Understanding and developing a resilient health system in Majdal Anjar, Lebanon

Partners: American University of Beirut, Lebanon and Liverpool School of Tropical Medicine, UK

This study aims to understand and support the development of a resilient health system in Lebanon through collaboration with local stakeholders and community-based partners. We will co-develop and implement innovative interventions to help deliver inclusive, gender-equitable and quality healthcare in the country.

Background

Lebanon is a fragile setting that has been facing a multi-crisis situation since 2019, presenting critical developmental challenges to Lebanese society and its health system. These challenges compromise the functioning of an already eroded, exhausted, and poorly-controlled health system that has already undergone several shocks over the last decade. These tests include the influx of Syrian refugees since 2012, political instability, the financial crisis and subsequent increased poverty, the exodus of healthcare workers, the shortage in medical commodities, the Beirut explosion in 2020, plus the COVID-19 pandemic that further laid bare the country’s already weak and fragile health system.

Innovative, timely and contextually-tailored evidence generated in partnership with key local and national stakeholders is critical if we are to develop and implement innovative interventions that can strengthen the health system and help provide equitable and quality health care services. However, local and context specific evidence is currently lacking, with few groups working on these issues in a robust and policy-relevant way. Our study will help address that omission.

Study design

Our study design uses a participatory action research (PAR) approach in a learning site which we will establish in the municipality of Bar Elias. There we will work alongside local community partners and key stakeholders in Majdal Anjar over three years to co-produce knowledge about the local health system and promote action that will strengthen the health system to deliver gender-equitable and quality services. The PAR cycle includes: mapping the health system capacities and challenges using document review and key informant interviews; community-based partners and local stakeholders identifying priority areas for action and developing interventions and action plans in participatory workshops (Group Model Building workshops); implementing these actions; reflecting on what is/is not going well; adapting the interventions in critical reflection meetings with community-based partners and local key stakeholders; and exploring the effects of the intervention on the priority areas through an analysis of secondary data and key informant interviews. The PAR process is a spiral of repeated cycles, where the experience of and learning from action becomes the input for a new round of collective, self-reflective inquiry, drawing in wider relevant knowledge from other sources to inform analysis and action (Loewenson et al, 2014). In our learning site, the cycle will be undertaken three times, addressing different priority areas. This will generate innovative, timely and relevant evidence with the aim of developing a stronger and more resilient health system, that is responsive, inclusive, gender-equitable and sustainable.

Project outputs

• Poster: Transforming Healthcare Governance in Lebanon: Advancing Justice, Inclusion, Belonging, and Resilience through a Municipal Health Committee in Majdal Anjar – presented at Health Systems Research 2024
• Case study: Moving beyond capacity: A journey to evidence-based action
• Case study: A new model for local leadership for health in Lebanon
• Case study: The power of knowledge: evidence-based action in the local governance of the Lebanese health system
• Video: From concept to reality: challenges of decentralising healthcare governance in Lebanon – a presentation on the process of supporting the creation of the Municipal Health Committee in Majdal Anjar
• Video: Claiming local decision space: the Municipal Health Committee in Majdal Anjar – a presentation
• Blog post: Local health system strengthening in Lebanon – introducing the Majdal Anjar Municipality Health Committee
• Blog post: The translation of the resilience framework – on the challenges of using an English-language framework in an Arabic-speaking setting
• Blog post: ReBUILD’s visit to Majdal Anjar
• Social media: the Majdal Anjar Municipality Health Committee has been launched as part of this collaboration and is very active – follow them on Instagram and on Facebook [both open a new tab].

Image: A primary healthcare centre in Majdal Anjar, Lebanon