a total score. The final target area for the whole project is Strategic Priority V. This area is focused on preparedness, alert, and response. The project is targeting Lebanon’s emergency risk and crisis management to create a more efficient and effective management team to deal with possible epidemic and pandemic prone diseases.

PHARM IN

One of the ways Lebanon’s government feels it can improve the general standard of healthcare offered is by producing more of its drugs domestically. In the summer of 2013, Arwan Pharmaceutical Industries opened its $40 million pharmaceutical plant in Chouf. The company hopes it will become a game changer in the region and help to attract more of the $1 trillion in estimated pharmaceuticals turnover to the region. The CEO of Arwan, Abdul-Razzaq Yousef, told The Daily Star that the plant’s gross sales in its first 18 months of operations is expected to be $45 million. After this period, a rise in production should increase sales to $180 million. Arwan chose Lebanon to build its facility because of the country’s dedication to creating a high-caliber healthcare industry. Yousef stated Lebanon’s high standards for medical professionalism, minimal visa and residency complications, and high-quality workforce were key factors in building the factory in Lebanon. In addition to these, the country’s free trade zones (FTZs) allow for the export of pharmaceutical products with lower tariffs.

The pharmaceutical sector is big business in Lebanon, with the total value in 2012 coming in at $1.28 billion, growing 6.5% on the 2011 figure according to the Investment Development Authority of Lebanon (IDAL). The forecast annual compound growth for the sector is expected to come in at 7.71% up until 2015, which should bring the value of the sector to $1.41 billion. This increase in value is also followed by an increase in the sales of pharmaceuticals, with per capita expenditure rising from $206 in 2009 to an expected $426 in 2019. Arwan’s new plant is hoping to change the balance of domestic versus foreign pharmaceuticals. In 2012, 90% of drugs consumed in Lebanon were imported, while only 10% were produced domestically. The top sources of imports came from France, the UK, Germany, and Switzerland, while Lebanon’s top export destinations were to Arab countries, mainly Jordan, Iraq, and the UAE. Even though Lebanon imports the vast majority of its drugs, its exports have been increasing steadily between 2008 and 2012 at a compound annual rate of 14.1% to reach $31.43 million according to IDAL.

REFUGEES

During the Syrian civil war, Lebanon has gone above and beyond its neighborly duties in taking in over 1 million refugees, which equates to 25% of the Lebanese population. In two years, refugees have racked up a health bill of over $92 million according to the World Bank, and since only 2% of this is being funded by foreign donors, much of the bill is being paid for by an already over-stretched and under-funded public health system. Since the Ministry of Public Health has long preferred to fund the private health system, the public sector has very limited funding at only 2.9% of the government’s budget in 2011. Of the 163 hospitals in the country, only 20 are public and they account for only 15% of hospital beds, according to a 2013 Banque Bemo report. This reliance on the private sector has demonstrated a critical underlying problem in the health system of Lebanon. According to the latest government statistics, 51.7% of Lebanese people are uninsured, which technically means that they are the responsibility of the Ministry of Public Health. Uninsured patients are supposed to pay 5% in public or 15% of the bill in private hospitals for treatment, while the Ministry covers the rest. However, due to budget constraints, payment by the Ministry has not been forthcoming and the cost of the treatment has often been pushed onto the hospitals themselves. Private hospitals have been able to counteract this problem via fee-paying patients; however, public hospitals have been saddled with crippling debts. Add to this the influx of 1 million uninsured refugees; unless something changes soon, it is only a matter of time before something gives. The UNHCR is active in the refugee camps, but only deals with the relatively inexpensive primary healthcare, such as medication, tests, and consultations. However, the more expensive secondary and tertiary healthcare is dealt with by the Lebanese healthcare system. Before 2011, hospitals in Lebanon used to deal with roughly 140 refugee cases a year, while in 2012 this went up to 2,400 a year, until suddenly in 2013 the number of Syrians going through hospitals increased dramatically to 2,600 a month. The UNHCR has stated that more attention must be paid to primary healthcare to reduce the number of patients seeking unnecessary secondary and tertiary health treatment. A recent report by the World Bank stated that to return the system to pre-crisis quality levels, an investment of at least $431 million is needed in both the public and private sector. Currently, there is no easy solution to this problem. International donors are hesitant to back public hospitals, which are not allowed to refuse services to people in need. Ultimately, while the crisis is ongoing, more funding is needed from international donors.

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