Family Physicians and Libya's Health Care System Reform

Introduction

Understanding the role of a family physician is essential before examining the importance of family physicians within any community health care system. Many reforms have been made to health care systems in communities around the world. Almost all of these reforms focus on the prevention and treatment of disease, the promotion of health, and the management of chronic conditions. All of these areas fall at the center of family medicine, and therefore family physicians have a critical role to play.

This paper examines the current health care system in Libya and considers how the government and organizations such as the World Health Organization (WHO) are working to improve it, with particular emphasis on the role of family physicians. Additionally, the paper sheds light on the general perception that people hold about family physicians and how these physicians are important in providing better health care to the public.

Health Care System in Libya

In Libya, all citizens are provided with health care facilities. All regulations pertaining to training, health, education, rehabilitation, family issues, housing, old-age benefits, and disability are governed by "Decision No. 11" of the General People's Committee, which was formed under the Promulgation of the By-Law Enforcement Law No. 20 based on the Social Care Fund of 1998. It should be noted, however, that the health care system is not solely run by the state; there are also many small private hospitals in different areas of the country. Furthermore, when comparing Libya's health statistics with those of other countries in the Middle East, the average health of the Libyan population is above the regional average. Childhood immunization receives special attention, and all newborn children are vaccinated. One reason for the improved state of health in the country is the improvement in sanitation and the provision of clean drinking water. The two main hospitals in the country are located in Benghazi and Tripoli (Libya: Health, 2011).

Statistical records show that the number of dentists and doctors increased by almost sevenfold between 1970 and 1985, resulting in approximately one doctor for every 673 citizens. In 1985, roughly one-third of doctors in Libya were Libyan-born, while the remainder were foreign nationals. The number of hospital beds also increased during the same period. During the 1970s, the major endemic diseases challenging the country included paratyphoid, typhoid, leishmaniasis, infectious hepatitis, meningitis, rabies, schistosomiasis, and venereal diseases. Malaria had been eradicated by that time, and efforts were being made to eliminate leprosy and trachoma. In 1985, the infant mortality rate was recorded at 84 deaths per 1,000 children. By 2004, this rate had dropped to 25.7 per 1,000 children, with some reports indicating a further decline to 20 per 1,000. There were approximately 7,000 estimated cases of HIV, derived mainly from intravenous drug abuse. It was also recorded that many people had developed multi-drug-resistant tuberculosis in areas where intravenous drug use was prevalent (Libya country profile, 2005).

The Ministry of Health of Libya has taken many significant steps toward improving the country's health care system. Toward the end of 2011, the Ministry asked WHO to help the country revitalize its declining health care system so that people could access quality services and all citizens could receive equal care, regardless of their financial status.

Rebuilding the Libyan Health Care System

One of the critical problems identified in the provision of primary health care was the absence of any established concept of a family physician, as well as a shortage of district hospitals and local clinics. Libya's total population of 6.5 million is served by only 1,500 local clinics. As a result, people are unable to obtain routine checkups and must wait for hours outside national hospitals to secure appointments with specialists. Furthermore, without family physicians, there is no one to guide patients through the appropriate treatment protocols.

In some parts of the country, health facilities were extremely rare. In areas where they did exist, they were often in poor condition. The situation was made worse when conflict broke out in Libya in 2011 and most of the foreign medical personnel fled to their home countries, creating an even greater demand for nurses and doctors, particularly in rural areas.

Following the conflict, the health needs of the population changed and demands increased. Adel Mohamed Abushoffa, then Deputy Minister of Health of Libya, stated that there were many critical areas requiring special attention, including psychosocial support and mental health care for those traumatized by the conflict. He noted with particular concern that the country had only 14 psychiatrists nationwide. He also highlighted the constant need for improvement in maternal and neonatal services to make childbirth safer and to ensure that newborns are given appropriate conditions for a healthy life. Emergency health services were similarly identified as requiring improvement.

The damage to the health care system has not only harmed the health of Libya's citizens but has also imposed a significant financial burden on the government, which must pay millions of dollars per day when Libyans travel abroad to obtain services unavailable at home.

Primary Health Care and Family Physicians

Preliminary ideas were outlined for an action plan to address all six areas, and the next stage involved discussing this plan with other stakeholders in the country's health care system. The WHO Representative in Libya, Dr. Samir Ben Yahmed, described this as an important platform that would bring together health care stakeholders, consumers, and health authorities — identified through questionnaires and meetings held across Libya — to reconcile their views on rebuilding the health care system in a way acceptable to all.

The Assistant Director-General for Health Systems and Services at WHO, Dr. Carissa Etienne, acknowledged that rebuilding Libya's entire health care system is a major challenge but also a significant opportunity — a chance for the country to make a fresh start and create a system that provides quality and equitable health care services meeting the expectations and needs of the people.

The challenge is not entirely unprecedented for WHO. For example, following years of conflict in Iraq, WHO took on responsibility for the health care system and ensured that vaccines for Haemophilus influenzae type B and rotavirus were made available at all health care centers as part of the Good Governance of Medicines program in Iraq (WHO, 2012).

Family physicians are the key to primary health care renewal and are the backbone of health care systems worldwide. Dr. Barbara Starfield, a leading researcher in primary health care, concluded that strengthening a primary care system requires better communication between those who provide health care services and those who receive them (Starfield, 2003). As health care systems have evolved, consumers have increasingly demanded not only treatment but also care that leaves them feeling genuinely satisfied. Patients tend to view health systems through the lens of their family physicians, and that is how they evaluate the strength of any health care system. This is one reason why having a family physician is so important: it ensures that patients are guided appropriately within the health care system of their community.

The central role of the family physician must also be clearly identified. That role is to coordinate care for patients, make proper referral arrangements when needed, and sustain the continuity of health care services so that comprehensive care is delivered. It is also the duty of the family physician to ensure that patients understand and accept the treatment they are receiving and that they are satisfied with it.

The importance of primary health care lies in the fact that it forms the foundation of the entire health care system. At the same time, primary health care is part of an integrated system designed to provide services to patients at the first point of need. Although family physicians play an extremely important role in primary health care, they must be capable of addressing all levels of care — primary, secondary, and tertiary.

It is unfortunate — for the world in general and for Libya in particular — that most patients do not have access to health care beyond the primary level. This reality further underscores the role of the family physician, who must ensure that patients can access secondary and tertiary services when needed. Primary health care, however, encompasses more than prevention and treatment. It also involves educating patients about what to do if they face a similar health problem in the future, and informing them of their right to just and equitable health care services. Family physicians must therefore view primary care broadly, accepting responsibility for advocating preventive measures and advising patients accordingly. This recognition has implications for many aspects of primary health care, including the development of advisory boards on community health and the creation of interdisciplinary care teams.

Conclusion

The reason why exponential growth is required in the field of family medicine in Libya is that family physicians play a critical role in the delivery of health care services. They serve as the initial point of entry into the medical system and ensure the continuous provision of services to patients (Little et al., 2004). The example of Canada is instructive: when Canada reconstructed its health care system, it placed great emphasis on family medicine and the establishment of a strong primary care delivery system, with family physicians as a central component. This resulted in better communication between consumers and providers of health care (Kates, 1997).