Higher Institute of Public Health, Saint-Joseph University of Beirut, Beirut, Lebanon.
World Health Organization Country Office for Lebanon, Beirut, Lebanon.
BMJ Open. 2022 Jun 1;12(6):e058622. doi: 10.1136/bmjopen-2021-058622.
This study aimed to assess the capacities and governance of Lebanon's health system throughout the response to the COVID-19 pandemic until August 2020.
A qualitative study based on semi-structured interviews.
Lebanon, February-August 2020.
Selected participants were directly or indirectly involved in the national or organisational response to the COVID-19 pandemic in Lebanon.
A total of 41 participants were included in the study. 'Hardware' capacities of the system were found to be responsive yet deeply influenced by the challenging national context. The health workforce showed high levels of resilience, despite the shortage of medical staff and gaps in training at the early stages of the pandemic. The system infrastructure, medical supplies and testing capacities were sufficient, but the reluctance of the private sector in care provision and gaps in reimbursement of COVID-19 care by many health funding schemes were the main concerns. Moreover, the public health surveillance system was overwhelmed a few months after the start of the pandemic. As for the system 'software', there were attempts for a participatory governance mechanism, but the actual decision-making process was challenging with limited cooperation and strategic vision, resulting in decreased trust and increased confusion among communities. Moreover, the power imbalance between health actors and other stakeholders affected decision-making dynamics and the uptake of scientific evidence in policy-making.
Interventions adopting a centralised and reactive approach were prominent in Lebanon's response to the COVID-19 pandemic. Better public governance and different reforms are needed to strengthen the health system preparedness and capacities to face future health security threats.
本研究旨在评估黎巴嫩卫生系统在应对 COVID-19 大流行直至 2020 年 8 月期间的能力和治理情况。
基于半结构式访谈的定性研究。
黎巴嫩，2020 年 2 月至 8 月。
选择的参与者直接或间接地参与了黎巴嫩 COVID-19 大流行的国家或组织应对工作。
共有 41 名参与者纳入研究。该系统的“硬件”能力表现出响应能力，但深受具有挑战性的国家背景的影响。卫生工作者表现出了很高的适应力，尽管在大流行的早期阶段医疗人员短缺且培训存在差距。系统基础设施、医疗用品和检测能力充足，但私营部门在提供护理方面的不情愿以及许多卫生筹资计划对 COVID-19 护理的报销不足是主要关注点。此外，公共卫生监测系统在大流行开始几个月后就不堪重负。至于系统的“软件”，虽然有尝试采用参与式治理机制，但实际的决策过程具有挑战性，合作和战略眼光有限，导致社区之间的信任度降低和混乱加剧。此外，卫生行为体和其他利益相关者之间的权力不平衡影响了决策动态和科学证据在决策中的应用。
在黎巴嫩应对 COVID-19 大流行期间，采取集中和被动方法的干预措施较为突出。需要更好的公共治理和不同的改革，以加强卫生系统的准备和应对未来卫生安全威胁的能力。
