Healthcare in Lebanon

12/10/2020
A report commmisioned for the Fondation ABOUZEID
Geneva, Switzerland
Introduction
The reason why of this report

Message to be delivered by Hossam Abou

Zeid (Abou Zeid Foundation), completed if
it looks relevant by Karim Hatem (Ylios)

2
 Table of content
I. Overview of healthcare in Lebanon
I General and Health related policy

II Health expenditure and Financing

III Explosion

IV Specialties

II. Analysis
I Speakers
Ceci est la structure du Tome II ?
II Timeline
Oui

III Supporting actors

IV Specialties

V Recommendations
 Table of content – Overview of healthcare
in Lebanon

I General and Health related policy

II Health expenditure and Financing

III Explosion

IV Specialties
Presentation of Ylios Executive Consulting
A matrix organisation combining our industry sectors et our areas of intervention

Our industries of intervention

Strategy, Prospective, Regulation and Economics

Organization, Governance, and Performance

Healthcare & Life Sciences

Transports & Construction

Infrastructure & Networks
Management
Our Expertise

Public Institutions
Energy & Utilities
Leadership, Management & Transformation

Innovation & Digital Transformation

Influence and Lobbying

5
Presentation of Ylios Executive Consulting
Our skills in Executive Consulting in Strategy and Organization
Our interventions generally combine analytical and rational savoir-faire ("hard") and skills that focus on people and
collective intelligence ("soft").

Strategy We work with our clients while continuously They have been trusting us for the last 30 years
Prospective, renewing the concepts and methodology of
strategy, to help them build the relevant vision of
Regulation and the future and secure the successful IV TRANSPORTS & CONTSRUCTION
I TELECOMS AND NETWORK INDUSTRIES
Economics implementation of their strategic roadmaps.

Organization We help our clients to elaborate and adapt their

Governance and governance, their organizations and their steering
Performance in order for them to be able to confront the issues
Steering they encounter and support their future projects.
II ENERGY & UTILITIES VPUBLIC SECTOR AND INSTITUTIONS

We put our knowhow and our methodologies at

Leadership, work to help the development of leaders, for an
appropriate development of leadership skills, at
Management & the right levels and at the right place in
Transformation organization, to help them take appropriate
decisions.

We are committed in the development of

Innovation & methodologies and differentiating frameworks and
Digital methodologies to assist large organizations to III INFRA., EQUIPMENTS, NETWORKS VI HEALTHCARE AND LIFE SCIENCES
Transformation handle the critical issues of innovation and
digitalization.

We assist our clients in the design, the

Economic implementation and the steering of their
intelligence influence battles, in the fields of economic, policy
and Influence and media, by supporting their interests, their
positions and their views in the public debate.

6
Healthcare system in Lebanon
I General and Health related
policy
General and Health policy related comparison by number of inhabitants (2020)

Nu mb er of in hab itants
14000000
12,210,000
12000000
Comparison
between 10000000
8,669,000
countries 8000000
according to 6000000
5,806,000 6,000,000
their
4000000
population
2000000 1,316,000
602,000
38,700
0
o g k e
ac ur nia ar no
n nd nc
on bo ts o nm ba rla Fr
a
M em
E e Le it ze
x D de
Lu Sw Ile

Monaco Luxembourg Estonia Lebanon Switzerland Denmark Ile de France

(Paris, région)
Population (in millions)
0,39 0,6 1,3 6 8,57 5,8 12,3

Area (km2) 2 2 586 45 227 10 400 41 285 43 094 12 012

GDP per capita ($US) 163 000 104 100 19 700 8 500 82 797 59 831 54 800
Healthcare expenditure as
a share of GDP 4,3% 6% 6,5% 6,4% 12.1% 10,3% 11,5%

Healthcare expenditure
per capita ($US) 7 302 6 812 1 668 987 9 956 4 782 4 500

Source : OECD, World Bank, WHO,

7
Healthcare system in Lebanon
I General and Health related
policy
General and Health policy related comparison by GDP (2020)

GDP p er cap it a
16000 14,910
14000
12,301
Comparison 12000
between 10,275
10000 9,273 9,370
countries 8,500
according to 8000

their GDP 6000

4000

2000

0
Lebanon Bulgaria Turkey Mexico Romania Croatia

Turkey Mexico Romania Lebanon Croatia Bulgaria

Population (in millions)

82,2 126,2 19,4 6 4,1 7,0

Area (km2) 783 562 1 964 375 238 397 10 400 56 594 110 994
GDP per capita ($US) 9 370 10 275 12 301 8 500 14 910 9 272,6
Healthcare expenditure as a
share of GDP 4,5% 5,48% 5% 6,4% 7% 8,1%

Healthcare expenditure per

capita ($US) 445 1 080 1 029 987 1 031 664

Source : OECD, World Bank, WHO,

8
Healthcare system in Lebanon
I General and Health related
policy
Lebanon is composed of eight regions where the population is distributed unevenly

Akkar
Mount Lebanon is among the
largest regions in the country and
North surrounds the administraive
region of Beirut. The region of
Beirut is partly compose of the
city of the same name
Mount
Lebanon

Beirut Distribution of the population by

region (% of total)
Baalbek

• North : 22%
South
• Beqaa : 15%
Bequaa
• Nabatyieh : 8%

• South : 12%

• Mount Lebanon : 34%

• Beirut : 9%
Nabatyieh

9
Healthcare system in Lebanon
I General and Health related
policy
Beirut is the capital and the most populated city in Lebanon with almost 2 million inhabitants

Rank City Number of % as total

inhabitants

1 Beirut 1 916 100 66,2

2 Tripoli 229 554 7,9

3 Sidon 163 554 5,6

4 Tyre 135 204 4,6

5 Nabatiye El 120 000 4,1

Tahta

6 Habbouch 98 433 3,5

7 Jounieh 96 315 3,3

Distribution of the population 8 Zahle 78 145 2,7

• Lebanon's main cities are mostly located along the coast

• Beirut is located on a rocky cape that constitutes, at equal distance from 9 Baalbek 30 916 1,0
Lebanon's northern and southern borders
• Beirut is the capital of Lebanon and the most important city in the 10 En Naqoura 23 910 0,8
country with almost 2 million inhabitants

Source : World population review, 2020; Atlas monde

10
Healthcare system in Lebanon
I General and Health related
policy
Syrian refugees in Lebanon account for 1,572,753 people and represent 30% of the total population of the
country
Access of refugees to medical facilities

65 400 Hospital referrals were made for

lifesaving and obstetric
interventions (60% of which were
deliveries) in 2019

100 000 Syrian refugees and 1,000

refugees and asylum-seekers of
other nationalities access
subsidized secondary and tertiary
medical care in 2020

Households – demography by age

60+

18-59

12-17

5-11

0-4
0% 5% 10% 15% 20% 25% 30%

Female Male
Refugees by nationalities N*
Palestinians 476 033 (31 Dec 2019)
NB: Some neighbourhoods in the directly affected areas of Beirut
Syrians 1 572 753 (among which are amongst the poorest, housing refugees, migrants and
879,598 are registered with Lebanese, often in collective housing or informal dwelling
the UNHCR)

Source : UNHCR, data2,UNRWA 11

Healthcare system in Lebanon
I General and Health related
policy
The Lebanese diaspora is estimated to be almost three times the size of the population of Lebanon and
resides in more than 70 countries around the world

Number of Lebanese graduated abroad

120

100
15 10
80
30
30
60
10 30
40
70
20 40
25
0
Number of general Number of Specialty Number of engineering
practice graduates up Medical Graduates to graduates until 2020
to 2002 2002

Lebanon Arab countries Eastern Europe

Western Europe North America Other

Region Number of lebanese % as total

Europe 430,000 3,4
North America 2,570,000 20,8
Latin America 8,584,000 69,4
North America 68,000 0,6
Asia 2,600 0,02
Arab world 265,000 2,1
Oceania 435,000 3,5

Source : Ministère de l’information libanais 2016, Atlas du Liban, 2013

12
Healthcare system in Lebanon
II Health expenditure and
Financing
The Health expenditure has been consistently increasing over the years but represents a small but stable
percentage of the GDP since 2010

Current Health expenditure as % gross domestic product in

the years
Total expenditure on Health as a percentage of GDP in the 7 14.00%
Middle East 6,3%
6 12.00%

5 10.00%

4 8.00%

3 6.00%

2 4.00%

1 2.00%

0 0.00%
1998 2005 2012 2015 2016 2017

Current health expenditure (in Billion LBP)

Current Health Expenditure as % Gross Domestic Product

• The total Health expenditure in Lebanon represents 6,29%

of the GDP
• The total Health expenditure per capita equals $719.4 (as
of Dec 2017)
• The government’s budget for Health amouts 10,72% of the
total government expenditure (as of Dec 2017)

Source : WHO, MoPH, NHA

13
Healthcare system in Lebanon
II Health expenditure and
Financing
The Lebanese Health expenditure fluctuates around 7% of the GDP every year

Current Health expenditure (% of GDP) Current Health expenditure (per capita)

Lebanon Luxembourg Estonia

(current US$) (current US$) (current US$)

2016 667. 3 5,595.6 1,185

2015 655.8 5,567.4 1,112

2014 676.3 6,681 1,237

8.15% 8.00% 7.97% 7.83% 8.02%

7.44% 7.76%
6.99%
Monaco NB: The low Health
Luxembourg expenditure per capita
in Lebanon (10 times
Estonia
less than in
Lebanon Luxembourg) can be
Switzerland explained by the low
Denmark level of GDP per capita
of the country
0%
20 09 2 01 0 20 11 2 01 2 2013 2014 2015 2016

Source : IndexMundi, WHO

14
Healthcare system in Lebanon
II Health expenditure and
Financing
The Lebanese Health expenditure fluctuates around 7% of the GDP every year but only represent 664 US
dollar per capita

Current Health expenditure (% of GDP) Current Health expenditure (per capita)

Lebanon Croatia Romania

(current US$) (current US$) (current US$)

2016 667. 3 884 476

2015 655.8 838 442

2014 676.3 958 503

8.15% 8.00% 7.97% 8.02%

7.76% 7.83%
7.44%
6.99%
NB: Lebanon’s Health
Croatia Romania Expenditures evolve in
a non-proportional way
in relation to GDP,
Turkey Lebanon unlike other countries

Mexico Bulgaria

0%
20 09 20 10 201 1 20 12 2013 2014 2015 2016

Source : IndexMundi, WHO

15
Healthcare system in Lebanon
II Health expenditure and
Financing
Lebanese households finance a third of the total Health expenditure every year

 Household OOP  Government*

33.1% 21.4%

Budget (2016)

Total MoPH budget

642,08,286
Health bill
MoPH budget out of total
government budget of $4b in
2.64%
2017

19.1%%

NB: The MoPH covers as ‘insurer of last  NGOs**** 23.4%

resort’ cost of primary and hospital care
for approximately 50% of the population. 19.1%%  Social Health Insurances**
Less than 5% of the MoPH budget goes to
preventive programs and interventions.  Private insurance***

Additional Humanitarian donations

• WHO, UNICEF, UNFPA, UNHCR
• World Bank, Italian Cooperation …

* Includes Ministry of pUblic Health and Military Schemes

** Includes atioanl Social Security Fund and Mutuelle des Fonctionnaires de
l’Etat
*** Includes private insurances, mutual funds and corporations
Source : Statistical bulleting 2018, MoPH, Indexmundi
**** Inlcudes local and inter national NGOs
16
Healthcare system in Lebanon
II Health expenditure and
Financing
Among all providers, hospital expenditures account for almost half of the total healthcare expenditure

Distribution of healthcare expenditure by type of

provider
100.00%

80.00%
46.8% 45.1%

* Includes providers of all ambulatorr services such

60.00% Hospitals (including residential
as providers of medical consultations and dental
long-term facilities)
practice and providers of ancillary services such as
Providers of ambulatory and ancil-
laboratory and imaging services
12.4% lary services*
12.0%
Providers of pharmaceuticals and
** Includes providers of preventive care, providers 40.00% other medical gooods
of health cae administration and financing the rest Others**
of the economy, providers outside lebanon, un-
classified expenditures and some expenditures the 27.2%
26.6%
boundaries of health and not elsewher classified
20.00%

14.6% 15.3%

0.00%
2016 2017

Source : Statistical bulleting 2018, MoPH

17
Healthcare system in Lebanon
III Explosion

Mount Lebanon and Beirut total 37% and 8% of the Lebanese hospitals and 48% of the country's private
hospitals

Distribution of hospitals by
location
7% 8%
Beirut
20%
Mount Lebanon
37% North Lebanon
16%
Bekaa
South Lebanon
12% Nabatiyeh

-
Public hospitals
8% Private hospitals
8%
24% 12%
20%
17% 40%
8%
16% 24% 19%

Number of admissions by hospital and

location
60

50 9.962

15.475 10.9
40
In thousands

30 5.989
Public
45.134
Private
20 38.439
34.876 15.665
14.408
27.83
10
8.828 9.134
0
Beirut Mount North Bekaa South Nabatieh
Source : Statistical Bulletin 2018 Lebanon Lebanon Lebanon
18
Healthcare system in Lebanon
III Explosion

Public hospitals, which represent a small portion of hospitals in the country, suffer from a limited number
of beds and a saturation of capacity

MoPH subsidized admissions by Mohafaza and type of

120
108 hospitals, 2018
Number of hospitals

100
6.966
80
58 9.98 31.265
60
46 39.795

In thousands
39.185 21.488
40 31 29
21
20 16 16 16
7 3 19.612
0 0 0
0 8.018

y
21.878
is rs

er
on ys re tic
s
tio
n py
he

rg
ati al ca he ra t 13.607

su
iz ta e
l Di rm os
t i li th O 9.351 5.228

rm
ta te pr ab io
s pi ng d rfo eh ad
o R
pe
lH Lo an R
Beirut Mount North Beqaa South Nabatiyeh
to

a s
er ce
ed

n Lebanon Lebanon Lebanon

en a
p

li
ui

G
pp
Eq

c a Private hospital Public Hospital Public (N=77,694) Private (N=148,579)

di
ope
th
Or Distribution of hospitals by type
Distribution of Hospitals by Number of Beds Total
Number of beds Public Hospitals Private Hospitals
15%
Up to 70 beds 14 96 110
71 to 200 beds 6 43 49
Over 200 beds 0 4 4
Total 20 143 163 0.85

Hopsital bed density: 27.3 beds/10,000 population (2017)

France: 65 beds/ 10,000 population (2013)
Source : Hospitals in Lebanon, Banque BEMP, 2013, Statistical Bulletin 2018, MoPH private public
19
Healthcare system in Lebanon
III Explosion

Lebanon has sufficient specialized Health practitioners but suffers from a lack of nursing staff as well as
High-tech equipments

Health workforce (per 10,000 Medical technologies (per million

population) inhabitants)
Lebanon Luxembourg Switzerland Estonia Danemark Number of high-tech equipment in N* Total
the public and private sector
Physicians 31.2 29.8 43.4 34.8 41.9
Open heart surgery departments 27 2%
Dentists 15.6 9.7 5.1 9.7 7.21
Cardiac catheterization 59 5%
Pharmacists 19.8 7.0 6.9 7.2 5.4
Kidney transplant 8 1%
Nursing and
Midwifery 37.4 117.2 175.9 62.9 101.0 Bone marrow transplant units
personnel 6 1%
Specialized burns centers 3 0%

Hospitalisations CT scan machines 110 10%

While Lebanon is the
Hospitalizations have been MRI machines
second most populated 408 619 512 41 4%
country in the recorded within public and
benchmark it is also the private hospitals in 2019 PET scan machines 7 1%
one with Surplus of
Dialysis 841 76%
medical doctors and
shortage of nurses and 20 000 000 Hospitalizations only have been
midwives estimated within public hospitals. Quick benchmark – medical
Considering the recent Private ones take on most of the technologies per million
explosion of the Beirut medical services and admissions inhabitant:
port, the situation is every year
alarming for the - Luxembourg : 16,13
country - Switzerland : 39,7
- Estonia : 18,91
- Danemark : 40,65
Source : Ministère de la santé libanais, Hospital billing database, IT department MoPH, 2019, OCDE
20
Healthcare system in Lebanon
III Explosion

The frequency of patients within the PHC (Primary Healthcare Centers) is strongly increasing each year
due to the increasing demand for General Medicine services

Admission frequency Health indicators

Number of Lebanese accessing PHC centers, Mortality and local Health estimates   Comparison
2015/2016 France
120000
Neonatal mortality rate (per 1000 live births)
100000 (2016) 4.7 2.7

80000 +28% Under-five mortality rate (probability of dying by

age 5 per 1000 live births) (2016) 8.1 5
60000
Maternal mortality ratio (100 000 live births) (2017)
40000 23 10
20000
Life expenctancy at birth (years) (2015)
74.9 82.59
0
2015 2016

 Total hospital bed capacity: 20.3 per 10 000 people

General Reproductive Dental and oral Cardiovascular Diabetes and Other

Specialty PHC Paediatrics
Medicine Health health health endocrinology specialty
2015 303 546 320 378 155 318 174 907 71 843 31 073 436 828

 Number of consultations by specialties, in PHC centers

According to a study conducted in Beirut in 2020, the major specialities represented in

the country seem to be the following: Obstetrics and Gynecology, Pediatrics, Pyschiatry,
Anesthesia
Source : Hospital industry report, Ministry of Public Health, Primary Health Care Systems
21
Healthcare system in Lebanon
III Explosion

The ambulance and emergency services system is based on the humanitarian actions of the Red-Cross as
well as of local volunteers

Pick-up at home Misfunctioning system: Ambulance

ride
• Not-for-profit ambulance
system, organization with • Patients taken care by volunteers
two parties trained to perform first cares until
- Croix-Rouge: proper treatment at the hospital
6am-6pm 1
- Local volunteers:
2 (certification granted upon
completion of 455 hours of training)
6pm-6am • “Mobile clinic”
• Croix-Rouge and Thought Strategy
leadership
volunteers are financed
through small donations

Medical emergencies
and ambulances
in Lebanon

Emergency department Lebanese Red-Cross

pick-up centers

• Care by doctors and •36 Medical - social centers

specialized practitioners •46 EMS centers
• Medical coverage •8 Mobile clinics
dependent on the •13 Blood transfusion centers
patient insurance plan

Source : Interviews, Ouest-France 2018, redcross.org

22
Healthcare system in Lebanon
III Explosion

Lebanon's aging population creates a growing need for retirement homes

Segmentation of the population by age Retirement and Nursing Homes

Years 0-14 years % 15-64 years % > 64 years • In 2010, 1.2% of seniors live in residential institutions and
2018 22,56% 68,71% 8,73% 98.8% live within their family or alone. The current aging
population confirms this trend
2017 23,09% 68,40% 8,51%
• Access to care remains complicated due to the lack of
2016 23,57% 68,11% 8,32%
nurses and midwifery personnel. Specialized institutions
2015 23,99% 67,87% 8,14% remain very expensive
2014 24,05% 67,81% 8,14% • Lebanon counts 33 long term Nursing Homes that are
distributed in all the 6 administrative units (Mohafazat)
2013 23,90% 67,92% 8,18%
across the country, but are heavily concentrated in urban
areas
• Several charities, associations and NGOs target older adults
as part of their services
• Home care in Lebanon is limited to 2–3 organizations that
provide part-time nursing staff and physical therapists for
homebound elderly individuals with chronic medical
conditions

NB: New retirement homes have opened in 2018-2019,

but the demand for specialized institutions for the elderly
is still skyrocketing

Source: L’orient le jour, WHO

23
Healthcare system in Lebanon
III Explosion

The access to a medical insurance is highly stratified in Lebanon. Underprivileged residents have difficult
access to advantageous and inexpensive coverage.

Major coverages Complementary and private insurances

CNSS Independent systems

• Covers 40% of Lebanese (active people only)
• Concern professors, judges, port and airport
• Covers up to 80% of external hospitalizations
officials...
• Reimburses doctors up to 40-50% of medical
• Covers 5% of the population and 80% of medical
expenses
expenses
• Prior payment of 1 200 000 L per household every
year

Sécurité sociale Private insurances

• Covers 90% of the French in Lebanon • Concern doctors, lawyers, engineers, pharmacists …
• Covers up to 70% of medical expenses • Covers 15% of the population
• Insurance company with an annual premium in
partnership with the orders,
• 100% coverage in hospitals and 50% coverage on
drug expenses
• Prior payment of 800-2 000$ par year per
Army beneficiary
• Covers the military and their families (10% of the
population)
• Treats in its own hospitals free of charge

Internal security force

• Covers 10% of the populations
• Covers 100% of the medical expenses
Source : Interviews
24
Healthcare system in Lebanon
III Explosion

The payment system for Healthcare practitioners based on long payment terms is encountering some
difficulties

1 2

Financing the staff Donations

► Doctors and practitioners ► Medical equipments

‒ Practitioners get paid 6 months to 8 months afyer
each medical procedure (exemple in surgery). Fee
usually adapted to the patients Officiall Currently
banks are blocking the access to bank accounts,
complicating the situation enormously
► Nurses
‒ Very uneven salary depending on the region of
activity and the type of hospitals, fixed
remuneration evey month by the government
► Emergency physicians
‒ Work on donations from local authorities and
mostly from inhabitants
‒ Covid has intensified the urge to receive medical
equipement as well as monetary fundings for most
of the Lebanese hospitals
‒ Total funding requirements ~ US$ 69-76 Mn for 7
out of the 17 damaged hospitals; ~ US$ Mn 66 are
for the 4 severely damaged ones – additional
funding is yet to be estimated
‒ French hospitals donate medical equipment since
the recent explosion (Hôpital de la Tour, CHU Reims
…)
► Response to Syrian Crisis
‒ In response to the migration of huge numbers from
Syria to Lebanon, the precense of international
humanitarian partners has significantly increased

Source : Hôpital de la Tour, Interviews

25
Healthcare system in Lebanon
III Explosion

Lebanon has received a great amount of humanitarian aide

More than US$ ~10 million

pledged to the Lebanese Red Cross
so far

TECHNICAL GUIDANCE

- UNICEF
International - WHO
support for the
DONATIONS
Healthcare sector
- US$ 15.1 Mn for health
assistance
- US$ 1.2 Mn in immediate aid via
the German Red Cross
- US$ ~28 Mn in aid for hospitals
from Norway
- US$ ~2 Mn in aid for healthcare
and food security
…

MEDICAL SUPPLIES
MEDICAL PROFESSIONALS
- 18 tons of medical aid including medicines,
vaccines and hygiene kits from France - Team of emergency doctors from France
- 20 tons of WHO health supplies - 2 field hospitals of 500 beds from Bahrain
- 2 Air Force planes with 8 tons of medical - 1 field hospital from c
equipment from Italy ...
...

Source : Statistical bulleting 2018, MoPH

26
Healthcare system in Lebanon
III Explosion

On top of a crisis hardly managed, the explosion of August the 4th hit the medical infrastructures badly
(1/3)

Source Source : Strategy& - Beirut impact assessment – Page 9:

27
Healthcare system in Lebanon
III Explosion

On top of a crisis hardly managed, the explosion of August the 4th hit the medical infrastructures badly
(2/3)

Source Source : Strategy& - Beirut impact assessment – Page 9:

28
Healthcare system in Lebanon
III Explosion

On top of a crisis hardly managed, the explosion of August the 4th hit the medical infrastructures badly
(3/3)

Source Source : Strategy& - Beirut impact assessment – Page 9

29
Healthcare system in Lebanon
III Explosion
Following the 08/04, the international community has mobilized to help the country
Beyond loss of life and many injuries, as well as widespread physical damage, the explosion has deepened a
Consequences of the
explosion
► Relief supplies
- Need for major reconstruction
support for at least two
hospitals and equipment
support for other severely
damaged health infrastructure
► Medicine
- Need for drugs to manage
acute diseases and chronic
illness in affected areas
► Hospital reconstruction and
equipment support
- Need for relief supplies,
personal protective equipment
and mobile medical units.
Lebanon does not have any
local production of medical
supplies
Source: USAID, development initiatives (IFRC, DFIs, UN Office for the Coordination of Humanitarian Affairs, FTS), European union, Red cross report
crisis of trust
Total funding committed towards UN-coordinated appeals increased by 18% for Lebanon in
2019, up to US$1.2 billion.
Lebanon was the 8th recipient of humanitarian aid in 2019, and in 2020, the humanitarian aid
increased even more.
The US gave $396M in the FY 2020
The European Council was able to obtain pledges of up to 252.7 million Euros to be used
for humanitarian aid for Lebanon on the summit they organized  83,2M euros from EU
in 2020
The red cross gave 978 000 euros
Many associations have taken actions such as Oxfam, action contre la faim, Médecins
du monde…
Along with the cash help, the UN, the World Bank Group, and the European Union,
developed a Reform, Recovery and Reconstruction Framework (3RF) to provide a road map
for addressing medium- to long-term needs in Lebanon.
Despite all the help, Development Initiative calculated that all humanitarian and
development grants could only cover for 10% of the cash needed to answer Covid-19 crisis
and the country hasn’t fully recovered from this explosion
30
Healthcare system in Lebanon
III Explosion

Hospitals are facing an influx of patients linked to the explosion of last August

Implications for
Implications for the refugees the facilities

1 2 3
► Approximately 1.5 million
refugees from Syria is Healthcare
Hospitals Containers
straining the health system centers

► In 2017, 89% of refugees ► 27 containers, out of which

► 17 hospitals have been
report that they had access to
damaged, of which 4 (Saint
the ambulatory care they
George, Hopital des Soeurs
needed and 80% to hospital
du Rosaire, Karantina, and
care
Geitawi Hospitals) been
severely damaged and are
currently non-operational
17 medical supplies
► 22 of 55 primary healthcare
containers and 10 personal
centers (~40%) that are
protective equipment
within 15 km of the
containers have been
explosion have suffered
destroyed, as well as 10% of
moderate to serious damage
vaccines in cold rooms that
UNICEF had provided

Patients Healthcare Facilities COVID-19

General Sharp decline in professionals Closed wards in Significant increase in cases
impacts of healthcare provision for Laid off health personnel underfunded hospitals due have been reported post-
the crisis ~1 million residents to the economic crisis explosion
due to economic
located in the perimeter constraints
of the explosion
Source : Beirut explossion impact assessment, Strategy&
31
Healthcare system in Lebanon
III Explosion

The Lebanese pound continues to fall : no next steps seem to be planned, but it impacts the exchanges
between Lebanon and the rest of the world, which affects the country’s health system and workforce

Since 2019, the Lebanese pound has lost 90% of its value against the dollar, which weakens the living standards in Lebanon
(falling wages and purchasing power) and causes uproar and protests throughout the country

 3 different rates:
1. The official rate: 1,500LBP for $1, Rate of the currency on the parallel market (average)
2. The rate instituted by the circular 16000
n°151, in force until the end of
March, slightly higher (currently 14000
3,900LBP for 1$), 12000
3. The rate of the parallel market,
10000
which is exploding (in March 15,000
LBP for 1$) 8000

6000
 There is not yet any information on the
4000
post Circular 151, and the multiple rates
complicate the situation. 2000

0
20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 21 21 21 21 21 21 21
0 1 / 02 / 02 / 02 / 03 / 03 / 04 / 04 / 05 / 05 / 06 / 0 6 / 06 / 07 / 07 / 07 / 07 / 08 / 08 / 0 9 / 09 / 09 / 10 / 10 / 10 / 11 / 11 / 1 2 / 12 / 12 / 01 / 01 / 02 / 0 2 / 02 / 03 / 03 /
/ / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /
22 02 12 21 0 4 28 09 22 04 19 02 12 2 2 01 11 21 31 10 24 03 1 3 24 04 16 27 08 20 03 1 5 28 10 21 02 12 24 09 21
For instance, the $246 million loan granted
by the World Bank will be paid out at 6,240 Rate of the currency on the parallel market (average)
LBP per $1, another different rate.

Source: L’Orient le jour, le Figaro, lebaneselira

32
Healthcare system in Lebanon
III Explosion

The Lebanese Central Bank’s currency reserves have reached dangerously low levels, and the purchase
subsidies will have to stop by the end of the month

 Facing the fast depreciation of the currency, the Lebanese Bank has set up an import financing system for some products :

Fuel Wheat Medicines Medical

...
equipment
 These importers buy 85-90% of the amounts they pay at the official rate (1507.5 pounds to $1), and 15-10% at the actual rate.
 Another scheme has been put in place for essential goods and allows the importers concerned to buy all their dollars at the
rate of 3,900 pounds.

 Despite all this, shortages have appeared throughout the country, of medicines or of everyday products such as milk and oil , and
paying for medical equipment has become impossible for many hospitals

 Furthermore, subsidies will gradually disappear : the government has already announced the end of fuel subsidies at the end of
March, and subsidy of medicines is criticized since some Lebanese medicines had been found up to Syria and some of Africa’s
countries

While the government is still struggling to be formed, nothing is yet certain for the post-circular 151 and the
situation is still deteriorating : Lebanese population under the poverty line ($3.84 per day) rose from 45% in
August 2020 to 55% in March 2021, according to the UN

Source: L’Orient le jour, Capital

33
Healthcare system in Lebanon
III Explosion

The covid-19 crisis has hit Lebanon hard, and the country might be paying the consequences in the long
term

After one of the strictest lockdown in the world in January 2021, the country starts to open up again, but the situation
is still not improving

Total cumulative deaths and cases since the beginning of

the epidemic
500,000 7,000
450,000  Saturation of hospitals, up to the point that
6,000
400,000 some hospitals take care of their patients in
350,000 5,000
their cafeterias (southern suburbs of Beirut) or
300,000
250,000
4,000 directly in their cars
200,000 3,000
150,000 2,000  In addition to the lack of space in hospitals, they
100,000
1,000 lack doctors, which leads to overworked teams
50,000
0 0
1 21 1 0 0 0 0 0 0 0 0 0 0
s-2 r.- v .-2 c.-2 v.-2 ct.-2 t.-2 ût-2 il.-2 in-2 ai-2 r .-2 rs-2
ar fé
v
jan dé no o se
p
ao ju ju m av a
m m

Total cas cumulés (variation J-1) Total décés cumulés

High cost per patient (up to 20 million LBP in some Beirut's hospitals) and abnormally long delays in reimbursement by the
Lebanese Bank :
 In the public hospitals, patients only pay 10 to 15% of the cost of the care, but the State struggles to cover the 85% left.
 In the private sector, which accounts for 80% of available beds in the country, they have to pay even more
 Facing this situation, many chose to try to cure themselves at home

Source: coronavirus statistiques, L’Orient le jour, le Point

34
Healthcare system in Lebanon
III Explosion

Medical workforce emigration: the former hospital of the Middle East is at an all-time low

-20%
of the country’s medical workforce since 2019 (a thousand doctors)

Healthcare professionals’ situation is deteriorating :

- Last year, 40% of the nursing workforce was laid of because the hospital couldn’t pay them
- Working conditions are really intense : due do the lack of doctors and nurses, they can work up to 6 days a week, 24 hours
in a row
- Their salary are every day less important due to the fall of the LBP and the lack of funds hospitals are facing, their saving
have lost their value
- Since the explosion last year, they feel they have less perspective in this country and that opportunities are bette in some
other places

The brain drain creates two gaps:

 There are not enough doctors
 Even if the country could train enough doctors to compensate, they would still need more experienced professionals to
manage this workforce and finish the formation

Source: N world, L’Orient-le jour, Le Point, Le Monde, Red Cross

35
 Version préliminaire
Pre-conclusion of Part I of our Report A compléter

 The lebanese Healthcare system has been put under extreme strain by the unique combination of crisis that are presently the country
– The political and economic crisis
– The Beirut 4th of August explosion
– The Covid19 Crisis, that is affecting all countries

 These combined strains have severe consequences, both for the Healthcare system and for the Lebanese population :
– The Covid19 crisis has overrun the capacities of the system : unconsistent policies have conducted to the present situation in with the death toll is
very high compared to the population of Lebanon
– Access to Healthcare system has been significantly reduced : reduction of subsidies, dwindling of purchasing power, …
– A very high number of qualified doctors have already emigrated, fulfilling uncovered needs in many developed countries and more are to follow

 We will explore in a more focused approahc different areas of healthcare activities, and make an assessment of the most critical needs of the Lebanese
Healthcare system, in order :
– To cope with immediate needs
– To safeguard the foundations of what used to be a top-tier healthcare system, with a high level of training of doctors and an attractive Healthcare
sector

36
Annexes
Lexique

 MoPH : Ministry of Public Health

 LBP : Lebanese pound
 PHC : Primary Healthcare Centers
 NH: Nursing Homes
 CNSS: Caisse Nationale de la Sécurité Sociale (Social Security Main Office)

International institutions
 WHO : World Health Organization
 UNICEF : United Nations International Children's Emergency Fund
 UNFPA : United Nations Population Fund
 UNHCR : United Nations High Commissioner for Refugees

38
Ministry of Public Health diagram

39
Healthcare system in Lebanon

As a consequence of the crisis, half of Lebanon's population lives in conditions of poverty and
precariousness

2019
Post-crisis consequences
50%
45% 45,6% • 30% reduction in the size of the middle-income group (57
40% to 40% of the total population)
35% • 45% of the population live under the poverty line
30%
• 35% of the population in unemployed
25%
20% 19,8% • Food products already registered an increase of 49.6%
15% 15% • 70.6% of the wealth is owned by 10% of the adults
< 14$ per 11,5%
10% 8,1%
day
5%
0%
Extreme Poverty Lower middle Upper middle Affluent
poverty income income
2020
50%
45%
40%
35% 35,2%
32%
30%
25% 23,2%
20%
15% < 14$ per
10% day
5% 4,6% 5%
0%
Extreme Poverty Lower middle Upper middle Affluent
poverty income income
Source : Atlas du Liban, 2013, UNESCWA 40
Europe1, article, 24/07/2020
Healthcare system in Lebanon

Value chain

Gouvernance, Pilotage, régulation Médecine technique – Examens

- Radiology
Support - Opérationnel - Organisation - Gouvernance

Stratégie et articulation : - Medical biolology

cœur de métier, Directions fonctionnelles, support - Radiotherapy
- Anatomie – pathologique
- Pharmacy
Management et parcours métier

Gynechological Surgery
Gestion et management de la production et du parcours patient - Endometriosis
- Fibrome
Recherche / enseignement

Autres Medicine
Accueil /
Urgences /
spécialités : - Anesthesiology
Médecine / Cancéro Plateaux - Allergology.
Consultations /
Chirurgie / Psychiatrie médico - SSR - Cardiology
Orientation /
Obstétrique Poly- techniques
Admission /
pathologies - Gastroenterology
Sorties - Endoctrionolige
ALD
- Dermatology
Système d’information - Infectionology

Fonctions hôtelières et logistiques

Specialties : Oncology
Infrastructure et équipement

Fonctions support Medical-technical platforms

- - Medical imaging
- - Radiology
- - Anaesthesia
41 - - Endoscopy
Source : Ylios documentation
Healthcare system in Lebanon

Financing and donations (2/2)

Source : National Health Account 2017, MoPH 42

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