Journal Article

Political Economy of Non-Communicable Disease (NCD) prevention and control in Lebanon: identifying challenges and opportunities for policy change and care provision reforms

Loffreda, Giulia, deVos, Pol, Diaconu, Karin, Witter, Sophie, Bou-Orm, Ibrahim R.

2023

Overview

Introduction Lebanon is a middle-income country facing substantial fragility features. Its health profile shows a high burden of NCD morbidity and mortality. This paper intends to analyse the political economy of NCD prevention and control in Lebanon. Methods This study adopted a literature-based case study research design using a problem-driven political economy analysis framework. A total of 94 peer-reviewed articles and documents from the grey literature published before June 2019 were retrieved and analysed. Results Lebanon’s political instability and fragile governance negatively affect its capacity to adapt a Health-in-All-Policies approach to NCD prevention and enable the blocking of NCD prevention policies by opposed stakeholders. Recent economic crises limit the fiscal capacity to address health financing issues and resulting health inequities. NCD care provision is twisted by powerful stakeholders towards a hospital-centred model with a powerful private sector. Stakeholders like the MOPH, UN agencies, and NGOs have been pushing towards changing the existing care model towards a primary care model. An incremental reform has been adopted to strengthen a network of primary care centres, support them with health technologies and improve the quality of primary care services. Nevertheless, outpatient services that are covered by other public funds remain specialist-led without much institutional regulation. Conclusion Our study revealed a locked equilibrium in NCD prevention policymaking in Lebanon, but with an incremental progress in service delivery reforms towards a primary care model. Advocacy and close monitoring by policy entrepreneurs (such as civil society) could initiate and sustain the implementation of policy change and care model reforms.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Advocacy / Biostatistics / Blocking / Care and treatment / Case studies / Case-Control Studies / Chronic diseases / Civil society / Democracy / Diabetes / Diagnosis / Disease control / Disease prevention / Economic crisis / Economics / Entrepreneurs / Environmental Health / Epidemiology / Evaluation / Fragility / Governance / Health care / Health disparities / Health Policy / Health services / Health system reforms / Humans / Inequality / Infectious diseases / Interest groups / Lebanon / Literary criticism / Literature reviews / Medical care, Cost of / Medical policy / Medical technology / Medicine / Medicine & Public Health / Methodological problems / Morbidity / Mortality / NGOs / Non-communicable diseases / Noncommunicable Diseases - prevention & control / Nongovernmental organizations / Outpatient services / Policy / Policy implementation / Policy Making / Political economy / Political economy analysis / Political factors / Political risk / Political systems / Politics / Prevention / Primary care / Private sector / Public Health / Quality of care / Reforms / Research design / Respiratory diseases / Risk factors / Social networks / Stability / Stability analysis / Stakeholders / Vaccine