The role of contractual arrangements in improving health sector ...

Lebanon
input from contracted parties, the study was not designed for this purpose and therefore this
was limited in scope.
4. Synthesis of data. Information from multiple sources was synthesized. In light of the
breadth of contractual arrangements in Lebanon, several case studies were conducted,
rather than focusing on one study, to examine the performance of different levels of the
health sector in Lebanon. Reviewing several case studies jointly also allowed for
identification of important opportunities for improving performance through strategies of
coordination and integration.
5. Summary of findings and recommendations. Based on examination of current situation, a
scorecard is developed to illustrate where contractual arrangements have succeeded and
failed, and to identify future steps that can be taken to improve performance. A set of
recommendations are provided. These build on identified strengths and weaknesses. They
represent a point for discussion with different stakeholders in Lebanon.
The checklist provided by the Regional Office for assessing the role of contractual
arrangements was useful both in guiding in the actual research and in developing the report.
However, it was not possible to answer all questions in the checklist meaningfully for all the
different contractual arrangements in Lebanon. This is mostly due to the sheer number of these
arrangements.
FINDINGS
Health sector in Lebanon
Lebanon is a middle-income country of approximately 4 million inhabitants (80%
urbanized) who live in 6 administrative regions, or mohafazat. The greater Beirut area houses
more than 40% of the population. Around 45% of Lebanese are under the age of 21 years and
10% are over age 65. Lebanon has favourable health indicators compared with other countries of
the Eastern Mediterranean Region: life expectancy is 72 years for females and 69 years for
males; overall and infant mortality rates are 7 and 28 per 1000, respectively (regional health
inequalities are notable). Lebanon has undergone an epidemiological transition, with over 80%
of the current mortality burden due to noncommunicable diseases and 10% due to injuries. The
morbidity profile, compiled in the context of a national burden of disease study, suggests a
similar pattern.
Health is an important component of economic activities, consuming 12%–13% of GDP.
Most health spending, however, is out-of-pocket (around 70%–75%), more heavily shouldered
by the poorer segments. Slightly more than 10% of all public expenditures go to health. The
main public financers are: the Ministry of Public Heatlh (receives 4% of the total budget and 1%
of GDP), NSSF, Civil Service Cooperative (CSC), Ministry of Defense, Ministry of the Interior
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