Written by the following Drafting Committee Members;
R El Oakley(*), A Aboutwerat, N Alageli, S Sager, E Aburawi, K Neami, R Kerwat, . . .[restrict]A Elfituri, H Ziglam, A Saifenasser, A Bahron, A Taguri, M Ghrew.
Dedicated to all Libyans who lost their Fortune, Dignity and Life in search of health care outside the country. And to those, young and old, who were let down by an ailing health system before and during the Revolution.
The extra-demand imposed upon the health services during and after the liberation war in 2011, led the ailing health care system in Libya to collapse. The National Health Systems Conference (NHSC) was held between the 26th and the 30th of August 2012 in Tripoli. The aim of this conference is to study how health systems function at the international arena? Identify the problems within the health system at home and propose potential solutions.
The Ministry of Health in collaboration with the WHO and other International experts in the field organized the conference. The scientific program adopted the WHO health care system framework (Appendix I) and used its six system building blocks (figure 1) to structure the debate. A half-day pre-conference workshop on clinical governance was attended by around 170 health care professionals from allover the country.
The initial one and half day didactic lectures provided the scientific basis of the Health Systems and addressed the current status of health service in Libya and compared that to modern Health Systems Internationally. The working group discussion was spread over the last three days (half a day each) in the following sequence; Health Governance, Health Care Finance, Health Service Delivery, Human Resources for Health, Pharmaceuticals and Health Technology, and finally Health Information Service.
Participants were encouraged to think about each block through a structured approach starting with clarifying the concepts, evaluating the current status of that health system block in Libya thereby identifying the strengths, weaknesses and major deficiencies. Each session was chaired by a national delegate and co-chaired by a WHO expert.
This report is a summary of the discussions and recommendations made by more than 500 Libyan Health Care professionals who ceased the opportunity to map a modern health care system that Libyans deserve and will take the country into the 21st century.
In order to improve the health systems in Libya the delegates made a number of recommendations including;
- To ensure the commitment and the support of the Parliament and the Government to develop and modernize the Health Care System, through the formation of a Supreme Council for Health (SCH) (Appendix II). SCH recommendation will be legally binding to all executive authorities in Libya. SCH may immediately assume the responsibilities of National Crisis Committee.
2. Restructure the organizational Chart of the Ministry of Health and decentralize the service in harmony with developing a patient-oriented quality health services.
3. Establishment of Independent Councils to regulate Medical, and other Allied Healthcare Specialties (Appendix III).
4. Development of a national program to promote and regulate Public-Private Partnerships.
5. Universal access to free basic and preventive health care to all Libyans should be the rule and not the exception. However, there is an urgent need for a major review of the current funding mechanism for health services.
6. To consider a new “Libyan-style” medical insurance (or health saving account) where the government pays the expected cost of hospital treatment for currently ill individuals (including the injured) into a “special saving bank account” that is to be used, only, for health expenditure by the patient and his and/or here immediate relatives. A similar strategy may be considered for every individual in the long term. Private Insurance can be purchased directly from these saving accounts.
7. Urgent need for workforce strategic planning, regulation, professional development and re-distribution according to the regional and institutional needs.
8. Introducing financial and/or higher training incentives to attract staff to work in technically demanding or rare specialities such as family practices, biomedical engineering, high-risk areas, and those requiring relocation to geographically remote areas of the country.
9. Need to restore the image and the reputation of the health service and its staff.
10. To review regulations and legislations related to production, importing and prescribing pharmaceutical products.
11. To develop national strategies to reduce corruption and criminal activity and promote inter-disciplinary cooperation between regulatory authorities, police, customs services and the judiciary to effectively regulate the pharmaceuticals’ market and enforce health technology guidelines.
12. To create a supportive environment for the local manufacturing of pharmaceutical products and health technology.
13. To establish a National Information Technology Steering Committee to oversee the development of health information systems across the entire health care establishments.
14. Recruiting and training of Information, Communication and Technology staff to work side by side with clinicians to develop and manage local and national Health information technology.
15. There is an urgent need to develop National registers for some diseases or disease-groups e.g. Cardiovascular Diseases, Cancer and Trauma registries. And to ensure that nationally collected data is accurate, including the current WHO/MOH lead Primary health Care and Health Facility Surveys hat began early in 2012.
16. Re-orientation of the Health Service Delivery to be patient-centered i.e. designed around the patient to guarantee good access, continuity of care and universal coverage (Figure 2)
17. To reconfigure the national health care system and separate its 3 functions (Health care Finance, Service Delivery and Monitoring and Quality assurance) so that each function works independently, yet in close collaboration.
18. To develop primary care services including up grading the current buildings and facilities and building new health care centers to ensure universal coverage for essential services and beyond.
19. De-centralization of health care services so that local health authorities become responsible for ensuring that comprehensive health care is delivered to the local population with all its elements of coverage including preventive, curative, palliative and rehabilitative services and health promotion.
20. To develop national programs to deal with major Public Health issues including prevention of the cardiovascular diseases, cancer screening, smoking cessation, road safety and health-related environmental issues.
21. To Establish National Medical Research Council to regulate and fund health care-related research.
THE WAY FORWARD: A National Health System Task Force is required to carry these recommendations forward. It is essential that the Libyan Parliament and Government grant the necessary legislative powers to the National Health System Task Force and the Minister of Health to introduce the necessary administrative changes and help implement these recommendations as soon as possible.
(*) Corresponding Author;
Reida El Oakley FRCS MD
Libya Representative at the WHO,
Permanent Mission of Libya to the United Nations Office at Geneva, Switzerland
Tel: Libya (+) 218 918677614 Geneva (+) 41791247313