Lebanon

Total Population: Six million GDP: $50 billion USD Population Coverage: 68% Membership Type: Associate

Building a health care system resilient to shocks.

Lebanon has invested a significant effort into health system reforms and development over the past two decades, resulting in increased financial sustainability for the health system, large gains in population coverage, and improved quality of health care services.

The Context

Lebanon has invested a significant effort into health system reforms and development over the past two decades, resulting in increased financial sustainability for the health system, large gains in population coverage, and improved quality of health care services. Since reforms began in the 1990s, Lebanon has developed a stable public-private partnership health system based on collaborative governance enabling the country to reduce out-of-pocket payments and achieve the health-related Millennium Development Goals.

Despite these achievements, Lebanon still struggles with political instability and financing challenges. Armed conflicts in the region have put additional strains on the health system. Due to the recent influx of over one million refugees, Lebanon has one of the highest refugee populations per capita.

To attain universal health coverage (UHC), Lebanon plans to continue its universal coverage for hospital care, increasing the capacity of the health system and reducing coverage gaps by expanding primary health care and setting patient pathways. The country’s continued progress in accessibility to quality health care underscores the resiliency of the health system and Lebanon’s dedication to achieving UHC.

Key Reforms

The 1991 Conference on Primary Health Care heralded an era of renewed commitment to expand the system’s capacity and informed the development of the National Strategy for Primary Health Care, which spearheaded the creation of a national network of primary health care centers and provided in-kind contributions in the form of (i) capacity building, (ii) pooled procurement and provision of vaccines, drug and medical supplies; and (iii) provision of a health information system.

After two decades of establishing horizontal primary care coverage by expanding the number of primary care centers within the network, the Ministry of Public Health (MoPH) refocused efforts on quality assurance in primary care. In 2008, and in line with international standards, the MoPH introduced the Accreditation Program as a quality assurance mechanism at the level of primary care. Additionally, Lebanon became one of the only five countries in the world to receive an International Cold Chain Certification award from UNICEF and WHO for transportation and storage of vaccines.

Most recently in primary care, as a step towards achieving UHC and to deal with the massive influx of Syrian refugees, the MoPH implemented the Emergency Primary Healthcare Restoration Project. The project subsidizes 150,000 vulnerable Lebanese for a basic benefits package of essential health care services at selected primary care centers in the national network. The aim of the project is to act as the basis of a national program that covers all Lebanese for a primary care package.

Along with fortifying primary health services, the Ministry of Public Health reinvigorated health system financing through the introduction of flat-rates for surgical procedures and the autonomy of public hospitals. These reforms
incentivized shifting financial responsibilities from the ministry to individual hospitals.

To improve the quality of care that patients receive in hospitals, Lebanon began implementing accreditation standards in 2000. Following the establishment of an accreditation process, Lebanon conducted audits to ensure compliance and continuous improvement. As a part of those efforts, the Ministry of Public Health introduced performance contracting in 2014, effectively linking quality and affordability of care to reimbursement for patients covered by the national health agency.

To support evidence-informed policymaking, in 2018 the MoPH established the health Policy Support Observatory (PSO) in a tripartite partnership agreement with the American University of Beirut and the World Health Organization. The PSO aims to: (i) provide direct analytical and informational support to the Ministry’s policy-making, and (ii) promote innovation and knowledge sharing in policymaking.

Because of these reforms, the utilization of health services has improved in tandem with health outcomes. Lebanon’s strategic plan for 2016-2020 focuses on updating governance, maintaining emergency response programs and boosting public health as part of the country’s progress toward UHC.

Lebanon in the JLN

Lebanon has joined as an enthusiastic member having expressed interest in a robust variety of JLN activities. The Ministry of Public Health looks forward to sharing their knowledge on maintaining a health care system during a crisis or profound shifts in demographics.