THE PERIODS OF THE LEBANESE HEALTHCARE SYSTEM ESTABLISHMENT
- Authors: Naumenko YN1, Makhinova OV1, Lara Al-Yassine -1
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- Issue: Vol 6, No S2 (2017)
- Pages: 11-11
- Section: Articles
- URL: https://new.vestnik-surgery.com/index.php/2415-7805/article/view/3791
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Abstract
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The medical sector became known in Lebanon around the middle of the 19th century. It was a specific feature of big cities and included a few skilled doctors mostly missionaries, or members of the Ottoman Army, the governing power at that time. Missionaries played a key role in the implementation of medical education in the country, mainly through two universities, one English-speaking and the other French-speaking. During this period, health care was carried out in medical units belonging to charitable institutions which were mostly religious. Public hospitals were small, catering essentially to poor patients that were suffering from contagious diseases. The government’s main concern was to protect the population from infectious diseases and environmental hazards. After World War I, under the French mandate, a number of institutions were established including the first Health Department which was found within the Ministry of the Interior. All the public administrations that were set up at that time were exposed by the French especially in terms of inspection, control and centralization. In addition, the few small private hospitals that were established also followed the French model of clinics [2]. After Lebanon’s independence proclamation, health-related issues became the sole responsibility of the Ministry of Health and Social Affairs whose main role was the supervision, coordination, and legislation of these matters in addition to the protection of the environment and the surveillance of contagious diseases. During the 1950s, this Ministry began developing a public health system thus establishing the internal structures and a network of hospitals and primary health care centers where the poor could see a doctor. In spite of these initiatives, a big part of the country remained deprived of these services thus limiting the accessibility of the population to healthcare [5]. At the same time, private hospitals started to flourish and offered better quality services. Efforts were carried out to tighten links between the private and public sectors. Beginning in 1958, the Lebanese government undertook a series of reforms in the health field namely. Even though these reforms were important, they did not have the desired positive impact. On the contrary, they weakened the role of the Ministry of Health in the public sector and created duplications in terms of services granted and health coverage. With the beginning of the Civil War in 1975, the services of the Ministry of Public Health (MOPH) declined and with time, the Ministry became dysfunctional. The demand for help and healthcare increased, the public sector collapsed leaving the private hospitals as the only viable source for healthcare. The Ministry found itself under the obligation of contracting to these hospitals in order to guarantee care for war victims as well as the general population. Consequently, the MOPH became the main funder of these hospitals and its role shifted to that of a contracting agent. Health expenses increased rapidly. The MOPH also had to distribute expensive medication free of charge. By the end of the war, the MOPH was taking care of the health of the population with no social coverage as the National Soсial Security Fund (NSSF) seemed incapable of covering healthcare expenses due to the rapid increase in their cost as well as the prevailing economic situation [4]. The only remaining ray of hope lied in private insurances which unfortunately were only available to a specific socio-economic class and could not, alone, cover the needs of the entire population. War had a negative impact and harmful consequences. Its influence was catastrophic on infrastructure, human resources and the economy of the country, in both the private and public sectors. The Lebanese health system was not spared as it totally disintegrated. The private sector however, continued to evolve. At the end of the war in 1990, the Lebanese health system was at its worst. The war had destroyed the health sector, as well as many other sectors in the country. Although most of the problems of the healthcare system stemmed immediately from the war, some were inherent to the conception of the system itself [3]. As a result, the Lebanese government adopted in 1993 a Public rehabilitation strategy for the health sector, with the double objective of supporting the Ministry of Public Health in planning for health resources and services, as well as reducing health expenditure [1]. This project was funded by the World Bank and has been the object of several studies and surveys carried out in collaboration with the WHO and different actors in the health field. The current health system is described as being fragmented and pluralistic. The public sector has been absent for a long time because of the civil war. Since then, the MOPH realized a number of achievements. The health reform that started more than 15 years ago has attained accomplishments that are recognized by worldwide experts [6].×
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