Initiatives

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Libyans Rebuilding Libya
Local-Regional Cooperation: Healthcare

The Need to Go Local

Despite wide recognition that local authorities ought to play a major role in governing Libya, no one has provided a comprehensive vision of how this should work. The logic is clear: individual local units of governance have performed relatively well. Local mediation, conflict management, and governance mechanisms have all achieved more than national mechanisms. But the local pockets of stability are isolated from one another and still quite short on the kind of technical expertise to manage many of their affairs well. There is thus a great need to develop a way for these local pockets to both upgrade their capacity and build links with each other. A platform or institution that can practically do both would be of immense help – and would lay the groundwork for the organic development of a vision of how Libya might work more bottom-up in the future.

Start with Healthcare

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 teh 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.

 

Build a Practical Strategy on Strength

Locales need to take greater control over their own healthcare system – and eventually other areas of governance – and find ways to upgrade it to meet the needs of their populations. This will not be easy, but there are untapped resources and capacities that can be leveraged if the right strategy was adopted. This should be highly practical and build on Libya’s strengths:
 

  • Focus on a small number of relatively well governed places initially; 

  • Encourage the organic development of local-regions around one or more municipal government in order to ensure sufficient critical mass of capacity and take advantage of scale efficiencies;

  • Undertake assessments of healthcare administration and clinical facilities in targeted locales (if possible, by sending in qualified person from overseas);

  • Create an advisory board of international healthcare professionals – centred on the Libyan diaspora – to guide efforts; 

  • Establish a platform or institution within Libya to manage efforts, develop overseas partnerships, and strengthen horizontal communication and cooperation across local-regions; 

  • Build partnerships with overseas universities, hospitals, and health organisations to provide much needed telemedicine, training, and on-site consultations and service through a targeted travel program;

  • Develop a better healthcare management system centred around cooperation between local-regions (using technology as much as possible);

  • Convene meetings around the targeted locales to share knowledge horizontally and expand the participating local-regions; 

  • Develop a dedicated funding stream to expand the capacity and programs of the institution.


If this effort succeeded, it would point the way forward to how other sectors could be similarly strengthened. A template for success would be established. It would encourage the development of other local-regions. These could join together to improve governance all over the country.

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