Injuries related to Lebanon’s historic demonstrations that began in October 2019. Trauma and damage resulting from the massive Beirut port explosion in August 2020. Medical care and treatment due to continuing surges of COVID-19. The health care sector in Lebanon has been on the frontlines for months treating patients across the country, exhausting already overstretched institutions and workers. Political instability and economic collapse have also led to complex and compounding crises affecting individuals and institutions alike. For the health care sector, these crises have led to increased shortages in workers, supplies, equipment, and medicine, all of which hamper the ability of institutions to provide adequate medical care. Additionally, unpaid bills from public and private hospitals continue to accumulate as the government faces difficulties in reimbursing services.
Health care is not immune to these multiple crises. It is for this reason capacity-building efforts within the sector must be accompanied by proactive, comprehensive action at the societal and community levels. I will describe three key societal- and community-level recommendations for decreasing pressure on the health care system and increasing its ability to respond to COVID-19: 1) Leverage existing resources by implementing a coordinated, national strategy for COVID-19, 2) Reduce the spread of COVID-19 by investing in public health, and 3) Address political and economic system failures by enacting comprehensive reforms.
1) Leverage existing resources by implementing a coordinated, national strategy for COVID-19. Operational and coordination challenges among entities supporting the COVID-19 response exemplify the larger fragmentation of public, private, and non-governmental stakeholders and priorities in Lebanon. A detailed, comprehensive preparedness and response plan is therefore central to optimize the resources available to address COVID-19, as well as align efforts with blast-related recovery work. Partnerships must be based on shared responsibility and shared action. Data-driven decision making, respectful communication and engagement, clear roles and responsibilities, and resilient mechanisms for collaboration within and across stakeholders must also be included in a comprehensive preparedness and response plan. Populations most vulnerable to the virus, its health consequences, and its secondary impacts like unemployment and hunger, must be considered and consulted in plan development. These populations include, but are not limited to, poor households, refugees, migrant workers, persons with disabilities, older persons, and female-headed households.
2) Reduce the spread of COVID-19 by investing in public health. Lebanon’s public health system suffers from decades of underinvestment, meaning many of its core functions like monitoring and tracking spread of the virus and identifying and investigating cases have been unable to keep up with demand. These, in addition to widespread testing, affordable and accessible preventive care, and the collection and analysis of public health data are critical to containing COVID-19. Policy makers are understandably focused on increasing the availability of hospital beds for COVID-19 patients, but the response to COVID-19 doesn’t start there - it ends there as people test positive, become ill, and require medical intervention. Public health must not be neglected as preventing cases in the first place is central to relieving pressure on the health care system.
3) Address political and economic system failures by enacting comprehensive reforms. The health care system operates in and is affected by the broader social, political, and economic conditions of the country. Therefore, until those conditions are addressed, the sector will remain vulnerable to unpaid and falling wages, difficulties in importing much needed equipment, gaps in basic services like water and electricity, and challenges in ensuring the availability of medical care and treatment. Policies to address social, political, and economic conditions will not only benefit the health care sector, but in fact all people in Lebanon. Comprehensive economic reforms, assurance of basic services, and good governance through transparency and accountability are critical to address increasing rates of unemployment, poverty, and hunger. These steps may also begin to restore trust and confidence in the government and its partners, which has been critical in other countries curbing the spread of COVID-19.
As a public health professional, it is natural for me to look at the context of an individual to understand their health and wellbeing. My preceding recommendations take on this lens with the health care sector and the impacts resulting directly and indirectly from the country’s multiple complex crises. Implementing a coordinated, national strategy, investing in public health, and enacting comprehensive reforms will support the health sector through this pandemic and beyond, and ultimately improve the health outcomes of all people in Lebanon.