Addressing Non-Communicable Diseases in Fragile Lebanon: A Mixed-Methods Research Study

Abstract

Introduction: Lebanon has faced a substantial increase in the burden of NonCommunicable Diseases (NCD) over the last decade. There is a dearth of research focusing on health systems and policy responses to NCD. This PhD thesis analyses how the NCD burden is addressed in the context of fragile Lebanon and identifies policy-, health system- and community-related factors affecting NCD prevention and control. Methodology: This thesis adopts a pragmatic paradigm and incorporates: 1. a political economy analysis of NCD, based on a literature review; 2. a system analysis of NCD prevention and control, based on semi-structured interviews and group-model building workshops with 79 health providers and community members in urban Greater Beirut; 3. a survey with 941 persons living with NCDs to identify the magnitude of key factors affecting NCD control in Greater Beirut. Findings: The political economy analysis revealed an unbalanced power relationship between NCD policy promoters (e.g. civil society) and blockers(e.g. private entities). This has led to a gap in the prevention policy landscape. Care is provided under the auspices of a highly privatized hospital-centric model where services are offered for commercial gain rather than public good. The systems analysis validated these insights, with health provider and community participants linking the challenging socio-political environment to lacking prevention policy/action. This increases NCD incidence and creates barriers in accessing care. Experiences with NCD care were noted to be varied and influenced by perceptions of service quality and trust in providers. The survey confirmed that inequities in access to care exist in Greater Beirut and highlighted that service delivery patterns differ by provider. Communities evaluated different dimensions of trust in healthcare and identified gaps in the reliability, fairness and fidelity of the current system. Conclusions: The thesis concludes with an overview of how to strengthen Lebanon’s response to NCDs.