CC BY 4.0 DEED Attribution 4.0 InternationalBou-Orm, IbrahimLoffreda, GiuliaDiaconu, KarinWitter, SophiedeVos, Pol2023-12-182023-12-182023-12-182023-07-03Bou-Orm, I.R., Loffreda, G., Diaconu, K., Witter, S. and deVos, P. (2023) ‘Political Economy of Non-Communicable Disease (NCD) prevention and control in Lebanon: identifying challenges and opportunities for policy change and care provision reforms’, BMC Public Health, 23(2526). Available at: https://doi.org/10.1186/s12889-023-17357-1.https://eresearch.qmu.ac.uk/handle/20.500.12289/13631https://doi.org/10.1186/s12889-023-17357-1From Springer Nature via Jisc Publications RouterHistory: received 2023-07-03, registration 2023-11-28, accepted 2023-11-28, collection 2023-12, epub 2023-12-18, online 2023-12-18Acknowledgements: Not applicable.Publication status: PublishedFunder: National Institute for Health and Care Research; doi: http://dx.doi.org/10.13039/501100000272; Grant(s): NIHR Global Health Research programme 16/136/100, NIHR Global Health Research programme 16/136/100, NIHR Global Health Research programme 16/136/100, NIHR Global Health Research programme 16/136/100Ibrahim Bou-Orm - ORCID: 0000-0003-3563-4014 https://orcid.org/0000-0003-3563-4014Giulia Loffreda - ORCID: 0000-0003-4895-1051 https://orcid.org/0000-0003-4895-1051Karin Diaconu - ORCID: 0000-0002-5810-9725 https://orcid.org/0000-0002-5810-9725Sophie Witter - ORCID: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Introduction: Lebanon is a middle-income country facing substantial fragility features. Its health profile shows a high burden of NCD morbidity and mortality. This paper intends to analyse the political economy of NCD prevention and control in Lebanon. Methods: This study adopted a literature-based case study research design using a problem-driven political economy analysis framework. A total of 94 peer-reviewed articles and documents from the grey literature published before June 2019 were retrieved and analysed. Results: Lebanon’s political instability and fragile governance negatively affect its capacity to adapt a Health-in-All-Policies approach to NCD prevention and enable the blocking of NCD prevention policies by opposed stakeholders. Recent economic crises limit the fiscal capacity to address health financing issues and resulting health inequities. NCD care provision is twisted by powerful stakeholders towards a hospital-centred model with a powerful private sector. Stakeholders like the MOPH, UN agencies, and NGOs have been pushing towards changing the existing care model towards a primary care model. An incremental reform has been adopted to strengthen a network of primary care centres, support them with health technologies and improve the quality of primary care services. Nevertheless, outpatient services that are covered by other public funds remain specialist-led without much institutional regulation. Conclusion: Our study revealed a locked equilibrium in NCD prevention policymaking in Lebanon, but with an incremental progress in service delivery reforms towards a primary care model. Advocacy and close monitoring by policy entrepreneurs (such as civil society) could initiate and sustain the implementation of policy change and care model reforms.Licence for this article: http://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.http://creativecommons.org/licenses/by/4.0/Non-communicable diseasesHealth policyPolitical economy analysisHealth system reformsarticle2023-12-18