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Human Resource Development (HRM-627)
VU
Lesson 25
HEALTH SECTOR
Taken from page: http://www.emro.who.int/lebanon/crisis/Leb_national_strat_early_recovery_Aug06.pdf
National Strategy for Early Recovery of the Health Sector in Lebanon
31 August 2006 Christopher Black/WHO
INTRODUCTION
The conflict across the border between Lebanon and Israel that started on 12 July has claimed over 1100
civilian lives, left more than 4000 people wounded, and displaced more than a quarter of the Lebanese
population.
The people of Lebanon showed remarkable unity in responding to the crisis, with communities banding
together to absorb the displaced, providing temporary shelter in their own homes, and food and provisions
from local supplies. Yet the challenges faced by the population remain overwhelming and will be compounded
with the on-going blockade. Access to basic services, such as health, water, and education is significantly
reduced across the country, and especially for all those who live in the affected areas. The Ministry of Public
Health, with collaboration from the UN system, and especially from WHO, conducted an assessment of the
damages to the health infrastructure in affected areas and identified the main effects on the population's health.
Based on this initial analysis, a national strategy for early recovery of the health sector, summarized below, was
prepared.
Health Impact of the Lebanon Crisis
Thirty-three days of military operations in mainly South Lebanon and South Beirut, as well as the Bekaa Valley,
have left a long-lasting mark on the Lebanese population and infrastructure. The impact on the health sector
can be summarized as follows:
 A High number of injured and disabled people generating additional pressure on the already
overwhelmed health services;
 More than 900 000 internally displaced people (IDPs) and refugees, and an especially high number of
returnees who have lost their homes and livelihoods, resulting in further constraints in accessibility and
affordability of health care services;
 Disruption of basic public health functions normally provided by the local health authorities;
 Considerable damage to health facilities and functional disruption mainly of Primary Health Care
clinics and centers, as well as key hospitals;
 Damage to roads and bridges, limiting access to health facilities;
 Shortages of fuel, drugs, and medical supplies.
1. High number of injured and disabled people: The casualties resulting from military operations,
particularly the bombing of buildings and infrastructure, have lead to a considerable number of injured,
engendering a corresponding increase in the demand for emergency health services, surgical procedures and
hospitalization. Further, the number of disabled patients requiring treatment and rehabilitation has also
increased. All of this has occurred against a backdrop of disrupted health services functionality and difficult
access, hampering financial affordability and adding significant pressure to the already reduced number of
functional health services in the affected areas and in the rest of the country.
2. Unmet health needs of IDPs and returnees: The populations that left the affected areas are rapidly
returning. However, in many cases their homes and their livelihoods have been destroyed. Furthermore, severe
economic disruption has affected their income and their ability to afford services such as health care.
The provision of adequate shelter, food, potable water and health care therefore are critical since it will take
time to fully re-establish basic living conditions.
3. Disruption of public health functions: In the Governorates of the affected areas, the basic functioning of
the local health authorities and their ability to perform essential public health functions has been significantly
hampered. Many public health services such as communicable diseases surveillance and control, immunization,
and environmental health, have been widely disrupted for more than one month. Restoring the ability to
sustain epidemiologic surveillance and early warning systems activities of is of great importance, especially in an
early recovery phase.
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4. Damage to health facilities and functional disruption of health services: Preliminary results of the
Health Facilities Damage Assessment conducted in August indicate that the level of destruction of health
buildings varies drastically from one place to another. It is most severe in the regions of southern Tyre,
Marjayoun, Nabatiyeh, Bint Jbeil, west Bekaa, Baalbek and Akkar. Indeed, between 50% and 70% of all
Primary Health Care (PHC) facilities in Bint Jbeil and Marjayoun have been completely destroyed. The
assessment shows that serious shortages of fuel, power supply and drinking water continue. In general, only
32.8% of health facilities have potable water, and only 26.9% remain linked to the general sewerage system.
Only 24% of health facilities have a public power supply, meanwhile 31% use generators but only 16.6% have
the fuel to run them.
The functional damage of the health care system is clearly demonstrated by the rapid assessment of the health
facilities which shows a gap in maternal and child care services ­ only 23.3% of PHC services are able to
provide antenatal care, 9.7% clean delivery, and 11.4% emergency obstetric care. As well, only 18.8% of the
PHC services are still able to provide nutrition and breast feeding advisory services. Only 32% of PHC facilities
have a functional cold chain, and 13% only are able to provide some mental health services.
5. Impediments to access and health care coverage: Government authorities, with the support of NGOs
and UN agencies, have already begun clearing rubble from roads, destroyed buildings and bridges. However,
access to health facilities needs to be completely resumed in order to meet the needs of populations returning
en masse to their places of residence. Unexploded ordnances (UXO) continue to threaten safe population
movement and to hinder humanitarian operations. Currently only 65% of the health facilities are accessible by
road in the affected region, and merely 16.6% of hospitals have functioning ambulances.
6. Exhaustion of supplies: During the conflict period the delivery of medical care and health services to 950
000 IDPs both overstretched and exhausted limited resources like drugs, supplies and fuel for most of the
country's health facilities. In addition, damage to power station and water supply systems resulted in increased
running costs. Moreover, the stockpiling of medicines has caused the uneven distribution and availability of
drugs and medical supplies, particularly those related to mental health and to chronic diseases.
Main Challenges
The fundamental challenges faced by the health sector after the war and once the cessation of hostilities has
been implemented are:
In the short term:
 Meeting the health needs of internally displaced populations to the affected areas, especially the most
vulnerable groups of returnees who have lost their homes and their livelihoods.
In the medium and long term:
 Re-establishing and further improving the functionality of the health system in the affected areas
involving all pertinent stakeholders;
 Rehabilitating the damaged health infrastructure and ensuring that is fully operational; Ensuring
adequate presence of qualified health manpower in the affected areas.
Strategic Approaches
The issues mentioned above call for two different but complementary approaches that need to be articulated as
the "National Early Recovery Strategy and Action Plan for the Health Sector in Lebanon".
The first approach should be the implementation of urgently needed interventions that will allow the
restoration of essential public health functions, basic health care services, and mechanisms of referral to
specialized care.
This operation needs to take place between now and December 2006, concentrating on the affected areas. It
will be led by the Ministry of Health, supported by WHO, in close cooperation with all pertinent national and
local health partners. It should be aimed at ensuring:
a) Continuity in the provision of essential health care services, particularly to the most vulnerable
including:
 The delivery of essential primary health care, including psychosocial services, to the affected
population, targeting the most vulnerable groups;
 Nutritional supplementation to the most vulnerable groups;
 The implementation of immunization campaigns in the affected areas thus assuring sustained and
improved coverage;
 Adequate referral to secondary and tertiary health care services for the affected population.
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b) Reinforcement of the capacity of the health system in discharging the essential public health functions
including:
 The supply of potable water in the affected areas;
 Epidemiological surveillance and early warning systems for the early detection and control of
communicable diseases;
 Environmental health interventions.
Early recovery interventions will be closely coordinated with nongovernmental organizations (NGOs) already
operative in the health sector. Interventions will encompass the temporary organization of local public health
teams, using existing staff from the public sector, from health NGOs and private health care providers. There
would also be a need to strengthen and/or develop the public health infrastructure of local health authorities.
The entire operation would aim to improve social protection in health for affected populations in areas
damaged during the conflict. A special unit for early recovery will be established in the Ministry of Health with
sub-units in each health district or local health circumscription.
The second approach would be the development and implementation of a Master Plan for Reconstruction of
the Health Sector in Lebanon. Developed over the next three to four months, the Master Plan will form the
fundamental agenda and roadmap for the long term reconstruction of Lebanon's health system, identifying
permanent and sustainable solutions for the full recuperation of the health system functionality in the affected
areas.
The exercise will be led by the Ministry of Health in close collaboration with the Ministries of Finance,
Economic Planning, and the Office of the Prime Minister, and could be closely supported by both WHO and
the World Bank. To this end, a planning team could be established or strengthened within the Ministry of
Health and technical assistance provided by WHO.
Producing this Master Plan would Encompass:
 Conducting a detailed health situation and health systems needs assessment in the affected areas,
beginning as early as possible in September 2006;
 Developing a framework for prioritizing necessary actions to meet the needs, and public and private
investments in the health sector that can bring them to fruition;
 Developing projects for the prioritized interventions thus enabling the development of detailed
investment projects within a comprehensive and strategic framework;
 Mobilizing resources from public, private and international sources to support the reconstruction agenda;
 Establishing a roadmap of implementation of investment projects, and coordinating their harmonious
execution so that results can be obtained rapidly in terms of recovering and further improving the
functionality of the health system, and ultimately in terms of improved health outcomes among the
affected population;
 An Action Plan for the early recovery of the Health Sector.
ACTION PLAN
The Action plan for the early recovery of the health sector will focus on priorities for the restoration of public
health functions and the provision of primary health care services with a supporting referral system for
returnees. It will also include urgently needed interventions for the rehabilitation of the health infrastructure in
the South.
The main projects include:
1) Immediate revitalization of routine immunization services, in close partnerships with WHO and
UNICEF. This will include quick recovery of the cold chain system.
2) Expanding and maintaining the Disease Early Warning and Alert and Response System to monitor
trends in communicable diseases and to respond to disease outbreaks. It involves extending reporting
sites to cover all areas in the south, and supporting the compilation and analysis and use of information,
as well as establishing linkages with the national disease surveillance system.
3) Monitoring environmental health threats and taking appropriate action to ensure the provision of safe
water, sanitation, and control of environmental hazards.
4) Revitalizing primary health care services in the affected areas. This includes urgently needed
interventions to rehabilitate damaged health facilities, provision of essential medicines and basic supplies,
consumables and laboratory reagents. It also includes the development of guidelines, and training and
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capacity building of local health personnel, particularly in the areas of psychosocial care, management of
chronic diseases, and nutrition. Support to ensure outreach services will also be needed.
5) Building capacity for emergency response and management at the central and governorate levels. An
adequate stock of essential medicines, supplies and trauma kits, improved medical stores, strengthened
communication and transportation system including requirements for outreach and effective referral
systems.
6) Securing maternal and newborn health, and strengthening reproductive health services to ensure safe
pregnancy and deliveries, maximizing outreach services, and improving referral systems.
Setting the stage for long term reconstruction: The national early recovery process August 2006; Restoring Basic Social Services-
Health
RESTORING MINIMUM ACCESS TO CRITICAL HEALTH SERVICES
GOVERNMENT ENTITY: Ministry of Health
TITLE OF THE INITIATIVE: Restoring Minimum Access to Critical Health Services
LOCATION: Main targets are the Governorates of South Lebanon and Nabatieh (8 districts or Qadas), the
Beirut Southern
Suburbs and the two qadas of Baalbeck and Hermel in the Governorate of the Beka'. All together, these areas
are served by 11 public hospitals, 44 private hospitals (Total 55 inpatient facilities) and 118 dispensaries and
health centers for outpatient care.
DURATION: Six months
ESTIMATED STARTING DATE: Immediately
SECTOR: Health
BENEFICIARY: 1,200, 000, including 350,000 in the 0-14 year age group
OUTLINE
THE IMMEDIATE NEED: The ability of many Lebanese citizens, and children and other vulnerable groups
in particular, to access critical health services has been severely reduced, with key infrastructure, including
hospitals and other care centers, severely damaged, and exhaustion of supplies and essential vaccines.
Furthermore, with the vast destruction in shelter and water pipes, the risk of communicable disease and water-
borne diseases has become a major concern. The capacity of local governorate authorities to respond to the
needs and monitor the long term impact of the conflict is also strained.
OBJECTIVES AND IMPACT: Quick-revitalization of life saving immunization services for children, by
reactivating the primary health care services, particularly in routine immunization services, providing essential
vaccines and drugs, reestablishing the cold chain system, scaling up sustainable outreach services to
underserved areas.
-  Revitalization of primary health care services, through rehabilitation of infrastructure, provision of
equipment and essential medicines and drugs, and ensuring adequate water and power supply to health
facilities
-  Revitalization of hospital care and referral systems, through rehabilitation of infrastructure, provision of
equipment and essential medicines, and filing the gaps in human resources
-  Building the capacity (equipment, human resources, and infrastructure) of emergency management at the
central and governorate level, to develop information systems, monitor health trends, stockpile essential
medicines and ensure rapid responses.
TOTAL BUDGET IN US$: 13,300,000
Budget Preliminary Breakdown Description:
a.  Quick Revitalization of Life Saving Immunization Services in Affected Areas
b.  Building the Capacity of Emergency Management at the Central and Governorate Level
c.  Revitalization of Primary Health Care services
d.  Revitalization of hospital care and referral systems
ESTIMATE COST IN US$: 3,150,000; 2,550,000; 3,830,000; 3,770,000
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Table of Contents:
  1. INTRODUCTION TO HUMAN RESOURCE DEVELOPMENT:The Concept and its Dimensions, Targets of Development
  2. FOUNDATIONS OF HUMAN BEHAVIOR:Attitudes, Personality, Emotional Intelligence
  3. PERCEPTION:Attribution Theory, Shortcuts Frequently Used in Judging Others
  4. INTRINSIC MOTIVATION:Why Choose Big Five Framework?, THE OUTCOME OF FIVE FACTOR MODEL
  5. FIVE FACTOR MODEL:The Basis of Intrinsically Motivated Behavior, Intrinsic Motivation and Values
  6. MOTIVATION:EARLY THEORIES OF MOTIVATION, Designing Motivating Jobs
  7. The Motivation Process:HOW TO MOTIVATE A DIVERSE WORKFORCE?,
  8. INTERPERSONAL COMMUNICATION:PRINCIPLES OF INTERPERSONAL COMMUNICATION
  9. THE WORLD BEYOND WORDS:DIFFERENCES BETWEEN VERBAL AND NONVERBAL COMMUNICATION, MINDFUL LISTENING
  10. TRANSACTIONAL ANALYSIS:EGO STATES, Parent Ego State, Child Ego State
  11. TYPES OF TRANSACTIONS:Complementary Transactions, Crossed Transactions, Ulterior Transactions
  12. NEURO-LINGUISTIC-PROGRAMMING
  13. CREATE YOUR OWN BLUEPRINT
  14. LEADERSHIP:ORGANIZATIONAL DEMOCRACY
  15. LEADERSHIP:Environment and Strategic Leadership Link, Concluding Remarks
  16. UNDERSTANDING GROUP BEHAVIOR:Stages of Group Development, Advantages of Group Decision Making
  17. UNDERSTANDING TEAM BEHAVIOR:TYPES OF TEAMS, Characteristics of Effective Teams,
  18. EMOTIONAL FACET:PHYSICAL FACET
  19. HUMAN RESOURCE DEVELOPMENT & THE ROLE OF GOVERNACE:Rule of Law, Transparency,
  20. HUMAN RESOURCE DEVELOPMENT:The Concept and Its Dimensions, Targets of Development
  21. HUMAN DEVELOPMENT INDEX (HDI):Methodology,
  22. REPORTS:Criticisms of Freedom House Methodology, GROSS NATIONAL HAPPINESS
  23. SECTORS OF A SOCIETY: SOME BASIC CONCEPTS:PUBLIC SECTOR, PRIVATE SECTOR
  24. NON GOVERNMENTAL ORGANIZATIONS (NGOS):Types, Methods, Management, Citizen organization
  25. HEALTH SECTOR:Health Impact of the Lebanon Crisis, Main Challenges,
  26. A STUDY ON QUALITY OF PRIMARY EDUCATION BACKGROUND AND RATIONALE
  27. ADULT EDUCATION:Lifelong learning
  28. THE PRACTICAL PERSPECTIVE OF ADULT EDUCATION:Problems of Adult Literacy, Strategies for Educating Adults for the Future
  29. TECHNICAL & VOCATIONAL EDUCATION:VET Internationally, Technical Schools
  30. ASSESSING THE LINK BETWEEN INTELLECTUAL CAPITAL FORMATION AND PERFORMANCE OF A UNIVERSITY
  31. SCIENCE & TECHNOLOGY EDUCATION:Social responsibility, Curriculum content
  32. ENVIRONMENT:Dark Greens and Light Greens, Environmental policy instruments
  33. HDI AND GENDER SENSITIVITY:Gender Empowerment Measure
  34. THE PLIGHT OF INDIAN WOMEN:
  35. ENTREPRENEURSHIP:Characteristics of entrepreneurship, Advantages of Entrepreneurship
  36. A REVISIT OF MODULE I & II
  37. HUMAN DEVELOPMENT & ECONOMIC GROWTH (1975 TO 2003):
  38. PUBLIC PRIVATE PARTNERSHIP:Origins, The Desired Outcomes of PPPs
  39. PRINCIPLES OF PUBLIC PRIVATE PARTNERSHIP (PPP):Situation in Pakistan,
  40. DEVOLUTION REFORMS A NEW SYSTEM OF GOVERNMENT:
  41. GOOD GOVERNANCE:Participation, Rule of law, Accountability
  42. MACROECONOMIC PROFILE OF A COUNTRY: EXAMPLE ECONOMY OF PAKISTAN
  43. COORDINATION IN GOVERNANCE: AN EXAMPLE OF EU, The OMC in Social Inclusion
  44. MOBILIZING REGIONAL EDUCATIONAL RESOURCES: THE ASEAN UNIVERSITY NETWORK, A CASE STUDY
  45. GOVERNMENT PRIORITIES AND POLICIES:Role of Government, Socio Cultural Factors in Implementing HRD Programs