The Libyan Health System has gone through different stages of evolution over the last 100 years. During the Italian colonial time, health care provision was very limited to main cities and the coverage and resources were very poor although existing facilities were run efficiently.
Following independence, the country resources were very limited and very little was done to improve healthcare services until the discovery of oil in the Libyan Sahara. With the new found wealth the Government of Kingdom of Libya started very ambitious programme to modernize the healthcare system and made detailed plans for improving coverage and invest in the infrastructure. Following Gaddafi’s military coup, these plans were taken forwards in the seventies. The system was structured with vision for future 3 layers of care, Primary care at primary health care centres, intermediary care (specialist clinics and minor surgery) at polyclinics and secondary/tertiary care at hospitals. The intention continued to guarantee good quality health care free of charge funded by the state.
However, from the late seventies onwards the system suffered from lack of investment and deep-rooted corruption, therefore health services deteriorated progressively until the end of the Gaddafi regimen in 2011.
The national feeling of patriotism and optimism following the revolutions created new mood of determination among profession leaders to reform and modernize the healthcare system. To capitalize on this and channel this energy into common vision and goals, the Ministry of Health organized a national Health Systems Conference (26-30 August 2012) in collaboration with multiple international organizations and partners including WHO, European Union, MSF, and IMC. 500 Libyan experts and profession leaders attended the conference supported by a number of international experts from the collaborators. The outcome of the conference deliberations were summarised in Conference Report presented to the Ministry of health and a paper published in the Libyan Journal of Medicine. Since then the conference report was seen as the document which represent the national consensus and common vision for the health care system.
To assist the Libyan Government to achieve this common vision, the European Union signed an agreement with the Libyan Government to sponsor a national reform programme aiming to strengthen and modernized the health care system. The programme structure and design was highly influenced by the conference outcome documents and the programme steering committee was formed mainly by members of the conference scientific committee and directors of the concerned directorates within the Ministry of Health.
Work of the programme started formally in January 2013 and good progress was made in working detailed plans for reform based on multiple initiatives and projects. However, implementation of these initiatives struggled initially due to inability of the ministry of health to meet the financial obligation to fund these projects as per agreement and subsequently, instability in the country political, financial and security status presented new challenges and changing priorities for the Ministry of Health. The programme had to be formally suspended in October 2014 due to civil war and deterioration in the security status leading to departure of most foreign missions and organizations.
With the new national reconciliation agreement sponsored by the United Nations and the formation of Government of National Accord, it was agreed to re-launch the programme. However, to learn from past experience and re-orientate the programme towards implementation of change, it was decided the re-launch should start with a 2nd Inception phase during which the previous work of the programme is fully analysed and detailed plans for re-launch are made.
During the review period, the review team noted that many international and national organizations were involved in the reform process and sometimes there was risk of duplication of work or working on different directions making the process less efficient therefore it was recommended that the process of health system reform should be led and coordinated by a national institution with the objectives of:
- Leading the process of change. Planning and implementing the necessary changes that will allow the system to evolve towards the intended structure and based on agreed national strategy
- Co-ordination national and international work intended to support system reform and ensure working towards common goals and avoid duplication.
- Build its role as national health care think-tank to support evidence based policy and decision making
Following a series of meetings and discussions with key stakeholders including the Ministry of Health, Ministry of Planning and the Presidential Council of the Government of National Accord; it was agreed that establishing this body under the prime Minister office has significant advantage over keeping it within the Ministry of Health. This arrangement can secure easier access to key stakeholders involved in reforming the health care system other than the Ministry of health including the Ministry of Finance, Ministry of Planning, Ministry of Local Governance, etc.
In March 2017, the Presidential Council of the Government of National Accord issues the Decree number (255) paving the way to establish the National Centre for Health System Reform.