Improving Primary Health Care Provision in Libya
Title: Improving Primary Health Care Provision in Libya
Commissioned by: Federal Ministry for Economic Cooperation and Development (BMZ)
Lead executing agency: Ministry of Health, Libya
Overall term: 2018 to 2022
Due to the ongoing political crisis and devastating security situation, the health sector in Libya is highly fragmented and has been significantly weakened. The state-run Primary Health Care Centres (PHCCs), which act as the first point of contact for general medical care, are unable to ensure adequate levels of health care provision. In addition, health services are particularly difficult to access for vulnerable population groups, such as for people with disabilities or in need of psychosocial support; girls and women; victims of gender-based and other forms of violence; elderly people; internally displaced persons as well as migrants and refugees.
The quality of primary health care provision is improved in selected municipalities in Libya and vulnerable population groups have access to a broader range of health services.
To promote the provision and expansion of primary health care services in Libya, the project applies the Family Practice Approach (FPA). This approach focuses on the health needs and expectations of the individual and puts them in the context of its community. The World Health Organization (WHO) recommends the FPA as the central approach for the provision of primary health care in countries in the Middle East and North Africa (MENA). The Libyan Ministry of Health adopted the FPA in 2018 and is now gradually introducing it.
At the onset of the project in 2018, the health needs in the 16 partner municipalities of the Libya Programme of the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH were analysed. Based on the results, the Ministry of Health in Libya and GIZ selected eight municipalities with the greatest health needs that could be supported by the project despite the ongoing civil war. The project’s activities in the eight selected municipalities with a population of around 420,000 people are divided into two intervention areas:
The first intervention area includes increasing the operational capacity of selected PHCCs. This is achieved through in-service trainings, equipping and renovating facilities, and maintaining and repairing medical devices. Expert advice on clinical guidelines, creating learning materials as well as support with implementing quality standards are also part of the assistance offered. The project further supports PHCCs in expanding their range of services to include services for vulnerable population groups. This includes prenatal care, care for people with disabilities, psychosocial support and services for victims of gender-based violence. The non-governmental organisation International Medical Corps (IMC) functions as implementing partner on the ground.
The second intervention area includes training and continuing professional development at a broader level for health care staff at selected PHCCs and further health centres. The aim is to foster specialist, administrative and organisational skills, thus improving the quality of care and ensuring that the services respond to the needs of the people. In addition, the project implements a training of trainers (ToT) approach in areas such as the FPA and the treatment of non-communicable diseases. The ToT approach enables staff to implement continuing professional development measures themselves at their own PHCCs for their fellow staff members. This intervention area is being implemented in cooperation with accredited national educational institutions.
Alongside the targeted activities in both intervention areas, the project is supporting the engagement of civil society through primary health care committees in the municipalities. These enable members of the community to get involved, take part in key decision-making processes and help to shape local health care provision directly. One of the tasks of the committees is the selection of Community Health Workers (CHWs) who act as liaisons between PHCCs and the community. The project is supporting the Ministry of Health with inducting and training the CHWs.
Health care provision has improved in the municipalities due to continuous skills development for health professionals and the introduction of additional clinical guidelines, for instance on the treatment of non-communicable diseases. For example, more than 280 staff from PHCCs in the partner municipalities took part in FPA orientation workshops, and more than 30 of these staff members were selected to be trained as independent trainers in the next step.
Renovation work and the supply of medicines and medical equipment have improved the access to medical services, particularly for vulnerable population groups.
During the coronavirus pandemic, the project supported selected PHCCs with training courses on detecting COVID-19, preventing infection and maintaining essential health services.