Page 210 - Lybia Flipbook

Beyond the Diagnosis: Healing the Healthcare System
An unintended transformation is underway in the Libyan health system. Although health care remains free and universal in principle, that policy and the actual reality are growing apart. With diminishing capacity and increasing demand, private clinics and pharmacies are sprouting up to cater to those who can pay or simply plug the holes left by the public system. Understanding this new dynamic and its shortcomings is critical to preparing the healthcare system of the future.
Health workers largely remain on the public payroll,
and all medicines and supplies are supposed to be procured and imported by the Ministry of Health. After 2011, however, insecurity led to an exodus of health workers, and within five years, the healthcare workforce was significantly reduced. But today, the problem is not a lack of health personnel. On the contrary, the availability of too many doctors and nurses often leads to some working far below their capacity. The problem with doctors is the unbalanced distribution of specializations – too many dentists and too few pediatricians result in a health system that is costly yet unable to provide the necessary services. As for nurses, they tend to be insufficiently trained, limiting them from playing a more meaningful role in patient care.
Medical infrastructure and administration have also suffered. By 2017, about a fifth of health institutions had closed, and most of those remaining operated at a dimin- ished capacity. At the same time, public expenditures on health care declined, includ-
With the decline in health care quality, Libyans are increasingly seeking medical assistance abroad. Increas- ingly, taking a relative to Tunisia or Turkey for health care has become common. In principle, the government covers many of the costs of medical services abroad, including the expensive treatment of persons wounded in conflict, and public servants are left to scramble to reconcile
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ing investments in upgrading
administrative systems, and the
medical supply chain has suffered.
Without appropriate controls on
stock inventories and credible
monitoring, needed medicines
and medical supplies often are
not available. The lack of procurement oversight also opens opportunities for diversion, leading to frequent accusations of corruption.
Many of Libya’s health indicators are below those of other countries of similar affluence. For instance, life expectancy is increasing but at a slower pace than in other upper middle-income countries, while maternal mortality has even worsened since 2011. The prevalence of non-communicable diseases such as diabetes, cancer and respiratory illnesses has risen considerably, in part because the poorly functioning primary healthcare system does not identify signs of these diseases early enough to stop them from mutating into a life-altering condition. As a result, health problems that could be easily addressed degenerate until they require hospitalization.
“I wish that the area in which I live provided me with modern-style health and educational infrastructures.” Fatima, 30 years
outstanding multi-million-dollar medical bills.
For those who cannot go abroad, private health care is the next best solution. As the saying goes, health is better than wealth, and Libyans prove it. Private payments to private healthcare providers have
more than doubled since 2011, and they continue to grow despite the decline in people’s purchasing power. These payments cover the full care range, from private clinics to specialized services like imaging centers, dentistry, and maternal care. Almost a quarter of primary healthcare clinics are now private, with more opening all the time. Private pharmacies are also multiplying to compensate for the shortcomings of the public supply chain, encouraging the purchase of overpriced brands.
Private sector growth is generally considered a sign of a strong economy. When it comes to the health sector, however, it can have negative impacts. For one, only those who can afford to pay for healthcare and live close to these services can get access. This leaves the less afluent, particularly migrants and those living in rural areas, at a critical disadvantage. Second, without regulations, the