Developing quality essential care for poor populations in Lebanon: The SOHA 2 Project

BACKGROUND

The SOHA project (“Soha” means “health” in Arabic) focuses on prevention, the development of medical consultations, the treatment of patients suffering from chronic diseases, the fight against over-consumption of medication, and support for the financial stability of healthcare structures. 

CONTEXT

The Pierre Fabre Foundation has been active in Lebanon since 2002, supporting the activities of the Khaldieh medical-social center operated by the Order of Malta Lebanon. Since 2016, it has also been involved in setting up a mobile medical unit in the Western Beqaa to meet the health needs of refugees from Syria and disadvantaged Lebanese populations.

Alerted to the country’s worsening health situation by its long-standing partner, the Foundation participated in building a three-year program (2020-2022), which aims to meet the growing need for quality care, coupled with awareness and screening campaigns to facilitate early patient treatment.

Since 2019, Lebanon has been experiencing one of the three most serious economic and financial crises in the world, plunging more than 30% of the population into extreme poverty, according to the World Bank. Key indicators have deteriorated, while the burden of chronic disease remains the most important component of Lebanon’s health profile, accounting for 91% of all deaths according to the World Health Organization.

The Soha 2 project aims to address the health consequences of the impoverishment of the population in Lebanon. It adopts an innovative approach based on prevention and access to healthcare for the most vulnerable patients with chronic pathologies, thanks in particular to community mobilization and the introduction of a hybrid medical approach combining outpatient consultations and tele-expertise, while regulating the trend towards over-consumption of medicine and drugs. The initiative’s sustainability hinges on a revised approach to healthcare, in conjunction with the long-term primary healthcare subsidization protocol, continued accreditation of the primary healthcare centers of the Order of Malta Lebanon (OML), epidemiological monitoring and efforts to achieve financial stability.

DESCRIPTION  

The changing living conditions of the people in Lebanon — in an environment that has deteriorated sharply against a backdrop of economic and social crisis, renewed tensions between the Lebanese and Syrian populations, and the possible extension of the conflict with Israel — calls for a rethinking of the medical approach by opting to maintain the population in good health through the prevention of chronic diseases. This medical approach, aligned with the National Health Strategy: Vision 2030 launched by the Ministry of Public Health (MoPH), involves a change in the doctor-patient relationship. Preventive measures include information on lifestyle, prophylaxis against chronic diseases, mental health and vaccination, with particular emphasis on community mobilization. Information campaigns are organized in close coordination with the MoPH, including gender and youth programs.

Care for patients suffering from multimorbid pathologies focuses on risk factor reduction, reinforced medical monitoring, a personalized mix of outpatient consultations and tele-expertise, appropriate treatment and patient empowerment. The care protocols meet the national recommendations of the Long-term primary healthcare subsidization protocol. Now that drug inventory management is effective both at the OML’s central depot and in the pharmacies of its primary health centers, a solution for quickly recording medical prescriptions is being developed in the Phenics health information system. This makes it possible, in particular, to manage purchases on a tailored, forward-looking basis, and to reconcile medications.

Following the accreditation of 6 out of the 11 primary care centers managed by the OML, a quality control process has been set up and includes the integration of care protocols, the use of algorithms, and regular internal audits of specific activities in all centers. The quality approach is based on a quest for the financial stability of the centers. Monitoring and evaluation tools are defined for each medical activity. Operationalization processes are reviewed to improve efficiency, and monthly monitoring is carried out. Research topics are directly linked to medical activities so as to measure their relevance and effectiveness. Research findings are used as decision-making tools to guide medical activities. They are also published and shared with technical and financial partners working in Lebanon (ministries, UN agencies, bilateral and multilateral donors, non-governmental organizations).

OUTCOMES

At the end of the Soha 2 project, over 420,000 patients will have benefited directly from the project. 6 information campaigns will have been organized. 12,000 patients will have been screened thanks to the 6 campaigns carried out. 108,000 patients will have benefited from medical-pharmaceutical care. 1,980 people will be trained. The financial sustainability of the centers will be improved, guaranteeing better continuity for the OML’s medical activities. The two centers that report directly to the OML, not yet accredited, will be and/or will be ready to be accredited. The outcomes of epidemiological monitoring activities will be shared with the Ministry of Public Health (MoPH). The model developed through the Soha project (1 and 2) is a benchmark with a reproducible approach that has set a precedent in the context of a failed state, particularly for other primary health centers integrated into the Ministry of Public Health’s network.