How did the economic crisis affect the healthcare in Lebanon?

Outline:

• Background
• Problem statement
• Aims and objectives
• Literature review
• Methodology
• Findings of both survey and interviews
• Solutions and interventions

 

Background:

Healthcare is a part of life we all consider to be something we are entitled to – It is our right to have access to healthcare whenever we need it. However, for many people across the world, this is simply not an option. But for some people in Lebanon healthcare is not even an option. In 2019, revolutions against corruption in the governmental institutions and the politicians in the parliament invaded the whole region, which leads to the economic crisis that Lebanon is facing today. Not to forget the worldwide pandemic that deteriorated the country as a whole, especially the health sector. In addition, Lebanese population has been facing the consequences of the explosion in Beirut that happened on the fourth of august 2020 that was ranked the sixth largest accidental artificial non-nuclear explosion in human history.

 

Problem statement:

Within the crumbled economic system in Lebanon and due to the fluctuation of the currency (the dollar rate used to be 1,515 Lebanese pounds but now it is 100,000 Lebanese pound which is 100% inflammation) the Lebanese healthcare system has been negatively affected. Without access to healthcare, people are far more at risk. Diseases, malnutrition, pregnancy – all can become incredibly dangerous without proper help and support. The hospitals and medical centers which remain open are full to capacity, with patients in need of urgent care overflowing as healthcare professionals struggle to cope with the influx of patients and a severe shortage of essential medical supplies. Moreover, qualified doctors and health professionals are leaving the country for better job opportunities due to the instability in the country.

Lebanese doctors went on strike in protest against the general insecurity in the country and in particular the dangers that confront the medical profession.

 

Pharmacies across Lebanon shut their doors as a part of protest against severe medicine shortages because of the worst economic crisis the country has experienced in decades

When an explosion ripped through Beirut on august fourth 2020 it heavily damaged 4 hospitals, putting them largely out of commission. More than 20 primary care facilities were damaged and destroyed according to WHO.

During the observation period from 2009 to 2021, the average inflation rate was 22.7% per year. Overall, the price increase was 544.36%.

 

 

• Aims and objectives:

 

1. Assess the impact of the economic crisis on the availability and accessibility of healthcare services in Lebanon.
2. Examine the financial constraints faced by healthcare providers and their impact on service delivery, infrastructure, and medical supplies.

• Develop strategies and recommendations to enhance the resilience of the healthcare system and ensure equitable access to quality healthcare services.

 

• Literature review:

 

Introduction:

In recent years, Lebanon has faced an unprecedented economic crisis that has significantly impacted various sectors of its society. One of the sectors profoundly affected by this crisis is healthcare, which plays a crucial role in ensuring the well-being and quality of life of its citizens.

Impact of Lockdowns and Economic Crisis:

Lebanon implemented a nationwide lockdown in response to COVID-19, exacerbating the ongoing economic crisis. More than 50% of the population fell below the poverty line, leading to a lack of access to essential items and medications. As Mohamad Fleifel and Khaled abi farraj  (2022) mentioned in their article “Many doctors, including American Board-Certified Lebanese doctors, emigrated to countries with more stable political and economic conditions, causing a shortage of skilled healthcare professionals. The American university Beirut medical center reported a 40% loss of emergency medical staff. “

 

Shortages of Medications and Medical Equipment:

The removal of subsidies on drugs resulted in increased prices, making it difficult for individuals to afford essential medications. People resorted to buying medications from neighboring countries or relying on limited provisions from the government. This shortage led to a surge in hospital admissions and delayed seeking medical care. The lack of access to affordable drugs also impacted preventive care and screening programs. (Elie bou sanayeh and Carolla El Chamieh, 2023)

Impact of Beirut Port Explosion:

The catastrophic explosion at Beirut’s port further strained the healthcare system, as hospitals were already overwhelmed by the COVID-19 pandemic and economic crisis. Hospitals and critical health infrastructure suffered severe damage, leading to the loss of hospital beds and essential medical supplies. Jalal dahham (2023) reported that the world bank estimated that the  economic loss and physical damage were estimated to be equivalent to 24% of the GDP.

Financial Difficulties and Staff Shortages:

Hospitals in Lebanon face financial difficulties due to a lack of access to foreign currency, decreased government funding, and patients’ inability to pay for medical care. This has resulted in a shortage of medical supplies and equipment, decreased quality of care, and challenges in recruiting and retaining qualified staff. Healthcare workers have also experienced psychological distress due to the cumulative impact of the various crisis.

Potential Solutions:

To address these challenges, a collaborative effort between the public and private sectors is necessary. The Ministry of Public Health should implement immediate plans to tackle threats and initiate a long-term healthcare plan to improve the overall system. This plan should focus on investing in infrastructure, increasing funding, for public health hospitals, and ensuring a stable supply chain for essential medical resources.

Conclusion:

The healthcare system in Lebanon has been severely affected by the COVID-19 pandemic, economic crisis, and Beirut port explosion. The challenges faced by hospitals include shortages of medications and medical equipment, financial difficulties, and staff shortages. Immediate action and long-term planning are required to address these issues and improve the overall healthcare system in Lebanon.

Methodology:

1. Literature review (review different articles that discuss how healthcare is affected by the economic crisis)
2. Survey (we surveyed 41 respondents from different ages and gender)
3. Interview ( we interviewed a hospital manager in aley region)

 

• Survey findings

1. How would you rate the current economic situation in Lebanon?

• very good: 2%
• good: 5%
• fair: 7%
• poor: 27%
• very poor: 59%

 

2. Have you noticed any changes in your overall health in the past 2 years?

 

61% of the surveyed people reported that they have noticed changes in their health in the past 2 years and those changes are characterized by changes in physical health such as weight loss/gain, body pain, tiredness, reduced exercise. Other changes in mental health such as stress, anxiety, and depression, not to forget the economic and social effects. 39% reported that they have not noticed any change.

3. How has the economic system in Lebanon affected your access to healthcare services?

• reduced access: 63%
• improved access: 2%
• no change: 15%
• I don’t use healthcare services: 20%

 

4. Have you experienced any difficulties in affording healthcare expenses due to the economic situation in Lebanon?

• yes : 58%
• no: 27%
• I don’t use healthcare services: 15%

 

5. Are you satisfied with the quality of healthcare services available in Lebanon?

• very dissatisfied: 29%
• dissatisfied: 27%
• neutral: 42%
• satisfied: 0%
• very satisfied: 2%

 

6 .Have you faced any challenges in accessing essential medications or medical supplies?

• yes: 66%
• no 34%

 

7. How has the economic situation in Lebanon affected your mental well-being?

• improved mental well-being: 5%
• declined mental well-being: 66%
• no change: 29%

 

8. Have you experienced an increase in stress levels or anxiety due to the economic situation in Lebanon?

• yes: 85%
• no: 15%

 

9. Have you observed any changes in the nutritional status of yourself or your family members due to the economic changes in Lebanon?

 

66% of the surveyed people reported that yes they have noticed nutritional changes in both their selves and their family members, these changes are characterized by the difficulties in obtaining nutritious food, limited dietary choices, expensive food and changing food habits. 34% reported that no they have not observed any nutritional changes.

 

10. Have you or your family members delayed or avoided seeking medical treatment due to financial constraints caused by the economic situation in lebanon?

• yes: 66%
• no: 34%

 

11. How has the economic crisis affected your ability to engage in preventive healthcare practices, such as regular check-ups or screenings?

I check myself every:

• 3 years: 46%
• 1 year: 37%
• 6 months: 10%
• 3 months: 7%

 

12. Is your insurance system still covering your medications and hospitalization?

• yes: 41%
• no: 59%

 

13. Have you witnessed an increase in the prevalence of diseases or health conditions in your community as a result of the economic crisis?

• yes: 73%
• no: 12%
• not sure: 15%

 

14. Do you believe that the economic crisis in Lebanon has had a long-term impact on the overall health of its citizens?

 

•  yes: 90%
• no: 3%
• not sure: 7%

 

• Interview

 

1. What are some specific challenges healthcare facilities and staff have faced due to the economic crisis?

The inflammation and currency devaluation lead to conflict in prices due to the difference between the prices of the services in the ministry of public health and the black market, so the services and products  in the ministry where on the official dollar rate (1,515) while the dollar in the black market increased to 140,000 L.L, not to forget that this affected salaries of the staff, who used to receive high salary received the minimum wage.

 

2. Have there been any noticeable changes in the healthcare workforce, such as staff shortages or emigration of healthcare professionals?

During covid, high numbers of healthcare staff emigrated to gulf areas ( emirates, saudi arabia and Qatar) since opportunities with higher salaries where there, so Lebanon lost his skilled and qualified doctors. Doctors in AUBMC mostly migrated to America and Australia while in mount Lebanon mostly migrated to gulf areas. Only few studied abroad in France and Russia to collaborate with the European union.

3. How have healthcare professionals and organizations adapted to the economic crisis to ensure continued provision of essential healthcare services?

This is a very hard question, we worked more on the motivation for both the staff and patients. Some doctors worked with this issue in ethics and morals, mainly in mount Lebanon they worked together not only as a hospital but also citizens and effective parties. Those considered it not only as economic crisis but an economic war for a couple of years, so they scarified for their country. Some Lebanese communities in developed countries helped as much as they can even with small amounts.

 

4. How has the shortage of medical supplies and equipment impacted the quality of healthcare in Lebanon?

The shortage of medical supplies and equipment enabled the hospitals to renew and update their medical supplies and even to maintain it. So some equipment were out of service. It was a very tough period. We, as a hospital, suffered from this in the CT equipment, if this equipment stopped working there is no substitute, it’s tube costs 30,000 $ and in the hospital this service only costs 0.5 – 1$. This leads to a gap and some hospitals were forced to close due to this issue.

 

5. How has the economic crisis impacted the mental health of healthcare staff, considering the increased workload and limited resources?

Knowing that healthcare work depends on humanity and community service, some workers were tired enough from the situation so they considered that they were obliged to come to work and lost their moral and work ethics and this affected the mental health of both the worker and patient.

 

6. What are some potential long-term consequences of the economic crisis on the overall health and well-being of the Lebanese population?

The patients health and well being was really bad, early detection decreased to the maximum, people only went to the hospital when their cases were severe. This lead to increased mortality.

 

7. Has the economic crisis affected the quality of medical education and training opportunities for aspiring healthcare professionals in Lebanon?

It was affected in a negative way, knowing that large and known hospitals suffered from problems with trainees since training used to be paid, and the quality of the medical education decreased leading to medical errors. There was a huge gap in the last 2 years especially in hygiene and house keeping, services provided by nurses and doctors due to online learning. Due to emigration of professionals, inappropriate training were given to fellows. We need 3-4 years to have a break even and make up the loss.

 

• Policy recommendation

 

1. Infrastructure development: Investing in healthcare infrastructure is crucial. This includes building and upgrading hospitals, clinics, and medical facilities across the country. Ensuring that these facilities are well-equipped with modern medical technologies and equipment can improve the quality of care.

 

2. Increase healthcare funding: Allocating more funds to the healthcare sector can help in addressing the resource constraints faced by the system. Increased funding can be used to recruit and retain skilled healthcare professionals, purchase necessary medical supplies and equipment, and expand healthcare services to underserved areas.

 

3. Health insurance reforms: Implementing comprehensive health insurance reforms can enhance access to healthcare services for all Lebanese citizens. This can involve developing a universal health coverage system that ensures affordability and equity in healthcare access. Encouraging employers to provide health insurance coverage to their employees can also be considered.

 

4. Strengthen primary healthcare: Emphasizing primary healthcare is essential for early detection and prevention of diseases. Enhancing primary healthcare services, including increasing the number of primary care clinics and training more primary care physicians, can reduce the burden on hospitals and improve overall health outcomes.

 

5. Health information technology: Implementing health information technology systems, such as electronic health records (EHRs) and telemedicine, can improve efficiency and coordination of care. EHRs enable healthcare providers to access patient information easily, leading to better diagnosis and treatment decisions. Telemedicine can also help in reaching patients in remote areas and providing them with necessary healthcare services.

 

6. Education and training: Strengthening healthcare education and training programs is vital for producing a skilled and competent healthcare workforce. Investing in medical schools, nursing programs, and continuous professional development for healthcare professionals can enhance the quality of care provided.

 

7. Public health initiatives: Prioritizing public health initiatives, including health promotion campaigns, disease prevention, and immunization programs, can contribute to reducing the burden of preventable diseases. These initiatives can be implemented through collaborations between the government, healthcare organizations, and NGOs.

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8. Regulatory reforms: Strengthening healthcare regulations and governance mechanisms can improve the overall quality and safety of healthcare services. Implementing robust licensing and accreditation processes for healthcare facilities and professionals can ensure that standards are met and maintained.

References 

• Farha, L., & Abi Jaoude, J. (2020, September 6). Lebanese Healthcare System: How Will the Aftermath Look? Cureus, 12(9), e10270. doi:10.7759/cureus.10270. PMID: 33042708; PMCID: PMC7538024.
• Bou Sanayeh, E., & El Chamieh, C. (2023). The fragile healthcare system in Lebanon: sounding the alarm about its possible collapse. Health Econ Rev, 13, 21. https://doi.org/10.1186/s13561-023-00435-w
• Dahham, J., Kremer, I., Hiligsmann, M., et al. (2023). Valuation of Costs in Health Economics During Financial and Economic Crises: A Case Study from Lebanon. Appl Health Econ Health Policy, 21, 31–38. https://doi.org/10.1007/s40258-022-00769-2
• Fleifel, M., & Abi Farraj, K. (2022, May 26). The Lebanese Healthcare Crisis: An Infinite Calamity. Cureus, 14(5), e25367. doi: 10.7759/cureus.25367. PMID: 35769680; PMCID: PMC9235031.