Lebanese Monitor for Your Rights in Health

Why the “Lebanese Observatory for the Right to Health” Now?

Health has become a global challenge—even in the most developed countries—and in Lebanon, it faces major hurdles, including:

• Lack of Equity: The absence of balanced development makes health issues more severe in regions with poor healthcare indicators. National health statistics in Lebanon mask large regional and social disparities.

• Strong Link Between Poverty and Health: The health-social crisis stems from inequality in both the quantity and quality of healthcare services accessible to Lebanese citizens. This inequality is tied to income levels and regional disparities in basic service availability.

• Lack of Universal Coverage: Around 50% of Lebanese citizens are not covered by health insurance, except for limited services provided by the Ministry of Public Health.

• Demographic Shift Burden: The growing elderly population (60+ years) poses a heavier burden on the system. Ironically, citizens often lose health coverage when they need it most.

• Decline of Public Sector Role: The war weakened the state’s institutional capacities, diminishing its role in healthcare. Non-governmental and private sectors filled the gap, leading to a significant public sector retreat in favor of private and civil organizations. This manifests as:

  • Weak administrative and medical oversight by the ministry and insurance funds.

  • Institutional fragility in quality control and limiting unjustified consumption.

  • Poor planning and weak preventive programs.

• Shift in Ministry of Health’s Role: The Ministry increasingly acts as a financier for private hospitals by covering bed expenses for eligible patients.

• Public Health Financing and Unfair Tax System: The healthcare budget depends on an unfair (regressive) tax system relying heavily on indirect taxes, burdening lower-income groups.

• Low Public Spending on Health: Government health expenditure, including that through the general budget and various insurance funds, does not exceed 20% of total healthcare spending. The Ministry’s share is less than 3% of the national budget.

• Lack of Sustainability: Public health funding faces significant obstacles:

  • Ever-increasing demands for health spending.

  • High spending not always tied to quality outcomes.

  • Huge outstanding debts owed by the public sector to insurance funds and private hospitals.

• Fragmentation of Insurance Providers: Multiple public and semi-public funds support different segments of public sector workers.

• High Healthcare Costs: Increasing healthcare costs and growing reliance on expensive modern technologies shift the financial burden to families through out-of-pocket expenses.

• Soaring Medication Costs: The rising cost of pharmaceuticals burdens families and reduces fair financing for healthcare professionals. The sector suffers from inflated drug variety and monopolized supply structures.

• Service Inefficiencies:

  • Overreliance on costly, low-return curative services rather than preventive ones.

  • Minimal investment in effective public health programs.

  • Inefficient government spending focused more on hospitalization and medications than on preventive and primary care.

• Human Resource Disparities: Oversupply of doctors but scarcity in supporting medical roles like nursing.

• Rise of Chronic Diseases: Diseases once associated with wealth—obesity, diabetes, high blood pressure—have reached alarming levels.

• Persistent Infectious Diseases: These still cause high child mortality despite immunization and prevention programs.

• Loss of System Effectiveness: Due to:

  • Weak state involvement in healthcare.

  • Lack of technical and professional efficiency in health insurance.

  • Absence of standardized procedures, pricing, contracts, and monitoring.

• Destructive Competition: In healthcare, supply creates demand, leading to overuse of unnecessary services because of guaranteed payment, a phenomenon known as “destructive competition.”

• Fragmented Oversight on Public Health: Public health also depends on environmental safety, food, and water. Overlapping ministerial responsibilities weaken regulatory control.

• Political and Sectarian Interference: Political and commercial sectarianism corrupts the system and increases law violations and corruption.

• Corruption: Healthcare corruption remains one of the sector’s gravest issues.

• Delegation of Ministry Duties: NGOs and political parties now handle roles originally assigned to the Ministry of Health.

Proposed Solutions

1. Replacing the Health System with a Fairer One: Health is a human right, not a favor or charity. The “right to health” is enshrined in the charter of the Office of the High Commissioner for Human Rights, signed by the Lebanese government. The WHO defines health as a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” As Lebanon’s health system faces collapse, it’s crucial to reform it for more justice, aligning with Article Z of the Lebanese Constitution’s preamble on balanced regional development as a pillar of national unity and stability.

2. Reducing Regional Disparities to Achieve Equity: All provinces face national challenges such as hospital bed shortages and a surplus of doctors versus a critical shortage of nurses. Despite this, some provinces show moderate health indicators, while areas like Akkar, Minieh, Dinnieh, and Hermel, and impoverished urban neighborhoods have very low indicators. Measures include:

   • Providing public health services, especially in rural areas where private sector incentives are low and infrastructure is lacking.

   • Increasing protections for the poor from healthcare costs, as they suffer the most from service inadequacies.

3. Achieving Universal Health Coverage Through Diverse Funding Sources:

   • The state provides a basket of essential preventive and curative services through a network of public health centers and hospitals.

   • Private sector treatments are only covered when unavailable in public networks and with prior approval.

   • Maintain diverse funding sources: contributions, taxes, and household spending, ensuring stability and sustainability.

   • Equity in tax-based funding requires using direct taxes tied to income, wealth, and profits instead of regressive indirect taxes.

4. Promoting Healthy Behavior:

   • Launch awareness campaigns to influence hygiene and disease prevention habits.

   • Rationalize healthcare consumption by reducing unnecessary demand and promoting prevention through education and preventive programs.

5. Rebuilding Trust in the Ministry of Health and Enhancing Oversight:

   • The Ministry often allocates most of its budget to treatments in private hospitals, many owned by sectarian groups.

   • Public service tools are insufficient, hindering employee performance.

   • Politicians and media often exaggerate the Ministry’s shortcomings, creating mistrust.

   • Shift the Ministry’s role from a mere financier to a central regulator and planner:

     • Expand oversight to include both public and private sectors under licensing.

     • Strengthen administrative and institutional support.

     • Establish a modern organizational structure.

     • Enhance district health departments and ensure adequate staffing.

6. Fostering Administrative Collaboration:

   • Address diverse public health threats through inter-ministerial cooperation.

   • Unite efforts across all stakeholders—government, health and social sectors, civil society, private sector, and media.

   • Redefine tasks to avoid overlaps and ensure complementary roles.

   • Hold each ministry fully accountable within its jurisdiction.

7. Reforming Health Financing:

   • Address pricing disparities between public insurance and private hospitals.

   • Simplify procedures for patient reimbursement.

   • Regulate capitalization in the healthcare sector, ensuring equipment meets actual needs.

   • Combat pharmaceutical market chaos and lower drug prices.

   • Unify operational systems through:

     • Central health database.

     • Standard medical service pricing.

     • Unified hospitalization system.

     • Empowering public medical arbitration and hospital governance.

     • Flat-rate surgical pricing.

     • Promote outpatient alternatives like one-day clinics and home care.

     • Family doctor system as a gatekeeper.

     • Unified agreements between insurance providers, hospitals, and doctors.

8. Reducing the Cost of Healthcare:

   • Clarify stakeholder roles, especially the public sector’s.

   • Set unified medical service prices.

   • Streamline administrative processes to cut financial and time costs.

   • Allocate resources more effectively through needs-based planning and investment.

   • Implement fair tax increases.

9. Improving the Pharmaceutical Sector:

   • Reduce monopolization and enhance regulation.

   • Develop rational drug use policies and essential medicines lists.

   • Maintain a unified drug registry.

   • Ensure quality control through GMP standards.

   • Establish general principles for new drugs, especially regarding trials and ethical use, aligned with the 2000 Helsinki Declaration.

   • Define and limit covered drugs to a unified list coordinated by the Ministry, WHO, and medical associations.

   • Promote generic drug use through semi-public institutions and public awareness.

   • Revive the central laboratory for drug, food, and water safety analysis.

10. Expanding and Strengthening Primary Healthcare Services:

• Provide a broad service basket as per WHO’s definition.

• Promote primary care centers to reduce reliance on expensive specialist services.

• Implement quality assurance programs to improve efficiency and reduce costs.

11. Developing Human Health Resources:

• Enhance nursing education capacity.

• Elevate the medical profession through academic rigor and competency exams.

• Improve medical ethics and academic standards.

• Regulate auxiliary health professions.

12. Establishing a Comprehensive Health Information System: Create a centralized data system to guide planning and assess programs.

13. Continuous Evaluation of Health Services: Promote research and adjust services based on ongoing systemic changes.

14. Revitalizing Public Hospitals:

• Complete new hospital construction projects.

• Upgrade and equip existing facilities.

• Propose administrative reforms for hospital boards.

• Adjust financial ceilings to align with hospital roles.

• Staff hospitals adequately.

• Activate oversight departments to evaluate performance and enforce accountability.

15. Enhancing Private Hospitals:

• Rationalize the Ministry’s financial ties with private hospitals based on regional needs.

• Develop oversight to prevent illegal overcharges.

• Operationalize completed but idle hospitals.

• Set strict construction standards for new hospitals.

• Enforce compliance with accreditation standards.

16. Combating Chronic Diseases:

• Tackle risk factors: smoking, unhealthy diets, and inactivity.

• Educate citizens on healthy behaviors.

• Focus especially on school-aged children, emphasizing media’s educational role.

Health in Numbers (Lebanon – as of 2013 unless otherwise specified)

1. Total Population: 4,822,000

2. Gross National Income per Capita (PPP, International USD): $17,390

3. Life Expectancy at Birth (Male/Female): 78 / 82 years

4. Under-5 Mortality Rate (per 1,000 live births): 9

5. Probability of Dying Between Ages 15 and 60 (Male/Female per 1,000 population): 70 / 46

6. Total Health Expenditure per Capita (International USD, 2012): $979

7. Health Expenditure as Percentage of GDP: 7.3%

8. Number of Primary Healthcare Centers Nationwide: 152

9. Number of Public Hospitals Contracted with the Ministry of Health: 25

10. Number of Private Hospitals Contracted with the Ministry of Health: 138

11. Estimated Population Eligible for Ministry of Public Health Benefits: 2,086,845

12. Patients Benefiting from the Central Warehouse for Chronic Disease Medications: 19,129

13. Beneficiaries of the National Social Security Fund’s Medical Services: 1.2 million

14. Health Sector Budget Allocation in 2013: 6.6%

15. Annual Hospitalization Bill Paid by the Lebanese Ministry of Health: 420 billion LBP

Source: Latest available data from the WHO Global Health Observatory – WHO Lebanon Health Profile

References

• The National Human Rights Plan, developed by the Lebanese Parliament’s Human Rights Committee with support from the United Nations Development Programme (UNDP) and the Office of the High Commissioner for Human Rights (OHCHR), coordinated by Dr. Paul Morcos and the Justicia Foundation team in 2008.

• Strategic Directions for the Health System in Lebanon, authored by Dr. Walid Ammar, published in 2012 on the official website of the Ministry of Public Health:
  www.moph.gov.lb

• The Health Situation in Lebanon – Realities and Solutions, a study by the National Front for Reform:
  www.amelinternational.org/Amelinternational

• The Development Program 2006–2009 (Health Sector), published on the website of the Council for Development and Reconstruction:
  www.cdr.gov.lb/arabic/home.asp