By Mutaz O. Shegewi
Boston, MA, USA
I had the privilege of participating in the National Health Systems Conference that took . . .[restrict]place on the 26th to 30th of August 2012 in Tripoli, Libya. It was hosted under the auspices of the Ministry of Health and World Health Organization. Its aims were two-fold. Firstly, to discuss the vast and pressing issues facing the Libyan health system and its reforms. Secondly, to assess the Libyan health system through determining its strengths, weaknesses and priorities.
The conference program was distributed over a period of five days through a focused theme on the WHO framework for action for health system strengthening. This framework was introduced in the 2007 WHO publication ‘Everybody’s Business – Strengthening Health Systems to Improve Health Outcomes’ and targets the improvement of six health system building blocks: service delivery, health workforce, information, medical products, financing and leadership/governance.
The conference participants consisted of a wide range of health professionals from Libya, USA, UK, Ireland, Sweden, Finland and other countries. In spite of being limited to 500 participants, opportunities for wider engagement are anticipated and much information about the conference can be found on the official conference website Libyancharities.com.
Many deserve acknowledgement for the success of the event. The steering committee and its respective scientific, organizing and selection teams did a fantastic job in bringing it all to life in an incredibly short amount of time. The participants all showed an extraordinary level of productive interaction throughout the event.
The local media showed a remarkable level of professionalism and provided special coverage throughout the event. The facilities at the Tripoli hotel, where the conference was held, were first rate.
Several of the fighters and volunteers from the Libyan revolution and war of 2011 must also be mentioned for having done an admirable job as conference security and support personnel.
A Remarkable Start
On the first day, a pre-conference workshop offered highly stimulating presentations and thought-provoking discussions on clinical governance to a group of invited Libyan health professionals. This broke the ice for what was to be a tremendous week ahead.
Later in the evening were four keynote talks and an opening ceremony. I was second in line to take the podium with the incredible responsibility of being the first Libyan (and youngest) speaker. “What Do Libyan Health Care Professionals Want” was the title of my talk that I gave to the audience of some 500 guests and dignitaries.
It aimed to take everyone on a journey into a world of strategic thought regarding the pressing issues facing Libyan health care professionals. These derived from the findings of an extensive academic health care policy research study I conducted in late 2011 on the Libyan health system and its professionals. It was also translated into Arabic and broadcast live on TV for household viewers to watch throughout Libya.
I stepped off the stage that evening as a changed person. Firstly, I felt forever honored to have been given the opportunity to speak in front of so many esteemed people at such an interesting time for Libya and its health system.
Secondly, I realized just how far Libya had truly come in having been able to publicly give a voice to this long voiceless stakeholder group and critically shed light on this vital subject.
Thirdly, I was greatly humbled by the overwhelmingly positive response and notions of support I received from everyone at the conference and throughout Libya. In fact, all keynote speakers that evening created such a strong and lasting first impression on everyone that the conference could have been considered an immediate success.
I was particularly fascinated by the special appearance made later on the same stage by the world-renowned Hans Rosling who is ranked one of the 100 leading global thinkers. Hans presented the “Health and Wealth of Nations” a truly fascinating trip through the statistics of health over time (which can be found at Gapminder.org).
During the next four days, there were a number of comprehensive scientific, plenary and workshop sessions. All the discussions were highly informative, relevant to the context and of much benefit to everyone. Speaking for myself, there was much I learned alongside the highly accomplished professionals who brought their insights, experiences and knowledge from all stretches of Libyan and international health communities.
In fact, the vast majority were local Libyan health care professionals. I felt this aspect of the conference was of crucial importance as Libyan health care professionals are perhaps most knowledgeable about challenges in the system, especially in the area of service delivery, and best positioned to contribute effectively towards improving it.
On the closing day, recommendations emerged from the outcomes of a series of workshop sessions. These sought to identify and address points that stemmed from underlying challenges related to the health system, such as established trends of outbound medical tourism, workforce demotivation and rampant corruption – to name a few. These were formulated with the intent of being carried onwards to the Ministry of Health for further consideration and the timing was highly appropriate.
Where we are today?
The Libyan health system is in dire need of effective policies and reforms. Present day challenges resulting from the aftermath of war supplement an inheritance of dysfunction and failures from the past. In addition, the future is for the most part unclear as health systems worldwide tend towards complexity.
One thing that inspired me at the conference was the high levels of willingness, talent and pragmatism held by local Libyan participants. These had accepted that change would not be an uncomplicated, painless or rapid process. Nevertheless and with little surprise to me, they were strong, ambitious and ready as ever to step up to plate in facing the challenges ahead.
I was also comforted in that many were those who shared my long-held belief in that the most effective approaches towards health system policies and reforms for Libya will not come in the form of prescriptions, quick fixes or silver bullets. Waving the magic wand will not work. Instead, the aim should be to give the system a sense of direction by shedding light on potential policy options that can be taken in moving forward.
In thinking strategically, there are three key considerations for the present day. Firstly, to consider the goals of a health system. According to WHO these are the betterment of health, responsiveness to expectations and fairness in financial contribution. Secondly, to raise a number of critical questions about the system that establishes a sense of direction towards these goals. These should not be any questions but the ‘right’ questions. Thirdly, to formulate a visionary plan that will achieve these goals. This should not be any plan but a ‘good’ one that will work.
Yet, the key question on my mind and perhaps those of others is if the political will and capacity to change the system will ultimately be there to see such strategic deliberations through. Will the system see effective, transparent and accountable governance? When will it see it? Will patients regain trust in the service? What will it take? How should the service be modeled?
What would make a suitable financing mechanism? How can professionals be best motivated? What role can society play in all this? How can stakeholders be empowered to ensure change finds its way into the system? Where is the system headed? Where is it now? Where does it need to go? Will that place live up to and surpass the aspirations set in stone by the Libyan society? Will it celebrate and honor what Libyans faced and the global community witnessed in 2011 as a prolonged as well as costly war for freedom, liberty and change?
Where we should go?
After having fairly recently conducted much needed qualitative research on the Libyan health system and particularly after attending this important conference, I feel there are a number of options that current and future policy-makers may wish to consider.
On the short-term, drastic measures must be taken to lighten the overwhelming burden on the system. These should urgently address issues of front-line shortages, work force motivation and system capacity. Alongside this should be a genuine initiative to establish an appreciable level of transparency and accountability in governance that marks a true disengagement from a past era of failed practices and a shift in culture.
The health system should be seen as a great place to write a success story on a slab that could inspire and be transferred to other social systems; like the educational system for example.
On the medium-term, attention must be given to the six health system building blocks of service delivery, health workforce, information, medical products, financing and leadership/governance. There are numerous issues and countless ways of approaching these.
Priority could be given to rejuvenating primary health care and public health, ensuring effective holistic preventive approaches and inter-sectoral collaboration; addressing qualitative issues at the secondary and tertiary levels of care; re-establishing trust in the service through a focuson patient-centeredness; reforming Libyan medical education and workforce planning; instilling Herzberg’s motivator factors in the workplace; giving more reasons for migrated Libyan professionals to repatriate back to the system and fewer reasons for local Libyan professionals to migrate; operationalizing health information and pushing research forward; enhancing medical product, technological and pharmaceutical regulation; identifying and implementing a robust financing mechanism; nurturing new leadership and consolidating governance processes.
On the long-term, investments must be made into continuous improvement and building of capacity, infrastructure and methods that ensure a sustainable robust trajectory into the future. The vision for the Libyan health system must be an endless strive that does not constrain its potential. On a personal level, I strongly believe there is no reason why the Libyan health system cannot become an exemplary model for both the region and global community. The only thing separating such a dream from reality are limits imposed by those who do not dream… nor believe.
The Road Ahead
In moving forward, there are those who will place the system ahead of themselves and want to see it improve and truly believe it can be changed. If such an attitude is shared collectively among people, it will provide the momentum needed for achieving change. Others may not feel the same and will instead place themselves ahead of the system.
There will always be differences and resistant forces to change. Alongside will be various levels of emotion, sensitivity, tension and obstacles. These may obstruct and perhaps even threaten progress. Yet, there is something in the air of Libya since February 2011 that is undeniable to anyone who stops in the heat of the moment to reflect and feel. Hope. A torch that burns bright and strong, which must be carried forward by as many people as possible.
The initiative must now be taken. The calling is for a collective thunderous voice. One that contributes productively towards radically improving the health system through ourselves and those around us. It is obvious that the challenges are immense and extensive. It is also obvious that the system needs much help and urgently.
Therefore, there is neither space nor time for additional burden on the system. What may perhaps be unclear is that there is indeed space for everyone to play a role in becoming a friend to the system. This applies to those who did not attend the conference as much as to those who did. It also applies to those who are not health professionals as much as to those who are. The system exists and functions to serve society. It is time society exists and functions to serve the system.
The conference marks the beginning of a new era. One where for the first time, people from all over Libya and the world united for it. One where many minds were thinking together, trying to ask the ‘right’ questions with an aspiration of formulating a ‘good’ plan for it. This is with no doubt a successful start, just what Libya and its health system needs. A positive yet sensible ambience. A gathering of people that builds momentum and consensus for the road ahead. The challenge now is in translating it all into actions that deliver tangible results.
Dr. Mutaz Shegewi is a US-based Libyan strategic advisor and specialist in health care policy, health care management, business management and qualitative research. He is a member of the American College of Healthcare Executives (ACHE) and fellow of the Chartered Management Institute (CMI). To learn more, please visit www.mutazshegewi.com [/restrict]