Abstract
BackgroundThe Syrian crisis has put tremendous strain on the Lebanese health system, particularly in the historically underserved border region. The ICRC Primary Health Care program has focused on refugee and host communities in these areas. This study objectives were: 1) to determine whether the ICRC program was reaching the most vulnerable populations; 2) to understand the key perceived health needs in the catchment areas of the ICRC supported facilities; and 3) to identify barriers to utilization of health care services.MethodsBetween July and September 2017 we conducted two cross-sectional studies - one randomized household survey and one clinic-based - in the catchment areas of three ICRC-supported facilities, targeting women of reproductive age and caretakers of children under five. Differences between groups were analysed with t-test or chi-squared test.ResultsIn the household survey, similar socio-demographic profiles were observed between Syrian refugee women and vulnerable Lebanese hosts. With regard to the study objectives:The most vulnerable populations were those seen in the ICRC-supported facilities.For both populations, the most common reasons for seeking care were non-communicable diseases (40.6%) and sexual and reproductive health issues (28.6%). Yet the people reaching the ICRC supported facilities were more likely to seek care for communicable diseases affecting their children (37.8%), rather than for the most common reasons expressed in the household survey.In the catchment areas, reported gaps included low immunization coverage and low levels of antenatal care and family planning both for Syrian and Lebanese. Dental care also emerged as an issue. Out of pocket expenditures was reported as a critical barrier for utilization of primary health care services for both populations, while the most important barrier for utilization of ICRC-supported services was lack of awareness.ConclusionsDespite the ICRC reaching the most vulnerable Syrian and Lebanese communities, the population-based survey revealed that important gaps exist in terms of utilization of health care services among women of reproductive age and their children. A stronger outreach component is needed to address lack of awareness. Innovative solutions are also needed to address cost barriers at the levels of both facility and individual user.
Highlights
The Syrian crisis has put tremendous strain on the Lebanese health system, in the historically underserved border region
The people reaching the International Committee of the Red Cross (ICRC) supported facilities were more likely to seek care for communicable diseases affecting their children (37.8%), rather than for the most common reasons expressed in the household survey
Out of pocket expenditures was reported as a critical barrier for utilization of primary health care services for both populations, while the most important barrier for utilization of ICRC-supported services was lack of awareness
Summary
The Syrian crisis has put tremendous strain on the Lebanese health system, in the historically underserved border region. The Lebanese healthcare system is highly privatized, based on fee for service in both the public and private sector In this context, the initial humanitarian health response to the Syrian crisis in Lebanon focused on subsidizing and financing health care services according to the established payment mechanisms [3]. The Ministry of Public Health (MoPH), supported by the World Health Organization (WHO) and the United Nations High Commissioner for Refugees (UNHCR), coordinated international and national Non-Governmental Organizations (NGOs) to ensure the widest possible coverage of services. Additional support for these services was granted by UNICEF, the World Bank and the European Union, in a joint effort to strengthen and expand the availability of basic primary health care services within the existing Primary Health Care (PHC) network of 223 health facilities operating all across the Lebanese territory. Factors include lack of awareness among the populations residing in the most underserved areas of Lebanon of the availability of supported services [8] and challenges in ensuring cost control in a dominant privatized health system operating outside the MoPH network
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