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Country Profile
Lebanon
Health Promotion in Lebanon's National Health System
by Sahar Tabarra, M.S.
population: between three and four million
life expectancy: 73.5 women, 71 men
infant mortality: 11.8 per 100,000
one doctor for every 600 people
Health care in Lebanon is provided by several public and private agencies. The Ministry of Health provides care for the Lebanese population in its own hospitals and outpatient facilities and reimburses costs of services rendered in private hospitals with which it has contracts. The National Social Security Fund (NSSF) arranges financial reimbursement for health care charges incurred by employees in the private sector. Funding comes from employees, employers and the Ministry of Finance. The Army and Public Security Force is responsible for health care in military facilities.
Twenty to 25 percent of the population have private health insurance and a major source of health care financing in Lebanon comes from out of pocket expenditures for drugs, physicians and other health-related costs.
After several years of civil war in Lebanon, the health system was impacted heavily. A lack of coordination among health providers lead to an oversupply of services, false billing, and long waiting lists for admissions to hospitals. Another obstacle currently facing the effective delivery of health care is the lack of consistent and retrievable data. As a result, this can lead to improper planning in the management of unreported cases and most definitely will cause a tremendous increase in health care costs for the government while placing a burden on the public, as well as health providers.
Collaborative efforts from several sources that include the Ministry of Public Health and other ministries, hospitals, practitioners, non-government organizations (NGOs), WHO, UNICEF and all public health officers are currently improving the health system.
Major Health Risk Factors in Lebanon
A recent study entitled "Dietary trends and obesity in Lebanon, 1998" (Baba, Adra 1998) using percent body fat as a criterion for obesity, stated that 47.3 percent of the Lebanese were classified as obese (25.5 percent males, 69.1 percent females). This can be a contributing factor to the predicted rise of non-insulin dependent diabetes mellitus in the next decade.
There is also a high prevalence of familial hypercholesterolemia TC>=240mg/dl) and increased triglyceride levels among the adult population (47 percent in men and 32 percent in women). Among men and women ages 30-64, approximately 26 percent of both men and women suffer from hypertension. Smoking is a major health problem, with 37 percent of men and 27 percent of women smoking. Coronary heart disease is also very high in Lebanon.
The Ministry of Health adopted a National Health Strategy Plan in 1998. As a result of a recent study, "The Epidemiology of Cardiovascular Risk Factors Among Adult Lebanese Population," it was recommended that a comprehensive health care program should be initiated and implemented. The goal of this intervention is to influence health-related behavior, such as smoking, diet, and physical activity, environmental factors, and other risk factors in the community. Additionally, AIDS prevention programs have been established. A newsletter about AIDS prevention, as well as a web site, has been put together by the Ministry of Public Health (www.public-health.gov.lb). Another web site will developed by the National Council for Scientific Research so researchers and policy makers can access health-related information. Also, health education will be implemented in school programs in the near future. A curriculum has been developed and a second draft is being studied.
Another important focus is the training and development of health manpower and placement of personnel throughout Lebanon. One example is the reinstatement of the Health Behavior Education degree at the American University of Beirut. Lebanese young people are catching up very fast with the new trend in health education even though some misconceptions about health issues still need to be clarified.
Health Clubs are being developed in Lebanon, especially in Beirut, and the concept of health promotion seminars is now under evaluation as a viable project to implement in conjunction with the International Institute for Health Promotion.
Ms. Tabarra is a health promotion consultant and may be reached at e-mail: saharTab@aol.com
