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Rebuilding the Ruins

rebuilding_libya_healthcare_graphGraham Jarvis looks at the state of Libya’s healthcare system and the struggles faced by the National Transitional Council

The infrastructure of Libya’s health service has taken a massive hit after the recent revolution that finally saw Colonel Gadaffi’s demise. In office since November 2011, the North African state’s Health Minister, Dr Fatima Hamroush, told a US newspaper that the conflict has taken a ‘terrible toll’ on the country’s healthcare system, and that Libya urgently needs change.

A major conflict would stretch the resources of any country’s health system to near breaking point, but Libya’s has also been afflicted by rampant corruption and nepotism. Dr Hamroush recently commented that the corruption was like an infectious disease that is incompatible with progress, and claimed that Libya’s healthcare system is in dire need of an overhaul.

Dr Hamroush is admant that the first step is to tackle widespread corruption. Bribes play a massive role in the running of hospitals; a particularly large bribe can, for example, decide who wins the contracts for hospital equipment. The main basis for any procurement decision should be the quality of the equipment, but under the circumstances during and following the conflict, this is sadly not considered. As a result, Libya’s hospitals have often ended up buying defective or substandard equipment, with the knock-on effect of doctors and nurses being unable to do their jobs as effectively as they might otherwise be able to do.

Many doctors and nurses themselves pose a significant problem: in post-conflict Libya, medical qualifications do not necessarily determine whether one finds work in a hospital. Connections are often seen as being far more important, thus adversely affecting the quality of patient care. Dr Hamroush therefore considers the fight against corruption and nepotism, and changing peoples’ mindsets, as her key challenges, but is under no illusions as to how difficult this will be.

These issues, however, are only one aspect of a multi-faceted problem. The World Health Organisation (WHO) specifies that one of the most critical issues for Libya is the lack of primary healthcare facilities, including local clinics and district hospitals.  ‘Libya has less than 1,500 of these for a population of 6.5 million and as a result, people seeking basic or routine care have to line up outside the country’s specialist hospitals,’ the organisation announced in a statement.

Dr Ahmed Shalabi, of non-profit organisation World Medical Camp for Libya (established to address the urgent and immediate need for medical aid in the country), highlights yet another vital problem area: ‘a lot of doctors leave Libya to pursue specialised training elsewhere, and many of them don’t return once they become consultants because it isn’t financially viable for them to do so.’ Given that quality training and students are a prerequisite for a successful health service, their preference for training in other countries is severely affecting Libyan medical care.

When the revolution reached terrifying heights, Libyan doctors fled, and a number of foreign healthcare workers also left the country. Dr Moez Zeiton, Research Director for Health at the Sadeq Institute, a non-profit, non-governmental think tank based in Libya, therefore believes that the National Transition Council (NTC), which is currently ruling the country, needs ‘to convince other governments that Libya is a safe place to come and work in order to recruit the necessary cadre of healthcare professionals to fill the gap that was created when third party nationals left the country.’ The NTC has already begun to see some results from its campaign as nurses are being recruited from the Philippines, but there still remains a great shortage of healthcare professionals in the country.

These troublesome issues led the Ministry of Health to outline a few main areas that require immediate attention. The standard of mental health services, specifically, needs to be improved; a quality control management system must be created; the current infection control system and the facilities thereof should improve; and amongst other things the maternal, neonatal and infant mortality rates could optimally be reduced, in accordance with UN Millennium Development Goals.

‘I think the ministry has a huge challenge in setting up a primary healthcare service in Libya, but it is essential that we have one established,’ Dr Ahmed Shalabi commented. In his eyes, the first challenge is to ensure that the appropriate infrastructure is in place as the country ‘currently hasn’t got one.’  Secondly, he believes that the Ministry of Health needs to undertake a ‘proper population distribution study to evaluate how family physicians or general practitioners will be distributed throughout the country.’

However, he believes the training of doctors and nurses in family medicine is the most vital issue. Family medicine is a specialist division of primary care that provides continuing health services by one doctor for the individual and  family across all ages, sexes and diseases. One doctor would therefore possess a wide knowledge of a range of illnesses and thus would be able to treat a greater number of patients. Sadly, according to Dr Shalabi, many Libyans were trained in family medicine outside of the country and could not practice it back in Libya, as ‘that specialisation had ceased to exist.’ The thousands of undergraduate students who enrolled on either engineering or medical training courses at Libyan universities would seem to suggest a positive influx of new doctors, but a huge number of them failed to make the grade.

With so much work to do, the WHO was invited to help the Ministry of Health to develop a programme to rebuild Libya’s health system in November 2011. Accordingly, it established six priorities: the scaling up of primary healthcare; improvement of key aspects of healthcare service organisation; strengthening laboratory services and developing better radiology services; enhancing drug supply management; and the need to increase the pool of trained nurses.

Nevertheless, despite all these negatives, Freya Raddi, who works with Médicins Sans Frontières (MSF) in Libya, says that the country’s healthcare system is ‘not nearly as bad as in many other countries where MSF is working.’ She continues: ‘Libya is in a transitional phase with a lack of legislation to protect vulnerable groups such as migrants, refugees and other internally displaced people.’ This positive spin cannot cloak the fact that Libya still has a long way to go before a functional health system comes into being.

The hope is that the Ministry of Health’s planned initiatives will be implemented under the NTC. However, what is making the healthcare situation far more urgent in the country is the fact that Libya is going to the polls on 23 June 2012, with the intention of electing a new government who might want to instigate a completely different health policy agenda. So given the current time limitations, how far can  the current Ministry of Health – along with the WHO – begin to seriously address their healthcare issues? Surely this will take years rather than a matter of weeks? There are just three months until this becomes clear.


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