Healthcare System & Local Governance in Libya in the Wake of COVID-19

Recording of the event available here.

Bakground:

As of 20 August, 8975 cases of COVID-19 have been confirmed in Libya, including 157 deaths. There has been an influx from last month. The World Health Organization (WHO) has since June classified Libya among the high-risk countries in the region. Yet there is a very limited access to healthcare in many cities due to the ongoing conflict and structural marginalization associated to centralized system of governance. There is a limited access to testing capacity as there are only two testing laboratories in Tripoli and Benghazi. There is also limited contract tracing, difficulties in reaching much of the population. In the wake of lockdown announcement, many healthcare centers have closed due to lack of training, unavailability of protective personal equipment or clear instructions and guidelines. In those facilities that are open, there is a lack of medicines, equipment and staff to provide critical services. Meanwhile, it is not clear whether and how smaller cities away from the urban centers– are faring and have access to healthcare services in the wake of the pandemic especially with the lack of information sharing.

Despite the Global call for ceasefire on humanitarian grounds in order to respond to COVID-19, the conflict in Libya continues to rage. Civilian infrastructures have also been deliberately targeted, resulting in water and electricity cuts, and leaving people with no access to basic services. Hospitals have continued to be hit by shelling. On 6 April, heavy shelling hit Tripoli’s Al Khadra General Hospital, injuring at least one health worker and damaging the fully-functioning medical facility. The 400-bed Al Khadra hospital was one of the potential COVID-19 assigned health facilities. As of March 2020, a total of 27 health facilities have been damaged due to proximity of clashes, including 14 health facilities that have been closed and another 23 which are at risk of closure due to shifting lines of conflict.

The two governments (the GNA in Tripoli & the Government in the East) have failed miserably to respond to the crisis. There is no unified national effort to respond to the Coronavirus pandemic. Local municipalities are left with limited resources and restrictive mandate to confront the pandemic alone.

Local governments play an essential role in crisis management as they attempt to ensure service delivery. Libyan local governments are already actively taking up these responsibilities, but are unfortunately missing the knowhow and the means. It is important to assess the needs of local governments in building up their capacity with regard to crisis management especially in healthcare system at the wake of COVID-19.

Healthcare as a main entry point for local governance

Healthcare is the obvious place to start, especially given the challenges posed by COVID-19. The Libyan health system is near collapse. Many professionals have left the country, producing a severe brain drain. There is a great shortage of personnel—especially trained junior doctors and specialist nurses—and significant gaps in the quality of care. Hospitals have closed or are unable to work anywhere near capacity. Health workers are starving for better education. There are few opportunities to train in the country or resources to upgrade deficiencies. The lack of transparency in the ministry and sector do not help—huge sums are lost every year due to inadequacies in management, storage, accounting, and distribution. Meanwhile, needs are multiplying—even before coronavirus, the country saw upticks in malaria, polio, and drug-resistant tuberculosis.

The uneven distribution of health professions exacerbates the crisis. Many places—especially outside Tripoli—have major gaps. These have a larger impact than previously because of the difficulties in traveling across the country. And there is a gross disconnect between policy—made in the capital—and the needs of frontline workers.

Objectives of the webinar:

The webinar brings together diverse stakeholders involved in the healthcare system. The participants are of different backgrounds (diaspora, east, West and South), and different professions (healthcare workers, entrepreneurs, members of local municipalities). The webinar aims at identifying the challenges and gaps in the healthcare system in Libya and charting practical policy recommendations towards the following:

1. Strengthening decentralisation through establishing efficient mechanisms of service delivery (in this case its heathcare);
2. Create a national vision of healthcare in Libya;
3. Create an advisory board of international healthcare professionals—centered on the Libyan diaspora—to guide efforts;
4. Establish a platform or institution within Libya to manage efforts, develop overseas partnerships, and strengthen horizontal communication and cooperation across local-regions;
5. Strengthening local governance through digital solutions;
6. Making sure solutions work for local communities too;
7. Enhancing cooperation and horizontal learning across local –regional learning through sharing best practices and lessons learned;
8. Getting started now before any national peace settlement;
9. Ensuring that external interventions are made after thorough needs assessment of local communities;
10. Letting science and innovation lead the way. Linking healthcare with innovation and explore how digital healthcare solutions can advance health equality and equity.

Agenda:

• Challenges: conflict-weak governance, lack of knowhow capacity. 60 minutes
• Lessons observed: 60 minutes
• What can we do?...Policy Recommendations :60 minutes

Speakers:

• Dr. Ahmad Al Hassi, Deputy Head of the Committee in the East
• Dr. Rashia, representative of WHO in Sabha.
• Dr Al Najjar, Head of the National Committee in Tripoli

Moderator: Dr. Hani Shennieb