Libyan
Health Care System
To reform or to transform that is the
question ?
" Health
is human wrights "
Introduction
This article is intended to encourage debate
about the Libyan health care system and why it is important to reform/transform
.?
health care is broadly defined to include the prevention,
diagnosis, treatment and management of illness including medical,
surgical and mental . health
promotion, rehabilitation, and palliation is considered as
essential services . "1"
The health sector in Libya is experiencing an
unprecedented period of challenge, increasing demand and a decrease of supply
will increasingly strain the public health system. This means optimizing
resource use is imperative if the health care sector is to continue to meet the
needs of the Libyan community.
While
Authority has actually taken little action on health care reform, there has
been no shortage of discussion among
Libyan citizens in and out the health system .
The principal
motive for healthcare reform/transform is dissatisfaction with
the existing healthcare system: the authority is dissatisfied with
the economic inefficiency of the system, doctors and other health workers are
dissatisfied with their income, the instability of the system, and
job satisfaction , and the people are mainly dissatisfied with access
, the behavior of staff, and regular shortages of drugs .
Therefore ,
healthcare reform/transform should primarily focus on financing,
rationing of services, revision of the legislation that govern the practice and introduction of private
incentives in the provision of services. But the question to be
raised is whether to reform the old, outdated , tired health care system or to transform
the system radically with the vision of the 21st century ?
The Current Situation
Healthcare
system in Libya
is based on a national health insurance model (with a high degree of
equity and a free services) but with insufficient financial resources.
The current system providing health care in Libya
Despite this success, numerous shortcomings have appeared, and the
system faces strong pressures to adapt. from the mid-80s on, the health system has suffered
from endless list of problems, including :
- Massive dropdown of the oil price in the 80s and it is direct effect
- Sanction by US and UN
- Movement of the qualified doctors outside the country (hard brain drain)
- Decrease of efficiency of those who returned (soft brain drain)
- Mismanagement of the system at all levels by inexperienced, unqualified beruoqrate people .
- Lack of policy making central body
- Eruption of medical schools with poor quality product
- Wrong kind of competition within the system
- And the most important is lack of trust between the people and the system
However
, the Libyan health care system is not without marked achievement particularly
at the level of primary health care, as matter of fact the improvement in the fields of child
and pregnant women care, immunization
, as well as the number of qualified physician and nurses as shown in
table 1 ."2" has been achieved in almost no time , the control of
infectious diseases was successful as reported by WHO
" no outbreaks, from
this country have been posted to disease outbreaks news recently "3" .
|
Indices
|
|
|
|
|
|
|
GPD per capita
|
$7,703
( 2204)
|
$ 8,162 (2004)
|
$ 4,947
(2004)
|
$ 4,274
|
$ 31,308
|
|
Life expectancy at birth
|
M 70 year
F 75 year
|
M 70 year
F 74 year
|
M 68 year
F 73 year
|
M 66 year
F 70 year
|
Male 76
year
Female 81 year
|
|
Healthy life expectancy at birth
|
M 62.3 year
F 65 year
|
M 61.3 year
F 63.6 year
|
M 59.7 year
F 62.3 year
|
M 57,8 year
F 62,2 year
|
M 68,1 year
F 72,1 year
|
|
Child mortality per 1000
|
M 20
F 19
|
M 29
F 22
|
M 28
F 26
|
M 36
F 36
|
M 6
F 5
|
|
Adult mortality per 1000
|
M 186
F 109
|
M 166
F 110
|
M 187
F 119
|
M 239
F 158
|
M 102
F 63
|
|
Total health expenditure per capita
|
$ 327 (2003)
|
$ 409
|
$ 440
(2003)
|
$ 235
|
$ 2,389
|
|
Total health expenditure as% of GDP
|
4.1 % (2003)
|
5.4 %
(2003)
|
9.4 %
(2003)
|
5.8 %
|
8.0%
|
|
Skilled attendant at birth
|
94.4 %
|
89.9 %
|
99.5 %
|
69.4 %
|
99 %
|
SOURCE : WHO country profile
Discussion :
The
analysis of the above table will clearly show that the general health situation
in the country is not as bad as it look, in spite of the little amount of money
spent on health care system as total health expenditure per capita ($327) 2003 ,
or total health expenditure as% of GDP (4.1 %) 2003. So where is the problem then ? . Shortage of money spending appears
as major player in the current health care system in Libya . Comprehensive health system reform proposes to
redirect the flow of a substantial portion of the Libya
The authority seems to appreciate this problem
of money issue in health care system, taking in consideration many aspects like
salary , supply of consumptive and equipment, reconstruction of health care
facilities and started to inject large
amount of the money into the system , But what about the latent problems which
hidden in the health system and no body wants to get close to them , issues
like brain drain, legislation , quality services, job satisfaction competition, hospitals administration, poor
graduate of medical schools and
privatization of the practice . Injecting of large amount of money in leaking
system ( brain drain, poor
administration, low standard medical and nursing student and graduate, old
non-practical legislation ) will
make the situation much worse and let people down if we thing money and money
alone can solve all the problems . Money can buy things but cannot fix every
thing .
In
my opinion as practitioner , what we need right now is to have national forum
to address the following issues and answer some questions :
- Is it worth it to inject large amount of money aiming at reforming old, tired outdated health care system ? or transforming the whole system into 21st century vision and practice ? .
- What about brain drain ? How big is the problem ? What can we do about it ?
- Is the legislation ? and the way our hospitals running are effective ? or it should be changed and how ?
- What should we do to have private practice, that is affordable , up to the standard , and complementary to public health care ?
- And the most important is building trust between the system and the people .
Some body will say no health care system is
perfect , that’s true, but there are many successful, effective health care
which we need to look at and may even adapt …
Reform of health care systems in this country
must be continuous process which seeks to reconcile the often contradictory
aims of maximizing quality, efficiency and equality of access as well as
guaranteeing the viability of the system, against a background of limited
government resources and rapid demographic and technological change .
We
need to talk much more and at all levels in the health system .
Prof. Amer Eltwati Ben Irhuma
References
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