Study of Medical and Allied Health Education and Training Institutions

State of Libya

Ministry of Health Health Information and Documentation Center

The Libyan Health System: Study of Medical and Allied Health Education and Training Institutions

2018

Report Preparation Team

Writing, formatting, editing

Prof Dr Ibrahim Jabeal: Professor of Surgery and Expert in Health Service Management and Planning

Dr Haroon ur Rashid, Consultant Health Information System, World Health Organization, Libya.

Accreditation Standards Review Team

Prof Dr Ibrahim Jabeal

Dr Azza Alsadege Grew

Dr Abdelaziz Alhalafi

Dr Haroon ur Rashid

Editorial Board

Mohammad Ibrahim Saleh Daganee

Dr Haroon ur Rashid

Prof Dr Ibrahim Jabeal

Mr Omar Al Aref Said

Disclaimer

The information and views set out in this study are those of the author(s) and do not necessarily reflect the official opinion of the European Union. Neither the European Union institutions and bodies nor any person acting on their behalf may be held responsible for the use which may be made of the information contained therein.

Libya 2018-Health Education and Training Institutions ||2 Introduction

The Health Information and Documentation Center, Ministry of Health is honored to publish the present report, which documents the current status of medical and allied health education institutions and training of Human Resources for Health, more particularly focusing on exploring the supply side of the medical and allied health staff necessary for providing healthcare services. It is a vital component in Human Resources (HR) Planning (HRP), and will guide the HR policies-making process to plan the continuous and adequate supply of trained and qualified health workforce resulting in improving the quality of health service delivery. On behalf of The Ministry of Health Information and Documentation Center, we would like to express our deepest thanks and gratitude to the World Health Organization (WHO), represented by the Country Office in Libya and by the Regional Office for the Eastern Mediterranean, for the continuous technical support for strengthening the health information system of Libya. We are also thankful to WHO for their guidance and support in generating evidence based information which will help the policy makers to make informed decisions especially when the country is resource constraint and facing lot of challenges. We sincerely acknowledge the efforts of the European Union. We wish to thank the EU for its financial support for this study as well as for their continuous support and generous support in other interventions related to health information system in Libya. We are also pleased to extend our sincere thanks and appreciation to the research team Chair Dr Ibrahim Jabeal and the team members who collected the data from the medical and health educational and training institutions. We do acknowledge their great efforts in preparing this valuable report and successfully reaching fruitful results, and we anticipate that it will be useful in adjusting human resources for health policies. We would also like to thank the staff of the universities, faculties, institutes and various education and health institutions for their cooperation in providing the required data in a timely manner. Finally, we would like to extend our appreciation to our sincere colleagues, namely Dr. Syed Jaffar Hussein, the WHO Representative and his team and Ms Edda Costeralli, Health Expert of the European Union, whose contributions were vital in bringing this work to completion.

Mr. Mohammed Ibrahim Saleh Daganee Director of Information and Documentation Center - Ministry of Health

Libya 2018-Health Education and Training Institutions ||3 Acknowledgments

I would like to thank the Government of Libya and the Ministry of Health for their hard work and dedication in developing and preparing this important report on the study of health education and training institutions in Libya. This study in addition to other upcoming research data will inform the Human Resource for Health (HRH) planners for effective planning for human resources strategy. I am confident that the evidence produced by Health Information Centre, MOH will enable the decision makers to improve the performance, quality and impact of the health workforce through informed human resource policies for health and align investment in human health resources with the current and future needs of the population and health systems. The policy makers will consider the findings of this study and will take into account the dynamics of the labor market and education policies to address the shortage of specialized staff and improve the distribution of health workers so as to maximize improvements in health outcomes, social welfare, job creation and economic growth. It is reassuring that the Health Information Center, MOH have kept the inventory of human health resources in District Health Information System (DHIS-2) to have monthly updated data from all the public health institutes. Establishing international standards for the education and qualifications of the health workforce and fostering improvement in the quality of education and qualifications are integral to the WHO mandate. My sincere gratitude to the whole team in collective evidence on the accreditation standards for basic medical education, dentistry, nursing and pharmacy. Although the findings of the review of the accreditation standards are not encouraging but with support of the Ministry of Education and Health, we expect that we will improve the quality of education; and Libyan Institutions will rank high in the list of accredited universities. I express my special appreciation and gratitude to Mr. Mohamed Ibrahim Saleh Daganee, Director of the Information and Documentation Center, MOH and especially the team that supervised the study, especially Prof Dr. Ibrahim Jabeal - Professor of Surgery and Expert in Health Management and Planning and Mr Omar Al Aref Said - Director of the Documentation Office at the Information and Documentation Center, Ministry of Health. I also appreciate the efforts made by the WHO Country team specially Dr Isiaka Alo, Dr Haroon ur Rashid and Mr. Moncef Bouslama for the technical guidance and support provided to Ministry of Health. The World Health Organization highly appreciates the financial support of the European Union and acknowledge the contribution of Ms Edda Costeralli, Health Expert of European Union. Dr: Syed Jaffar Hussain Representative and Head of Mission World Health Organization, Libya

Libya 2018-Health Education and Training Institutions ||4 Forward

The medical and staff and health assistants play a key role in the care system by promoting the well-being of the healthy, providing preventive and curative services, and rehabilitating patients and different types of sick people. Currently there is an increasing criticism of the current state of the provision of health care services in government hospitals and institutions along with rising discontent with the Libyan medical staff and health assistants despite their great efforts in providing the best possible services. On one hand survey reports sizeable workforce in the country but on other hand efforts are underway to enhance the quantity of the graduates of Medical Faculties with different healthcare specializations. Thus studying the number of students and graduates of the Ministry of Education institutions, as well as the number of trainees and their specializations in both the Ministry of Health training institutions and in private Health Sciences educational institutions is one of the most important issues that requires research fieldwork. The Ministry of Health Information and Documentation Center, with the support of the European Union and the World Health Organization (WHO) represented by the Country Office in Libya, conducted a statistical field survey to identify the number of Medical Faculties and the number of students and graduates for the last seven years in both public and private sector. The objective of the study is also to gather information on medical educational institutions with different healthcare specializations so as to design a database of students, graduates, and medical faculties as well as training institutions in the medical field and to realize the current output of Libyan educational system in terms of quantity and suitability to provide distinguished medical care services. The study team designed a special type of questionnaire for producing data and executed a range of field visits to the target institutions. The study comprises several chapters to attain the objectives fixed at its outset and ends with a section in which conclusions and recommendations are presented. The study comprises eleven chapters. The first two chapters introduces the context and methodology of the study. In third and fourth chapter the human resources in the health sector and overview of basic medical and allied health education is presented. Chapter five presents the results of data collected from medical education institutes. Chapter six briefly shed light on the examination and curricula of different specialties. Seventh chapter explains the technical education in the country and in next chapter the continuing medical education is explained. Chapter nine is on private medical education. Chapter 10 highlights the findings of the review of accreditation standards of different faculties. Last chapter shows the need analysis followed by recommendations. In conclusion, the study team wants to express its sincere thanks to all those who contributed to funding and supervising this study. We should mention in particular the Minister of Health, the Director of the Ministry of Health Information and Documentation Center, the European Union and the staff of the WHO Country Office in Libya as well as the data collectors and the personnel of the institutions who take active part in this study. Dr. Ibrahim Ali Jabeal Professor of Surgery and Expert in Health Services Management and Planning

Libya 2018-Health Education and Training Institutions ||5 List of content Introduction ...... 3 Acknowledgments ...... 4 Forward 5 Executive Summary ...... 16 Chapter One: Context of the Study ...... 32 1. Introduction ...... 32 1.1 Background: ...... 32 1.2 Rationale: ...... 33 1.3 Objectives of the study:...... 33 Chapter 2: Methodology of the Study ...... 34 2.1 Study Methodology: ...... 34 2.2Study Period...... 34 2.3Analysis ...... 34 2.4Limitations ...... 35 Chapter 3 Human Resources in Health Sector ...... 36 3. Studying the current status of human resources in the healthcare sector ...... 36 3.1 Introduction to Human Resources: ...... 36 3.2 Medical staff and healthcare assistants: ...... 36 3.3 Status of Human Resources for Health (HRH)Libya, according to MDG Criteria . 37 3.4 Human resources for health: comparing different countries of the region: ...... 38 RESULTS OF THE STUDY ...... 39 Chapter 4 :Basic Medical and Allied Health Education and Training in Libya...... 40 4. Overview of Basic Medical and Allied Health Education and Training in Libya ...... 40 4.1 Historical Prospective ...... 40 4.2 Current status of medical and allied institutes in Libya ...... 41 4.3 Number of graduates of Medicine, Dentistry and Pharmacists in Libya ...... 42 Chapter Five Findings of Basic Medical Education in Libya ...... 43 5. Field Study of Basic Medical Education Institutions in Libya ...... 43 5.1-Introduction...... 43 5.2 Number of students in medical schools during the last seven years (2010-2017) 43 5.3 Schools of Oral and Dental Surgery: ...... 47

Libya 2018-Health Education and Training Institutions ||6 5.4 Nursing School: ...... 51 5.5 Schools of Pharmacy: ...... 55 5.6 Medical Technology School:...... 59 5.7 School of Health Sciences: ...... 63 5.8 Public Health Schools: ...... 66 Chapter 6 Study and exams in medical colleges ...... 69 6. Medical and health education and training in Libya ...... 69 6.1 Preface ...... 69 6.2 Education curriculum in the medicaland allied universities ...... 70 Chapter 7 Technical Health Education in Libya ...... 71 7. Technical Health education in Libya (intermediate institutes, higher institutes and centers of medical profession) ...... 71 7.1 Preface ...... 71 7.2 Early era: 1957 - 1968: ...... 71 7.3Era of Intermediate Institutes of Health (1970-2003) ...... 71 7.4 Era of Higher Institutes / Centers of Medical Professions: ...... 72 7.5Era of Faculties and resurfacing of Intermediate Health Institutes for Nursing: (2015-2017)...... 72 Chapter 8 Continued Medical Education ...... 75 8. Training and continuous medical education ...... 75 8.1 Preface ...... 75 8.2 Medical Manpower Development Center: ...... 76 8.2 A: Midwifery in Libya: ...... 76 8.3Libyan Board of Medical Specialties: ...... 76 8.4 Committee for the evaluation of foreign certificates at the LBMS: ...... 78 8.5 Arab Council for Medical Specialties: ...... 79 8.6 Research activities and biomedical publications...... 80 Chapter 9. Private Medical Education ...... 82 9. Private Medical Education ...... 82 9.1 Preface ...... 82 9.2 Medical Altahadi University - Tripoli Libya: ...... 82 8.3 Libyan International Medical University for Medical Sciences in Benghazi - Libya: ...... 83

Libya 2018-Health Education and Training Institutions ||7 8.4: Graduates of the Libyan International University of Medical Sciences: ...... 84 8.5 Al Kaleg Libya Collage of Dentistry ...... 84 Chapter 10 :Review of Accreditation Standards of Undergraduate Basic Medical Education, DentistryEducation, Nursing and Pharmacy Education ...... 85 10. Accreditation of Basic Medical Education ...... 85 10.1 Introduction ...... 85 10.2: Standards ...... 86 10.3 Accreditation mechanism of health education institutes of Libya ...... 86 10.4 Status of accreditation standards of three major undergraduate medical schools of Libya ...... 88 10.5 Faculty of Medical School ...... 88 10.6 Status of accreditation standards of Benghazi Dentistry School of Libya ...... 89 10.7: Faculty of Dentistry Benghazi ...... 89 10.8 Nursing Education ...... 89 Introduction ...... 89 10.9 Status of accreditation standards of three major undergraduate nursing schools of Libya ...... 90 10.10 Faculty of Nursing ...... 90 10.11 Status of accreditation standards of three major undergraduate pharmacy schools of Libya ...... 91 10.12 Faculty of Pharmacy ...... 92 Chapter 11 Current Status and Need Assessment of Health Workforce ...... 93 11. Estimates of Libya's medical and medical assistance needs until 2030...... 93 11.1 Analysis of Existing Health Workforce (Physicians, Nurses/Midwives) against UHC/SDG and End of Preventable Maternal Mortality Criteria ...... 93 11.2 Analysis of Physicians current status and projected numbers in comparison with different countries 2017-2030 ...... 94 11.3 Analysis of Dentists current status and projected numbers in comparison with different countries 2017-2030 ...... 95 11.4 Analysis of Nurses current status and projected numbers in comparison with different countries 2017-2030 ...... 97 11.5 Analysis of Pharmacists current status and projected numbers in comparison with different countries 2017-2030 ...... 98 11.6 Analysis of Specialists current status and projected numbers in comparison with different countries 2017-2030 ...... 100

Libya 2018-Health Education and Training Institutions ||8 11.7 Conclusion: ...... 102 11.8 Recommendations: ...... 102 x. References: ...... 103

Libya 2018-Health Education and Training Institutions ||9 List of tables

Table 1 : Current status of medical and allied health institutions ...... 17 Table 2 : Frequency of healthcare workforce for the year 2017 ...... 36 Table 3 :Comparison of the distribution of medical and paramedical staff in Libya according to different hypothetical regions ...... 37 Table 4: Human Resources for Health per 10,000 people according to MDG Criteria ...... 37 Table 5 : Regional comparison of human resources for health ...... 38 Table 6: Status of the faculties related to medical and allied health education in Libya...... 41 Table 7: The number of undergraduate new medical students enrolled, final year students, total number of students and graduates from 2010-2017 ...... 43 Table 8: The number of new students, final year and total students and graduates in Dental and Oral Medicine Faculties for the last seven years ...... 47 Table 9: The number of new students, final year, total students and graduates in Nursing Faculties for the last seven years ...... 51 Table 10 : The number of new students, final year and total students and graduates in Pharmacy Faculties for the last seven years ...... 55 Table 11 : The number of new students, final year and total students and graduates in Medical Technology Faculties for the last seven years ...... 59 Table 12: The number of new students, final year and total students and graduates in Health Science Faculties for the last seven years ...... 63 Table 13 : The number of new students, final year and total students and graduates in Public Health Faculties for the last seven years ...... 66 Table 14: The number of graduates of Intermediate health Institutes from 1970 to 2003 ... 72 Table 15: New Intermediate Nursing Institutes ...... 73 Table 16: Distribution of graduate Midwives across Libyan universities ...... 76 Table 17: The number of the recipients of the Medical Specialties Board Certificate: the first batch of graduates in the period of time spanning from 1995 to 31/12 2017 ...... 77 Table 18: The number of foreign approved certificates (till date) ...... 79 Table 19: The number of Libyans who obtained The Certificate of the Arab Board of Health Specializations ...... 80 Table 20: Number of graduates of medical Altahadi University (2005-17) ...... 82 Table 21: The distribution of students in the two academic years at At-Tahadi Medical University - Tripoli, Libya ...... 83 Table 22: The number of students and the number of new students at The Libyan International Medical University ...... 83 Table 23: The total number of students and graduates at The Libyan International Medical University throughout the years of study ...... 84 Table 24: shows distribution of students of Al Kaleg Libya College of Dentistry ...... 84 Table 25: Libya status: 8.68 Per 1000 population ...... 93

Libya 2018-Health Education and Training Institutions ||10 Table 26: Current ratio and projection of needed physicians based on comparison with different countries ...... 94 Table 27: Current ratio and projection of needed dentists based on same target ...... 95 Table 28: Current ratio and projection of needed nurses based on comparison with different countries ...... 97 Table 29: Current ratio and projection of needed pharmacists based on comparison with different countries ...... 99 Table 30: Libya Specialist ratio per 100,000 population...... 100

Libya 2018-Health Education and Training Institutions ||11 List of Figures

Figure 1: Total number of graduates from 1970 till end 2017...... 42 Figure 2: Trend of undergraduate medical students in the last seven years ...... 44 Figure 3 : shows the mean number of new students, final students, total students and graduates of medical schools of Libya (2010-2017)...... 44 Figure 4 : Trends of undergraduate dentistry students for the last seven years ...... 47 Figure 5: Mean number of new students, final year students, total students and graduates for the year 2010-2017...... 48 Figure 6 : Coordinates of Oral and Dentistry Schools in Libya ...... 49 Figure 7 : Photos of some dentistryschoolsof Libya ...... 50 Figure 8: Trends of Faculty of nursing students in the last seven years ...... 51 Figure 9: Mean number of new, final year, total students and graduates in the last seven years (2010-2017)...... 52 Figure 10: Nurses/Midwives output by type and level of institutions...... 52 Figure 11 : Coordinates of Nursing Schoolsof Libya ...... 53 Figure 12 : Photos of some nursing schools in Libya ...... 54 Figure 13: Trend of undergraduate pharmacy students in the last seven years (2010-2017) 55 Figure 14: Mean number of new, final year, total students and graduates of pharmacy for the last seven years (2010-2017)...... 56 Figure 15 : Coordinates of the Pharmacy Schools in Libya ...... 57 Figure 16 : Photos of Some Schools of Pharmacy...... 58 Figure 17 : Trend of students of Faculty of Medical Technology for the last seven years ...... 59 Figure 18: Mean number of new, final year, total students and graduates in the last seven years (2010-2017)...... 60 Figure 19: Gender wise distribution of graduates from intermediate institutes (1972-2003)61 Figure 20: Gender wise distribution of graduates of higher institutes (2004-2017) ...... 61 Figure 21 : Coordinates of Medical Technology Schoolsof Libya ...... 62 Figure 22: Trend of students of Health Sciences for the last seven years...... 63 Figure 23: The mean number of new, final year, total students and graduates for the last seven years...... 64 Figure 24: Trends of students of Public Health Faculty for the last seven years ...... 67 Figure 25: Mean number of new, final year, total students and graduates in the last seven years...... 67

Libya 2018-Health Education and Training Institutions ||12 List of annexure A. 1 Distribution of universities and faculties of different specialties in Libya ...... 104 A. 2: Centers of Medical Profession (High Health Institutes) ...... 105 A. 3: Intermediate Nursing Schools ...... 106 A. 4: Distribution of first year undergraduate medical students by universities ...... 107 A. 5: Distribution of final year undergraduate medical students by universities ...... 107 A. 6: Distribution of total undergraduate medical students by universities ...... 108 A. 7: Distribution of graduatesfrom faculty of medicine by universities ...... 108 A. 8: Distribution of first year undergraduate dental students by universities ...... 109 A. 9: Distribution of final year undergraduate dental students by universities ...... 109 A. 10: Distribution of total undergraduate dental students by universities ...... 110 A. 11: Distribution of graduatesof faculty of dentistry by universities ...... 110 A. 12: Distribution of first year nursing students by universities ...... 111 A. 13: Distribution of final year nursing students by universities ...... 111 A. 14: Distribution of total nursing students by universities ...... 112 A. 15: Distribution of nursing graduates by universities ...... 112 A. 16: Distribution of first year pharmacy students by universities ...... 113 A. 17: Distribution of final year pharmacy students by universities ...... 113 A. 18: Distribution of total pharmacy students by universities ...... 114 A. 19: Distribution of graduates of faculty of pharmacy by universities ...... 114 A. 20: Distribution of first year medical technology students by universities ...... 115 A. 21: Distribution of final year medical technology students by universities ...... 115 A. 22: Distribution of total medical technology students by universities ...... 116 A. 23: Distribution of graduates of medical technology faculty by universities ...... 116 A. 24: Distribution of first year health sciences students by universities ...... 117 A. 25: Distribution of final year health sciences students by universities ...... 117 A. 26: Distribution of total health sciences students by universities ...... 118 A. 27: Distribution of graduates of faculty of health sciences by universities ...... 118 A. 28: Distribution of first year public health students by universities ...... 119 A. 29: Distribution of final year public health students by universities ...... 119 A. 30: Distribution of total public health students by universities ...... 120 A. 31: Distribution of public health graduates by universities ...... 120 A. 32: Medical school curriculum ...... 121 A. 33: School of Dentistry curricula: ...... 121 A. 34: Nursing school ...... 122 A. 35: Public Health ...... 124 A. 36: Pharmacy...... 125 A. 37: Year 1 of Medical technology: ...... 126 A. 38: Dental Technology division of Medical Technology Faculty: ...... 126 A. 39: Medical laboratories Division...... 127 A. 40: Physiotherapy division...... 128

Libya 2018-Health Education and Training Institutions ||13 A. 41: Public Health Division...... 129 A. 42: The number of graduates of Intermediate Health Institutes per year, from 1970 to 2003 ...... 130 A. 43: Activities of the Medical Manpower Development Center (2003-2015) ...... 131 A. 44: Detail scoring of accreditation standards by areas of three major undergraduatemedical institutes of Libya ...... 132 A. 45:Faculty Staff of undergraduate medical schools ...... 133 A. 46:Detail scoring of accreditation standards by areas of Benghazi Dentistry School of Libya ...... 135 A. 47 : Detail scoring of accreditation standards by quality criterions of three major nursing faculties of Libya ...... 138 A. 48 : Faculty of Nursing in Libya ...... 138 A. 49 : Detail scoring of accreditation standards by quality criterions of three major pharmacy faculties of Libya ...... 140 A. 50 : Faculty of Pharmacy (Benghazi and Omar Mukhtar) ...... 141

Libya 2018-Health Education and Training Institutions ||14 Abbreviations and Acronyms

CCAPP : Canadian Council for the Accreditation of Pharmacy Program CME : Continued Medical Education CPD : Continued Professional Development DHIS : District Health Information System EPMM : Ending Preventable Maternal Mortality EU : European Union GDP : Gross Domestic Product HIC : Health Information Center HRH : Human Resources for Health HRP : Human Resource Planning LBMS : Libyan Board of Medical Specialty LMJ : Libya Medical Journal MDG : Millennium Development Goals MOH : Ministry of Health OSCE : Objective Structured Clinical Examination SARA : Service Availability and Readiness Assessment Survey SDG : Sustainable Development Goals SHAMS : Strengthening Health Information System and Supply Chain System. UHC : Universal Health Coverage WFME : World Federation for Medical Education. WMA : World Medical Association WHO : World Health Organization

Libya 2018-Health Education and Training Institutions ||15 Executive Summary

Study of medical and allied health institutions was conducted for the first time in the history of Libya. It aims to provide updated inventory of medical and allied health education and training institutions, provide information on the input and output of the health workforce studying in different disciplines of the country and to explore the accreditation standards of undergraduate medical, dental, nursing and pharmacy institutes. The study was conducted by Health Information Center, MOH with technical support of World Health Organization and financial support of European Union (EU) funded Strengthening Health Information and Medical Supply (SHAMS) project.

Perceived shortages of health workers have many causes and may be a result of inadequate numbers and skills mix of persons being trained or maldistribution of their deployment. The decade old emergency and unstable situation of the country have direct implications on the human resources of health. Service availability and readiness assessment survey (SARA) in Libya have clearly highlighted the imbalance and maldistribution of human health resources. The exodus of national and foreign skill workers, inability of the mangers to enforce the vague regulations, lack of monitoring and supervision, the continued absence or limited presence of some staff coupled with limited availability of medicines have severely affected the service delivery of the country. The critical situation of human resources in Libya is well known but the knowledge about how to tackle it is limited. In Libya, the production of human resources for health is the prime responsibility of Ministry of Education. Ministry of Health also plays a role in production of certain cadres but there is a clear disconnect between two ministries. The pre-service training institutions should have the capacity to meet the demand for health services. There is a need to understand the critical gaps in the supply of health cadres and to take inform decisions on spending the limited resources available on the cadres that meets current health system goals and requirements. Since decades, the pre service education and human resource development have continually being neglected by the policy makers. The quality of education and accreditation standards were never given a priority during expansion phase of the institutes. The fragmented governance, lack of leadership and coordination in both sectors kept the status quo with no active intervention or supervision. The Government have no updated information on the quality and quantity of health and allied institutes. This information when triangulated with other upcoming research data on distribution, skill mix and retention will create a comprehensive set of recommendations for policymakers, donors, and other stakeholders to consider both short-term options to address the immediate crisis and long-term options to build human resource sustainability. An approach that integrates training into a comprehensive HRH strategy will help achieving more sustainable improvements in HRH.

Libya 2018-Health Education and Training Institutions ||16 In order to generate evidence, a study was conducted to make Inventory of medical and allied health education and training institutions in Libya, update Information on the input and output of the health workforce studying in different disciplines of university and review the accreditation standards of undergraduate medical education, dentistry, nursing and pharmacy schools.

Table 1 : Current status of medical and allied health institutions

Ministry of Education Ministry of Health

institutes

Specialty

Technician

Profession

Universities

Public Health

Dental Schools

Health Health Sciences

Nursing Schools

Medical Medical Schools

Pharmacy Pharmacy schools

Medical Medical

rs of Medical

development center

Cen Intermediate nursing Medical manpower Libyan Board of Branch of Arab Board

* 2 *1 *1 *1 0 0 0 0 0 0 0 0

Non Non

Functional Functional

16 14 8 10 3 3 11 15 14 1 1 1 27

Functional

18 15 9 11 3 3 11 15 14 1 1 1

Total

Graduates of all cadres from Libyan Institutes. Since beginning of the medical and allied education, 1970 till end of 2017, Libyan institutions have produced, 30,056 nurses, 30007 technicians, 21,393 medical doctors, 15,064 dentists and 8,918 pharmacists.

Libya 2018-Health Education and Training Institutions ||17 Status of new students, final year students, total students and graduates from Libyan Institutes from 2010-2017. Faculty of Medicine Results of the last seven years (2010-2017) shows that average new admission in medical faculties of Libya is 2671. Only 35.5% of the students graduate as compared to the mean number of medical students in the final year (2010-2017) resulting in a high proportional mean increase in number of total students.

Faculty of Dentistry Analysis of the last seven year shows that the mean number of new students is 1468 while the mean number of graduates is 1150.The number of new students, final year’s students and total students are steadily increasing as compared to medical faculty. The trend shows that the new admissions are gradually on rise but with a steady graduation rate of 83.2%which is significantly higher than basic medical education.

Faculty of Nursing The number of new students of faculty in nursing in 2016-2017 have almost doubled as compared to year 2010-2011. The average graduation rate is 73.7%. On average 194 nursing graduates are produced by the faculty of nursing. Analysis shows that the total mean out of all type of nursing graduates is 334 while the faculty of nursing produces only 194 graduates. Some of the intermediate institutes have again started enrolling new students but have not produced any graduates yet.

Faculty of Pharmacy Analysis of the last seven year shows that on average 629 new pharmacy students are joining the faculty and on average 563 graduates are produced every year by the faculty of pharmacy. Trend shows the number of new admissions in pharmacy is on decline. By average 71.8% of the students graduate each year.

Faculty of Medical Technology The enrollment of new students have increased almost six times in 2016-2017 as compared to 2010-2011. On average 1516 new students are joining the faculty of medical technology and on average 1448 graduates are produced each year by the Libyan medical technology institutes. The average graduation rate is 80.4% which is significantly higher than medical graduates. Analysis of the output of the intermediate institute shows that there was no female trained in lab technicians, hygiene health and health inspection programs. Similarly no male was trained in community health. The male are frequently observed in radiology technician and pharmacy assistant cadres. Analysis of the output of the higher institute shows that the male and female are receiving the education in all the technical fields however male are frequently observed in all the technical fields.

Libya 2018-Health Education and Training Institutions ||18

Faculty of Health Sciences Result shows that on average 302 students are entering the health sciences institutes and on average 99 students are graduating with an average graduation rate of 77.3%. The number of new students are steadily increasing.

Faculty of Public Health Result shows irregular pattern of new students in faculty of public health. The graduation rate is high (89.5%) as compared to medical faculty. Data of the last seven year shows that on average 326 students are joining public health institutes and on average 249 students are graduating.

Technical education in Libya Since independence the nursing and other technical education kept on transforming and can be briefly explained in the different eras as follows. a. Early era. b. Intermediate Institutes. c. Higher Institutes. d. Faculties. e. Resurfacing of intermediate institutes Early era: 1957 - 1968: The first nursing assistance school was established in 1957, in Souk al Jumu’aa Tripoli to train female staff as assistant nurses. The medium of education was Arabic and duration of study was for 18 months, following the primary school education. After few years, 24 nursing assistance schools were established in Libya. In 1957 Benghazi Health Institute was established with support of WHO and other UN organization having specialties of nursing, health inspectors, laboratory technicians, pharmacy and radiology technician.

Era of Intermediate Institutes of Health (1970-2003) Technical health education developed after the establishment of the intermediate health institutes while assistance schools continued till 1994, from which 9678 assistant nurses graduated. The first Intermediate Health Nursing institutes was established in 1968. The admission criteria was successful completion of class 9th. It was three years of education in Arabic language. In 1980 the institutes were allowed to add other disciplines like laboratory, radiology, physiotherapy, public health, oral health and pharmacy assistants. The number of intermediate health institutes reached 49 distributed all over the Libya. There were 31 nursing schools attached to hospitals and it continued to work until the year 1998 during which all intermediate institutes have been closed.

Era of Higher Institutes / Centers of Medical Professions: The system of study in higher institutes was established by decision No. 898 of 1984 of the General People's Committee and were under the supervision of Ministry of Health. The decree No. 569 of 1987 was issued for the establishment of the first high institute of nursing. The decree No 298 of 1996 established higher health institutes for females all over Libya, with

Libya 2018-Health Education and Training Institutions ||19 an education period lasting three years after the secondary level. The number of institutes in nursing rose to 17 high institutes. The number of trainers are 270, teaching assistants are 275 while the number of students are 3766 in various professional disciplines In 2004 these higher institutes added other specialties. The system of higher institutes was officially suspended in 2007 where they opened 15 medical professional development centers having financial and administrative autonomy and have been transferred from the Ministry of Health to the Ministry of Education under the supervision of the National Authority for Technical Education. These centers have the following specialties: nursing, physiotherapy, optometric, laboratories, pathology and dentistry.

Era of Faculties and resurfacing of Intermediate Health Institutes for Nursing: (2015-2017) In 2007, the Faculties of Nursing was established and till date it reached 7 schools and is working under supervision of Ministry of Education. Similarly the Faculty of Medical Technology, Health Sciences and Public Health were established. After the exodus of the human resources for health as a result of the events and armed conflicts in Libya, the Ministry of Health considered the re-establishment of the system of intermediate schools to cover the shortage of nursing in the shortest possible time. Therefore, a number of 14 institutes were developed in the Western, Central and Southern Region. The program includes 30% theory and 70% practical training. The duration of the study is three years and gives the graduate an intermediate qualification which make them eligible to pursue their career in labor market or for continuing education in higher institutions but not at university colleges .The qualification falls within the educational and career ladder of the state. The number and distribution of intermediate health institutes, as shown in below table for the year 2015, reached 1288 students in the field of nursing.The students have not yet graduated and the institutes are affiliated with MOH.

Continuing Medical Education (CME). There are two institutions in Libya playing a major role in continuing medical education, with one specializing in medical subjects (the Libyan Board of Medical Specialties)and the other serving all the elements working in the health sector, regardless of its specialization and field of work (the Center for the Development of Medical Manpower). a. The Center for the Development of Medical Manpower conducts short training sessions for doctors in a number of areas such as: ultrasound, ECG, resuscitation, specialized qualification of 18 months to qualify in specialized fields such as: surgery, midwifery, neonatology, and intensive care. It also conducts training courses to enhance the capacity of health workforce in a number of medical, administrative and financial fields such as medical rehabilitation, ECG, sterilization, hospital infection, financial auditing and administrative affairs. b. The Libyan Board of Medical Specialties (LMBS) was established in 1994 along the lines of the Arab Council for Medical Specialties and the British Council for Medical Specialties. It facilitates the health workforce in achieving the required knowledge, skills and practical experience to obtain the certificates as specialized doctors. Till date 1002 doctors have completed postgraduate in different specialties. The LBMS is also responsible for the continuing medical education program, as well as encouraging research and cooperation with other regional and international training bodies such as the British Royal Colleges. The medical specialties currently provided by the LMBS are supervised and implemented

Libya 2018-Health Education and Training Institutions ||20 by scientific councils of professors and consultants, according to its specialization. These councils are managed by an administrative committee which is responsible for the administrative procedures related to the council according to its specialization and field of work. The council grants the Libyan fellowship certificate which qualifies its holder for appointment as a specialist in health facilities and staff teaching in medical education institutions as stated in Article VII. The current disciplines that the Council is implementing are: 1. Pediatrics.2. Internal Medicine.3. General Surgery.4. Emergency medicine.5. Neurosurgery. 6. Burns and Plastic surgery 7. Community Medicine.8. Anesthesia and intensive care.9. Orthopedic surgery.10. Diagnostic Radiology.11. Urology surgery12. Obstetrics and Gynecology 13. General medicine.14. Ophthalmology.15. Laboratories.16. Pathology.17. Otorhinolaryngology.18. Dermatology and venereology 19. Radiotherapy.

The number of beneficiaries of specialization from the Council of Medical Specialties since the graduation of the first batch in 1995 rose to 1002 specialists in various medical fields.

Committee for the evaluation of foreign certificates at the Council of Medical Specialties: The Ministry of Health wide decree No. (327) issued on 04.09. 1995 and in accordance to its fifth article, authorized the LBMS to evaluate the scientific certificates granted to the medical personnel who completed their specialized or training studies outside the country. A special committee called the “Evaluation Committee for Certification of Medical Specialist” was established by decision of the Secretary of the General People's Committee for Health No. 35 of 1996 issued on December 16, 1996. The Committee has equated 1319 certificates from the date of its establishment issued by different countries shown in below table

Arab Board of Specialty In 1980, several Arab countries, including Libya, set up the united Arab Board in many clinical specialties. The aim of the board is to improve residency training program, set comprehensive training standards for the various specialties and to establish a basis for a uniform assessment of the scientific, technical and practical level of trainees in the Arab states. The Arab Council for Medical Specialties is established by the League of Arab States and is headquartered in Jordan. It has branches in most of the Arab countries that are members of the Council. It is a specialized council in setting special examinations in most medical specialties in Libya. Many examinations have been held in the following disciplines:

- Otorhinolaryngology- Obstetrics and gynecology- Anesthesia and intensive care- Radiology - Ophthalmology. General Medicine - Cardiac Surgery.- Pathology and Anatomy.- Dermatology and venereology - Psychiatry.- Pediatrics - Pediatric surgery.- Orthopedic Surgery.

620 graduates obtained the certificate of the Arab Council for Medical Specialties till the end of 2017.

Libya 2018-Health Education and Training Institutions ||21 Research activities and biomedical publications Currently the following journals are published. 1. Libyan Journal of Infectious Disease published by Nation Center for Disease Control. 2. Libyan Medical Journal published by Libyan Board of Medical Specialties. 3. Tripolitana Medical Journal issue by Tripoli University 4. Benghazi University Medical Journal issued by Benghazi University 5. Libyan Journal of Dentistry issued by Benghazi University.

Status of Accreditation standards of Faculties of Medicine, Dentistry, Nursing and Pharmacy in three major institutes of Libya Introduction Establishing international standards for the education and qualifications of the health workforce and fostering improvement in the quality of education and qualifications are integral to the WHO mandate. Its strategic partnership with the World Federation for Medical Education (WFME) is based on a network of engaged partners with a long-term sharing of values and standards as the link between health professions education and health needs of the society. Its imminent goal is incorporation of global standards in national standards and accreditation procedures and in the development of guidelines for accrediting agencies. The WFME global standards embrace all phases of medical education, i.e. basic (undergraduate) medical education, postgraduate medical education and continuing professional development of medical doctors. The trilogy of global standards intends to facilitate the relationship between the stages of medical education.

Accreditation Standards The 2015 revision of the WFME global standards for quality improvement of Basic Medical Education, comprising altogether 106 basic standards and 90 quality development standards. The set of standards are structured according to 9 areas with a total of 35 sub-areas, being aware of the complex interaction and links between them. AREAS are defined as broad components in the process, structure, content, outcomes/competencies, assessment and learning environment of basic medical education and cover: 1. Mission and outcomes, 2. Educational program, 3. Assessment of students, 4. Students, 5. Academic staff/faculty, 6. Educational resources, 7. Program evaluation, 8. Governance and administration, 9. Continuous renewal Standards are specified for each sub-area using two levels of attainment: Basic Standard. These standard in principle must be met by every medical school and fulfilment demonstrated during evaluation of the school. Basic standards are expressed by a “must”.

Libya 2018-Health Education and Training Institutions ||22 Quality Standard. These standards are in accordance with international consensus about best practice for medical schools and basic medical education. Fulfilment of these standards will vary with the stage of development of the medical schools, available resources and educational policy and other local conditions influencing relevance, priorities and possibilities. Quality standards are expressed by “should”.

Accreditation mechanism of Libya In Libya there is a specialized center for Accreditation named National Center ofAccreditation and Quality Assurances of Teaching and Training institutes, established in 2007 under the supervision of Ministry of Education. It is responsible for accreditation and quality assurances of public and private teaching and training institutes. The center have a guide line for quality assurances. The process of accreditation is divided in two parts: First part: Governance and Program Management accreditation which consist of 9 Parameters with168 indicators. Second part: Academic Program accreditation which consist of 8 Parameters with134 indicators.

Status of accreditation standards of undergraduate medical education The three major undergraduate institutes of Libya were reviewed. It includes Tripoli Medical School, Benghazi Medical School and Omar Mokhtar Medical School.

Basic Standards Medical Quality Standards Medical 120 106 100 90 100 86 90 80 80 72 61 70 59 60 54 60 52 50 33 40 40 22 23 19 16 30 22 22 20 16 16 4 20 9 0 10 2 Total Tripoli Benghazi Omar 0 Standards Almoktar Total Tripoli Benghazi Omar Standards Almoktar

Achieved In progress No achievement at all Achieved In progress No achievement at all

Review shows that only 22 (20%) basic standards are achieved by Tripoli medical school, 33 (31%) by Benghazi medical school and only 4 (3%) by Omar Mukhtar Medical School. Very few quality indicators are achieved by all the medical schools.

Libya 2018-Health Education and Training Institutions ||23

Faculty of Medical School There is shortage of faculty in all medical schools. There is no professor and assistant professor for Anatomy in all medical schools. Benghazi and Omar Al Mukhtar medical school have only lectures for Anatomy. The shortage of faculty is evident in all fields of basic medicine.

Status of accreditation standards of undergraduate dental education Study team was able to review only Faculty of Dentistry Benghazi. Review shows that only 13 out of 106 basic standards of dentistry school are met. The school only provide evidence on 9 quality indicators out of 90.

Total Standards Dentistry 120 106 100 89 90

80 73

20 13 9 4 8 0 Total Standrads Basic Status Basic Total Standards Standards Quality Quality

Achieved In progress No achievement at all

Faculty of Dentistry Benghazi There are only 4 lectures for basic sciences in Dentistry School Benghazi. There is no professor for orthodontics, Oral biology, Pedodontics and basic sciences.

Review of Nursing Standards The WHO Regional Office recommends six standards for accreditation of Nursing Institutes. Standard one is related to governance structure and have 9 quality criterion. Standard 2 covers administrative structure and have 8 quality criterion. Standard 3 covers teaching, learning and organizational environment and have 11 quality criterion. Standard 4 is related to graduate professional practice and ethical standards and have 17 quality criterion. Standard 5 covers educator’s sufficiency in numbers and required competencies. It have 9 quality criterion. Standard 6 is related to infrastructure and teaching/learning resources and have 6 quality criterion.

Libya 2018-Health Education and Training Institutions ||24 Nursing Standards 80 70 70 60 47 47 50 40 36 30 19 20 15 14 15 9 8 10 0 Total Standards Tripoli Benghazi Omar Almoktar

Achieved In progress No achievement at all

Review shows that the nursing faculties have evidence of achievement of standards as low as 8 and as high as 18. More than two third (75%) of the standards are not met.

Faculty of Nursing Nurse’s education is not uniform in the schools. The three major subjects taught In Benghazi Nursing School are clinical audit, maternal and child nursing; and psychiatric and community nursing. There is no professor, associate or even lecturers for all the subjects. They have only two visiting staff for clinical audit, 5 other staff for maternal and child nursing and 10 other staff for psychiatric and community nursing. Nursing School of Tripoli conducts 4 major courses. Fundamentals of Nursing, General Nursing, Surgery and Operation Theater and Midwifery and Neonatology. This school is also relying on a limited number of lecturers in all subjects. In Omar Mukhtar Nursing school only general nursing courses are conducted and have only 5 staff.

Review of Accreditation Standards of Pharmacy. The CCAP accreditation are divided into 3 major parts i.e. academic program, governance and program management; and resources. The total standards covering these three parts are 24 and having 64 sub criterion. Assessment is done based on sub criterion. Part I: Academic Program. It covers educational outcomes, learning environment, curriculum, teaching, learning and assessment. Part 2: Governance and Program management. It covers university structure and commitment, faculty organization and leadership, planning and evaluation, admissions, continuous quality assurance of the program. Part 3: Resources. It covers student resources, human resources, practice site resources, financial resources, physical facilities and infrastructure and information resources.

Libya 2018-Health Education and Training Institutions ||25 Total Standards Pharmacy

70 64 60 54 50 44 40 28 30 18 18 19 20 8 10 1 2 0 Total Sub criterion of Tripoli Benghazi Omar Almoktar 24 standards

Achieved In progress No achievement at all

Overall result shows that institution having 75-100% evidence of achieving criterion ranges between 1 and 28. More than half of the sub-criterion does not qualify the criteria of accreditation.

Faculty of Pharmacy There is no professor for all 5 major subjects taught in Benghazi and Omar Mukhtar School for Pharmacy. The faculty in Omar Mukhtar is limited and have only lecturers or assistant lecturers.

Analysis of Existing Health Workforce (Physicians, Nurses/Midwives) against UHC/SDG and Ending of Preventable Maternal Mortality Criteria Libya have the health workforce (physicians, nurses/midwives) of 8.68 per 1000 population which is far higher than the criteria of achieving universal health coverage/SDG criteria of 4.45 per 1000 population and Ending of preventable maternal mortality criteria of 5.9 per 1000 population.

Analysis of Physicians current status and projected numbers in comparison with different countries 2017-2030 Libya have current 2.13 physicians per 1000 population. Projections are done to find out the needs based on maintaining the current ratio of 2.13 as well as applying the targets to 2.5, 3 and 4 per 1000 population of other countries having good indicators. In order to maintain the target of 2.13, 3541 doctors have to be hired in addition to the numbers who get retired or leave the Ministry of Health. The total minimal production of medical graduates till 2030 is expected to be 16731. It means 21 % of the graduates have to be hired by Ministry of Health to maintain the target of 2.13 physicians per 1000 population.

Libya 2018-Health Education and Training Institutions ||26

If MOH wants to enhance the target to 2.5 per 1000 population, then 6546 medical graduates have to be hired which is 39 % of the total production of graduates till 2030. If the planners desires to achieve target of 4 per 1000 population then the production of medical graduates have to be increased.

Analysis of Dentists current status and projected numbers in comparison with different countries 2017-2030 Libya have currently 0.894 dentists per 1000 population. The WHO global observatory shows that Jordan have the highest (0.896) dentists per 1000 population ratio. Need forecasting is done on the current ratio of 0.894. Analysis shows that till year 2030, 1484 dentists will be needed to maintain the same ratio of 0.894. The total estimated production of dentists till 2030 is 14590. The Ministry in addition to the dentists who will get retired or leave the Ministry have to hire 10% of the total dentists produced.

Libya 2018-Health Education and Training Institutions ||27

Analysis of Nurses current status and projected numbers in comparison with different countries 2017-2030 Projection to ascertain nurses needs are done based on maintaining current ratio (6.652 per 1000 population), Canada (9 per 1000 population) and Norway/Denmark (17 per 1000 population). In order to maintain the same standards, 20055 nurses will be required till end of year 2030. The average estimated production of nurses is 334 each year from nursing faculties and higher institutes. We assume that the number of production will reach 600 if we add the graduates of recently opened intermediate institutes. Estimates of production is done on 334 and 600 graduates each year. The projected estimates shows that the current ratio of 6.652 nurses per 1000 population cannot be met as the need is far more than the production. In future the country will face severe shortage of nurses.

Libya 2018-Health Education and Training Institutions ||28

Analysis of Pharmacists current status and projected numbers in comparison with different countries 2017-2030 Libya have 0.612 pharmacists per 1000 population. The annual production of pharmacists is 563 per annum. In order to maintain the current ratio till 2030, Libya will be needing 1014 pharmacists. Projected figure shows that till 2030, Libya will produce 7319 pharmacists. If the planners want to enhance the target to 1.59 per 1000 population, then 8957 pharmacists will be needed.

Libya 2018-Health Education and Training Institutions ||29

Analysis of Specialists current status and projected numbers in comparison with different countries 2017-2030 In Libya there are 1499 specialists registered with Libyan Board and Arab Board of Specialty. We couldn’t find any recommended criteria to assess the needs of specialists per population. However some study shows the number of specialist per 100,000 population. For every specialty, depending on the burden of disease, the criteria is different. Studies from America shows a high level of specialist per 100,000 population but we are comparing our results with at least one specialist per 100,000 population. This data does not reflect necessary the active specialists nor the one who have done post- graduation from the foreign institutes. Findings are based on registered specialists with Libyan Board or Arab Board and does not include foreigners.

Result shows that there is no specialty which fulfills the criteria of at least 1 specialist per 100,000 population. The specialist pediatricians are more frequently observed (344) while there are only 2 maxillary and facial specialist surgeons. Recommendations: Short Term  Establish a high level multisector committee to review the findings of the available evidence (Health institutions study and SARA study).  Recruit (import) the faculty especially for basic medical sciences.  Review of nursing curriculum and plan for the upcoming shortage of nurse’s crisis. Mid-Long Term  Review of accreditation standards of all faculties according to the international recommendations.  Enhance the capacity of the National Center of Accreditation and Quality Assurances of Teaching and Training institutes.

Libya 2018-Health Education and Training Institutions ||30  Invest in development of faculty staff by sending them abroad.  Develop human health resource strategy with clear targets and career laden pathways for all cadres.  Develop human resource development plan  Plan for increasing the number of specialists.

Libya 2018-Health Education and Training Institutions ||31 Chapter One: Context of the Study

1. Introduction 1.1 Background:

The ability of a country to meet its health goals depends largely on the knowledge, skills, motivation and deployment of the people responsible for organizing and delivering health services. Evidence shows a direct and positive link between numbers of health workers and population health outcomes (1, 2). Although it is important to know the total numbers of staff employed in each cadre but human resources for health (HRH) assessment is not just a “head count”. Perceived shortages of health workers have many causes and may be a result of inadequate numbers and skills mix of persons being trained or maldistribution of their deployment, as well as losses caused by death, retirement, career change or out-migration (3). The decade old emergency and unstable situation of the country have direct implications on the human resources of health. Service availability and readiness assessment survey (SARA) in Libya have clearly highlighted the imbalance and maldistribution of human health resources (4). The exodus of national and foreign skill workers, inability of the mangers to enforce the vague regulations, lack of monitoring and supervision, the continued absence or limited presence of some staff for few hours, coupled with limited availability of medicines have severely affected the service delivery of the country. The critical situation of human resources in Libya is well known but the knowledge about how to tackle it is limited. Funding for HRH and leadership to advocate for a comprehensive, long- term approach are lacking. Donor support tends to focus on disease specific projects without taking into account health services as a whole. Problems in HRH are viewed as MOH problems, but solutions require a multisector approach. Health managers and donors, who sometimes equate HRH with training, may propose incomplete solutions, such as adhoc hiring and training. Although training is an essential component of HRH, but should be planned in the context of effective human resource management. In Libya, the production of human resources for health is the prime responsibility of Ministry of Education. Ministry of Health also plays a role in production of certain cadres but there is a clear disconnect between the two ministries. The pre-service training institutions should have the capacity to meet the demand for health services. There is a need to understand the critical gaps in the supply of health cadres and to take inform decisions on spending the limited resources available on the cadres that meets current health system goals and requirements. Sustainable health workforce development is based on a comprehensive HRH strategy. It need leadership, multisector collaboration, and a long-term commitment. An approach that integrates training into a comprehensive HRH strategy will help achieving more sustainable improvements in HRH.

Libya 2018-Health Education and Training Institutions ||32 1.2 Rationale:

Since decade, the pre service education and human resource development have continually being neglected by the policy makers. The quality of education and accreditation standards were never given a priority during expansion phase of the institutes. The fragmented governance, lack of leadership and coordination in both sectors kept the status quo with no active intervention or supervision. The Government have no updated information on the quality and quantity of health and allied institutes. Limited studies (5-8) are available which highlights some of the issues related to human resource development. The information available in these studies is of great value but is not comprehensively addressing all the research questions; is limited to few institutes and moreover is not updated. Health and educational authorities are continually called upon to make a wide variety of decisions affecting the health workforce for example how many health workers, of what types and with what qualifications are required? How should the health workforce be distributed? What should they do and how should they be managed? The obvious reason for HRH planning is therefore to improve the quality of these decisions, and thus facilitate the orderly and timely training and deployment of the workforce. Against the backdrop of increasing demand for information, building knowledge and databases on the health workforce requires coordination across sectors. This is an attempt by the Information and Documentation Center to fill in the gap and conduct a field study to provide some base line information. This information when triangulated with other upcoming research data on distribution, skill mix and retention will create a comprehensive set of recommendations for policymakers, donors, and other stakeholders to consider both short- term options to address the immediate crisis and long-term options to build human resource sustainability. 1.3 Objectives of the study:

1. Inventory of medical and allied health education and training institutions in Libya. 2. Information on the input and output of the health workforce studying in different disciplines of university. 3. Review of the accreditation standards of undergraduate medical, dentistry, nursing and pharmacy education.

Sub-objectives of the study: • Quantitatively describing, analyzing and interpreting data on medical education output, so as to determine the weaknesses and strengths. • Evaluating the output of Higher Medical Education in relation to the country's needs and comparing this output with the number of currently active medical staff and health assistants in Libyan care facilities and the staffing approved in the health sector and against international indicators. • Analyzing the data and reports of Libyan health training institutions. • Explore the continuous professional development and continuous medical education.

Libya 2018-Health Education and Training Institutions ||33 Chapter 2: Methodology of the Study

2.1 Study Methodology: There is no organized record keeping system in Libyan medical universities. In order to obtain required information the following techniques were adopted.

• Desk Review: Historical data, Institutions report, Ministry of Education reports and Ministry of Health Reports. Institutes websites and published and unpublished research. • Data Collection Forms: Two separate data collection forms were designed and information was gathered from the institutions through repeated visits. • Data on all the trainings were collected from training institutes • Focus group discussion was conducted with Libyan Board of Specialties. • Focus group discussion with faculty of medicine, dentistry, nursing and pharmacy.

2.2Study Period. 01/02/2018 to 15/10/2018.

2.3Analysis a. Institution Data The data on number of new students enrolled, final year students, graduated students and total number of students in the last seven years were collected from all institutes. The aggregate number are presented in tables in main report while data by each institution is annexed. The mean number of new students, final years and graduate students of the last seven years are calculated. The percentage of graduated students are calculated from the mean number to explore the trends and do forecasting. Population estimates were taken from Bureau of Statistics, Libya. Forecasting is done based on the average output of the last seven years. The forecasted figures of defined health workforce (physicians, nurses/midwives) are compared with 2 targets mentioned below. The forecasted figures of physicians and nurses are compared with countries having good population ratios. The current ratio of pharmacist is projected as it ranks second after Jordan.  UHC coverage and SDG indicator criteria.  Ending preventable maternal mortality (EPMM) criteria  Comparison with other countries b. Accreditation Standards  Medical and Dental Institutes: The standards used are of World Federation of Medical Education.  Nursing Institutes: The WHO Regional Accreditation Standards are used.  Pharmacy Institutes: International Accreditation Standards of the Canadian Council for Accreditation of Pharmacy programs are used.

Libya 2018-Health Education and Training Institutions ||34 The guidelines of accreditation standards include analysis for each standard. Analysis was done based on evidence produced. A likered scale of 0-4 was used. 0 stands for having no evidence. 1 stands for having evidence in range of 0 to less than 25%. 2 equals for having the evidence in a range of 25-less than 50%, 3 equals for the evidence in a range of 50-less than 75%. 4 equals for the evidence in a range of 75-100%. The 106 basic and 90 quality standards of medicine and dentistry education were analyzed separately. In order to show the gaps and achievement, results are shown in total as having no achievement at all, in progress (0-less than 75%) and target achieved (75-100%). Analysis for nursing was done based on six standards having 70 quality criteria. Analysis for pharmacy was done based on 64 sub criterion, making 24 criteria. The standards are divided in three major parts. (Detail in accreditation chapter)

2.4Limitations 1. Data have been collected from all the functional faculties, except three i.e. Faculty of Dentistry of the University of Gharyan, the Faculty of Medicine of the University of Ijdabia and the Technical College of Bani Walid University for various reasons. 2. The number and expertise of faculty were not assessed because of some local constraints. 3. Accreditation standards of dentistry school of Tripoli could not be assessed because of local challenges.

Libya 2018-Health Education and Training Institutions ||35 Chapter 3 Human Resources in Health Sector

3. Studying the current status of human resources in the healthcare sector 3.1 Introduction to Human Resources:

The Libyan health sector and medical education has witnessed many changes in the past decades. The health system has been affected by the inefficiency of funds allocated from the state budget leading to acute shortage of medicines and equipment’s and lack of specialized critical staff. To cope with, new adhoc staff is hired instead of balancing the health workforce distribution. This growing number of ad hoc staff in the health sector has further exacerbated the myth of “ghost workers” phenomenon. There is limited coordination between health- related sectors, especially Ministry of Education in terms of acceptance of students in Medical Faculties with their different specialization fields. The sector do not keep pace with the modern information and communication era depriving the staff from benefitting from latest communication technologies. During the past few years many health and educational institutions faced destruction, burglary, vandalism and shortage of equipment, supplies, medicines and laboratory consumables, training equipment and laboratoriesreagentsetc.9. During the same period, a number of Libyan nationals and skilled workers settled abroad and a large number of skilled expatriates left the country because of lack of security, material and administrative reasons. All these challenges have resulted in low quality of health service delivery which led to a paradigm shift in the health seeking behavior of the population. Those who can afford, prefer to seek treatment abroad or visit private health facilities which is a great loss to the exchequer of the country.

3.2 Medical staff and healthcare assistants:

The number of workers in the health sector in Libya reached (132,209) persons from various medical and paramedical specialties and other functions (administrative, financial, etc.). Table 1 shows the distribution of workers in the health sector in 2017 according to their specialties.

Table 2 : Frequency of healthcare workforce for the year 2017 SPECIALIZATIONS NUMBER Specialists 4,391 General Practitioners 9,336 Nurses 41,934 Midwives 1,041 Dentists 5,776 Pharmacists 3,956 Health Technicians 29,375 Others jobs 36,400 Total 132,209 Source: Information and Documentation Center, MOH 2017

Libya 2018-Health Education and Training Institutions ||36 Libya has large number of health workforce but is mal distributed resulting in critical shortage of human resources in many health facilities. The weak governance due to security challenges and the financial constraints have encouraged the staff to use its influence and get transferred on one pre text or other. Some of the health workers do not come to facility at all and few visit the facility once a week. The imbalance distribution of health workforce in Libya is a recognized major problem as shown in below table.

Table 3 : Comparison of the distribution of medical and paramedical staff in Libya according to different hypothetical regions

Region / Specialists General Practitioners Nurses Midwives Specialization

Distribution Sanctioned Filled Sanctioned Filled Sanctioned Filled Sanctioned Filled Tripoli 1807 728 3624 2570 6819 3498 265 116 South 220 40 235 192 797 952 60 50 Eastern 536 241 663 601 2022 1735 134 70 Benghazi area 630 333 946 880 2153 1421 127 90 Central 359 166 439 387 1267 847 68 50 Western 705 389 851 796 2602 2210 172 91 Total 4257 1897 6758 5426 15660 10663 826 467 Source: Service Availability and Readiness Assessment Survey (SARA) 2017

Analysis highlights that the southern region has a large surplus in nursing and midwifery and a shortage of doctors, while Tripoli is facing nursing and midwifery shortage. The central region has a high percentage of midwifery and a shortage of specialist physicians and nursing. The Eastern region suffer from the shortage of specialist and midwives while Benghazi and the western region suffers from a shortage of specialist doctors. There is also midwifery shortage in the Western Region.

3.3 Status of Human Resources for Health (HRH) Libya, according to MDG Criteria

Table 4: Human Resources for Health per 10,000 people according to MDG Criteria

Specialization Ratio for each10,000 of the Ratio for each10,000 people globally, population in Libya according to WHO Criteria Doctors 21 : 10000 Nursing 66.5 : 10000 The overall ratio total doctors and nursing 20 : 10000 10000 :23 Dentists 8.9 : 10000 - Pharmacists 6 : 10000 - Source: Health Information and Documentation Center Report for 2014.

Libya 2018-Health Education and Training Institutions ||37 Above table shows that Libya has almost achieved the global target of 23 staff per 10,000 population.

3.4 Human resources for health: comparing different countries of the region: Table 4 shows the comparison of health workforce force indicators between Libya and a number of countries in the region per 10,000 population. According to the World Health Organization Statistics Report 2017, Libya has the highest ratio of nurses and midwives per 10,000 population followed by Kuwait.

Table 5 : Regional comparison of human resources for health Country Doctors Dentists Pharmacists Nursing and midwives Jordan 14.1 7.1 15.5 18.9

Bahrain 24.0 4.0 5.7 48.3

Tunisia 13.0 3.1 2.3 40.9 Libya 19.5 8.0 5.0 71.0 Iran 11.4 3.3 2.0 18.7 Syria 12.2 6.8 10.1 14.6 Amman 19.6 0.9 1.4 44.8 Kuwait 29.0 6.0 9.0 65.0 Lebanon 31.0 15.1 18.2 34.2 Egypt 8.1 1.8 3.9 15.0 Morocco, West, 6.3 1.4 0.1 8.9 sunset Saudi Arabia 23.9 4.4 7.9 57.0

Libya 2018-Health Education and Training Institutions ||38

RESULTS OF THE STUDY

Libya 2018-Health Education and Training Institutions ||39 Chapter 4 : Basic Medical and Allied Health Education and Training in Libya

4. Overview of Basic Medical and Allied Health Education and Training in Libya 4.1 Historical Prospective

 1951: Students sent abroad to Egypt, Italy and Britain on scholarship in form of economic assistance.  1957: First University was established having only 33 students.  1960: Medical students sent abroad by Libyan Government.  1970: First medical school established in Benghazi.  1973: Second medical school established in Tripoli.  1977-1978: The first batch of physicians (36) graduated from Benghazi Medical School.  1978-1979: The first batch of dentists (24) graduated from Benghazi Dental College.  1979-1980: First pharmacy school established in Tripoli.  1980: Arab board of specialty was introduced.  1984: Benghazi medical school merged with other health education related schools and became Al-Arab Medical University.  1986: Tripoli medical school merged with other health education related schools and became Al Fateh Medical University.  1986-87: The first batch of pharmacists (31) graduated from the Faculty of Pharmacy in Tripoli  1995: Libyan Board of Specialty was established.  2010: The Al Fateh Medical University merged with Al Fateh University offering non- medical education and was named as Al Fateh University. In 2011 it was renamed as Tripoli University.  2010-2011: The first batch of 9 nurses graduated from faculty of nursing in Tripoli.  2005-2006: The first batch of 100 laboratory technicians graduated from faculty of technician in Tripoli.

Libya 2018-Health Education and Training Institutions ||40 4.2 Current status of medical and allied institutes in Libya

Table 6: Status of the faculties related to medical and allied health education in Libya Ministry of Education Ministry of Health

Specialty

Universities Medical Schools Dental Schools Nursing Schools Pharmacy schools Health Sciences Public Health Medical Technician Centers of Medical Profession Intermediate nursing institutes manpower Medical development center Libyan Board of Specialty Branch of Board of Arab

al 0 0 0 0 0 0 0 0

Non * 2 *1 *1 *1

Function

16 14 8 10 3 3 11 15 14 1 1 1

Functiona

18 15 9 11 3 3 11 15 14 1 1 1

Total

*The official decree is issued to the university but has not started enrolling the students

The Libyan universities have accredited 18 medical schools (including 1 private), 15 dental schools (including 3 private) and 9 nursing schools. There are 11 pharmacy schools (including 1 private), 3 health sciences schools, 3 public health schools and 11 medical technician schools. Out of the total 27 universities related to medical and allied health education, only 2 universities which are owned by government (Sidra and Aljofra) are not in operational mode. In Sidra university, all the four schools (medical, dental, nursing, pharmacy) have not yet started enrollment. In Aljofra the medical technician school is functional but the undergraduate medical school has yet to start enrollment. Region wise details are available as (Annex 1). There are 15 centers of medical profession working under Ministry of Education. Details available as (Annex 2).There are also teaching institutes which are attached to the hospitals and are working under the Ministry of Health. There are 14 intermediate nursing schools (Annex 3), a medical development center and Libyan Board of Specialty. The branch of Arab Board of Specialty is also functional.

Libya 2018-Health Education and Training Institutions ||41 4.3 Number of graduates of Medicine, Dentistry and Pharmacists in Libya

Figure 1: Total number of graduates from 1970 till end 2017.

Graduates of all type of caders from the Libyan Institutes (1970-2017)

35000 30056 30000 30007 25000 21393 16895 20000 15064 15000 10776 12549 10117 8918 10000 11337 2938 6199 5667 5633 2001 3475 4912 3232 5000 1475 1463 3961 464 861 1358 0 125 1977-1987 1987-1997 1997-2007 2007-2017 Total Medical 1475 3475 5667 10776 21393 Dentists 125 861 3961 10117 15064 Pharmacist 464 1463 1358 5633 8918 All type of Nurses 2938 12549 11337 3232 30056 Technicians 2001 6199 4912 16895 30007

Medical Dentists Pharmacist All type of Nurses Technicians

Since beginning of the medical and allied education till end of 2017, Libyan institutions have produced, 30056 nurses, 30007 technicians, 21,393 medical doctors, 15,064 dentists and 8918 pharmacists.

Libya 2018-Health Education and Training Institutions ||42 Chapter Five Findings of Basic Medical Education in Libya

5. Field Study of Basic Medical Education Institutions in Libya 5.1-Introduction

The improved health of all peoples is the main goal of medical education. It is the foundation on which high quality healthcare is built and will establish the principles in the formative years that will guide doctors through their ever-changing careers. Medical students must be educated in an atmosphere where excellence is expected and enabled to lead the changes as the year passes on. Training is equally important because the newly graduated doctor needs extensive knowledge and practical skills necessary to manage the humans. This section represent the findings of 15 out of 16 functional medical schools including one private medical school. 5.2 Number of students in medical schools during the last seven years (2010-2017)

Table 7: The number of undergraduate new medical students enrolled, final year students, total number of students and graduates from 2010-2017

Academic Year First year students Final year students Total Students Graduates

2010-2011 2500 4070 18286 474 2011-2012 1164 3021 16989 2046 2012-2013 3206 4358 19635 919

2013-2014 2097 3687 16063 1572 2014-2015 3249 3860 19165 1272 2015-2016 3654 3459 17777 1623 2016-2017 2830 2877 16797 1100

Mean 2671 3619 17816 1287

Graduation rate is calculated by taking the mean of last year students and graduates. The mean graduated rate is 35.5%. Below figure shows irregular patterns of admissions in the last seven years which warrants review of the accreditation of the medical undergraduates institutes especially the admission policy during the current emergency situation of the country.

Libya 2018-Health Education and Training Institutions ||43 Figure 2: Trend of undergraduate medical students in the last seven years

Trend of undergraduate medical students in the last seven years

2016-2017 2015-2016 2014-2015 2013-2014 2012-2013 2011-2012 2010-2011 0 5000 10000 15000 20000 25000 30000

Number of new student Final Year Students Total Students Graduates

Figure 3 : shows the mean number of new students, final students, total students and graduates of medical schools of Libya (2010-2017).

Mean

Graduate 1287

Total Students 17816

Final Students 3619

New Students 2671

0 2000 4000 6000 8000 10000 12000 14000 16000 18000 20000

Results of the last seven years (2010-2017) shows that average new admission in medical faculties of Libya is 2671. Only 35.5% of the students graduate as compared to the mean number of medical students in the final year (2010-2017) resulting in a high proportional mean increase in number of total students. University wise distribution of new students, final year students, total students and graduates for last 7 years is annexed as A4-7.

Libya 2018-Health Education and Training Institutions ||44 Coordinates of the Medical Schools in Libya

Libya 2018-Health Education and Training Institutions ||45 Images of some medical schools of Libya

Faculty of Medicine, Misruata Faculty of Medicine, Tripoli

Faculty of Medicine Benghazi Faculty of Medicine, Sabha

Faculty of Medicine Faculty of Medicine Faculty of Medicine El Marqab Omar EL Mukhtar Ezaouia

Libya 2018-Health Education and Training Institutions ||46

5.3 Schools of Oral and Dental Surgery:

Table 8: The number of new students, final year and total students and graduates in Dental and Oral Medicine Faculties for the last seven years

Academic Year First year students Final year students Total Students Graduates

2010-2011 1113 2063 6410 1064 2011-2012 1156 1278 6670 1761 2012-2013 1324 1573 6913 1797 2013-2014 1521 1297 7333 1326 2014-2015 1310 1363 6933 675 2015-2016 1677 1305 8331 954 2016-2017 2174 796 9942 470

Total 10275 9675 52532 8047 Mean 1468 1382 7505 1150

Analysis of the last seven year shows that the mean graduation rate is 83.2%. The graduation rate of dentists is 2.5 times greater than faculty of medicine. The number of new students, final year students and total students are also steady as compared to medical faculty. University wise distribution are annexed as A8-11.

Figure 4 : Trends of undergraduate dentistry students for the last seven years Trends of undergraduate dentistry students for the last seven years

2016-2017 2015-2016 2014-2015 2013-2014 2012-2013 2011-2012 2010-2011

0 2000 4000 6000 8000 10000 12000 14000 16000

The number of new students Final year students Total Students Graduated Student

Trend shows that the new admissions are gradually increasing but having a steady graduation rate as compared to undergraduate medical faculty.

Libya 2018-Health Education and Training Institutions ||47 Figure 5: Mean number of new students, final year students, total students and graduates for the year 2010-2017. Mean

New Students 1468

Final Students 1382

Total Students 7505

Graduate 1150

0 1000 2000 3000 4000 5000 6000 7000 8000

The mean number of new students is 1468 while the mean number of graduates is 1150 for the last seven years (2010-2017).

Libya 2018-Health Education and Training Institutions ||48 Figure 6 : Coordinates of Oral and Dentistry Schools in Libya

Libya 2018-Health Education and Training Institutions ||49 Figure 7 : Photos of some dentistry schools of Libya

The Faculty of Dentistry The Faculty of Dentistry Tripoli El Margib

The Faculty of Dentistry The Faculty of Dentistry Ezzaouia Sebha

Libya 2018-Health Education and Training Institutions ||50 5.4 Nursing School:

The Faculty of Nursing have 4 specific courses. General Nursing, Surgery and Operation Theater, Anesthesia and Intensive care unit, Midwives and Neonatology.

Table 9: The number of new students, final year, total students and graduates in Nursing Faculties for the last seven years

Academic First year Final year Total Students Graduates Year students students

2010-2011 368 224 1469 223 2011-2012 375 332 1308 216 2012-2013 378 325 1585 230 2013-2014 392 279 1502 201 2014-2015 498 183 1427 152 2015-2016 695 266 2430 201 2016-2017 879 229 2923 135 Mean 512 263 1806 194

Result shows that the number of new students in 2016 have almost doubled as compared to year 2010-2011. The average graduation rate is 73.7%. University wise distribution is annexed as A12-15.

Figure 8: Trends of Faculty of nursing students in the last seven years Trends of Faculty of nursing students in the last seven years

2016-2017

2014-2015

2012-2013

2010-2011 0 500 1000 1500 2000 2500 3000 3500 4000 4500

The number of new students Final year students Total Student Graduated Student

Libya 2018-Health Education and Training Institutions ||51 Figure 9: Mean number of new, final year, total students and graduates in the last seven years (2010-2017). Mean

Graduate 194

Total Students 1806

Final Students 263

New Students 512

0 200 400 600 800 1000 1200 1400 1600 1800 2000

On average 194 nursing graduates are produced by the faculty of nursing.

Figure 10: Nurses/Midwives output by type and level of institutions. Nurses/Midwives output by type and level of institutes

35000 30056 30000 25653 25000 20000 15000 10000 2464 5000 581 10 0 130 1358194 334 0 Midwife Intermediate Higher Faculty Total institutes Institutes

Number Mean output

Analysis shows that the total mean output of all type of nursing graduates is 334 while the faculty of nursing produces only 194 graduates. Some of the intermediate institutes have again started enrolling new students described below in the chapter on technical education.

Libya 2018-Health Education and Training Institutions ||52 Figure 11 : Coordinates of Nursing Schools of Libya

Libya 2018-Health Education and Training Institutions ||53 Figure 12 : Photos of some nursing schools in Libya

اNursing School Sabha Nursing School Tripoli

Nursing School Benghazi

Libya 2018-Health Education and Training Institutions ||54 5.5 Schools of Pharmacy:

Table 10 : The number of new students, final year and total students and graduates in Pharmacy Faculties for the last seven years

Total Academic Year First year students Final year students Graduates Students

2010-2011 1079 907 5408 777 2011-2012 468 791 5858 569 2012-2013 871 1344 5185 1012 2013-2014 358 1149 3575 947 2014-2015 532 640 2576 389 2015-2016 551 353 1926 194 2016-2017 542 303 1920 56 Mean 629 784 3778 563

Result shows that the number of new admissions in pharmacy is on decline. By average 71.8% of the students graduate. University wise distribution is annexed as A16-19.

Figure 13: Trend of undergraduate pharmacy students in the last seven years (2010-2017) Trend of undergraduate pharmacy students in the last seven years (2010-2017)

2016-2017 2015-2016 2014-2015 2013-2014 2012-2013 2011-2012 2010-2011

0 1000 2000 3000 4000 5000 6000 7000 8000 9000

New Students Final year students Total Students Graduated student

Libya 2018-Health Education and Training Institutions ||55 Figure 14: Mean number of new, final year, total students and graduates of pharmacy for the last seven years (2010-2017).

Mean

Graduate 563

Total Students 3778

Final Students 784

New Students 629

0 500 1000 1500 2000 2500 3000 3500 4000

Analysis of the last seven year shows that on average 629 new pharmacy students are joining the faculty and on average 563 graduates are produced every year by the faculty of pharmacy.

Libya 2018-Health Education and Training Institutions ||56 Figure 15 : Coordinates of the Pharmacy Schools in Libya

Libya 2018-Health Education and Training Institutions ||57 Figure 16 : Photos of Some Schools of Pharmacy

School of Pharmacy School of Pharmacy Benghazi Tripoli

School of Pharmacy Ezzaouia

Libya 2018-Health Education and Training Institutions ||58

5.6 Medical Technology School:

In Tripoli, the medical technology have 6 specialties. Laboratory, Pathology, Anesthesia and ICU, Dental technologist, physiotherapy and public health.

Table 11 : The number of new students, final year and total students and graduates in Medical Technology Faculties for the last seven years First year Final year Academic Year Total Students Graduates students students

2010-2011 679 3624 2773 2552 2011-2012 561 2862 2245 2104 2012-2013 714 1135 2237 1119 2013-2014 974 1653 2546 1211 2014-2015 1534 826 1981 726 2015-2016 2870 701 4294 668 2016-2017 3283 658 4703 636 Mean 1516 1637 2937 9237

Result shows that the enrollment of new students have increased almost six times in 2016- 2017 as compared to 2010-2011. The average graduation rate is 80.6% person which is significantly higher than medical graduates. University wise distribution annexed as A20-23.

Figure 17 : Trend of students of Faculty of Medical Technology for the last seven years Trend of students of Faculty of Medical Technology for the last seven years

2016-2017 2015-2016 2014-2015 2013-2014 2012-2013 2011-2012 2010-2011

0 2000 4000 6000 8000 10000 12000

The number of new students Final year students Total students Number of graduates

Libya 2018-Health Education and Training Institutions ||59 Figure 18: Mean number of new, final year, total students and graduates in the last seven years (2010-2017). Mean

Graduate 1320

Total Students 2937

Final Students 1637

New Students 1516

0 500 1000 1500 2000 2500 3000 3500

Result shows that on average 1516 new students are joining the faculty of medical technology and on average 1320graduates are produced each year by the Libyan medical technology institutes.

Libya 2018-Health Education and Training Institutions ||60 Figure 19: Gender wise distribution of graduates from intermediate institutes (1972-2003)

4500 3877 3878 3830 4000 3500 3000 2500 2140 2000 1688 1690 1500 1077 1077 1144 1176 1176 1000 544 649 283 283 415 234 500 0 1 0 0

Total Total Total Total Total Total Total

Male Male Male Male Male Male Male

Female Female Female Female Female Female Female Lab X ray CH Hyg Health Health insp Pharmacy Dental assistant technician

Analysis of the output of the intermediate institute shows that there was no female trained in lab technicians or hygiene health course or health inspection courses. Similarly no male trained was trained in community health. The male are frequently observed inradiology and pharmacy assistant education programs.

Figure 20: Gender wise distribution of graduates of higher institutes (2004-2017) Higher Institutes (2004-2017) 3000 2551 2500 2000 1736 1500 1303 1000 815 739 798 429 444 561 505 500 239 295 334 227 190 103 68 171

Total Total Total Total Total Total

Male Male Male Male Male Male

Female Female Female Female Female Female Lab X ray CH Oral Health Physiotherapy Optimetrics

Analysis of the output of the higher institute shows that the male and female are receiving the education in all the technical fields however male are frequently observed in all the technical fields.

Libya 2018-Health Education and Training Institutions ||61 Figure 21 : Coordinates of Medical Technology Schools of Libya

Libya 2018-Health Education and Training Institutions ||62

5.7 School of Health Sciences:

Table 12: The number of new students, final year and total students and graduates in Health Science Faculties for the last seven years

First year Final year Academic Year Total Students Graduates students students

2010-2011 322 131 1233 126 2011-2012 409 209 1322 116 2012-2013 254 173 1016 149 2013-2014 218 130 864 141 2014-2015 179 135 862 62 2015-2016 172 65 322 52 2016-2017 557 55 557 48 Mean 302 128 882 99

The Faculty of Health sciences have two specific courses i.e. General Nursing and Laboratory technician. Analysis shows that the number of new students are steadily increasing. The average graduation rate is 77.3%. University wise detail of the distribution of students is annexed as 24-27.

Figure 22: Trend of students of Health Sciences for the last seven years

Trend of students of Health Sciences for the last seven years

2016-2017

2015-2016

2014-2015

2013-2014

2012-2013

2011-2012

2010-2011

0 500 1000 1500 2000 2500

New students Final year students Total Students Number of graduates

Libya 2018-Health Education and Training Institutions ||63

Figure 23: The mean number of new, final year, total students and graduates for the last seven years. Mean

Graduate 99

Total Students 882

Final Students 128

New Students 302

0 100 200 300 400 500 600 700 800 900 1000

Result shows that on average 302 students are entering the health sciences institutes and on average 99 students are graduating.

Libya 2018-Health Education and Training Institutions ||64 Coordinates of Health Sciences Schools of Libya

Libya 2018-Health Education and Training Institutions ||65

5.8 Public Health Schools:

The Public Health Faculty course is for four years. In first two years the students are exposed to general public health curriculum. In next two years the technician specializes in three separate technical areas i.e. environmental health, nutrition and administration (management). The nutrition technicians work in hospitals by doing inspections and monitor the preparation and distribution of food to the patient. They also inspect and follow the food in industry, storage and distribution in shops. The environment health technicians support the authorities at the ports of entry, control food entry and sanitation at the ports, borders, plans, ships and support international certification process. The administration technicians support the authorities in management of the public health facilities.

Table 13 : The number of new students, final year and total students and graduates in Public Health Faculties for the last seven years

Academic Year First year students Final year students Total Students Graduates

2010-2011 462 339 1595 316 2011-2012 288 410 1493 366 2012-2013 63 368 1238 348 2013-2014 248 414 1171 369 2014-2015 226 24 297 22 2015-2016 346 16 568 15 2016-2017 648 377 1732 305 Mean 326 278 1156 249

Result shows irregular pattern of new students. The graduation rate is high (89.5%) as compared to medical faculty. Institution wise distribution of students are annexed A28-31.

Libya 2018-Health Education and Training Institutions ||66 Figure 24: Trends of students of Public Health Faculty for the last seven years

Trends of students of Public Health Faculty for the last seven years

2016-2017 2015-2016 2014-2015 2013-2014 2012-2013 2011-2012 2010-2011

0 500 1000 1500 2000 2500 3000 3500

New students Final year students Total students Number of graduates

Figure 25: Mean number of new, final year, total students and graduates in the last seven years.

Mean

Graduate 249

Total Students 1156

Final Students 278

New Students 326

0 200 400 600 800 1000 1200 1400

Data of the last seven year shows that on average 326 students are joining the public health institutes and on average249 students are graduating.

Libya 2018-Health Education and Training Institutions ||67 Coordinates of Public Health Schools of Libya

Libya 2018-Health Education and Training Institutions ||68 Chapter 6 Study and exams in medical colleges

6. Medical and health education and training in Libya 6.1 Preface

Medical education, the art and science behind medical learning and teaching, has progressed and become more scientific and rigorous. Curricula are based on sound evidence based scientific principles. Teachers have progressed from the role of problem-identifier to that of the solution-provider. During the last three decades medical schools have developed new curricula, new learning situations, new methods of assessment and a realization of the importance of staff development The effective and efficient delivery of healthcare requires not only knowledge and technical skills but also analytical and communication skills, interdisciplinary care, counseling, evidence and system-based care. This warrants our assessment systems to be comprehensive, sound and robust enough to assess the requisite attributes along with testing for essential knowledge and skills. Libya inherited the medical education from the colonial rule. The newly established medical education system was based on the British curriculum and used English as the language of instructions. The students have to go through a preparatory year where general subjects such as chemistry, physics, zoology, botany and statistics is taught. This is followed by 3 years of basic science teaching which includes anatomy, histology, biochemistry, physiology, microbiology, immunology, parasitology, pharmacology and pathology. This follows clinical training in different subjects such as internal medicine, surgery, obstetrics, gynecology and pediatrics. The ophthalmology, forensic medicine and community medicine were regarded as separated subjects and had their own exam. The graduates have to go through a year of internship which is divided as follows: 3 months general medicine, 3 months general surgery, 2 months obstetrics, 2 months pediatrics, 1 month community medicine and 1 elective month. The teaching method is mainly based on large group teaching in a form of didactic lectures. It is teacher centered and completely separates basic sciences from clinical ones. Previously the methods of assessment were based on written exams which mainly constitute multiple choice questions, short and long assays, clinical exam including short and long cases and viva. In the last five years all the exams are replaced by multiple choice questions and OSCE was introduced by the Tripoli University. In the first few years of the launch of both medical schools the number of students were limited, and good standards of teaching were applied. The selection criteria were clear and relied on the grades achieved by the students in their high school examinations. The schools adhered to the international standards of the time, and external visitors and examiners were a regular and essential part of the teaching and the assessment process. Both schools enjoyed a good reputation both regionally and internationally, and some of their graduates currently hold good clinical and research jobs in Europe and North America (5, 6). Over the years the number of students increased to several hundreds, and then several thousand without any matching increase in the resources. Neither school managed to develop or evolve which inevitably lead

Libya 2018-Health Education and Training Institutions ||69 to a slip in the general standards (5, 6).All new medical schools copied the same curriculum from Benghazi and Tripoli medical schools and applied similar teaching and assessment methods. The team of the national experts visited Egypt, Jordan, Lebanon, Britain and Philippines and examined their medical education programs including curricula and assessment methods. Central committees for each specialty were established and with support of internal expert’s medical education system, curricula and assessment methods were adapted and implemented. In 2010, based on the decree of the General People's Committee No. (501), the medical education system, curricula and assessment methods were reviewed. 6.2 Education curriculum in the medical and allied universities

The system of admission, study and examinations, courses and curricula vary in medical schools from one specialty to other. In 2008, the Ministry of Education modified courses and curricula for most medical specialties. The booklets were prepared and prepared by committees formed for this purpose. The results of these committees were consulted with the international experts. The Ministry of Education has directed the Libyan universities to modify and implement the new curricula. In 2013, a circular was issued by the Ministry of Higher Education on the modernization of curricula, and study plans for all colleges. Some of these colleges updated and amended their courses and curricula. The curricula of the medical colleges applied in the academic year 2017/2018of various faculties is annexed as A 32-41.

Libya 2018-Health Education and Training Institutions ||70 Chapter 7 Technical Health Education in Libya

7. Technical Health education in Libya (intermediate institutes, higher institutes and centers of medical profession) 7.1 Preface

The history of medical technology goes back to 1918, when the American College of Surgeons conducted the first inspection of the hospitals and recommended establishing a new cadre of laboratory technicians. In 1920’s eventually the American Medical Association established a structure by witch eventually the professionals “allied” with physicians could help physicians carrying out the lab work which was very time consuming. The technical health education in Libya goes back to 1932, the time of the Italian governor (Balbo) who started the first school of nursing and announced it in the local newspaper. It was called the (Islamic School of Health) with its headquarters in Al Zawiya Avenue in Tripoli. The medium of education was Italian with an additional year of training in obstetrics and nursing. The school closed three years after its opening. The teaching of males in the nursing profession started in Tripoli Central Hospital in the era of the English military administration. After the end of World War II in 1944, Libyan nurses were trained in short courses to assist foreign nurses. Since independence the nursing and other technical education kept on transforming and can be briefly explained in the following phase manners. a. Early era. b. Intermediate Institutes. c. Higher Institutes. d. Faculties. e. Resurfacing of intermediate institutes

7.2 Early era: 1957 - 1968:

The first nursing assistance school was established in 1957, in Souk al Jumu’aa Tripoli to train female staff as assistant nurses. The medium of education was Arabic and duration of study was for 18 months, following the primary school education. After few years, 24 nursing assistance schools were established in Libya. In 1957 Benghazi Health Institute was established with support of WHO and other UN organization having specialties of nursing, pharmacy technician, Laboratory technicians, health inspectors and radiology technician.

7.3Era of Intermediate Institutes of Health (1970-2003)

Technical health education developed after the establishment of the intermediate health institutes while assistant nurses schools continued till 1994. A total of 9678 assistant nurses graduated from these assistant nurses school. The first Intermediate Health Nursing institutes was established in 1968. The admission criteria was successful completion of class 9th. It was three years of education in Arabic language. In 1980 the institutes were allowed to add other disciplines like laboratory, radiology, physiotherapy, public health, oral health and pharmacy assistants. The number of intermediate health institutes reached 49 distributed all over the Libya. There were 31 nursing schools attached to hospitals and it continued to work until the year 1998 during which all intermediate institutes have been closed. Detail output of intermediate nursing institutes annex as A-41.

Libya 2018-Health Education and Training Institutions ||71

Table 14: The number of graduates of Intermediate health Institutes from 1970 to 2003 S. No Specialization Male Female Total 1 General Nursing 3586 22067 25653 2 Laboratory 1077 0 1077 3 Radiology technician 1144 544 1688 4 Physiotherapy 375 1558 1933 5 Community Health 1 3877 3878 6 Oral Hygiene 0 283 283 7 Health Inspectors 1176 0 1176 8 Pharmacist Assistant 1690 2140 3830

7.4 Era of Higher Institutes / Centers of Medical Professions:

The system of study in higher institutes was established by decision No. 898 of 1984 of the General People's Committee and were under the supervision of Ministry of Health. The decree No. 569 of 1987 was issued for the establishment of the first high institute of nursing. The decree No 298 of 1996 established higher health institutes for females all over Libya, with an education period lasting three years after the secondary level. The number of institutes in nursing rose to 17 high institutes. The number of trainers are 270, teaching assistants are 275 while the number of students are 3766 in various professional disciplines.

In 2004 these higher institutes added other specialties. The system of intermediate institutes was officially suspended in 2007 where they opened 15 medical professional development centers having financial and administrative autonomy and have been transferred from the Ministry of Health to the Ministry of Education under the supervision of the National Authority for Technical Education (Annex A-2). These centers have the following specialties: nursing, physiotherapy, optometric, laboratories, pathology and dentistry.

7.5Era of Faculties and resurfacing of Intermediate Health Institutes for Nursing: (2015- 2017)

In 2007, the Faculties of Nursing was established and till date it reached 7 schools and is working under supervision of Ministry of Education. Similarly the Faculty of Medical Technology, Health Sciences and Public Health were established. After the exodus of the human resources for health as a result of the events and armed conflicts in Libya, the Ministry of Health considered the re-establishment of the system of intermediate schools to cover the shortage of nursing in the shortest possible time. Therefore, a number of 14 institutes were developed in the Western, Central and Southern Region. The program includes 30% theory and 70% practical training. The duration of the study is three years and gives the graduate an intermediate qualification which make them eligible to pursue their career in labor market or for continuing education in higher institutions but not at university colleges .The qualification falls within the educational and career ladder of the

Libya 2018-Health Education and Training Institutions ||72 state. The number and distribution of intermediate health institutes, as shown in below table for the year 2015, reached 1288 students in the field of nursing. The students have not yet graduated and the institutes are affiliated with MOH.

Table 15: New Intermediate Nursing Institutes M Institute teachers Number of first Number of Total Number year students second year students 1 Tajura Institute 15 48 45 93 2 Zliten Institute 26 62 68 130 3 Msallata Institute 15 24 34 58 4 Gharyan Institute 16 35 55 90 5 Misurata Institute 15 45 66 111 6 Zintan Institute 15 60 0 60 7 Sabratha Institute 15 72 92 164 8 Ajaylat Institute 16 55 48 103 9 Sabha Institute 15 50 100 150 10 Al Zawia Institute 17 46 22 68 11 Burns and Plastic surgery 15 34 30 64 Institute 13 Murzuq Institute 15 30 45 75 14 Institute of Tripoli Medical - 47 - - Center Total - 627 661 1288 Source: Ministry of health 2018

 The strengths of technical Health education in Libya are as follows: 1. Availability of the infrastructure of a number of institutions which provides technical education. 2. Higher technical institutes accommodate large numbers of students, both males and females. 3. The horizontal expansion of the technical education institutions includes all regions of Libya and this facilitates access to these institutions. 4. The diversity of scientific disciplines in the higher technical institutes and their ability to adapt the skills required for the labor market. 5. Higher technical institutes have legal status having independent administrative and financial autonomy that enable them to compete. 6. The presence of one supervisory body responsible for practical coordination among them in terms of distribution of competencies and development of curricula.

Libya 2018-Health Education and Training Institutions ||73  Challenges of Higher Technical Institutes in Libya: • The reluctance of many graduates of basic education to enroll in the educational system of the institutes in some scientific disciplines because of the inferior social view to graduates of these institutions. • Poor coordination of planning efforts for technical higher education programs. • Poor coordination between educational and specialized institutions and the requesting bodies of graduates of these institutions and hence the inconsistency between the nature of education outputs and actual needs in the labor market. • Absence of an economic map that shows the distribution of economic activities in different regions of Libya on the basis of which educational, technical and academic programs are adopted. • Weak financial resources allocated to technical institutes which resulted in low quality of education. • Lack of available resources • Poor infrastructure of some of the higher technical institutes.

Libya 2018-Health Education and Training Institutions ||74

Chapter 8 Continued Medical Education 8. Training and continuous medical education 8.1 Preface

Continuing Medical Education (CME) is a process of continuous learning by which medical professionals keep themselves updated through acquisition of new knowledge, skills and attitudes to maintain professional competency, in-patient management, health services management (including organizing teaching) and their own professional development. Over the years, the scope of CME has broadened from mere clinical updates to a wide-ranging "continuing professional development" that includes behavioral change, social and managerial skills and the multidisciplinary context of patient care. The ultimate goals of the program are to reassure patients and the public that doctors remain competent, confident and compassionate throughout their career; and to augment patient care, outcome and satisfaction by setting standards for good medical practice. The increasing speed of innovation in the realm of medicine requires doctors to be prepared for lifelong learning and continuous, autonomous professional development. The CME/CPD program should be based on country needs, perceptions and prevailing practices. The organization and delivery of CME/CPD need to be shaped in the context of globalization of health, cross-country migration of medical workforce, evidence-based medicine, changing contents to meet societal, demographic, cost-effective demands; and also varied trends in assessment of professional competence. There should be a statutory body governing the CME/CPD system. The system should be efficient, fair, transparent, credible and accountable. The different characteristics of the system must be known and accessible to all stakeholders. The system would also ensure recognition, support, cooperation, collaboration, coordination and adherence to the guidelines. It should employ appropriate modalities based on comprehensive needs assessment in order to evaluate areas such as the physician perspective (training needs, career development needs, attitudes and perceptions on CME/CPD), patient perspective (expectations from a doctor), opinions of governing bodies, professional bodies and available logistics. There should be a mechanism in place to evaluate the impact of CME/ CPD. There are two institutions in Libya for training and continuous medical education, with one specializing in medical subjects (the Libyan Board of Medical Specialties) and the other serving in diverse subjects related to the health sector, regardless of its specialization and field of work (the Center for the Development of Medical Manpower).This part of the study focuses on these two institutions.

Libya 2018-Health Education and Training Institutions ||75 8.2 Medical Manpower Development Center:

The Medical Manpower Development Center was established in 1994 by the General People's Committee decision No. 5 of 1994 in order to enhance the capacity of the health workers in various fields. The Center offers specialized programs and training courses, as follows: 1. Short training sessions for doctors in a number of areas such as: ultrasound, ECG, resuscitation. 2. Specialized qualification of 18 months to qualify in specialized fields such as: surgery, midwifery, neonatology, intensive care. 3. Training courses to enhance the capacity of health workforce in a number of medical, administrative and financial fields such as physiotherapy, ECG, sterilization, hospital infection, financial auditing, and administrative affairs. From 2003 till 2015, 17665 trainings were conducted. In the same period 3387 specialized trainings were conducted. Year wise number of trainings are annexed as A-42.

8.2 A: Midwifery in Libya:

One of the important cadre produced by medical manpower centers is worth mentioning i.e. Midwives. The training of midwives in Libya has witnessed many challenges in the hospitals. Later on the midwifery trainings came under supervision of manpower development centers. Till date 581 midwives in Libya have graduated from the manpower development center as highlighted in below table.

Table 16: Distribution of graduate Midwives across Libyan universities Place of Training Years Students’ number Health Institute Tripoli 1976-2008 150 Al Jala - Tripoli Hospital 1998-1999 8 Benghazi 1999-2006 35 Murzuq 1995- -1996 8 Sabha 1997-1998 7 Tobruk 1995-2008 49 Sabratha 1994-1999 22 Misurata 2000-2007 15 Khums 2004-2005 8 Tarhouna 2003-2005 14 Msallata 2000-2001 7 Al zawia 2002-2006 11 College of Nursing - Tripoli 2011-2012 4 Abu Slim Institute of Health 2002-2016 243 Total 581

8.3Libyan Board of Medical Specialties:

Introduction: The Libyan Board of Medical Specialties (LMBS) was established in 1994 along the lines of the Arab Council for Medical Specialties and the British Council for Medical Specialties by Decree No. (131) for the year 1994. The joint decree was issued by the Ministry of Health and Social Security, and the Secretary of Education and Scientific Research. The LBMS was responsible

Libya 2018-Health Education and Training Institutions ||76 to equip the health workforce with the knowledge, skills and practical experience needed as specialized doctors. Currently wide decree no 557/2018 dated 7.5.2018 issued by the Presidency Council of the Government of National accord, the LBMS is directly under the supervision of Presidency Council having the same functions and autonomous structure. The medical specialties are supervised by scientific committees of professors and consultants, each according to its specialization. These committees are managed by an administrative committee which is responsible for the administrative procedures related to the LBMS according to its specialization and field of work. The LBMS grants the Libyan fellowship certificate which qualifies its holder for appointment as a specialist in health facilities and staff teaching in medical education institutions as stated in Article VII. The current disciplines that the LBMS is implementing are: 1. Pediatrics.2. Internal Medicine. 3. General Surgery.4. Emergency medicine. 5. Neurosurgery.6. Burns and Plastic surgery 7. Community Medicine.8. Anesthesia and intensive care. 9. Orthopedic surgery.10. Diagnostic Radiology. 11. Urology surgery12. Obstetrics and Gynecology 13. General medicine.14. Ophthalmology. 15. Laboratories.16. Pathology. 17. Otorhinolaryngology.18. Dermatology and venereology 19. Radiotherapy. The number of beneficiates of specialization from the LBMS since the graduation of the first batch in 1995 rose to 1002 specialists in various medical fields. Below table shows the number of graduates, in terms of specialization.

Table 17: The number of the recipients of the Medical Specialties Board Certificate: the first batch of graduates in the period of time spanning from 1995 to 31/12 2017 Year / Specialization Number Pediatrics 145 Internal Medicine 114 General surgery 136 Emergency 34 Neurosurgery 4 Burns and Plastic surgery 20 Family and community medicine 31 Anesthesia and intensive care 85 Orthopedic Surgery 50 Diagnostic imaging 55 Urology 33 Obstetrics and gynecology 64 General Medicine 111 Ophthalmology 32 Laboratory medicine 29 Pathology 7 Radiotherapy 14 Dermatology and venereology 20 Otorhinolaryngology 18 Total 1002

Libya 2018-Health Education and Training Institutions ||77 The LBMS took on the responsibility of the continuing medical education program, as well as encouraging research and cooperation with other regional and international training bodies.

The LBMS conduct many specialized courses for doctors in many fields including:

1. Ultrasound for Gynecologists.2. Use of ultrasound infertility. 3. Basic and advanced Life Support.4. First AID. 5. Advanced pediatric resuscitation.6. Advanced Cardiac Resuscitation.

The LBMS periodically publishes a scientific magazine called Libya Medical Journal (LMJ). The various councils hold scientific days, lectures and training courses for the doctors involved in the program. The trainee must submit a thesis to the research reporter under the supervision of the professors in the field of specialization. A committee approval of the thesis is mandatory without which the trainee will not receive the LBMS certificate.

Challenges facing medical education in Libya (a) The curriculum and teaching methods: Teaching methods are mainly based on lectures and spoon feeding, and active learning is not encouraged. Department of medical education is limited to few institutions. Assessment methods are designed to test the depth of knowledge not the ability to think critically and develop self-directed learning (Sagher 2006). Objective structured clinical examination (OSCE) has only been introduced yet as a clinical assessment procedure in Tripoli. (b) Students’ number and selection methods. The numberof medical students is in thousands without any matching recourses. No clear vision or strategy is emerging to justify the big expansion and there is a serious concern that an over-saturation of the Libyan job market will surface. The expansion in the number of universities and the medical schools were not matched with appropriate resources with detrimental effect on quality. The medical schools are not equipped with labs, libraries, IT facilities or even suitable lecture halls to cope with the number of students (Sagher 2006). (d) Teachers and academic staff: Courses to update the staff about the fast growing knowledge in the field of medical education are lacking. Moral and financial rewards for excellence do not exist. (e) Postgraduate medical training: Despite the establishment of the LBMS structured training in some specialties is still lacking. Continuing medical education programs are still not up to the desirable level. (f) Lack of quality control: There are no attempts to assess the quality of the graduates, and therefore data is lacking about this important issue.

8.4 Committee for the evaluation of foreign certificates at the LBMS:

The Ministry of Health wide decree No. (327) issued on 04.09. 1995 and in accordance to its fifth article, authorized the LBMS to evaluate the scientific certificates granted to the medical personnel who completed their specialized or training studies outside the country. A special committee called the “Evaluation Committee for Certification of Medical Specialist” was established by decision of the Secretary of the General People's Committee for Health No. 35 of 1996 issued on December 16, 1996. The Committee has equated 1319 certificates from the date of its establishment issued by different countries shown in below table

Libya 2018-Health Education and Training Institutions ||78 Table 18: The number of foreign approved certificates (till date) Country Number Germany 386 Britian 391 Ireland 72 Italy 71 Austria 78 Yugoslavia 79 Hungary 37 Bulgaria 14 Total 1319

8.5 Arab Council for Medical Specialties:

In 1980, several Arab countries, including Libya, set up the united Arab Board in many clinical specialties. The aim of the board is to improve residency training program, set comprehensive training standards for the various specialties and to establish a basis for a uniform assessment of the scientific, technical and practical level of trainees in the Arab states.

The Arab Council for Medical Specialties is established by the League of Arab States and is headquartered in Jordan. It has branches in most of the Arab countries that are members of the Council. It is a specialized council in setting special examinations in most medical specialties in Libya. Many examinations have been held in the following disciplines:

- Otorhinolaryngology- Obstetrics and gynecology - Anesthesia and intensive care- Radiology - - Ophthalmology. General Medicine - Cardiac Surgery. - Pathology and Anatomy. - Dermatology and venereology- Psychiatry. - Pediatrics - Pediatric surgery. - Orthopedic Surgery.

620 graduates obtained the certificate of the Arab Council for Medical Specialties to the end of 2017 distributed in the following specialties, according to below table.

Libya 2018-Health Education and Training Institutions ||79 Table 19: The number of Libyans who obtained The Certificate of the Arab Board of Health Specializations N Specialization Graduates number 1 Obstetrics and gynecology 196 2 General Surgery 24 3 Anesthesia and intensive care 35 4 Radiology 1 5 Pediatrics 199 6 Internal Medicine 3 7 Pediatric Surgery 3 8 Oral and Maxillofacial Surgery 2 9 Diagnostic pathology 7 10 Psychiatry 15 11 Dermatology and venereology 12 Total 620

8.6 Research activities and biomedical publications

The first article from Libya, according to the PubMed, was published in 1952 when a group of French physicians published an article about Biharzioses in Fazzan (the southern area of Libya) in Annales de Parasitologie Humaineet comparee. Thereafter and up to 1971, more than 50 papers were published mainly by Italian physicians about infectious diseases such as tuberculosis. Biomedical research papers in relation to the Libyan medical schools started to appear in the early 1970s, and peaked in 1988 by the publication of 23 original research articles. Unfortunately, the publications rate declined to eighteen 2007 despite the dramatic increase in the number of the medical schools and incorporation of a research project as an essential requirement to obtain the Libyan Board from the LBMS (Benamer 2008). There is clear evidence indicating that Libya is behind its peers when it comes to medical research. One paper looked at medical publications from 20 Arab countries; Libya ranked twelfth in the average annual publication rate, tenth when the data was normalized to the population and fifteenth when normalized to GDP (Shaban& Abu-Zidan 2003). Another study showed that Libya ranked lower than Morocco, Tunisia and Yemen in total number of PubMed publications between 2002and 2006 (Bakoush et al. 2007). The same result was found when the data was normalized to GDP (Bakoush et al. 2007). Libya did not appear in the top 20 African countries when the total number and the average annual number of biomedical publications were counted for each African country from1996 to 2005, and when the number of biomedical publications was normalized to annual publication rate per million inhabitants (Uthman&Uthman 2007). The culture of favoritism is rife when it comes to academic appointments and promotions within the medical schools (Daw&Elkhammas 2008). The Authority of Natural Science Research and Technology under the Ministry of Education award research grants. The first medical journal in Libya was published in 1978by the Medical School in Benghazi named as Garyounis Medical Journal. The last volume of this journal was published in2005 as indexed in the Libyan Medical Index. Several other journals appeared in the last two decades are: Alfateh Medical Journal, Sabha University Journal of Medical Sciences, LibyanJournal of Medical Research, Zuara Medical Journal, Libyan Orthopedic Journal and El-Razi Medical

Libya 2018-Health Education and Training Institutions ||80 Gazette. None of these journals survived for more than a year. LBMS launched Jamahiriya Medical Journal in 2001; the aim stated is ‘to exchange ideas and research between doctors in Libya, the Arab world and the rest of the world’. In 2007, The Libyan center for infectious diseases prevention and control launched a bi-yearly periodical under the name Libyan Journal of Infectious Diseases. However, all these new journals are in their infancy stage and not indexed in any international database.

In 2006, a group of Libyan doctors practicing in Europe and North America launched the Libyan Journal of Medicine as ‘a peer-reviewed open-access medical journal, published quarterly, and targeting both academic and clinical researchers. Its main goal is to spread the knowledge of medicine to all, for free. The journal succeeded in a large extent to attract original work from Libya and many developing countries, and has been indexed in Google Scholar, directory of Open Access Journals, and Embase.

Currently the following journals are published. 1. Libyan Journal of Infectious Disease published by Nation Center for Disease Control. 2. Libyan Medical Journal published by Libyan Board of Medical Specialties. 3. Tripolitana Medical Journal issue by Tripoli University 4. Benghazi University Medical Journal issued by Benghazi University 5. Libyan Journal of Dentistry issued by Benghazi University.

Libya 2018-Health Education and Training Institutions ||81 Chapter 9. Private Medical Education

9. Private Medical Education 9.1 Preface

Education is the basic right in Libya and is provided free of cost. Due to these reasons the private education is limited to enhance capacity in specialized area like laparoscopy or ultrasound or preparation for examinations in medical colleges. In 1995 the discussion on allowing private sector started and since then the private sector emerged. In this part of the study, the three private accredited institutions are described. 9.2 Medical Altahadi University - Tripoli Libya:

The Medical Altahadi University is an organization affiliated to Al-Wafaa Company for private Education, established on 19.7. 2000 under the decision of the People's Committee in Tripoli (formerly), while the university was established by the company's decision No. (6) Issued on 21.6. 2000. The first batch of dentists graduated from the College in 2005/2006. 465 students graduated from the College from the date of its establishment until the end of the academic year 2016. /2017.

Table 20: Number of graduates of medical Altahadi University (2005-17)

Year Number 2005 15 2006 16 2007 21 2008 25 2009 15 2010 26 2011 21 2012 42 2013 55 2014 64 2015 35 2016 40 2017 90

The number of students in the College of Dentistry for the academic year 2016/2017 rose to 686 students. In 2016/2017, the number of students was 604 students distributed in the school years. The below table shows that the number of female admission is on rise as compared to male.

Libya 2018-Health Education and Training Institutions ||82 Table 21: The distribution of students in the two academic years at At-Tahadi Medical University - Tripoli, Libya Academic year 2015/2016 2016/2017 Level Male Female Male Female Preparatory Year 63 100 39 104 First Year 43 60 43 123 Second Year 36 100 83 98 third year 46 60 37 85 Fourth year 33 63 19 55 Total for each sex 221 383 221 465 Total 604 686

9.3 Libyan International Medical University for Medical Sciences in Benghazi - Libya:

The Libyan International Medical University was founded in 2007 in the city of Benghazi in Libya by the decision of the Secretary of the General People's Committee for Higher Education No. 593/2007 of 19. 09. 2007. Approval of the initial institutional quality was granted by the decision of the Director of Quality Assurance and Accreditation of higher education institutions No. 17 of 2008 issued on 3 June 2008. The number of the faculty members of the University rose to 224 members with 152 of them being PhD holders. The part time staff constitute 90% of the total faculty members. The number of graduates since the establishment of the university has reached 1977 graduates from different disciplines and the number of students currently rises to 918 students, including 294 in medical colleges and includes the following colleges:

1. Faculty of Medicine.2. College of Oral and Dental Medicine. 3. College of Pharmacy.4. College of Basic Sciences. 5. College of Information Technology.6. Faculty of Administrative Sciences.

The number of students who enrolled at the university in its various specialties is 918 students in the medical field. Below table shows the number of students studying at the Libyan International University for Medical Sciences, new students and students in the final year and the number of graduates and success rate in each year of study. The total number of students in the academic year 2010-2011 was only 350 students including only 37 new students, while the number of students in the academic year 2016 - 2017 roe to 918 students and included 184 new students.

Table 22: The number of students and the number of new students at The Libyan International Medical University Academic year Students total number Total number of students 2010-2011 350 37 2011-2012 372 22 2012-2013 426 54 2013-2014 539 113 2014-2015 586 47 2015-2016 734 148 2016-2017 981 184

Libya 2018-Health Education and Training Institutions ||83 9.4: Graduates of the Libyan International University of Medical Sciences:

The number of graduates of the university during the years of study increased and reached (228) graduates and the number of students studying in the medical colleges at the university reached 294 students. This represents 32% of the total number of students studying in the university and distributed among the medical colleges as follows: Medicine 154 students, dentistry 97 students, pharmacy 32 students, and basic sciences 11 student. The number of students in the final years and the number of graduates as well as the success rate are précised in the following table.

Table 23: The total number of students and graduates at The Libyan International Medical University throughout the years of study Academic Year Number of final year Graduates number Success rate students 2010-2011 - - - 2011-2012 4 4 100% 2012-2013 19 16 84% 2013-2014 64 61 95% 2014-2015 - - - 2015-2016 101 95 94% 2016-2017 56 52 93%

9.5 Al Kaleg Libya Collage of Dentistry

The college is located in Janzour, Tripoli. It was accredited by the Ministry of Education through decree no 42 in 2018 on 21.5.2018. The student enrollment started in 1991. The first batch was graduated in 2005.

Table 24: shows distribution of students of Al Kaleg Libya College of Dentistry Academic Year New students Final Students Total Students Graduated Graduate rate Students 2010-2011 0 31 0 31 100% 2011-2012 0 26 0 26 100% 2012-2013 0 21 0 21 100% 2013-2014 0 33 0 33 100% 2014-2015 32 32 135 32 100% 2015-2016 44 19 166 19 100% 2016-2017 52 62 204 45 70%

Libya 2018-Health Education and Training Institutions ||84 Chapter 10: Review of Accreditation Standards of Undergraduate Basic Medical Education, Dentistry Education, Nursing and Pharmacy Education

10. Accreditation of Basic Medical Education 10.1 Introduction

Accreditation is defined as the process by which a credible, independent body assesses the quality of a medical education program to provide assurance that it produces graduates that are competent to practice safely and effectively under supervision as interns (or equivalent), and have been provided with an appropriate foundation for lifelong learning and further training in any branch of medicine. The accreditation framework encourage countries to utilize accreditation systems to ensure the provision of high quality medical education, identify inadequate medical education programs, assist education providers to improve the quality of their programs and ultimately, protect patients. The World Health Organization's commitment to medical education is of long standing. It originates from the Organization’s Constitution, adopted in 1948 when WHO came into being. Establishing international standards for the education and qualifications of the health workforce and fostering improvement in the quality of education and qualifications are integral to the Organization’s mandate. WHO's strategic partnership with the World Federation for Medical Education (WFME) is based on a network of engaged partners with a long-term sharing of values and standards as the link between health professions education and health needs of the society. Its imminent goal is incorporation of global standards in national standards and accreditation procedures and in the development of guidelines for accrediting agencies. The purpose of accreditation and quality improvement in medical education is to adjust medical education to changing conditions in the health care delivery system and to prepare doctors for the needs and expectations of society. Accreditation and quality improvement are expected to ensure training in the new information technologies in order to help doctors cope with the explosion in medical and scientific knowledge and technology, and inculcate in them the ability for lifelong learning. The WFME programs on global standards in medical education, approved by the World Health Organization (WHO) and the World Medical Association (WMA), had from the very outset three main intentions:  to stimulate authorities, organizations and institutions having responsibility for medical education to formulate their own plans for change and for quality improvement in accordance with international recommendations;

Libya 2018-Health Education and Training Institutions ||85  to establish a system of national and/or international evaluation, accreditation and recognition of medical educational institutions and programs to assure minimum quality standards for the programs; and  to safeguard practice in medicine and medical manpower utilization, in the context of increasing internationalization, by well-defined international standards in medical education. The WFME global standards embrace all phases of medical education, i.e. basic (undergraduate) medical education, postgraduate medical education and continuing professional development of medical doctors. The trilogy of global standards intends to facilitate the relationship between the stages of medical education.

10.2: Standards

The 2015 revision of the WFME global standards for quality improvement of Basic Medical Education, comprising altogether 106 basic standards and 90 quality development standards. The set of standards are structured according to 9 areas with a total of 35 sub-areas, being aware of the complex interaction and links between them. AREAS are defined as broad components in the process, structure, content, outcomes/competencies, assessment and learning environment of basic medical education and cover: 1. Mission and outcomes, 2. Educational program, 3. Assessment of students, 4. Students, 5. Academic staff/faculty, 6. Educational resources, 7. Program evaluation, 8. Governance and administration, 9. Continuous renewal Standards are specified for each sub-area using two levels of attainment: Basic Standard. This means that the standard in principle must be met by every medical school and fulfilment demonstrated during evaluation of the school. Basic standards are expressed by a “must”. Quality Standard. This means that the standard is in accordance with international consensus about best practice for medical schools and basic medical education. Fulfilment of these standards will vary with the stage of development of the medical schools, available resources and educational policy and other local conditions influencing relevance, priorities and possibilities. Quality standards are expressed by “should”.

10.3 Accreditation mechanism of health education institutes of Libya

In Libya there is a specialized center for Accreditation named National Center of Accreditation and Quality Assurances of Teaching and Training institutes. It was established in 2007 under the supervision of Ministry of Education which is responsible for accreditation and quality

Libya 2018-Health Education and Training Institutions ||86 assurances of public and private teaching and training institutes. The center have a guide line for quality assurances. The process of accreditation is divided in two parts: First part: Governance and Program Management accreditation which consist of 9 parameters with168 indicators. Second part: Academic Program accreditation which consist of 8 parameters with134 indicators. Process of accreditation in Libya: 1. Internal evaluation: Each institutes had to establish committee from their own staff to conduct internal evaluation according to the guidelines with the special forms from the National Center of Accreditation and Quality Assurances of Teaching and Training institutes. 2.The institute's has to prepare a complete file having data on General Information ,Academic Program , Curriculum ,Laboratory, infrastructure of the building, library and information about the number of student ,Faculty ,Programs, Examination procedure. 3. The National Center of Accreditation and Quality Assurances of Teaching and Training institutes will form a committee of expertise’s who have experience in quality control and accreditation. 4. The committee will visit the respective institute and revise the internal evaluation results followed by a meeting with: Stakeholders, Head of different department, Faculties, Student, Administration staff, Workers, Relative of the student. 5.Calculation of the evaluation is done as follow :- Each indicators had to be evaluated with scale of (0,1,2,3,4) and the total marks is 1000 marks. In order to qualify for accreditation, the institute must score 70 % of the total marks. In case scoring is less than 65 % for each parameter it will not be accredited. 6. Accreditation will be given to the institutes for 3 years if the institute get (70 to 80 %) and for 4 years if it get 80 -90 % and 5 years if it get more than 90 %. Admission policy and registration of schools in Libya: Admission policy and registration is regulated by decree number 501/ 2010 which regulate all the related subjects in the under and post -graduation studies. Like other countries, there has been a rapid expansion in the number of medical education programs, in Libya. Medical education is provided in both the government and private sectors and there is potential for the quality of the programs to vary considerably, even within a country. The global standards constitute a framework, serving as a yardstick against which those responsible for basic medical education can evaluate their own activities and organizations. Fulfilment of these standards will vary with the stage of development of the medical schools, available resources and educational policy and other local conditions influencing relevance, priorities and possibilities.

Libya 2018-Health Education and Training Institutions ||87 10.4 Status of accreditation standards of three major undergraduate medical schools of Libya

Basic Standards Medical Education Quality Standards Medical 120 106 Education 100 100 90 86 80 80 72 61 54 59 60 60 52

40 33 22 23 40 19 16 20 22 22 4 16 16 20 9 0 2 Total Tripoli Benghazi Omar 0 Standards Almoktar Total Tripoli Benghazi Omar Standards Almoktar Achieved In progress No achievement at all Achieved In progress No achievement at all

The three major undergraduate medical institutes of Libya were reviewed. It includes Tripoli Medical School, Benghazi Medical School and Omar Mokhtar Medical School. Review shows that majority (more than 80%) of the basic medical education standards are not achieved. Tripoli medical school provided evidence of achieving 22 out of 106 basic standards, Benghazi medical school 23 and Omar Mukhtar medical school only 4 out of 106 basic medical standards. Similarly the quality indicators which are achieved by institution lies between 2-16 standards out of the total 90 quality indicators. Details of standards reviews by each institution is annexedA-44.

10.5 Faculty of Medical School

There is shortage of faculty in all medical schools. There is no professor and assistant professor for Anatomy in all medical schools. Benghazi and Omar Al Mukhtar medical school have only lectures for Anatomy. The shortage of faculty is evident in all fields of basic medicine. Details of faculties are annexed as A-45.

Libya 2018-Health Education and Training Institutions ||88

10.6 Status of accreditation standards of Benghazi Dentistry School of Libya

Total Standards Dentistry 120 106 100 89 90

80 73

20 13 9 4 8 0 Total Standrads Basic Status Basic Total Standards Standards Quality Quality

Achieved In progress No achievement at all

Review shows that only 13 out of 106 basic standards of dentistry school are achieved. The school only provide evidence on 9 quality indicators which qualifies the criteria. Details of standards reviews are annexed as A 46.

10.7: Faculty of Dentistry Benghazi

There are only 4 lectures for basic sciences in Dentistry School Benghazi. There is no professor for Orthodontics, Oral biology, Pedodontics and Basic Sciences. Detail of faculty is annexed as A-47.

10.8 Nursing Education

Introduction Nursing and midwifery education is the foundation of a qualified and competent nursing and midwifery workforce. Improving the quality of nursing and midwifery education and training is an important way of strengthening health systems. This is approached principally by establishing standards for professional education, assuring quality educational processes and institutions, and accrediting institutions offering educational programs for initial, specialist and advanced professional education. The World Health Organization (WHO) established the first regional education standards in nursing and midwifery in 1998. Since then, these standards, supported by prototype curricula for nursing at the technical and professional levels, have been used across the WHO Eastern Mediterranean Region. More recently, in 2009, WHO published global standards for the initial education of professional nurses and midwives. These regional standards take into account

Libya 2018-Health Education and Training Institutions ||89 the concepts and directions provided by the global standards. It sets out a number of agreed regional nursing education standards, associated quality criteria and sources of evidence.

10.9 Status of accreditation standards of three major undergraduate nursing schools of Libya

The WHO regional Office have kept six standards for accreditation. Standard one is related to governance structure and have 9 quality criterion. Standard 2 covers administrative structure and have 8 quality criterion. Standard 3 covers teaching, learning and organizational environment and have 11 quality criterion. Standard 4 is related to graduate professional practice and ethical standards and have 17 quality criterion. Standard 5 covers educator’s sufficiency in numbers and required competencies. It have 9 quality criterion. Standard 6 is related to infrastructure and teaching/learning resources and have 6 quality criterion.

Nursing Standards 80 70 70 60 47 47 50 40 36 30 19 20 15 14 15 9 8 10 0 Total Standards Tripoli Benghazi Omar Almoktar

Achieved In progress No achievement at all

Review shows that more than two third (75%) of the nursing education standards are not achieved. The nursing faculties have evidence of achievement of standards as low as 8 and as high as 18. Detail analysis of standards by each institute is annexed as A 48.

10.10 Faculty of Nursing

In Libya, Nurse’s education is not uniform in the schools. The three major subjects taught In Benghazi Nursing School are clinical audit, maternal and child nursing; and psychiatric and community nursing. There is no professor, associate or even lecturers for all the subjects. They have only two visiting staff for clinical audit, 5 other staff for maternal and child nursing and 10 other staff for psychiatric and community nursing. Nursing School of Tripoli conducts

Libya 2018-Health Education and Training Institutions ||90 4 major courses. Fundamentals of Nursing, General Nursing, Surgery and Operation Theater and Midwifery and Neonatology. This school is also relying on a limited number of lecturers in all subjects. In Omar Mukhtar Nursing school only general nursing courses are conducted and have only 5 staff. Details of nursing faculty is attached as A-49.

10.11 Status of accreditation standards of three major undergraduate pharmacy schools of Libya

In current study, the standards are reviewed based on Canadian Council for the Accreditation of Pharmacy Programs (CCAPP). These accreditation standards recognize that pharmacy education of high quality will depend on multiple components, including general knowledge, basic and professional sciences, and professional practice experience. The CCAP accreditation are divided into 3 major parts i.e. academic program, governance and program management, and resources. The total standards covering these three parts are 24 and having 64 sub criterion. Assessment is done based on sub criterion. Part I: Academic Program. It covers educational outcomes, learning environment, curriculum, teaching, learning and assessment. Part 2: Governance and Program management. It covers university structure and commitment, faculty organization and leadership, planning and evaluation, admissions, continuous quality assurance of the program. Part 3: Resources. It covers student resources, human resources, practice site resources, financial resources, physical facilities and infrastructure and information resources.

Total Standards Pharmacy

70 64 60 54 50 44 40 28 30 18 18 19 20 8 10 1 2 0 Total Sub criterion of Tripoli Benghazi Omar Almoktar 24 standards

Achieved In progress No achievement at all

Result shows that out of total 64 sub criterion, pharmacy schools have achieved criterion as low as 1 and as high as 28. More than half of the sub-criterion are not achieved at all. Details of standards review by institutions are annexed as A 50.

Libya 2018-Health Education and Training Institutions ||91 10.12 Faculty of Pharmacy

There is no professor for all 5 major subjects taught in Benghazi and Omar Mukhtar School for Pharmacy. The faculty in Omar Mukhtar is limited and have only lecturers or assistant lecturers. Details of faculty are annexed as A 51.

Libya 2018-Health Education and Training Institutions ||92 Chapter 11 Current Status and Need Assessment of Health Workforce

11. Estimates of Libya's medical and medical assistance needs until 2030. The need for the following medical and paramedical personnel were estimated as follows:

11.1 Analysis of Existing Health Workforce (Physicians, Nurses/Midwives) against UHC/SDG and End of Preventable Maternal Mortality Criteria

Assumptions.  The MOH will retain the ratio of current workforce till 2030.  The Bureau of Statistics, Libya projected population is valid. Criteria: 1. UHC/SDG Criteria: 4.45 per 1000 population 2. End of preventable maternal mortality: 5.9 per 1000 population

Table 25: Libya status: 8.68 Per 1000 population Requirement End of Requirement preventable Target achieved (8.68) Human Health workforce UHC/SDG maternal (Surplus Staff) Criteria death criteria Nurses / Current Year Population Physicians 4.45 5.9 4.45 5.9 midwives HW 2017 6460448 13757 42975 56732 28749 38117 27983 18615 2018 6575607 13757 42975 56732 29261 38796 27471 17936 2019 6692606 13757 42975 56732 29782 39486 26950 17246 2020 6811577 13757 42975 56732 30312 40188 26420 16544 2021 6932338 13757 42975 56732 30849 40901 25883 15831 2022 7055311 13757 42975 56732 31396 41626 25336 15106 2023 7180567 13757 42975 56732 31954 42365 24778 14367 2024 7308004 13757 42975 56732 32521 43117 24211 13615 2025 7437611 13757 42975 56732 33097 43882 23635 12850 2026 7569508 13757 42975 56732 33684 44660 23048 12072 2027 7703925 13757 42975 56732 34282 45453 22450 11279 2028 7840835 13757 42975 56732 34892 46261 21840 10471 2029 7979778 13757 42975 56732 35510 47081 21222 9651 2030 8121337 13757 42975 56732 36140 47916 20592 8816

Currently Libya have a huge workforce (physicians, nurses/midwives) having 8.68 per 1000 population. With the assumption if the Ministry of Health, maintained the same number of health workforce till 2030, still it will have surplus staff as mentioned in above table.

Libya 2018-Health Education and Training Institutions ||93 11.2 Analysis of Physicians current status and projected numbers in comparison with different countries 2017-2030

Libya have current 2.13 physicians per 1000 population. Comparison with countries having higher ratios are done. Projections are done to find out the needs based on maintaining the current ratio of 2.13 as well as improving the targets to 2.5, 3 and 4 per 1000 population. In order to maintain the target of 2.13, 3541 doctors have to be hired in addition to the numbers who get retired or leave the Ministry of Health. The total minimal production of medical graduates till 2030 is expected to be 16731. It means 21 % of the graduates have to be hired by Ministry of Health to maintain the target of 2.13 physicians per 1000 population. If MOH wants to enhance the target to 2.5 per 1000 population, then 6546 medical graduates have to be hired which is 39 % of the total production of graduates till 2030. If the leadership desires to achieve target of 4 per 1000 population then the number of production of medical graduates have to be increased.

Table 26: Current ratio and projection of needed physicians based on comparison with different countries Annual Production Current Need Target Need Target Need Target Need

Year @ 1287 2.13 2.5 3 4

2017 13757 0 16151 2394 19381 5624 25842 12085 2018 1287 14006 249 16439 288 19727 345 26302 461 2019 1287 14255 249 16732 292 20078 351 26770 468 2020 1287 14509 253 17029 297 20435 357 27246 476 2021 1287 14766 257 17331 302 20797 362 27729 483 2022 1287 15028 262 17638 307 21166 369 28221 492 2023 1287 15295 267 17951 313 21542 376 28722 501 2024 1287 15566 271 18270 319 21924 382 29232 510 2025 1287 15842 276 18594 324 22313 389 29750 518 2026 1287 16123 281 18924 330 22709 396 30278 528 2027 1287 16409 286 19260 336 23112 403 30816 538 2028 1287 16701 292 19602 342 23523 411 31363 548 2029 1287 16997 296 19949 347 23939 417 31919 556 2030 1287 17298 302 20303 354 24364 425 32485 566 Total 16731 3541 6546 10607 18728

Country Physician per 1000 population Italy, Germany, Norway 4.021, 4.191, 4.385 Denmark, Finland, Jordan 3.65,3.19,3.4 America, Canada, Saudi Arabia 2.5 Algeria, Tunis, Oman 1.19,1.2,1.91 Libya 2.13 Source: WHO Global Observatory

Libya 2018-Health Education and Training Institutions ||94

11.3 Analysis of Dentists current status and projected numbers in comparison with different countries 2017-2030

Libya have currently 0.894 dentists per 1000 population. The WHO global observatory shows Jordan have the highest (0.896) dentists per 1000 population ratio. Need forecasting is done on the current ratio of 0.894. Analysis shows that till year 2030, 1484 dentists will be needed to maintain the same ratio of 0.894. The total estimated production of dentists till 2030 is 14590. The Ministry in addition to the dentists who will get retired or leave the Ministry have to hire 10% of the total dentists produced.

Table 27: Current ratio and projection of needed dentists based on same target

Year Produced Current Need @ 1150 per year 0.894 2017 5776 0 2018 1150 5879 103 2019 1150 5983 105 2020 1150 6090 106 2021 1150 6198 108 2022 1150 6307 110 2023 1150 6419 112 2024 1150 6533 114 2025 1150 6649 116

Libya 2018-Health Education and Training Institutions ||95 2026 1150 6767 118 2027 1150 6887 120 2028 1150 7010 122 2029 1150 7134 124 2030 1150 7260 127 Total 14950 1484

Country Physician per 1000 population Italy, Germany, Norway 0.788, 0.866, 0.851 Denmark, Finland, Jordan 0.75,0.716, 0.896 Saudi Arabia 0.398 Algeria, Tunis, Oman 0.32,0.294,0.247 Libya 0.894 Source: WHO Global Observatory

Libya 2018-Health Education and Training Institutions ||96 11.4 Analysis of Nurses current status and projected numbers in comparison with different countries 2017-2030

Projection to ascertain nurses needs are done based on maintaining current ratio (6.652 per 1000 population), Canada (9 per 1000 population) and Norway/Denmark (17 per 1000 population). In order to maintain the same standards, 20055 nurses will be required till end of year 2030. The average estimated production of nurses is 334 each year from nursing faculties and higher institutes. We assume that the number of production will reach 600 if we add the graduates of recently opened intermediate institutes. Estimates of production is done on 334 and 600 graduates each year. The projected estimates shows that the current ratio of 6.652 nurses per 1000 population cannot be met as the need is far more than the production. In future the country will face severe shortage of nurses.

Table 28: Current ratio and projection of needed nurses based on comparison with different countries Production Production Libya Canada Norway/Denmark @334 from @600 nursing including faculty and recently higher opened institutes intermediate institutes Current Need Target Need Target Need Year 6.652 9 17

2017 42975 0 58144 15169 109828 66853 334 600 2018 43741 766 59180 1036 111785 1958 334 600 2019 44519 778 60233 1053 113774 1989 334 600 2020 45311 791 61304 1071 115797 2023 334 600 2021 46114 803 62391 1087 117850 2053 334 600 2022 46932 818 63498 1107 119940 2091 334 600 2023 47765 833 64625 1127 122070 2129 334 600 2024 48613 848 65772 1147 124236 2166 334 600 2025 49475 862 66938 1166 126439 2203 334 600 2026 50352 877 68126 1187 128682 2242 334 600 2027 51247 894 69335 1210 130967 2285 334 600 2028 52157 911 70568 1232 133294 2327 334 600 2029 53081 924 71818 1250 135656 2362 334 600 2030 54023 942 73092 1274 138063 2407 4342 7800 Total 11048 30117 95088

Libya 2018-Health Education and Training Institutions ||97

11.5 Analysis of Pharmacists current status and projected numbers in comparison with different countries 2017-2030

Libya have 0.612 pharmacists per 1000 population. The annual production of pharmacists is 563 per annum. In order to maintain the current ratio till 2030, Libya will be needing 1014pharmacists. Projected figure shows that till 2030, Libya will produce 7319 pharmacists. If the planners want to enhance the target to 1.59 per 1000 population, then 8957 pharmacists will be needed.

Libya 2018-Health Education and Training Institutions ||98 Table 29: Current ratio and projection of needed pharmacists based on comparison with different countries

Current Based on production @ 563 Current Libya Jordan Year annually 0.612 Need 1.59 Need

2017 3956 0 10272 6316 2018 563 4024 68 10455 183 2019 563 4096 72 10641 186 2020 563 4169 73 10830 189 2021 563 4243 74 11022 192 2022 563 4318 75 11218 196 2023 563 4395 77 11417 199 2024 563 4472 78 11620 203 2025 563 4552 79 11826 206 2026 563 4633 81 12036 210 2027 563 4715 82 12249 214 2028 563 4799 84 12467 218 2029 563 4884 85 12688 221 2030 563 4970 87 12913 225 Total 7319 1014 8957

Libya 2018-Health Education and Training Institutions ||99

11.6 Analysis of Specialists current status and projected numbers in comparison with different countries 2017-2030

We couldn’t find any recommended criteria to assess the needs of specialists per population. However some study shows the number of specialist per 100,000 population. For every specialty, depending on the burden of disease, the criteria is different. Studies from America shows a high level of specialist per 100,000 population but we are comparing our results with at least one specialist per 100,000 population. This data does not reflect necessary the active specialists nor the one who have done post- graduation from the foreign institutes. Findings are based on registered specialists with Libyan Board or Arab Board and does not include foreigners.

In Libya there are 1499 specialists registered with Libyan Board and Arab Board of Specialty. Result shows that there is no specialty which fulfills the criteria of at least 1 specialist per 100,000 population. The specialist pediatricians are more frequently observed (344) while there are only 2 maxillary and facial specialist surgeons.

Table 30: Libya Specialist ratio per 100,000 population Libyan Arab Number per 100,000 Total Board Board population Year / Specialization Number Number Number Pediatrics 145 199 344 0.00344

Libya 2018-Health Education and Training Institutions ||100 Internal Medicine 114 3 117 0.00117 General surgery 136 24 160 0.0016 Emergency 34 34 0.00034 Neurosurgery 4 4 0.00004 Burns and Plastic surgery 20 20 0.0002 Family and community medicine 31 31 0.00031 Anesthesia and intensive care 85 35 120 0.0012 Orthopedic Surgery 50 50 0.0005 Diagnostic imaging 55 1 56 0.00056 Urology 33 33 0.00033 Obstetrics and gynecology 64 196 260 0.0026 General Medicine 111 111 0.00111 Ophthalmology 32 32 0.00032 Laboratory medicine 29 29 0.00029 Pathology 7 7 14 0.00014 Radiotherapy 14 14 0.00014 Dermatology and venereology 20 12 32 0.00032 Otorhinolaryngology 18 18 0.00018 Pediatric Surgery 3 3 0.00003 Oral and maxillofacial surgery 2 2 0.00002 Psychiatry 15 15 0.00015 Total 1002 497 1499 0.01499

Libya 2018-Health Education and Training Institutions ||101 11.7 Conclusion:

• Lack of a plan to balance the need and supply of human resources. Admission criteria not based on health human resources needs and capacity of the schools. • Horizontally expanding medical colleges. • There is a need to confirm the quality of medical and health education outputs. • There is a need to study the size of the loss of graduates from medical colleges. • Failure to direct students to the required areas of need led to the accumulation of the number of technicians in some areas. • Inadequate training institutions for nursing and midwives. • There is weakness in the use of technology in the registration and administration of examinations. • Integration of nursing schools in other institutions (health sciences).

11.8 Recommendations:

Short Term  Establish a high level multisector committee to review the findings of the available evidence by involving all the stakeholders.  Recruit (import) the faculty especially for basic medical sciences.  Review of nursing curriculum and plan for the upcoming shortage of nurse’s crisis. Mid-Long Term  Review of accreditation standards of all faculties according to the international recommendations.  Enhance the capacity of the National Center of Accreditation and Quality Assurances of Teaching and Training institutes.  Invest in development of faculty staff. The preceptors should be sent abroad as early as possible for post graduate studies. Affiliation with universities for online courses.  Develop human health resource strategy with clear targets and career laden pathways for all cadres.  Develop human resource development plan  Plan for increasing the number of specialists.  In depth analysis of the findings of this study such as: quality, curriculum, drop out.  Conduct researches and encourage production of Medical journals.  Develop electronic software for documenting all information related to medical education and should be linked withMOH.  Review of post graduate studies.  Review and make a plan for continuing medical education.

Libya 2018-Health Education and Training Institutions ||102 x. References:

1. Anand S, Bärnighausen T. Health workers and vaccination coverage in developing countries: an econometric analysis. The Lancet, 2007, 369: 1277–1285.

2. Speybroeck N et al. Reassessing the relationship between human resources for health, intervention coverage and health outcomes. Background paper prepared for The world health report 2006. Geneva, World Health Organization, 2006.

3. Toolkit on monitoring health system strengthening. World Health Organization, May 2009.

4. Service availability and readiness assessment (SARA) survey 2017. https://www.humanitarianresponse.info/sites/www.humanitarianres ponse.info/files/assessments/service_availability_and_readiness_as sessment_final_12-03-2018.pdf

5. Daw MA and Elkhammas EA. Libyan medical education. Time to move forward.

6. Medical education in Libya. The challenges. https://www.researchgate.net/publication/263751733_Medical_educ ation_in_Libya_The_challenges [accessed Sep 23 2018]. 7. Abdulmajid Ahmed Ali,OmranBakoush. 50% failure rate in final year medical exams; Whose fault is it? 8. Hani TS Benamer, Amin Bredan, OmranBakoush BMC Research notes The Libyan doctors' brain drain: an exploratory study :Short Report. 9. Elizia Volkmann. 09 October 2015. Issue No: 385. University World News. Libya Higher education disrupted by war, hopes for recovery.http://www.universityworldnews.com/article.php?story=20 1510061522270

Libya 2018-Health Education and Training Institutions ||103 XI. Annexes

A. 1 Distribution of universities and faculties of different specialties in Libya S. Name of University Ownership Status Medical Dental Nursing Pharmacy Health Public Technician No surgery Sciences Health 1 Tobruk Gov Open 1 0 1 0 0 0 0 2 Omar Mukhtar Gov Open 1 0 1 1 0 0 0 3 Sert Gov Open 1 1 0 0 1 0 0 4 Misurata Gov Open 1 1 1 1 0 0 1 5 Tripoli Gov Open 1 1 1 1 0 0 1 6 Al Zawia Gov Open 1 1 0 1 0 0 1 7 Nalut Gov Open 0 0 0 0 0 0 0 8 Zuwara Gov Open 0 0 0 0 0 0 0 9 Sabratha Gov Open 1 1 1 0 0 1 1 10 Al-Jafara Gov Open 0 0 0 0 0 0 1 11 Senussi Gov Open 0 0 0 0 0 0 0 12 Ajdabiya. Gov Open 1 0 0 0 0 0 0 13 Benghazi Gov Open 1 1 1 1 0 1 0 14 Sebha Gov Open 1 1 1 1 0 0 1 15 Al-Marqab University Gov Open 1 1 0 1 1 0 1 16 Azzaytouna Gov Open 1 0 0 0 0 0 1 17 Bright Star Gov Open 0 0 0 0 0 0 0 18 Gheryan Gov Open 1 1 0 0 1 0 0 19 Al-Zintan Gov Open 1 1 0 0 0 0 1 20 BaniWalid Gov Open 0 0 0 0 0 0 1 21 Sidra Gov CLOSED *1 *1 *1 *1 0 0 0 22 AlJofra Gov Medical CLOSED *1 0 0 0 0 0 1 23 Alasmariya Gov Open 1 1 0 1 0 1 0 24 Almafatoha Gov Open 0 0 0 0 0 0 0

Libya 2018-Health Education and Training Institutions ||104 25 Alkademia Gov Open 0 0 0 0 0 0 0 26 Libyan International Medical U. Private Open 1 1 0 1 0 0 0 27 Altahde U. Private Open 0 1 0 0 0 0 0 Khaleej Libya LitabAsna** Private Open 0 1 0 0 0 0 0 Total 18 15 8 10 3 3 11 *Decree issued but have not yet started enrolling the students ** Only faculty, no university status.

A. 2: Centers of Medical Profession (High Health Institutes) No of Preceptors N Institute Name Region No of trainers No of students

1 Ajdabiya Medical professions center Ajdabiya 7 310 12 2 Al Bayda' Medical professions center Al Jabal Al Akhtar 20 272 22 3 Yafran Medical professions center Nafusa Mountains 10 211 21 4 Jadu Medical professions center Nafusa Mountains 15 337 32 5 Zahra Medical professions center Jufrah 10 548 12 6 Wadi al Shati Medical professions center al Shati 12 253 07 7 El-Marg Medical professions center El-Marg 8 434 09 8 Garabulli Medical professions center El Mergib 4 443 00 9 Tarhuna wa Msalata Medical professions center El Mergib 21 386 15 10 Al Khums Medical professions center El Mergib - 875 06 11 Jumayl Medical professions center Nuqat al Khams 21 410 13 12 Benghazi Medical professions center Benghazi 11 601 15 13 Abu Salim Medical professions center Tripoli 17 352 13 14 Tripoli Medical professions center Tripoli 95 1735 65 15 BaniWalid Medical professions center BaniWalid 19 199 35 277 Total

Libya 2018-Health Education and Training Institutions ||105 A. 3: Intermediate Nursing Schools S Number of first Number of second Institute teachers Number Total No. of Student No year students year students 1 Tajura Institute 15 48 45 93 2 Ziliten Institute 26 62 68 130 3 Msallata Institute 15 24 34 58 4 Gharyan Institute 16 35 55 90 5 Misurata Institute 15 45 55 111 6 Zintan Institute 15 60 0 60 7 Sabratha Institute 15 72 92 164 8 Ajaylat Institute 16 55 48 103 9 Sebha Institute 15 50 100 150 10 Zawia Institute 17 46 22 68 11 Burns and Plastic surgery Institute 15 34 30 64 13 Murzuq Institute 15 30 45 75

14 Institute of Tripoli Medical Center - 47 0 47 Total 608 605 1213

Libya 2018-Health Education and Training Institutions ||106 A. 4: Distribution of first year undergraduate medical students by universities

Year Year Benghazi University Mokhtar Omar University Tobruk University Misurata University Asmariya Al University Tripoli University zawia Al University Sabratha University Gharyan University Zintan University Sebha SirtUniv iv ZitounaUn Univ University Almergab nal I Medical Libya Total

nternatio

2010-2011 0 162 90 136 0 1200 378 0 81 0 120 0 0 296 37 2500 2011-2012 124 135 232 0 0 0 0 0 103 0 250 81 0 217 22 1164 2012-2013 811 182 143 222 0 1020 0 0 126 0 240 60 0 348 54 3206 2013-2014 CLOSED 152 72 150 0 1207 0 0 111 0 220 72 0 0 113 2097 2014-2015 864 150 174 254 134 800 358 0 109 0 225 0 0 134 47 3249 2015-2016 860 126 180 158 157 810 368 0 106 160 170 0 77 334 148 3654 2016-2017 0 178 198 179 151 850 292 145 78 160 180 0 235 0 184 2830 Total 2659 1085 1089 1099 442 5887 1396 145 714 320 1405 213 312 1329 605 18700

A. 5: Distribution of final year undergraduate medical students by universities

MisurataUn

SabrathaUn

AlmergabU

ZitounaUni

AsmariyaU

University University University University University University University University

Libya IMU

Benghazi

Mokhtar

niversity Gharyan

SirtUniv

iversity iversity

Tobruk

Tripoli

Zintan

Sebha

Omar

Year

Total

Zawia

niv

2010-2011 0 87 43 166 0 3154 279 0 73 0 100 0 0 168 0 4070 2011-2012 540 0 85 0 0 2191 0 0 106 0 95 0 0 0 4 3021 2012-2013 852 129 81 173 0 2367 377 0 107 0 0 0 0 253 19 4358 2013-2014 0 163 89 184 0 2397 703 0 0 0 0 87 0 0 64 3687 2014-2015 1008 183 129 208 134 840 869 0 142 0 79 0 0 268 0 3860 2015-2016 600 195 148 188 157 800 864 0 150 0 0 0 77 179 101 3459 2016-2017 781 370 60 179 151 700 0 145 120 0 80 0 235 0 56 2877 Total 3781 1127 635 1098 442 12449 3092 145 698 0 354 87 312 868 244 25332

Libya 2018-Health Education and Training Institutions ||107 A. 6: Distribution of total undergraduate medical students by universities

Year University Benghazi University Mokhtar Omar University Tobruk niversity MisurataU niversity AsmariyaU Al University Tripoli University Zawia Al niversity SabrathaU University Gharyan University Zintan University Sebha SirtUniv v ZitounaUni Univ Almergab University Medical nal Internatio Libyan Total

2010-2011 3665 705 469 900 - 8918 2100 - 769 - 410 - - - 350 18286 2011-2012 2690 297 591 - - 9431 - - 710 - 490 771 - 1637 372 16989 2012-2013 2997 634 594 1121 - 7573 2240 - 813 - 555 683 - 1999 426 19635 2013-2014 CLOSED 843 612 1016 - 8276 2481 - 869 - 660 767 - - 539 16063 2014-2015 3917 842 965 1164 134 4524 3032 - 811 - 800 700 - 1690 586 19165 2015-2016 2820 725 950 1105 242 4336 3165 - 807 200 668 - 77 1948 734 17777 2016-2017 - 823 1089 779 344 5066 3365 145 850 375 675 - 501 1804 981 16797

Total 16089 4869 5270 6085 720 48124 16383 145 5629 575 4258 2921 578 9078 3988 124712

A. 7: Distribution of graduatesfrom faculty of medicine by universities

MisurataUniv

AlmergabUni

ZitounaUniv

University University University University University University University University University

University

Benghazi

Sabratha Sabratha

Mokhtar

Al Gharyan

SirtUniv

Tobruk

Asmariya

Tripoli

Zintan

Sebha Sebha

Omar Omar

ersity

LIMU

Total

Year

Zawia

2010-2011 0 34 36 101 0 0 180 0 62 0 61 0 0 0 0 474 2011-2012 242 0 68 0 0 1604 0 0 73 0 55 0 0 0 4 2046 2012-2013 456 72 72 113 0 0 45 0 66 0 0 79 0 0 16 919 2013-2014 0 104 57 106 0 1139 18 0 0 0 0 87 0 0 61 1572 2014-2015 554 122 71 116 0 0 274 0 76 0 59 0 0 0 0 1272 2015-2016 114 101 67 0 0 815 334 0 97 0 0 0 0 0 95 1623 2016-2017 273 84 0 0 0 620 0 0 0 0 71 0 0 0 52 1100 Total 1639 517 371 436 0 4178 851 0 374 0 246 166 0 0 228 9006

Libya 2018-Health Education and Training Institutions ||108 A. 8: Distribution of first year undergraduate dental students by universities

University/ Al-Asmariya Sabratha Al Zawia Khaleej Benghazi Sirte Misruata El Mergib Tripoli Zintan Sabha Altihadi LIMU Total University University University year Libya

2010-2011 315 57 72 0 536 53 0 43 0 0 37 1113 2011-2012 281 50 0 406 24 75 112 0 186 22 1156 2012-2013 136 53 81 0 592 23 93 124 0 168 54 1324 2013-2014 348 51 122 0 419 43 79 101 0 245 113 1521 2014-2015 66 144 142 0 316 113 83 166 0 201 32 47 1310 2015-2016 319 0 189 0 208 107 86 99 0 334 143 44 148 1677 2016-2017 496 0 117 50 429 131 78 84 192 198 163 52 184 2174 Total 1961 355 723 50 2906 494 494 729 192 1332 306 128 605 10275

A. 9: Distribution of final year undergraduate dental students by universities

Al- El Sabratha Al Zawia Khaleej University/ Benghazi Sirte Misurata Tripoli Zintan Sebha Asmariya Altihadi LIMU Total Mergib University University Libya University

2010-2011 536 37 51 0 1155 72 37 144 0 0 31 0 2063 2011-2012 447 40 109 0 438 78 33 103 0 0 26 4 1278 2012-2013 530 43 93 0 650 65 47 72 0 33 21 19 1573 2013-2014 383 36 68 0 493 59 38 75 0 48 33 64 1297 2014-2015 340 19 46 0 618 10 37 83 0 178 32 0 1363 2015-2016 347 0 62 0 533 17 53 99 0 0 74 19 101 1305 2016-2017 155 0 46 0 293 12 0 76 0 0 96 62 56 796 Total 2738 175 475 0 4180 313 245 652 0 259 170 224 244 9675

Libya 2018-Health Education and Training Institutions ||109 A. 10: Distribution of total undergraduate dental students by universities

Al- Al Z El SabrathaUn University/ Benghazi Sirte Misurata Tripoli Zintan Sebha Asmariya awia Altihadi Khaleej LIMU Total Mergib iversity University University

2010-2011 1855 208 503 0 3076 261 0 157 0 0 350 6410 2011-2012 1733 186 0 0 2437 377 0 437 0 1128 372 6670 2012-2013 1440 204 654 0 2136 291 320 453 0 989 426 6913 2013-2014 1364 170 612 0 2657 206 343 489 0 953 539 7333

2014-2015 829 120 752 0 2323 239 311 583 0 1055 135 586 6933 2015-2016 165 0 806 0 3414 244 399 551 0 1166 686 166 734 8331 2016-2017 1191 0 686 50 3574 307 427 529 308 1081 604 204 981 9942 Total 8577 888 4013 50 19617 1925 1800 3199 308 6372 1290 505 3988 52434

A. 11: Distribution of graduatesof faculty of dentistry by universities

University/ El Al-Asmariya Sabratha Al Zawia Benghazi Sirte Misurata Tripoli Zintan Sebha Altihadi Khaleej LIMU Total year Mergib University University University 2010-2011 75 56 50 0 640 52 31 108 0 0 21 31 0 1064 2011-2012 382 38 0 0 1088 72 33 76 0 0 42 26 4 1761 2012-2013 389 25 80 0 1056 77 31 47 0 0 55 21 16 1797 2013-2014 503 16 102 0 395 60 43 49 0 0 64 33 61 1326 2014-2015 0 0 91 0 367 56 33 61 0 0 35 32 0 675 2015-2016 293 0 0 0 440 8 0 59 0 0 40 19 95 954 2016-2017 0 0 0 0 270 14 0 0 0 0 90 44 52 470 Total 1642 135 323 0 4256 339 171 400 0 0 347 206 228 8047

Libya 2018-Health Education and Training Institutions ||110 A. 12: Distribution of first year nursing students by universities

University Benghazi Omar Mukhtar Tobruk Sabratha MISRATA Sabha Tripoli TOTAL

2010-2011 109 - 72 13 0 150 24 368 2011-2012 97 - 71 11 0 174 22 375 2012-2013 61 - 52 20 0 140 105 378 2013-2014 29 - 99 27 0 148 89 392 2014-2015 - - 105 26 0 130 237 498 2015-2016 94 - 120 24 141 99 217 695 2016-2017 130 61 162 28 162 110 226 879 Total 520 61 681 149 303 951 920 3585

A. 13: Distribution of final year nursing students by universities

year Benghazi Tobruk Tripoli Sebha SABARTA MISRATA Omar Mukhtar Total

2010-2011 27 80 11 106 0 0 0 224 2011-2012 27 122 13 170 0 0 0 332 2012-2013 53 120 42 110 0 0 0 325 2013-2014 95 65 30 81 8 0 0 279 2014-2015 - 80 35 59 9 0 0 183 2015-2016 53 79 45 62 9 18 0 266 2016-2017 53 50 73 27 9 17 0 229 Total 308 596 249 615 35 35 0 1838

Libya 2018-Health Education and Training Institutions ||111 A. 14: Distribution of total nursing students by universities

Benghazi Omar Mukhtar Tobruk Sabratha MISRATA Sebha Tripoli Total Year Medical 2010-2011 306 0 402 13 0 571 177 1469 2011-2012 296 0 330 30 489 163 1308 2012-2013 309 0 269 42 0 372 593 1585 305 2013-2014 262 0 61 0 268 606 1502

2014-2015 0 0 310 65 0 241 811 1427 2015-2016 233 0 328 57 473 290 1049 2430 2016-2017 283 61 367 75 581 293 1263 2923 Total 1689 61 2311 343 1054 2524 4662 12644

A. 15: Distribution of nursing graduates by universities University / Year Sabha BENGAZE MISRATA Tubrok Tripoli Sabratha Omar Mukhtar TOTAL 2010-2011 106 0 16 92 9 0 0 223 2011-2012 104 3 16 82 11 0 0 216 2012-2013 90 9 32 86 13 0 0 230 2013-2014 75 34 22 34 28 8 0 201 2014-2015 51 0 9 53 30 9 0 152 2015-2016 58 30 16 50 38 9 0 201 2016-2017 26 12 17 36 35 9 0 135 Total 510 88 128 433 164 35 0 1358

Libya 2018-Health Education and Training Institutions ||112 A. 16: Distribution of first year pharmacy students by universities Al-Asmariya Al Zawia Sebha University/ year Benghazi Omar Al Mukhtar Misruata El Mergib Tripoli Total University University University 2010-2011 407 170 134 130 16 0 222 0 1079 2011-2012 0 77 50 30 175 0 136 0 468 2012-2013 523 50 49 73 0 0 176 0 871 2013-2014 139 65 25 22 0 0 107 0 358 2014-2015 0 214 75 163 0 0 80 0 532 2015-2016 0 93 149 44 0 118 117 30 551 2016-2017 0 60 48 139 0 128 72 95 542 Total 1069 729 530 601 191 246 910 125 4401

A. 17: Distribution of final year pharmacy students by universities Benghazi Omar Al-Asmariya University /Year Misrata Tripoli Al zawia Sebha University El Mergib Total Medical Mukhtar University 2010-2011 258 95 41 264 125 0 0 124 907 2011-2012 - 145 85 305 144 0 0 112 791 2012-2013 525 168 67 299 130 0 0 155 1344 2013-2014 449 137 62 312 103 0 0 86 1149 2014-2015 0 183 65 217 104 0 0 71 640 2015-2016 0 122 72 0 104 0 0 55 353 2016-2017 0 85 30 0 122 0 0 66 303 Total 1232 935 422 1397 832 0 0 669 5487

Libya 2018-Health Education and Training Institutions ||113 A. 18: Distribution of total pharmacy students by universities Omar Al Al-Asmariya Al Zawia Sebha University/ year Benghazi Misurata AL Marqab Tripoli Total Mukhtar University University University 2010-2011 1771 766 412 505 1480 0 474 0 5408 2011-2012 2239 718 367 346 1681 0 507 0 5858 2012-2013 1992 634 291 433 1320 0 515 0 5185 2013-2014 1044 544 179 281 1104 0 423 0 3575 2014-2015 0 650 335 367 848 0 376 0 2576 2015-2016 0 539 386 333 0 118 520 30 1926 2016-2017 0 405 314 416 0 191 467 127 1920

Total 7046 4256 2284 2681 6433 309 3282 157 26448

A. 19: Distribution of graduates of faculty of pharmacy by universities Al-Asmariya Sebha University/ Year Benghazi Medical Omar Mukhtar Misurata AL Megrueb Tripoli Al zawia Total University University 2010-2011 244 95 37 96 195 110 0 0 777 2011-2012 0 101 56 78 247 87 0 0 569 2012-2013 376 141 56 117 214 108 0 0 1012 2013-2014 439 109 55 51 222 71 0 0 947 2014-2015 0 143 45 46 155 0 0 0 389 2015-2016 0 86 29 20 0 59 0 0 194 2016-2017 0 26 0 30 0 0 0 0 56 Total 1059 701 278 438 1033 435 0 0 3944

Libya 2018-Health Education and Training Institutions ||114 A. 20: Distribution of first year medical technology students by universities University / Misurata El Mergib Tripoli Aljafarah NALOT ALZETONA Jufrah ALZAWEA SABAHA SABARTA Total Year 2010-2011 243 0 0 0 53 0 42 0 0 341 679 2011-2012 152 51 0 0 42 0 46 0 0 270 561 2012-2013 201 0 150 0 44 0 38 0 36 245 714 2013-2014 143 83 330 0 37 0 45 0 194 142 974 2014-2015 142 214 213 0 110 0 370 0 45 440 1534 2015-2016 214 226 1377 0 91 0 345 0 97 520 2870 2016-2017 225 361 1625 145 80 0 175 0 201 471 3283 TOTAL 1320 935 3695 145 457 0 1061 0 573 2429 10615

A. 21: Distribution of final year medical technology students by universities

Year

Mergi

TONA

Misur Tripol

Aljafa NALO

SABA SABA

Total

ALZA

Jufra

ALZE WEA

RTA

rah

ata

El El

b h

2010-2011 273 4 3092 0 118 0 137 0 0 0 3624 2011-2012 168 0 2464 0 96 0 134 0 0 0 2862 2012-2013 213 1 734 0 90 0 97 0 0 0 1135 2013-2014 160 0 1362 0 47 0 84 0 0 0 1653 2014-2015 177 5 513 0 40 0 56 0 35 0 826 2015-2016 228 23 300 0 37 0 83 0 30 0 701 2016-2017 233 0 270 0 28 0 85 0 42 0 658 TOTAL 1452 33 8735 0 456 0 676 0 107 0 11459

Libya 2018-Health Education and Training Institutions ||115 A. 22: Distribution of total medical technology students by universities University/ ALZAWEA NALOT SABARTA Misruata El Mergib Tripoli Aljafarah SABAHA ALZETONA Jufrah Total Year

2010-2011 1873 53 341 243 - - - 0 0 42 2552 2011-2012 1684 42 270 152 51 - - 0 0 46 2245 2012-2013 1523 44 245 201 - 150 - 36 0 38 2237 2013-2014 1572 37 142 143 83 330 - 194 0 45 2546 2014-2015 447 110 440 142 214 213 - 45 0 370 1981 2015-2016 1284 91 520 214 226 1377 - 97 140 345 4294 2016-2017 1330 80 471 225 361 1625 145 201 90 175 4703 Total 9713 457 2429 1320 935 3695 145 573 230 1061 20558

A. 23: Distribution of graduates of medical technology faculty by universities University / Misuratha El Mergib Tripoli Aljafarah NALOT ALZETONA Jufrah ALZAWEA SABAHA SABARTA Total Year 2010-2011 243 4 2291 0 102 0 133 0 0 0 2773 2011-2012 152 1 1762 0 67 0 122 0 0 0 2104 2012-2013 201 0 784 0 66 0 68 0 0 0 1119 2013-2014 148 7 962 0 30 0 64 0 0 0 1211 2014-2015 142 34 443 0 19 0 53 0 35 0 726 2015-2016 214 62 243 0 33 0 86 0 30 0 668 2016-2017 225 68 213 0 23 0 65 0 42 0 636 TOTAL 1325 176 6698 0 340 0 591 0 107 0 101369237

Libya 2018-Health Education and Training Institutions ||116 A. 24: Distribution of first year health sciences students by universities University/ Year Sirte El Mergib Gharyan TOTAL 2010-2011 257 0 65 322 2011-2012 316 69 24 409 2012-2013 153 85 16 254 2013-2014 144 57 17 218 2014-2015 88 16 75 179 2015-2016 0 63 109 172 2016- 2017 0 221 336 557 Total 958 511 642 2111

A. 25: Distribution of final year health sciences students by universities University Sirte El Mergib Gharyan TOTAL /year 2010-2011 105 0 26 131 2011-2012 195 0 14 209 2012-2013 165 0 8 173 2013-2014 130 0 0 130 2014-2015 79 0 56 135 2015-2016 0 30 35 65 2016-2017 0 26 29 55 TOTAL 674 56 168 898

Libya 2018-Health Education and Training Institutions ||117 A. 26: Distribution of total health sciences students by universities

University / Sirte El Mergib Gharyan TOTAL

2010-2011 1133 0 100 1233 2011-2012 1204 69 49 1322 2012-2013 887 21 108 1016 2013-2014 690 111 63 864 2014-2015 609 96 157 862 2015-2016 0 124 198 322 2016-2017 0 221 336 557 Total 4523 642 1011 6176

A. 27: Distribution of graduates of faculty of health sciences by universities University Sirte El Mergib Gharyan TOTAL 2010-2011 100 0 26 126 2011-2012 102 0 14 116 2012-2013 141 0 8 149 2013-2014 141 0 0 141 2014-2015 6 0 56 62 2015-2016 0 17 35 52 2016-2017 0 19 29 48 Total 490 36 168 694

Libya 2018-Health Education and Training Institutions ||118

A. 28: Distribution of first year public health students by universities University Benghazi Asmariya Sabratha TOTAL / Year 2010-2011 404 - 58 462 2011-2012 257 - 31 288 2012-2013 43 - 20 63 2013-2014 217 - 31 248 2014-2015 - - 226 226 2015-2016 - 210 136 346 2016-2017 290 186 172 648 Total 1211 396 674 2281

A. 29: Distribution of final year public health students by universities University / Benghazi Asmariya Sabratha Year 2010-2011 296 0 43 339 2011-2012 363 0 47 410 2012-2013 339 0 29 368 2013-2014 382 0 32 414 2014-2015 - 0 24 24 2015-2016 - 0 16 16 2016-2017 352 0 25 377 Total 1732 0 216 1948

Libya 2018-Health Education and Training Institutions ||119

A. 30: Distribution of total public health students by universities

University Benghazi Asmariya Sabratha TOTAL

2010-2011 1434 0 161 1595 2011-2012 1367 0 126 1493 2012-2013 1153 0 85 1238 2013-2014 1070 0 101 1171 2014-2015 0 0 297 297 2015-2016 0 210 358 568 2016-2017 932 396 404 1732 Total 5956 606 1532 8094

A. 31: Distribution of public health graduates by universities

University / Benghazi Asmariya Sabratha TOTAL Year 2010-2011 278 0 38 316 2011-2012 328 0 38 366 2012-2013 331 0 17 348 2013-2014 342 0 27 369 2014-2015 - 0 22 22

Libya 2018-Health Education and Training Institutions ||120 2015-2016 - 0 15 15 2016-2017 278 0 27 305 Total 1557 0 184 1741

A. 32: Medical school curriculum Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Term 1: Term 3: Term 5: Term 6: Term 7: Term 9: Introduction to Biochemistry. Anatomy 2. Anatomy and Ophthalmology. Obstetrics and Medicine. Introduction to Physiology. Histology and Genetics 2 Embryology 4. Forensic and gynecology. Introduction to Anatomy. Physiology 2. Parasitology and toxicology. Biochemistry 2. Introduction to Histology. Microbiology 1. English language 3, Physics. Pharmacology 2. Arabic Language 1. Pathology 2. English language 1, Clinical skills 2. ICT Term 2: Term 4: Term 6: Term 7: Term 8: Term 10: Anatomy. Anatomy 3. Parasitology and Family medicine Pediatrics. Surgery Histology and Genetics Physiology 3. Microbiology 2. Community medicine. Physiology. Biochemistry 3. Pharmacology 3. Radiology> Biochemistry. Pharmacology 1. Pathology 3. Arabic Language 2. Pathology 1. Clinical skills 3. English language 2, Clinical skills 1.

A. 33: School of Dentistry curricula: Preparatory Year Year 1 Year 2 Year 3 Year 4 Biostatistics. Tal anatomy. Oral Histology. Oral Pathology. Oral Medicine. English language. Dental material. Conservative treatment. General surgery. Oral surgery. Biochemistry. Anatomy. Fixed Prosthesis and Crowns. General Medicine. Periodontology. Biology. Physiology. Removable prosthesis. Orthodontics. Physics. Histology. Pathology. Pedodontics. General Chemistry. Pharmacology. Conservative treatment.

Libya 2018-Health Education and Training Institutions ||121 Microbiology. Preventive dentistry. Fixed Prosthesis and Crowns. Removable prosthesis.

A. 34: Nursing school Year 1 Year 2 Year 3 Term 1: Term 3: General Nursing Surgery and surgical Anesthesia and Midwifery and Neonates English language 1. English language operations Intensive care Arabic language 1. 3. Term 5: Term 5: Term 5: Term 5: General Anatomy 1. Biochemistry. Surgical and Medical Surgical and Medical Surgical and Medical Surgical and Medical Nursing Introduction to nursing. Mother and child Nursing 1. Nursing 1. Nursing 1. 1. Mathematics and health1. Nutrition. Nutrition. Nutrition. Nutrition. Biostatistics. Pathology. Mental Health. Mental Health. Mental Health. Mental Health. Nursing Principals. Health Medical Ethics. Medical Ethics. Medical Ethics. Medical Ethics. Education. Clinical skills 3. Surgery and surgical Clinical skills 3. Clinical skills 3. Health Geriatric Nursing. operations 1. ICU Nursing 1. Midwifery and Neonates 1. Evaluation. General Nursing 1. Preoperative care ICU 1. Risk pregnancy. Clinical skills 1 Infection Control. Nursing. Palliative Nursing Pediatric preoperative care. Term 6: Term 2: Term 6: Abdominal Surgeries. Term 6: Surgical and Medical Nursing English language 2. Surgical and Medical Wound care. Surgical and Medical 2. Arabic language 2. Nursing 2. Nursing 2. Nursing research 1. General Anatomy 2. Term 2: Nursing research 1. Term 6: Nursing research 1. Community Nursing. ICT 1. English language Community Nursing Surgical and Medical Community Nursing. Clinical skills 4. 4. 1. Nursing 2. Clinical skills 4. Midwifery and Neonates 2. Microbiology. General Nursing. Nursing research 1. ICU Nursing 2. Difficult labor and Critical Mother and child Introduction to ICU Community Nursing. ICU 2. neonatal conditions. health 2. patients. Clinical skills 4. Introduction to Parasitology. Clinical skills 4. anesthesia.

Libya 2018-Health Education and Training Institutions ||122 Basic Nursing 2. General Surgery Surgery and surgical General Nursing. operations 2. Psychiatry. Rehabilitation ENT surgery. Clinical Skills 2. Nursing. Thoracic and Cardiovascular . Surgery. Urogenital system and Renal transplant.. Year 4 Note: each student should present a research project according to the specialty. Term 7 Term 7 Term 7 Term 7 Surgical and Medical Surgical and Medical Surgical and Medical Surgical and Medical Nursing Nursing 3. Nursing 3. Nursing 3. 3. Nursing research 2. Nursing research 2. Nursing research 2. Nursing research 2. Community Nursing Community Nursing 2. Community Nursing 2. Community Nursing 2. 2. General Nursing 2. General Nursing 2. General Nursing 2. General Nursing 2. Clinical skills 5. Clinical skills 5. Clinical skills 5. Clinical skills 5. Surgical and Surgical ICU Nursing 3. Midwifery and Neonates 3. Psychiatric Nursing. operation Nursing 3. ICU 3. Accident treatment Term 8: Term 8: Eye Surgery. Term 8: Nursing reports. Nursing reports. Neuro Surgery. Nursing reports. Nursing Management. Nursing Musculoskeletal Nursing Management. General Nursing 4. Management. Surgery. General Nursing 4. Nursing research 3. General Nursing 4. Nursing research 3. Clinical skills 6. Nursing research 3. Term 8: Clinical skills 6. Midwifery and Neonates 4. Clinical skills 6. Nursing reports. ICU Nursing 3. Nursing Management. ICU 3. General Nursing 4. Nursing research 3. . Clinical skills 6. Surgical and Surgical operation Nursing 4.

Libya 2018-Health Education and Training Institutions ||123

A. 35: Public Health Year 1 Year 2 Year 3 Introduction to Ecology Introduction to Ecology Nutrition Environment Management 1. 2. Nutrition. Epidemiology. Forensics Medicine. Forensics Medicine. Forensics Medicine. Biology. Parasitology. Communicable and non- Communicable and non- Communicable and non- General chemistry. General Health communicable diseases. communicable diseases. communicable diseases. Arabic language. management Microbiology. Microbiology. Health information 1. Anatomy and Biochemistry. ICT. ICT. Health economics. physiology. Microbiology. Applied Nutrition 1. Analytical chemistry Health Management. English language. Pharmacology. Clinical Nutrition. Environmental Health. Accounting principles. Introduction to public Biostatistics. Research Methods. Occupational Health. Occupational Health health. Pathology. Health Legislations. Ecology. Research Methods. Physics. Nutrition. Food Chemistry. Research Methods. Health Legislations. Food Chemistry. Year 4 Food analysis. Analytical chemistry. Health Services Professional ethics Professional ethics. management. Nutritional Groups. Marine ecology. Health Legislations. Clinical Nutrition. Environmental emergencies. Health information 2. Food health and safety. Waste Management. Health planning. Applied Nutrition 2. Environmental hazards. Organizational behavior. Food hygiene practices Field visits Population Health. Food preservation Field visits. Field visits.

Libya 2018-Health Education and Training Institutions ||124

A. 36: Pharmacy. Year 1 Year 2 Year 3 Year 4 Preparatory Term: Term 2: Term 4: Term 6: General Chemistry. Organic Chemistry 2. (+Practical) Pharmacology 2. Biopharmaceuticals English language. Analytical Chemistry 2. (+Practical) Medicinal Chemistry 2. Hospital Pharmacy. Physics. Physiology 2. (+Practical) Microbiology 1. Therapeutics 2. Botanic. Physical Pharmacy 2. (+Practical) Pharmaceuticals 3. Pharmaceutical analysis 2. Zoology 1. General Anatomy 2. Pharmaceutical technology 2. Industrial pharmacy 1. Arabic Language. Histology2. Biochemistry 2. Biochemistry. Biostatistics. Pharmaceuticals1. Medical Chemistry 2. (+Practical) Clinical Chemistry. Automatic Analysis. (+Practical) Term 1: Term 3: Term 5: Term 7: Organic Chemistry 1. Medicinal Chemistry 1. Therapeutics 1. Clinical Pharmacy and Toxicology. Analytical Chemistry 1. General Microbiology. Pathology. Microbiology 2. Physiology 1. Pharmaceuticals 2. Microbiology 2. Industrial pharmacy 2. Pharmacology. Pharmaceutical technology 1. Pharmaceuticals 4. Applied Pharmacology. Physical Pharmacy 1. Biochemistry 1. Pharmaceutical technology 3. Clinical Chemistry. General Anatomy 1. Medical Chemistry 1. (+Practical) Pharmaceutical analysis 1. Histology 1. Term 8: Clinical Pharmacy. Pharmaceutical Practice 1, Pharmaceutical Practice 2, Research Project.

Libya 2018-Health Education and Training Institutions ||125 A. 37: Year 1 of Medical technology: Term 1 Term 2 Arabic Language. Arabic Language. Biology, Biochemistry. General Chemistry, Botanics. English language, General and Organic Chemistry, ICT, Histology. Medical Physics, Microbiology. Biostatistics, English language, Zoology, ICT, Medical Physics, Biostatistics, Zoology,

A. 38: Dental Technology division of Medical Technology Faculty: Term 3 Term 4 Anatomy Principals. Biochemistry 2. Arabic Language. Oral Histology 2. Biochemistry 1. Oral Microbiology. Dental Material 1. Physiology 2. Oral Histology 1. Descriptive anatomy 2. Microbiology. Oral Health. Head and neck Anatomy. Dental Material 2. Descriptive anatomy 1. instruments and equipment ICT, Histology Principals. Physiology 1. Term 5 Term 6

Oral Histology 2. Fixed Prosthesis. Fixed Prosthesis. Removable prosthesis. Removable prosthesis. Orthodontics 1. Pathology. Behavioral Science. Pharmacology Research Methods, instruments and equipment Orthodontics 2. Behavioral Science Dental Imaging. Dental implants. advanced methods in dental technology الفصل السابع Term 6

Fixed Prosthesis. Fixed Prosthesis. Removable prosthesis. Removable prosthesis. Orthodontics. Research methods. Dental Imaging. Research Project. Dental implants. Health Management. Research Project Field practice. Maxillofacial replacement. Cosmetic Dentistry.

Libya 2018-Health Education and Training Institutions ||126 A. 39: Medical laboratories Division. Term 3 Term 4 Arabic Language. Analytical Chemistry 2. Biochemistry 1. Anatomy and Physiology. Analytical Chemistry 1. Biochemistry 2. Microbiology. Histopathology. Anatomy and Physiology. Molecular Biology. ICT Instruments and equipment. Laboratories Safety and management. Term 5 Term 6

Clinical chemistry. Clinical chemistry. General Hematology. Medical Parasitology. Medical Parasitology. Diagnostic Hematology. Histopathology. Immunology and Serology Diagnostic Microbiology. Diagnostic Bacteriology. Immunology and Serology Medical Virology and Mycology. Term 7 Term 8

Statistics and Research Methods. Practical Skills. Practical skills. Infection Control. Clinical chemistry. Research Project. Immune Hematology

Libya 2018-Health Education and Training Institutions ||127 A. 40: Physiotherapy division. Term 3 Term 4 Anatomy Principals. Physiology. Arabic Language. Biochemistry 2. Biochemistry 1. Pathology. Biomechanics. Biochemistry 1. Tests and measurements Biomechanics. General Chemistry. Electroconvulsive therapy and Hydrotherapy. General Microbiology. Tests and measurements Head and neck Anatomy. Descriptive anatomy 1. Pathology ICT, Histology Principals. Physiology 1. Zoology. Biostatistics. Medical Physics. Term 5 Term 6

Medicine and geriatrics. Medicine and geriatrics. Orthopedics. Orthopedics. Medicine and geriatrics physiotherapy. Medicine and geriatrics physiotherapy. Orthopedics physiotherapy. Orthopedics physiotherapy. Pharmacology. Psychiatry and professional ethics. Biochemistry. Obstetrics and gynecology. Obstetrics and gynecology Physiotherapy. Term 7 Term 8

Neurology and Neurosurgical diseases. Neurology and Neurosurgical diseases Neurology and Neurosurgical diseases physiotherapy. physiotherapy. Research Project. Research Methods. Pediatrics and Pediatric physiotherapy. Rehabilitation. Orthotics and prostheses. General Surgery. Sport injuries. General Surgery Physiotherapy.

Libya 2018-Health Education and Training Institutions ||128 A. 41: Public Health Division. Term 3 Term 4 Anatomy Principals. Health Databases. Biochemistry 1. (+ Practical) Immunology. Oral Histology 1. Community Health. Microbiology. Health Awareness and health education. Head and neck Anatomy. Medical Parasitology. Descriptive anatomy 1. Medical Legislations. ICT, Professional ethics. Histology Principals. Pharmacology and Toxicology. Physiology 1. Mental Health. Health Information. Health Surveillance. Community Health. International Health Surveillance. Health Awareness and health education. Medical Parasitology. Health Databases. Term 5 Term 6

Pharmacology and Toxicology. Life style and Health. Mental Health. Environmental Health. Medical Legislations and Professional Ethics. Epidemiology. Medical Microbiology. Occupational health and Safety. Life style and Health. Nutritional Microbiology. Environmental Health. School health. Health Policies. Health Disaster Management First Aids. Health Policies. Psychological and social support First Aids. Psychological and social support Term 7 Term 8

Nutritional Microbiology. Therapeutic nutrition. Health Disaster Management Health Policies. Infection Control. School Health. Research methods and data entry. Public Health Engineering Food quality and safety. Community health. Public health pest control. Research Project. Health protection for the elderly. Health and food inspection

Libya 2018-Health Education and Training Institutions ||129 A. 42: The number of graduates of Intermediate Health Institutes per year, from 1970 to 2003

Community Health Hygiene Health General Nursing Laboratories Diagnostic Technicians Nursing Pharmacist Assistant Specialization/ Technicians Health inspection

Year Male Female Male Male Female Male Female Male Female Male Female Male Male

1972 30 30 12 17 - - - - 29 - - - -

1973 14 42 17 10 - - - - 16 - - - -

1974 23 27 15 16 - - - - 18 - - 10 -

1975 16 53 10 11 - - - - 31 - - 13 -

1976 23 83 24 12 - - - - 19 - - 8 -

1977 1 54 13 21 ------10 -

1978 15 90 12 25 ------13 -

1979 46 75 22 23 ------18 -

1980 23 120 16 23 - - - - 49 - - 17 -

1981 32 92 33 20 - - - - 49 - - 19 -

1982 36 155 28 24 - - - - 49 - - 28 -

1983 72 352 39 16 - - - - 73 - - 53 42

1984 43 301 29 18 - - - - 57 - - 72 95

1985 82 477 28 20 - - - - 70 - - 60 162

1986 110 421 42 35 - - - - 85 - - 115 90

1987 86 825 47 32 14 - 187 13 100 - - 137 147

1988 119 569 32 20 15 - 152 30 21 - - 72 70

1998 122 811 41 34 12 - 128 27 55 - - 95 47

1990 342 774 61 32 29 - 204 - 80 - - 169 25

1991 345 825 69 33 21 - 153 - 78 - - 173 37

1992 332 1197 52 72 39 - 274 - 43 - - 55 82

1993 176 872 61 79 42 - 184 - 40 - - 81 100

Libya 2018-Health Education and Training Institutions ||130 1994 187 1065 64 97 14 - 163 - 36 - - 99 161

1995 216 1657 63 110 15 - 214 - 31 - - 65 227

1996 264 1638 79 86 106 - 357 27 34 - - 57 198

1997 245 2234 61 47 51 - 545 19 32 8 7 47 234

1998 216 2206 15 33 75 - 494 45 29 10 18 24 119

1999 68 1332 33 59 9 1 147 29 10 1 20 65 70

2000 83 1041 20 40 14 - 197 30 7 - - 51 84

2001 43 1058 17 24 27 - 228 22 - 11 37 17 62

2002 75 779 11 - 7 - 41 10 - - - - -

2003 69 730 11 55 54 - 209 31 35 2 - 47 88

Total 3554 21985 1077 1144 544 1 3877 283 1176 32 82 1690 2140

A. 43: Activities of the Medical Manpower Development Center (2003-2015)

Total Year/ 2003 2004 2005 2007 2008 2011 2012 2013 2015

Courses Training courses 1293 1165 1270 1416 420 632 1892 4632 439 13159

Specialized training 644 1042 268 315 437 - 56 97 0 2859

Libya 2018-Health Education and Training Institutions ||131

A. 44: Detail scoring of accreditation standards by areas of three major undergraduate medical institutes of Libya Tripoli Benghazi Omar Al Mukhtar Total Type of Ni 0<25 25<50 50- 75- Ni 0<25 25<50 50- 75- Ni 0<25 25<50 50- 75- Standard Standards l % % <75% 100% l % % <75% 100% l % % <75% 100% s Area 1 Basic 19 0 1 2 10 6 0 2 3 1 13 0 0 9 9 1 Mission and outcomes Quality 8 0 0 1 6 1 0 0 2 2 4 0 0 4 4 0

Area 2 Basic 21 1 1 5 10 4 1 2 0 9 9 1 0 12 7 1 Educational Program Quality 19 4 1 4 6 4 4 1 3 5 6 4 1 8 6 0

Area 3 Total B 10 0 0 0 2 8 0 0 0 2 8 0 0 4 5 1 Assessment of students Total Q 5 0 0 0 2 3 0 0 0 1 4 0 0 1 3 1 Area 4 Total B 13 9 0 0 2 2 9 0 1 1 2 9 0 2 2 0 Students Total Q 7 2 0 1 4 0 2 2 2 1 0 2 1 1 3 0

Area 5 Total B 8 2 0 3 3 0 1 2 5 0 0 1 0 4 3 0 Faculty Total Q 4 2 1 0 1 0 1 2 1 0 0 1 1 2 0 0

Area 6 Total B 15 3 6 0 6 0 1 9 4 1 0 1 1 6 7 0 Educational Resources Total Q 14 1 5 2 6 0 7 4 3 0 0 5 2 3 4 0

Area 7 Total B 10 3 0 5 2 0 2 2 5 1 0 0 0 7 3 0 Program Evaluation Total Q 13 7 1 3 2 0 4 3 4 2 0 0 0 10 3 0 Area 8 Total B 7 3 0 1 1 2 3 0 3 0 1 3 0 3 0 1 Governance and administration Total Q 8 4 0 2 1 1 3 0 3 0 2 3 0 4 0 1

Area 9 Total B 3 2 1 0 0 0 2 1 0 0 0 1 1 1 0 0 Continuous renewal Total Q 12 2 6 2 2 0 1 3 7 1 0 1 0 4 7 0

Total Basic 106 106 23 9 16 36 22 19 18 21 15 33 16 2 48 36 4 Total Quality 90 90 22 14 15 30 9 22 15 25 12 16 16 5 37 30 2

Libya 2018-Health Education and Training Institutions ||132 A. 45: Faculty Staff of undergraduate medical schools Basic Sciences Departments Degree Benghazi Tripoli Omar Mokhtar

1. Anatomy Professor - Associate .Prof - 1 Assistant .Prof - Lecturer 1 3 1 Assistant Lecturer 3 Other 3 preceptors 3 2. Histology Professor - 1 Associate .Prof 1 2 Assistant .Prof 2 2 Lecturer 3 5 1 Assistant Lecturer 12 5 other 16 preceptors 7 3. Physiology Professor 1 1 Associate .Prof - 1 Assistant .Prof 1 0 Lecturer 2 4 2 Assistant Lecturer 6 other 15 preceptors 2 4. Biochemistry Professor 2 1 Associate .Prof 3 2 Assistant .Prof 2 0 1 Lecture 9 3 1 Assistant Lecturer 2 2 other 7 preceptors 3 5. Microbiology Professor - 4 Associate .Prof 1 2 Assistant .Prof 2 4 1 Lecturer 2 8 2 Assistant Lecturer 4 2 2 other 3 preceptors 2 6. Pathology Professor - Associate .Prof 1 1 Assistant .Prof 2 Lecturer 2 1 Assistant Lecture 4 2 other 3 preceptors 6 7. Pharmacology Professor - 4 Associate .Prof - 4

Libya 2018-Health Education and Training Institutions ||133 Assistant .Prof - 2 Lecturer 1 4 1 Assistant Lecturer 14 4 other 7 preceptors 1 8. Parasitology Professor 1 1 Associate .Prof 1 Assistant .Prof - 2 Lecturer 1 4 Assistant Lecturer - 1 other 8 preceptors 3

Clinical Sciences

Departments Degree Benghazi Tripoli Omar Mokhtar

1. Community Professor 5 2 Associate .Prof 4 5 Assistant .Prof - 11 Lecturer 1 5 Assistant Lecturer 4 Other 11 preceptors 5 2. Forensic Professor - Associate .Prof 1 1 Assistant .Prof - Lecturer 3 2 Assistant Lecturer 2 1 other 15 preceptors 2 3. Gynecology Professor 2 9 Associate .Prof 4 10 Assistant .Prof 4 5 2 Lecturer 20 28 1 Assistant Lecturer 1 4 other 14 preceptors 10 4. Ophthalmology Professor 1 2 1 Associate .Prof 1 2 1 Assistant .Prof 3 5 2 Lecturer 2 20 Assistant Lecturer 6 1 other 15 preceptors 3 5. Medicine Professor 22 11 Associate .Prof 15 2 3

Libya 2018-Health Education and Training Institutions ||134 Assistant .Prof 11 4 3 Lecturer 67 19 3 Assistant Lecturer 2 5 4 other 46 preceptors 5 6. Surgery including: Anesthesia, ENT, Professor 11 25 3 Orthopedic, Urology, Radiology Associate .Prof 11 18 3 Assistant .Prof 18 20 4 Lecturer 46 15 8 Assistant Lecturer - 10 8 other 60 preceptors 15 6. Pediatric: Professor 13 15 Associate .Prof 8 7 2 Assistant .Prof 10 20 2 Lecturer 24 20 3 Assistant Lecturer - other 31 preceptors 2

A. 46: Detail scoring of accreditation standards by areas of Benghazi Dentistry School of Libya Total Type of Standards Nil 0<25% 25<50% 50-<75% 75-100% Standards Area 1 Basic 19 0 1 5 9 4 Mission and outcomes Quality 8 0 2 2 3 1 Area 2 Basic 21 0 2 12 6 1 Educational Program Quality 19 1 1 12 5 0 Area 3 Basic 10 0 0 2 2 6 Assessment of students Quality 5 0 0 0 1 4 Area 4 Basic 13 0 5 3 3 2 Students Quality 7 0 2 1 3 1 Area 5 Basic 8 0 3 3 2 0 Faculty Quality 4 0 0 3 1 0 Area 6 Basic 15 2 3 5 5 0 Educational Resources Quality 14 5 6 0 3 0 Area 7 Basic 10 0 0 0 10 0

Libya 2018-Health Education and Training Institutions ||135 Program Evaluation Quality 13 0 1 3 6 3 Area 8 Basic 7 2 0 1 4 0 Governance and administration Quality 8 2 1 1 4 0 Area 9 Basic 3 0 1 1 1 0 Continuous renewal Quality 12 0 2 0 10 0 Total Basic 106 4 15 32 42 13 Quality 90 8 15 22 36 9

A 47: Faculty of Benghazi Dentistry School Departments Degree Benghazi 1. Orthodontics Professor 0 Associate .Prof 2 Assistant .Prof 2 Lecturer 2 Assistant Lecturer 1 Other 4 preceptors 2. Periodontics Professor 1 Associate .Prof 1 Assistant .Prof - Lecturer 2 Assistant Lecturer 3 other 5 preceptors 3. Oral Biology Professor - Associate .Prof - Assistant .Prof 1 Lecturer - Assistant Lecturer 6 other 6 preceptors 4. Oral Pathology, Oral Medicine, Radiology & Diagnosis Professor 4 Associate .Prof 4 Assistant .Prof 2 Lecturer 1 Assistant Lecturer 4 other 18 preceptors 5. Oral Surgery Professor 1

Libya 2018-Health Education and Training Institutions ||136 Associate .Prof - Assistant .Prof 1 Lecturer 2 Assistant Lecturer 2 other 4 preceptors 6. Prosthetic Dentistry Professor 3 Associate .Prof - Assistant .Prof 1 Lecturer 4 Assistant Lecturer 16 other 26 preceptors 7. Pedodontics Professor - Associate .Prof 1 Assistant .Prof 2 Lecturer 3 Assistant Lecturer 10 other 15 preceptors 8. Conservative Dentistry Professor 1 Associate .Prof 1 Assistant .Prof 2 Lecturer 7 Assistant Lecturer 8 other 18 preceptors 9- Basic Sciences Professor - Associate .Prof - Assistant .Prof - Lecturer - Assistant Lecturer 4 other 25 preceptors

Libya 2018-Health Education and Training Institutions ||137 A. 48: Detail scoring of accreditation standards by quality criterions of three major nursing faculties of Libya

Tripoli Benghazi Omar Almoktar Standards Criterion Nil 0<25% 25<50% 50-<75% 75-100% Nil 0<25% 25<50% 50-<75% 75-100% Nil 0<25% 25<50% 50-<75% 75-100% Governance structure 9 2 5 2 2 2 2 3 1 1 7 Administrative structure 8 3 3 1 1 0 2 4 1 1 2 2 2 2 Teaching environment 11 3 1 1 4 2 2 2 1 4 2 1 2 8 Professional practice 27 2 1 2 10 12 2 3 10 1 11 2 25 Educators sufficiency /competency 9 3 2 1 3 1 2 2 3 1 1 1 1 1 5

Infrastructure 6 2 2 1 1 4 2 1 2 3 Total 70 15 9 6 21 19 9 17 18 12 14 8 7 6 2 47

A. 49: Faculty of Nursing in Libya Benghazi Departments Degree Total number 1. Clinical Adult Professor - Associate .Prof - Assistant .Prof - Lecturer - Assistant Lecturer - Other 2 2. Maternal & Child Nursing Professor - Associate .Prof - Assistant .Prof - Lecturer - Assistant Lecturer - Other 5 3. Psychiatric & Community Nursing Professor - Associate .Prof - Assistant .Prof - Lecturer - Assistant Lecturer - Other 10

Libya 2018-Health Education and Training Institutions ||138

Tripoli

Departments Degree Total number 1. Fundamental of Nursing Professor Associate .Prof 0 Assistant .Prof 0 Lecturer 2 Assistant Lecturer 6 Other (Preceptor) 4 2. General Nursing Professor 0 Associate .Prof 0 Assistant .Prof 0 Lecturer 1 Assistant Lecturer 2 other(Preceptor) 7 3. Surgery and Operation Theater Professor 0 Associate .Prof 0 Assistant .Prof O Lecturer 0 Assistant Lecturer 2 other(Preceptor) 6 4. Midwifery and Neonatology Professor 0 Associate .Prof 0 Assistant .Prof 0 Lecturer 1 Assistant Lecturer 1 Other(Preceptor) 4 Omar Mukhtar

Departments Degree Total number 1. General Nursing Professor - Associate .Prof - Assistant .Prof - Lecturer 2 Assistant Lecturer 3 Other -

Libya 2018-Health Education and Training Institutions ||139 A. 50: Detail scoring of accreditation standards by quality criterions of three major pharmacy faculties of Libya

Tripoli Benghazi Omar Almokhtar Standard Criterion Nil 0<25% 25<50% 50-<75% 75-100% Nil 0<25% 25<50% 50-<75% 75-100% Nil 0<25% 25<50% 50-<75% 75-100% Educational framework 2 1 1 2 2 Learning environment 3 2 1 3 1 2 Duration of course 7 1 6 4 1 2 1 6 Content of curriculum 6 2 4 1 2 3 3 3 Practice experience 2 2 2 2 Learning experience 1 1 1 1 Teaching methodology 3 3 3 3 University structure 3 2 1 2 1 2 1 University commitment 3 1 2 1 1 1 2 1 Faculty Organization 1 1 1 1 Status of Faculty 2 2 1 1 2 Governance structure 3 3 2 1 1 2 Research 1 1 1 1 Planning 2 2 1 1 2 Evaluation 2 2 2 1 1 Admission policy 2 1 1 2 1 1 Quality assurance 2 1 1 1 1 1 1 Student services 4 1 2 1 2 2 1 2 1 Human resources 5 1 3 1 1 1 2 1 1 4 Practice site resources 5 3 2 2 1 1 1 1 3 1 Infrastructure 1 1 1 1 Space for activities 1 1 1 1 Information resources 1 1 1 1 Infrastructure 2 1 1 2 1 1 Total 64 19 0 2 15 28 19 11 17 16 1 2 2 24 28 8

Libya 2018-Health Education and Training Institutions ||140 A. 51: Faculty of Pharmacy (Benghazi and Omar Mukhtar) Departments Degree Benghazi Omar Mukhtar 1. Pharmacology & Toxicology Professor - - Associate .Prof - - Assistant .Prof 2 - Lecturer 4 1 Assistant Lecturer 7 6 Other 6 2. Pharmaceutics Professor - - Associate .Prof 1 - Assistant .Prof 1 - Lecturer 4 1 Assistant Lecturer 10 5 other 10 - 3. Basic Medical Sciences Professor - - Associate .Prof 1 - Assistant .Prof - - Lecturer - - Assistant Lecturer 1 4 other - - 4. Pharmaceutical Chemistry Professor - - Associate .Prof - - Assistant .Prof 1 - Lecturer - - Assistant Lecturer 9 4 other 7 - 5. Pharmacognocy Professor - - Associate .Prof - - Assistant .Prof 1 - Lecturer 2 - Assistant Lecturer - - other 7 -

Libya 2018-Health Education and Training Institutions ||141

Project Management Study: Name Status in the study project

Mohammed Ibrahim Saleh Daganee General Supervisor of the project

Professor, Dr Ibrahim Jabeal Director of the study project

Omar Al-Arif Saeed project's reporter and manager Zaid Abdessalem Mohamed Project Manager

B. Data collectors’ names: 1 Ibrahim Ali Jebeil 2 Azza SeddikGraiou 3 Mbarka Abu KacemDhib 4 Salem MiloudJebeil 5 Fethia Baghdadi Ahmed 6 Dr. Salah Hassan Gonti 7 Omar Aref Said 8 Mohamed Hassan Achkham 9 Ali MahjoubHlach 10 Samir Fredj Ben Marzouk 11 Mohamed Mahmoud Mahjoub 12 Mohamed Omar Bettaieb 13 JomaaKhelifaGdara 14 Nachoua Mohamed Mahjoub 15 Dina RamadahnJarboua 16 Mohamed Mahmoud Sekta 17 Issa Abu KassemYoussfi 18 Abdelakder Mohamed AbouAjras 19 Mohamed Abu Elkhir 20 WardaBeni 21 Salah Mohamed Moussa 22 AbdelahediMeftahAbdessalem

Libya 2018-Health Education and Training Institutions ||142

Name of Faculty members who participated in accreditation review

1. Prof .Dr. AbdulRaoof Mohamed Algasbe: Dean of faculty of Pharmacy. 2. Dr.Jamal Saleh Almozoge: Vice President of faculty of Pharmacy. 3. Amal Abdul Majed Amar: Head of Quality Assurance Office. Faculty of Pharmacy – University of Tripoli. 4. Dr. Ali Mansor Aljornaze: Dean of faculty of Nursing University of Tripoli. 5. Dr.AmjadAltaherShaktour: Vice President of faculty of Nursing University of Tripoli . 6. Dr. Hend Mohamed : Head of Quality Assurance office. Faculty of Nursing – University of Tripoli. 7. Dr, Faten Abdul Hamed Benrajab: Dean of faculty of Medicine. 8. Dr.Kaled ben Gadara: Vice President of faculty of Medicine. 9. Dr.Yosef Salah Alkatale: Head of Quality Assurance Office. Faculty of Medicine, University of Tripoli. 10. Dr Omaima Algatlawi. Head of Quality Assurance office. Faculty of Medicine, University of Benghazi. 11. Dr Narges Kablan: Head of Quality Assurance office. Faculty of Pharmacy, University of Benghazi. 12. Dr Naima Beltamer: Head of Quality Assurance office. Faculty of Dentistry, University of Benghazi. 13. Minerva Phelebena: Head of Quality Assurance office. Faculty of Medicine – University of Benghazi

Libya 2018-Health Education and Training Institutions ||143