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Human Resource Development (HRM-627)

Lesson 25

HEALTH SECTOR

Taken from page: http://www.emro.who.int/lebanon/crisis/Leb_national_strat_early_recovery_Aug06.pdf

National Strategy for Early Recovery of the Health Sector in Lebanon

31 August 2006 Christopher Black/WHO

INTRODUCTION

The conflict across the border between Lebanon and Israel that started on 12 July has claimed over 1100

civilian lives, left more than 4000 people wounded, and displaced more than a quarter of the Lebanese

population.

The people of Lebanon showed remarkable unity in responding to the crisis, with communities banding

together to absorb the displaced, providing temporary shelter in their own homes, and food and provisions

from local supplies. Yet the challenges faced by the population remain overwhelming and will be compounded

with the on-going blockade. Access to basic services, such as health, water, and education is significantly

reduced across the country, and especially for all those who live in the affected areas. The Ministry of Public

Health, with collaboration from the UN system, and especially from WHO, conducted an assessment of the

damages to the health infrastructure in affected areas and identified the main effects on the population's health.

Based on this initial analysis, a national strategy for early recovery of the health sector, summarized below, was

prepared.

Health Impact of the Lebanon Crisis

Thirty-three days of military operations in mainly South Lebanon and South Beirut, as well as the Bekaa Valley,

have left a long-lasting mark on the Lebanese population and infrastructure. The impact on the health sector

can be summarized as follows:

· A High number of injured and disabled people generating additional pressure on the already

overwhelmed health services;

· More than 900 000 internally displaced people (IDPs) and refugees, and an especially high number of

returnees who have lost their homes and livelihoods, resulting in further constraints in accessibility and

affordability of health care services;

· Disruption of basic public health functions normally provided by the local health authorities;

· Considerable damage to health facilities and functional disruption mainly of Primary Health Care

clinics and centers, as well as key hospitals;

· Damage to roads and bridges, limiting access to health facilities;

· Shortages of fuel, drugs, and medical supplies.

1. High number of injured and disabled people: The casualties resulting from military operations,

particularly the bombing of buildings and infrastructure, have lead to a considerable number of injured,

engendering a corresponding increase in the demand for emergency health services, surgical procedures and

hospitalization. Further, the number of disabled patients requiring treatment and rehabilitation has also

increased. All of this has occurred against a backdrop of disrupted health services functionality and difficult

access, hampering financial affordability and adding significant pressure to the already reduced number of

functional health services in the affected areas and in the rest of the country.

2. Unmet health needs of IDPs and returnees: The populations that left the affected areas are rapidly

returning. However, in many cases their homes and their livelihoods have been destroyed. Furthermore, severe

economic disruption has affected their income and their ability to afford services such as health care.

The provision of adequate shelter, food, potable water and health care therefore are critical since it will take

time to fully re-establish basic living conditions.

3. Disruption of public health functions: In the Governorates of the affected areas, the basic functioning of

the local health authorities and their ability to perform essential public health functions has been significantly

hampered. Many public health services such as communicable diseases surveillance and control, immunization,

and environmental health, have been widely disrupted for more than one month. Restoring the ability to

sustain epidemiologic surveillance and early warning systems activities of is of great importance, especially in an

early recovery phase.

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Human Resource Development (HRM-627)

4. Damage to health facilities and functional disruption of health services: Preliminary results of the

Health Facilities Damage Assessment conducted in August indicate that the level of destruction of health

buildings varies drastically from one place to another. It is most severe in the regions of southern Tyre,

Marjayoun, Nabatiyeh, Bint Jbeil, west Bekaa, Baalbek and Akkar. Indeed, between 50% and 70% of all

Primary Health Care (PHC) facilities in Bint Jbeil and Marjayoun have been completely destroyed. The

assessment shows that serious shortages of fuel, power supply and drinking water continue. In general, only

32.8% of health facilities have potable water, and only 26.9% remain linked to the general sewerage system.

Only 24% of health facilities have a public power supply, meanwhile 31% use generators but only 16.6% have

the fuel to run them.

The functional damage of the health care system is clearly demonstrated by the rapid assessment of the health

facilities which shows a gap in maternal and child care services only 23.3% of PHC services are able to

provide antenatal care, 9.7% clean delivery, and 11.4% emergency obstetric care. As well, only 18.8% of the

PHC services are still able to provide nutrition and breast feeding advisory services. Only 32% of PHC facilities

have a functional cold chain, and 13% only are able to provide some mental health services.

5. Impediments to access and health care coverage: Government authorities, with the support of NGOs

and UN agencies, have already begun clearing rubble from roads, destroyed buildings and bridges. However,

access to health facilities needs to be completely resumed in order to meet the needs of populations returning

en masse to their places of residence. Unexploded ordnances (UXO) continue to threaten safe population

movement and to hinder humanitarian operations. Currently only 65% of the health facilities are accessible by

road in the affected region, and merely 16.6% of hospitals have functioning ambulances.

6. Exhaustion of supplies: During the conflict period the delivery of medical care and health services to 950

000 IDPs both overstretched and exhausted limited resources like drugs, supplies and fuel for most of the

country's health facilities. In addition, damage to power station and water supply systems resulted in increased

running costs. Moreover, the stockpiling of medicines has caused the uneven distribution and availability of

drugs and medical supplies, particularly those related to mental health and to chronic diseases.

Main Challenges

The fundamental challenges faced by the health sector after the war and once the cessation of hostilities has

been implemented are:

In the short term:

· Meeting the health needs of internally displaced populations to the affected areas, especially the most

vulnerable groups of returnees who have lost their homes and their livelihoods.

In the medium and long term:

· Re-establishing and further improving the functionality of the health system in the affected areas

involving all pertinent stakeholders;

· Rehabilitating the damaged health infrastructure and ensuring that is fully operational; · Ensuring

adequate presence of qualified health manpower in the affected areas.

Strategic Approaches

The issues mentioned above call for two different but complementary approaches that need to be articulated as

the "National Early Recovery Strategy and Action Plan for the Health Sector in Lebanon".

The first approach should be the implementation of urgently needed interventions that will allow the

restoration of essential public health functions, basic health care services, and mechanisms of referral to

specialized care.

This operation needs to take place between now and December 2006, concentrating on the affected areas. It

will be led by the Ministry of Health, supported by WHO, in close cooperation with all pertinent national and

local health partners. It should be aimed at ensuring:

a) Continuity in the provision of essential health care services, particularly to the most vulnerable

including:

· The delivery of essential primary health care, including psychosocial services, to the affected

population, targeting the most vulnerable groups;

· Nutritional supplementation to the most vulnerable groups;

· The implementation of immunization campaigns in the affected areas thus assuring sustained and

improved coverage;

· Adequate referral to secondary and tertiary health care services for the affected population.

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Human Resource Development (HRM-627)

b) Reinforcement of the capacity of the health system in discharging the essential public health functions

including:

· The supply of potable water in the affected areas;

· Epidemiological surveillance and early warning systems for the early detection and control of

communicable diseases;

· Environmental health interventions.

Early recovery interventions will be closely coordinated with nongovernmental organizations (NGOs) already

operative in the health sector. Interventions will encompass the temporary organization of local public health

teams, using existing staff from the public sector, from health NGOs and private health care providers. There

would also be a need to strengthen and/or develop the public health infrastructure of local health authorities.

The entire operation would aim to improve social protection in health for affected populations in areas

damaged during the conflict. A special unit for early recovery will be established in the Ministry of Health with

sub-units in each health district or local health circumscription.

The second approach would be the development and implementation of a Master Plan for Reconstruction of

the Health Sector in Lebanon. Developed over the next three to four months, the Master Plan will form the

fundamental agenda and roadmap for the long term reconstruction of Lebanon's health system, identifying

permanent and sustainable solutions for the full recuperation of the health system functionality in the affected

areas.

The exercise will be led by the Ministry of Health in close collaboration with the Ministries of Finance,

Economic Planning, and the Office of the Prime Minister, and could be closely supported by both WHO and

the World Bank. To this end, a planning team could be established or strengthened within the Ministry of

Health and technical assistance provided by WHO.

Producing this Master Plan would Encompass:

· Conducting a detailed health situation and health systems needs assessment in the affected areas,

beginning as early as possible in September 2006;

· Developing a framework for prioritizing necessary actions to meet the needs, and public and private

investments in the health sector that can bring them to fruition;

· Developing projects for the prioritized interventions thus enabling the development of detailed

investment projects within a comprehensive and strategic framework;

· Mobilizing resources from public, private and international sources to support the reconstruction agenda;

· Establishing a roadmap of implementation of investment projects, and coordinating their harmonious

execution so that results can be obtained rapidly in terms of recovering and further improving the

functionality of the health system, and ultimately in terms of improved health outcomes among the

affected population;

· An Action Plan for the early recovery of the Health Sector.

ACTION PLAN

The Action plan for the early recovery of the health sector will focus on priorities for the restoration of public

health functions and the provision of primary health care services with a supporting referral system for

returnees. It will also include urgently needed interventions for the rehabilitation of the health infrastructure in

the South.

The main projects include:

1) Immediate revitalization of routine immunization services, in close partnerships with WHO and

UNICEF. This will include quick recovery of the cold chain system.

2) Expanding and maintaining the Disease Early Warning and Alert and Response System to monitor

trends in communicable diseases and to respond to disease outbreaks. It involves extending reporting

sites to cover all areas in the south, and supporting the compilation and analysis and use of information,

as well as establishing linkages with the national disease surveillance system.

3) Monitoring environmental health threats and taking appropriate action to ensure the provision of safe

water, sanitation, and control of environmental hazards.

4) Revitalizing primary health care services in the affected areas. This includes urgently needed

interventions to rehabilitate damaged health facilities, provision of essential medicines and basic supplies,

consumables and laboratory reagents. It also includes the development of guidelines, and training and

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Human Resource Development (HRM-627)

capacity building of local health personnel, particularly in the areas of psychosocial care, management of

chronic diseases, and nutrition. Support to ensure outreach services will also be needed.

5) Building capacity for emergency response and management at the central and governorate levels. An

adequate stock of essential medicines, supplies and trauma kits, improved medical stores, strengthened

communication and transportation system including requirements for outreach and effective referral

systems.

6) Securing maternal and newborn health, and strengthening reproductive health services to ensure safe

pregnancy and deliveries, maximizing outreach services, and improving referral systems.

Setting the stage for long term reconstruction: The national early recovery process August 2006; Restoring Basic Social Services-

Health

RESTORING MINIMUM ACCESS TO CRITICAL HEALTH SERVICES

GOVERNMENT ENTITY: Ministry of Health

TITLE OF THE INITIATIVE: Restoring Minimum Access to Critical Health Services

LOCATION: Main targets are the Governorates of South Lebanon and Nabatieh (8 districts or Qadas), the

Beirut Southern

Suburbs and the two qadas of Baalbeck and Hermel in the Governorate of the Beka'. All together, these areas

are served by 11 public hospitals, 44 private hospitals (Total 55 inpatient facilities) and 118 dispensaries and

health centers for outpatient care.

DURATION: Six months

ESTIMATED STARTING DATE: Immediately

SECTOR: Health

BENEFICIARY: 1,200, 000, including 350,000 in the 0-14 year age group

OUTLINE

THE IMMEDIATE NEED: The ability of many Lebanese citizens, and children and other vulnerable groups

in particular, to access critical health services has been severely reduced, with key infrastructure, including

hospitals and other care centers, severely damaged, and exhaustion of supplies and essential vaccines.

Furthermore, with the vast destruction in shelter and water pipes, the risk of communicable disease and water-

borne diseases has become a major concern. The capacity of local governorate authorities to respond to the

needs and monitor the long term impact of the conflict is also strained.

OBJECTIVES AND IMPACT: Quick-revitalization of life saving immunization services for children, by

reactivating the primary health care services, particularly in routine immunization services, providing essential

vaccines and drugs, reestablishing the cold chain system, scaling up sustainable outreach services to

underserved areas.

- Revitalization of primary health care services, through rehabilitation of infrastructure, provision of

equipment and essential medicines and drugs, and ensuring adequate water and power supply to health

facilities

- Revitalization of hospital care and referral systems, through rehabilitation of infrastructure, provision of

equipment and essential medicines, and filing the gaps in human resources

- Building the capacity (equipment, human resources, and infrastructure) of emergency management at the

central and governorate level, to develop information systems, monitor health trends, stockpile essential

medicines and ensure rapid responses.

TOTAL BUDGET IN US$: 13,300,000

Budget Preliminary Breakdown Description:

a. Quick Revitalization of Life Saving Immunization Services in Affected Areas

b. Building the Capacity of Emergency Management at the Central and Governorate Level

c. Revitalization of Primary Health Care services

d. Revitalization of hospital care and referral systems

ESTIMATE COST IN US$: 3,150,000; 2,550,000; 3,830,000; 3,770,000