Challenges Facing Health Services in Libya after 17th Feb. revolution
by Dr Nagi Barakat-17/02/2012 18:58:00
The health services in Libya are suffering badly before and now. I was the director (Minister) of health services in Libya during the uprising till 30/11/2011. I was very close to everything at that time and I knew what the problems were. For those reasons I would like to share with my readers the challenges facing the health services in Libya. I am sure everyone knows what problems there are by listening to people, and also from the employees in this sector. Very rarely will you hear someone telling you what the solution could be. I have met many of the health services employees and the majority of them were talking about personal issues and what that person did or what that employee thinks about himself or herself.
I must admire the work done by the health services employees during the liberation and now. I really feel proud about their contribution and dedication to help patients, freedom fighters and the public. The majority of them worked hard and did what they could do with very limited resources and in unsafe environment. Many thanks to all of them and Libya needs even more dedicated people to build up these services and raise the standard of health care in Libya, where patient satisfaction will be the cornerstone of these services.
I met the newly MOH twice, one back at the end of September 2011 and one on 29th November 2011. At the first meeting she was apologising for her campaign against me since I had been appointed and asking to be appointed as the director of health office in Ireland which I did. The second meeting was a hand over meeting and we spent 150 minutes and she wrote down everything. The newly appointed MOH is trying very hard to put a face on health services in Libya with the help of very junior administrators. They are doing their best with what is available to them in very difficult circumstances and a very unsafe environment. They are not getting much support and they are struggling to cover all Libya due to lack of resources and no strategic planning in place.
The NTC and the government did not draw up a structured program with clear measured outcomes and left them alone to manage the health services without strict control and follow-up. They cannot be blamed for everything but they share the burden of failed system with all the employees of the health services in Libya. As we all know, there is no systematic approach to anything in Libya yet.
The ambulance services are not appropriate even to run a small city and Libya is totally dependent on importing everything from abroad to run the health services.
The challenges facing the health services in Libya:
The absence of quality leaderships in health services and the recent choice of a minister of health with very little experience in management are the major challenges facing the government and NTC. There are no real changes in delivering any clear program and everything is still haphazard without real planning or thinking. There is no any credibility for the work the MOH is trying to do and this has brought on her too many problems. This was started by appointing family members to higher positions and then firing them after complaints were made and being asked by the prime minister to dismiss her sister and two other members of her team.
This was followed by changing every head of administration which is a fatal mistake and this is still going on. The majority of them are very experienced and they know everything in MOH and health services. Changing them now is a foolish mistake which indicates lack of experience and that she does not have a clue about the management system in the administration field. The leadership quality in health services management is absent from the MOH and other sectors of health services.
The Minister at the MOH never held any higher position, the prime minister and his team put the MOH in a very awkward position when they asked her to submit her CV for the Minister position. They share the responsibility and the Minister should not be blamed for all of her mistakes because she has no leadership quality and no experience in management. This is very obvious and no one can deny it.
The lack of leadership in health services is not new in Libya and it used to be run by a group of Gaddafi loyalists and no chances were given to develop this field and also to develop the management sector at the level of MOH and PHC and hospitals. It is time to search for young good quality managers and train them for potential lead on improving the administration part of health services. Leaders should be made not appointed.
The most important challenges are to get trust back to health services in Libya. This will take time and this will not happen overnight. The worst thing is to come out and say, I will do this and that and then you cannot deliver it. The current MOH did not set any priorities and if any were set, they are not yet out for the public to see and start believing there will be changes. If there are any, they should come forward now and start implementing them very quickly. The most important priority now is to speed up importing medication, consumables, and spare parts for equipments. There are severe shortages now as the MOH stopped all contracts done by the previous director and his team. The second important point is to establish 3 centres of excellence and 5 rehabilitation centres. If the MOH works on these I am sure public confidence will be restored in health services and building on this trust would began.
There are no national rehabilitation programs and everyone is talking about it and there are many proposals but nothing on the ground. This is because the MOH does not trust anyone and wants to start everything from scratch and not build on what the previous director and his team had done. It is another fatal mistake to try to scrap everything and start from zero. This is one area which has shown up the lack of experience from both the MOH and the advisors surrounding her, most of whom have never done any executive job or worked in leadership positions. These rehabilitation centres can be established as many of the injured and traumatised freedom fighters will be back, if they’re not already in Libya. Working with some credible NGOs will help to get it off the ground. The ownership of this program should be handled by the government and the Prime Minister or the NTC president should lead on this as well. This will give it strength and credibility. The current MOH will not be able to do that as she has not got the vision or the strategies to do that. This is the truth and not a personal issue.
The other challenge is to stop the corruption in MOH and other sectors. The worst corruption happens when buying medicine and medical equipment. The only way to stop it is to negotiate contracts directly with the producing companies as we did when we were in Benghazi to buy medicine worth 370 million dinar to cover Libya for 6 months and payments after 6 months. This was stopped by MOH for reasons we do not understand which have led to severe shortages of everything. The producing company will be happy and long term contracts should be agreed and this will prevent MOH employees as well as hospitals managers from doing any businesses/ deals. The other areas of corruption which we found were in the fields of catering, cleaning and maintenance in hospitals, clinics and health centres. Issuing one contract with clear guidelines and robust control and follow-up department will help. Quality is paramount for any services provided to hospitals and other sectors. Starting quality control programs across all departments at MOH and hospital levels should prevent corruption and will deliver good services.
All of these need a substantive budget built on clear planning and excellent financial control. At the moment the worst corrupted people are the finance controllers. I think we should get rid of them all and make the audit authorities (financial control) more robust and effective and punish anyone who is trying to steal from public money.
The health services need good quality leadership, experienced managers, dedicated working doctors, nurses and technicians. The management should be left to the managers who are trained to do that and doctors should keep away and they are the worst as chief executives for hospitals. I am sure some doing doctors are doing a fantastic job at running hospitals but the majority are not. The Libyan experts who are living abroad should make sacrifices and go back and help in treating patients, help in managing hospitals – not to become directors, but to help in training and to reform health services. Libya needs to make sacrifices as many freedom fighters sacrificed themselves to give all Libyans the freedom they dreamed about, doctors who are practicing and living abroad should go back whenever possible to settle there, take career break for a certain period or as frequent visitors aiming to settle there when the time comes. Gaddafi is gone and his revolutionary committees are also gone away from Libya and no excuses.
Health services in Libya have many problems and no need to solve them all now. It will take many years to correct many of them. It is important now to work on the priorities mentioned above and with new government and hopefully with the help of experts, a clear vision, with strategy and systematic planning plus a comprehensive budget over next 5 years, health services reform in Libya could start after 12 months from now.
The most important thing for the Prime Minister to do is to make courageous decisions about the health services and its leadership. If we leave everything as it is, I am sure the public and the health services employees will not be happy and many will come out onto the streets. We should all help in this situation and doors should be open to listen to experts’ views as well to the strategists. To continue to ignore what is going on is not a good idea and can be very counter-productive and patients will suffer and many lives will be lost because of poor quality of leadership and the absence of experts in this field.
Libya will be free and will rise up against all odds and Libyans will govern Libya and guard it from anyone who thinks he can harm the Libyan people.
The writer is former Minister of Health. He contributed this article to The Tripoli Post.