Reforming Health System in Libya By Yusuf Çelik & Adel El Taguri 2 Reforming Health System in Libya © June 2021 | Statistical, Economic and Social Research and Training Centre for Islamic Countries (SESRIC) Kudüs Cad. No: 9, Diplomatik Site, 06450 Oran, Ankara –Turkey Telephone +90–312–468 6172 Internet www.sesric.org E-mail [email protected] The material presented in this publication is copyrighted. The authors give the permission to view, copy, download, and print the material presented provided that these materials are not going to be reused, on whatsoever condition, for commercial purposes. For permission to reproduce or reprint any part of this publication, please send a request with complete information to the Publication Department of SESRIC. The responsibility for the content, the views, interpretations and conditions expressed herein can in no way be taken to reflect the views of the SESRIC or its Member States, partners, or of the OIC. The boundaries, colours and other information shown on any map in this work do not imply any judgment on the part of the SESRIC concerning the legal status of any territory or the endorsement of such boundaries. All queries on rights and licenses should be addressed to the Publication Department, SESRIC, at the aforementioned address. ISBN: 978-625-7162-09-8 Cover design by Publication Department, SESRIC. For additional information, contact Research Department, SESRIC through: [email protected] LIST OF FIGURES i TABLE OF CONTENTS ACKNOWLEDGEMENTS .................................................................................... XI FOREWORD ...................................................................................................... XIII EXECUTIVE SUMMARY....................................................................................... 1 1 INTRODUCTION ......................................................................................... 15 2 HEALTH SYSTEM OF LIBYA AND THE ANALYTICAL FRAMEWORK .......................................................................................................................... 21 2.1 FRAMEWORK FOR ANALYZING HEALTH SYSTEM IN LIBYA........................ 21 2.2 A BRIEF INFORMATION ABOUT LIBYA AND ITS HEALTH STATUS .............. 24 2.2.1 GEOGRAPHY AND SOCIO-DEMOGRAPHY .................................................... 24 2.2.2 HEALTH STATUS ......................................................................................... 28 2.3 GOVERNANCE AND MANAGEMENT ........................................................ 29 2.3.1 HEALTH SYSTEM ORGANIZATION AND REGULATION................................. 31 2.3.2 HEALTH SERVICES PLANNING..................................................................... 33 2.4 HEALTH CARE FINANCING .................................................................... 33 2.4.1 HEALTH EXPENDITURES ............................................................................. 35 2.4.2 SOURCES OF HEALTH FINANCING .............................................................. 38 2.5 HEALTH SERVICES PROVISION ............................................................... 39 2.5.1 PRIMARY HEALTH CARE ............................................................................. 40 2.5.2 SECONDARY AND TERTIARY HEALTH CARE ................................................ 41 2.5.3 THE ROLE OF PRIVATE SECTOR .................................................................. 42 2.5.4 THE CAPABILITY OF HEALTH CARE FACILITIES .......................................... 43 2.6 HEALTH WORKFORCE ........................................................................... 44 2.7 MEDICAL SUPPLIES AND TECHNOLOGIES ............................................... 47 2.8 HEALTH INFORMATION SYSTEM ............................................................ 47 ii Reforming Health System in Libya 3 ASSESSMENT OF HEALTH SYSTEM PERFORMANCE INDICATORS AND MAIN ASPECTS OF LIBYAN HEALTH SYSTEM .................................. 51 3.1 THE FRAMEWORK USED TO ASSESS LIBYAN HEALTH SYSTEM PERFORMANCE AND IDENTIFY PATHS FOR IMPROVEMENT ............................... 51 3.2 HEALTH SYSTEM PERFORMANCE INDICATORS AND THE MAIN ASPECTS OF LIBYAN HEALTH SYSTEM ................................................................................ 53 3.2.1 OVERALL HEALTH SYSTEM ACHIEVEMENTS ............................................... 53 3.2.2 ASSESSING INTERMEDIATE HEALTH SYSTEM PERFORMANCE INDICATORS. 59 3.2.3 ASSESSMENT OF THE MAIN ASPECTS OF LIBYAN HEALTH SYSTEM: BUILDING BLOCKS OR CONTROL KNOBS ................................................................................. 61 4 THE RESEARCH ON IDENTIFYING THE ROOT CAUSES OF HEALTH SYSTEM PROBLEMS ......................................................................... 71 4.1 THE RESEARCH METHODOLOGY ........................................................... 71 4.1.1 DESK RESEARCH ......................................................................................... 71 4.1.2 FOCUS GROUP INTERVIEWS........................................................................ 71 4.1.3 HEALTH SURVEY ......................................................................................... 72 4.2 THE FINDINGS ...................................................................................... 73 4.2.1 THE LESSONS FROM BEST INTERNATIONAL PRACTICES IN HEALTH ........... 73 4.2.2 THE FINDINGS OF QUALITATIVE RESEARCH............................................... 78 4.2.3 THE FINDINGS OF THE HEALTH SURVEY .................................................. 123 5 HEALTH CARE REFORM PROPOSALS AND RECOMMENDATIONS FOR SUCCESSFUL IMPLEMENTATION ...................................................... 139 5.1 PROPOSED HEALTH REFORMS ............................................................. 139 5.1.1 REFORMS FOR GOVERNANCE AND LEADERSHIP ....................................... 139 5.1.2 REFORMS FOR FINANCING ........................................................................ 145 5.1.3 REFORMS FOR HEALTH SERVICES DELIVERY ............................................ 151 5.1.4 REFORMS FOR HEALTH WORKFORCE ....................................................... 157 5.1.5 REFORMS FOR MEDICAL SUPPLIES AND TECHNOLOGIES .......................... 159 5.1.6 REFORMS FOR HEALTH INFORMATION SYSTEM ....................................... 163 5.1.7 REFORMS FOR PATIENT EMPOWERMENT OR BEHAVIOR .......................... 164 LIST OF FIGURES iii 5.2 RECOMMENDATIONS AND LEGISLATION FOR EFFECTIVE IMPLEMENTATION .......................................................................................................... 165 BIBLIOGRAPHY ................................................................................................. 173 APPENDIX 1. SUMMARY OF HEALTH SYSTEM REFORM SUCCESS STORIES OF SOME COUNTRIES .................................................................... 178 APPENDIX 2. KEY DEMOGRAPHIC AND HEALTH INDICATORS FOR COUNTRIES HAVING SUCCESSFULLY REFORMED THEIR HEALTH SYSTEMS (2019 OR THE NEAREST YEAR OF AVAILABLE DATA) .............. 190 APPENDIX 3. THE REFORM AREAS OF BEST PRACTICE OR SUCCESSFUL COUNTRIES ACCORDING TO INTERNATIONAL DATA .......................... 191 APPENDIX 4. HEALTH SYSTEM EVALUATION SURVEY ........................... 192 APPENDIX 5. THE OPEN-ENDED QUESTIONS FOR ASSESSING BUILDING BLOCKS OF LIBYAN HEALTH SYSTEM DURING QUALITATIVE SURVEY .................................................................................... 203 APPENDIX 6. ROADMAP FOR HEALTH REFORM PROPOSALS ............... 206 iv Reforming Health System in Libya LIST OF FIGURES Figure 1. Framework for analyzing health system of Libya ....................................... 23 Figure 2. The Organization of the Libyan Ministry of Health.................................. 32 Figure 3. Financing the Health System in Libya ...................................................... 35 Figure 4. The Source of Revenues of Public and Private Health Care Facilities ........ 38 Figure 5. Health Services Delivery Organization in Libya ........................................ 40 Figure 6. The Framework for Assessing Health System Performance and Main Aspects of Libyan Health System.............................................................................. 52 Figure 7. The Recommended Health System Organization in Libya ...................... 142 Figure 8. Recommended Management Model for Regional Health Authorities ..... 144 Figure 9. Recommended Health Financing Model for Libya ................................. 147 Figure 10. Recommended Health Service Delivery Organization ........................... 153 LIST OF FIGURES v LIST OF TABLES Table 1. Population in Libya ................................................................................... 25 Table 2. Rural Population (% of Total Population) ................................................. 25 Table 3. Literacy Rate, Total Adults (% of people aged 15+) ................................... 26 Table 4. Economic Indicators of Libya .................................................................... 27 Table 5. GDP Per Capita (Constant 2010 US$) ...................................................... 28 Table 6. Health Status Indicators of Libya ............................................................... 29 Table 7. Health Expenditures .................................................................................. 36 Table 8. Current Health Expenditure (% of GDP) .................................................. 37 Table 9. Current health expenditure per capita