The primary healthcare network in Lebanon: a national facility assessment.

BACKGROUND: The assessment of material and human resources, as well as services at healthcare facilities can further our understanding of their capacity to adapt to a people-centred framework. AIMS: To assess health infrastructure, drugs, equipment and human resources in primary healthcare centres (PHCCs) within the Lebanese National Primacy Healthcare Network. METHODS: The study surveyed all 212 primary healthcare centres in the network to assess services, as well as material and human resource availability. The survey was developed by the Ministry of Public Health and administered at each PHCC through face-to-face interviews with the facilities' directors. Data collection took place between December 2017 and January 2018. Descriptive statistics and χ² tests were used to analyse the collected data. RESULTS: The majority of PHCCs in the network delivered all services required by the national standards (78%), and had all basic equipment necessary for the delivery of care (89%), in addition to viable means of communication (85%). However, there was a significant shortage of family medicine physicians and nurses. Bivariate analysis highlighted regional disparities between urban and rural areas. CONCLUSIONS: This study can further our understanding of the capacity and ability of healthcare facilities to adapt to a people-centred framework. It provides baseline data that will inform Lebanon in its efforts to strengthen primary health care, and assist donors and local and international nongovernmental organizations in planning interventions and programmes, and better allocation of financial support.

Lebanon's essential health care benefit package: A gateway for universal health coverage.

Recent years have demonstrated the resurgence of a global commitment toward universal health coverage (UHC). The first step toward developing a sustainable primary health care (PHC)-oriented UHC program is the creation and service delivery of an explicit essential health care benefit package (EHCP). This paper aims to describe the development, features, and progress of the EHCP in Lebanon, in addition to outlining barriers, facilitators, and next steps. Building on the investments made in the PHC network, the ministry of public health in Lebanon piloted an essential PHC package program in 2016 targeting vulnerable Lebanese and was able to enroll over 87% of targeted population to date. In order to scale up the EHCP to the national level and achieve UHC, modifications need to be made to the package entitlements, provider payment mechanisms, and implementation arrangements. The paper also notes that further advocacy and lobbying are needed in order to place UHC and the EHCP on the national agenda and stimulate public demand.

Patient satisfaction with primary healthcare services in Lebanon.

BACKGROUND: Reorienting the model of care towards preventive services is integral to successfully move towards a people-centered healthcare system. Patient satisfaction is an essential component of people-centered care and an important quality of care indicator. In its efforts to strengthen primary healthcare, the Ministry of Public Health in Lebanon assessed patient satisfaction with services offered at primary healthcare centers (PHCCs) and explored the relationship between patient satisfaction and patient characteristics and accreditation. METHODOLOGY: The study followed a cross-sectional design. A survey was administered through phone calls with 1313 patients receiving services as part of a benefits package provided by 59 PHCCs. The survey collected data on patients' sociodemographic characteristics, perceptions, and satisfaction. RESULTS: Overall, 96.66% of surveyed patients reported being either satisfied (60.23%) or very satisfied (36.43%) with the services provided at the PHCCs. Patients' perceptions of patient-provider communication, healthcare provider competency, and health education quality constituted strong predictors for satisfaction. However, facilities' accreditation status was not associated with satisfaction with PHC services. CONCLUSION: Patient satisfaction with primary healthcare services in Lebanon was remarkably high. Findings highlighted the need for quality improvement particularly in health education and the alignment of accreditation standards with patient needs and expectations.

The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon.

BACKGROUND: In 2009, the Lebanese Ministry of Public Health (MOPH) launched the Primary Healthcare (PHC) accreditation program to improve quality across the continuum of care. The MOPH, with the support of Accreditation Canada, conducted the accreditation survey in 25 PHC centers in 2012. This paper aims to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors; how accreditation affected staff and patient satisfaction; key enablers, challenges and strategies to improve implementation of accreditation in PHC. METHODS: The study was conducted in 25 PHC centers using a cross-sectional mixed methods approach; all staff members were surveyed using a self-administered questionnaire whereas semi-structured interviews were conducted with directors. RESULTS: The scales measuring Management and Leadership had the highest mean score followed by Accreditation Impact, Human Resource Utilization, and Customer Satisfaction. Regression analysis showed that Strategic Quality Planning, Customer Satisfaction and Staff Involvement were associated with a perception of higher Quality Results. Directors emphasized the benefits of accreditation with regards to documentation, reinforcement of quality standards, strengthened relationships between PHC centers and multiple stakeholders and improved staff and patient satisfaction. Challenges encountered included limited financial resources, poor infrastructure, and staff shortages. CONCLUSIONS: To better respond to population health needs, accreditation is an important first step towards improving the quality of PHC delivery arrangement system. While there is a need to expand the implementation of accreditation to cover all PHC centers in Lebanon, considerations should be given to strengthening their financial arrangements as well.

Improving primary healthcare through accreditation: baseline assessment of readiness and challenges in Lebanese context.

The quality of primary healthcare (PHC) has become of high importance. In 2009, the Lebanese Ministry of Public Health launched the PHC accreditation program to expand and improve quality across the continuum of care. This study will explore the readiness of PHC centers in Lebanon to implement the newly developed accreditation standards including challenges and required actions/strategies. Seventy-two centers were sampled, and respondents were asked to complete a 65-item questionnaire adapted from the national PHC accreditation standards and two open-ended questions. Descriptive analysis was conducted to assess responses to each item. Thematic analysis was used to analyze open-ended questions. Scale scores were considerably low, particularly for areas that relate to quality of service delivery. Most respondents (59.8%) indicated not having a strategic plan on the basis of community needs. Close to 70% of respondents indicated that they do not monitor and investigate trends in rates of sentinel events, near misses, and adverse events. Moreover, 76.2% indicated not having a system for incident and accident-reporting, and only 22.3% reported using one. The PHC accreditation in Lebanon can potentially reform this essential health system component. Results provide insights for policymakers and managers to consider in their efforts to improve quality and performance of PHC centers in Lebanon.