Author: Hend Mselati

The Fourth Medical Education Conference Report

Hend Mselati

The Fourth Medical Education Conference (The Future of Medical Education in Libya) National Center of Health System Reform

Saturday 23/02/2019

Bab Al Bahr Hotel, Tripoli

 

The National Center sends its best regards to those who contributed to the success of the Fourth Medical Education Conference, starting with the Ministers of Education, Health, and Labor, and gentlemen from different regions and cities of Libya, to all colleagues and specialists, those interested in reforming the medical education process in Libya and specially to the Arab African Academy.

One of the tasks of the National Center of Health System Reform is to coordinate all national and international efforts aimed at strengthening and developing the health system to serve the national health strategic goals, including setting plans necessary to develop the workforce management in the health sector. Therefore, the reform and development of medical education was one of the pillars of this work. We were delighted to have found in all the partners and stakeholders the patriotic and highly professional spirit needed to make this project a success.

We would also like to emphasize that the timing of this conference, despite its tightness, was very important, as we would not like to be behind our neighboring countries and the world in engaging in the international programs, sustainable development plans and the health workforce program 2030, which among its goals that all countries have accreditation mechanisms for health education and training institutions By the 2020, (WHO Global Strategy on Human Resources in Health Sector 2016). By saying that, we are aiming to reach the accreditation of our institutions by 2023 so that the graduates of Libya do not remain outside the global system.

 

Conference Program

Opening: 10:15- 10:45

Session 1

The New Trends of Medical Education – Dr. Aref Al-Araibi

The presentation included the reasons for the change in medical education, curricula and methods in the educational system of medicine, especially in the Canadian system. These were the most important points mentioned by Dr. Aref:

  • The educational system is now studying the needs of the medical sector and the desired outputs, and on this basis the curricula will be designed.
  • The modern medical education system relies mainly on clinical training.
  • The most important reason for redesigning the educational process is the large number of medical errors (Medical errors is the third reason for causes of death in the United States of America).
  • The term “Medical Education Outcomes” has been changed to “Entrustable Professional Activity EPA”, which includes many technical and non-technical clinical skills.
  • A part of the EPA is taught in the pre-graduate level and some in the postgraduate level.
  • The purpose of EPA skills is to graduate a human doctor capable of discovering the error and correcting it.
  • In the new program, the doctor is evaluated by his teachers, colleagues, patients, and the patient’s relatives.
  • The heavy burden of constant evaluation is among the most important defects of this system and for this reason the need for the use of information technology was required.
  • Teaching in the new system is reached by a discussion in the form of groups headed by the professor and prepared (the subject of discussion) by the students themselves.

 

Human Resources in Health Sector – Dr. Ibrahim Gabeel

The presentation included a study on the medical faculties’ outputs in general and keeping pace with the needs of the health labor market in Libya. These are the most important notes:

  • The study aims to compare medical colleges’ outputs with their inputs and estimate Libya’s human resources needs in the health sector in 2030.
  • Total number of universities in Libya is 26 universities, of which 20 are medical colleges.
  • The largest number of medical school graduates is in Tripoli region and the lowest is in the southern region, while the largest number of nursing graduates is from the southern region.
  • The southern region and Benghazi lack health sciences colleges, and the eastern region lack both science and dental colleges.
  • The unstable security conditions led to high loss / leakage from the medical colleges in Benghazi and the Eastern regions.
  • The surplus of physicians’ graduates in 2030 will be around 6,635 doctors, according to the expectation of the medical colleges outputs until 2024, with comparison with the required percentage (compared to the percentages found in countries with good numbers of medical staff).
  • By studying the numbers of medical staff, we find a surplus of doctors and a shortage of nursing and midwifery in Tripoli region and vice versa in the southern region. As for the central region, there is high percentage of midwifery and decreased numbers in the specialist doctors and nursing.

 

Accreditation of Educational Health Institutions – Dr. Murad Al-Grew

  • Accreditation is a governance method used to confirm the quality of an institution’s outputs, and the body responsible for accreditation relies on minimum quality assurance standards.
  • At the present time there are two bodies for the accreditation process, the first is under the Ministry of Health and is responsible for health institutions accreditation, and the other is under the Ministry of Education and is responsible for educational institutions accreditation.
  • The role of the General Health Council is to be responsible for accreditation of health services and medical education. As the accreditation standards for the educational process are detailed in order to ensure the continuity of professional preservation from graduation until retirement, including supervising the training of teaching staff in medical colleges.
  • The tasks of registering practitioners and assigning professional standards and dealing with complaints against doctors in terms of professionalism (not criminal / legal) were assigned to the General Health Council. The necessity of this body was the result of a prolonged discussion that started in the year 2012 in two conferences held in Tripoli and Benghazi, and a group of workshops directed by The Health System Strengthening Program funded by the European Union.
  • The unified national exam for the Libyan medical colleges’ graduates (if approved) will guarantee the quality of the outputs.

 

Discussion:

  • Emphasizing the need for the cooperation of health and education sectors and to support the institutions entrusted with this responsibility.
  • It is not reasonable to have two quality assurance institutions at the same time; this process must be restricted to one body.

Minister of Labor comments:

  • We cannot copy the educational processes of other countries and apply them as they are in Libya, however, these processes should be adapted to suit the Libyan situation.
  • All related institutions must be included in the change process.

Minister of Health comments:

  • Emphasizing the need to cooperate and work together.
  • The competence of the Libyan doctor must be ensured to guarantee continuity of international support to the Libyan health sector.

Minister of Education comments:

  • There must be definitive solutions to all the problems that each college faces separately.
  • The most important problems that face the university educational process is lack of academic staff, and the reason behind that is that the delegates abroad do not return back, as well as the difficulty to attract foreign staff due to the current circumstances.
  • Change must begin as soon as possible to deal with the problems created as a result of lack of international accreditation of Libyan medical colleges.

 

Session 2

Department of Medical Education at the Medical University – Dr. Aqila Al-Badri

  • One of the most important reasons for the poor student preparation is that most of the teaching staff in the faculty are doctors not teachers, and they have never been trained or prepared for teaching.
  • The importance of training teaching staff and developing their methods to keep pace with the development of the educational process and medical tools.
  • Medical curricula that have not been developed for a long time should be reviewed.

 

Lunch Break
Session 3

The Compatibility between Health Sector Needs and the outcomes of Medical Faculties of University of Sirt– Dr. Abdul Hakim Saad

  • Addressing the problem of decreased number of medical staff in the city of Sirt.
  • The aim of this study (which was not proposed in the presence of foreign medical staff) was to identify the requirements of the public and private sectors in the medical field.
  • The health labor market and its needs must be studied in order to be able to provide professional cadres specialized in the medical field.
  • The most important point concluded from the study is that the number of females in medical colleges exceeds the number of males, which is considered unfavorable in terms of economic feasibility due to the high percentage of girls who leave work immediately after graduation.
  • One of the most common problems facing the medical education sector in Sirt is the lack of teaching staff, the weakness of teaching tools, and the crowding in small halls not designed to accommodate the growing numbers of students.

 

Medical Education between Reality and Hopes – Dr. Adel Al-Deeb

  • Libyan universities are not within most of the world rankings of universities, and we should take urgent measures to deal with this situation.
  • Libya’s ranking regarding quality of education has risen in general during the last year due to the efforts of the Ministry of Education in this regard.
  • The number of medical colleges in Libya is high compared to the number of medical colleges in other countries with a much higher population.
  • There is a conflict in Libya between the medical education institutions, the Ministry of Health, and educational hospitals.

E-Medical Education – Dr. Jibriel Masoud

  • E-learning project is a national strategic project that is not limited to university education only.
  • Using E-learning does not mean excluding traditional educational methods, but rather, all the available methods should be used to reach better result.
  • This project needs a comprehensive study in terms of economic, educational and effectiveness feasibility, and the extent of its impact on students ’educational process.

 

Tele-Medical-Education – Dr. Rehab Hussein Bashir

  • Rehab talked about the experience of the Faculty of Medicine in Sabha with distance education.
  • This technology was used in the Faculty of Medicine, Sabha University to resolve the problem caused by the shortage of teaching staff in the college and to raise the educational level of students.
  • The ease of information access to the student who was geographically distant from the professor was the most important feature of this technology, as well as keeping updated with the new medical information and benefiting from experiences present in different parts of the world.
  • One of the disadvantages of this method is that it requires awareness and high sense of responsibility from students for the lack of necessity of the student attending the lecture at a specific time and place, as well as poor Internet services in the region, and the need for technicians familiar with the devices used.

 

Basic Medical Sciences – Dr. Abdullah Al-Mansoori:

  • Education and its relation with economy: Education must be adapted to the economy, and the Korean experience over the past fifty years was the best proof of that, as it resulted in launching creative projects which included industry, agriculture and literature.
  • We created some new departments at the University of Medical Sciences to keep pace with the needs of the job market.
  • The student should be given the opportunity to choose a specific major in basic medical sciences to continue studying within it or to complete his studies to become a doctor.
  • Students at the University of Basic Medical Sciences learn many non-medical skills, including leadership and creative thinking.
  • After years of conflict of legislation with this step, the student is now allowed to obtain a Bachelor of Basic Medical Sciences after the third year of medicine if he does not want to complete his journey to be a doctor.

 

A Study on the Proposed Curricula of the Medicine Colleges in Benghazi and Tripoli- Dr.Arif Al-Areiby:

  • The change in medical curricula is the first of its kind since the 1970s.
  • The patient’s health and well-being is the first objective of the development process.
  • There are recent development in medical curricula and accreditation standards terminology in medical education in Tripoli and Benghazi.
  • The change in the curricula of the Benghazi and Tripoli Faculties of Medicine is a fundamental change and needs a strict quality control and improvement program.
  • The existing project in developing medical education in Tripoli and the International University in Benghazi is good enough to be a national project that includes all of Libya, as it is an applicable and successful local experience.
  • To agree on a unified curriculum for all Libyan medical colleges after looking in to the programs of the medical colleges in Benghazi, Tripoli and the International University.
  • Suggesting a language and a personality exam for any medical graduate who is accepted to work in hospitals.
  • Proposing a unified national exam for professionalism, information and medical skills.
  • The change in the medical sector needs patience, and the results of this change will be seen in long-term.
  • The student, doctor and teacher must be prepared for the change process before starting it.

 

Recommendations

Create three work teams to carry out the necessary studies, develop plans and present reports and results at the Fifth Medical Education Conference, which was initially agreed to be held in March 2020. These teams work on the following:

  • A group to study the inputs and outputs of medical education, and come up with statistics indicating the needs for each profession in the health sector and to come out with the numbers of students that can be accepted in the coming academic years, as well as adding, modifying or canceling health facilities, according to the requirements of SDG3, UHC.
  • A working group to upgrade the scientific curricula: study the proposed curricula and come up with a minimum curriculum requirement for Libyan medical colleges with a full concept for curricula redesigning, or make recommendations for improving the content based on the foundations of modern medical education, Including the most effective student assessment methods for testing critical thinking and applying knowledge.
  • A working group for accrediting universities, medical colleges and educational hospitals: setting common standards and specifications for these institutions based on international standards in coordination with the Quality Assurance Center to reach international accreditation, and laying the foundations of monitoring and follow-up based on modern standards.

 

 

The National Center of Health System Reform and partners

Tripoli, March 2019

Meeting of the President of the Presidential Council with the Undersecretary of the Ministry of Health, Representatives of the Union of The Private Sector and the Director General NCHSR

Hend Mselati

A meeting was held on the 7th of January between the President of the Presidential Council, Faiz Al-Sarraj, Dr. Essa Al-Amiani, Undersecretary of the Ministry of Health, Dr. Samir Saqr, Director General of NCHSR, and Dr. Mahfouz Qaddour and Dr. Abu Al-Qasim Al-Barouni as representatives of the Union of The Private Sector  to discuss how to localize Medical care and take advantage of the potentials available in the private health sector.

 

In this meeting the president of  Presidential Council requested and asked the attendees to cooperate in the development of the health sector and that the government is ready to support the private sector to ensure patient safety, and also called for standardization of pricing as much as possible between clinics. The Undersecretary of the Ministry of Health also spoke about the program that the Ministry prepared to advance the sector which included Localizing treatment and involving the private sector in providing services.

The Director General of the NCHSR stated that the government is in the process of issuing regulatory decisions for the health sector from an administrative and technical point of view, including setting up regulatory institutions for supervision, organizing licensing of private clinics, and setting the necessary specifications that must be available.

Dr. Mahfouz and Dr. Abu Al-Qasim discussed the problems the private sector faced starting with debts arising from the Ministry of Health, the difficulty in obtaining medical supplies and the lack of access to the nursing and technical resources due to the difficulty in transferring their dues.

The Third Annual Conference of The National Center of Health System Reform

Hend Mselati

On Thursday, October 3, 2019, The Third Annual Conference of The National Center of Health System Reform was held at the Bab Al-Bahr Hotel – Tripoli under the title Decentralization in Governance, Financing and the Provision of Health Services, under the endorsement of the President of the Presidential Council who opened the conference with his speech indicating that the concept of decentralization is not limited to giving broad powers and greater benifits to satisfy the needs of their people only, but it also means liberating institutions from the state bureaucracy.

The Director General of the Center, Dr. Samir Sager, ended the first section of the conference by talking about the center’s history, plans and accomplishments. He also talked about the center’s ability to plan, coordinate and communicate with international and local experiences to find solutions.

The second section of the conference included presentations of:

1- Dr. Khaled Al-Maghboub – Decentralization in The New Health System.

Dr. Khaled defined in this presentation the specialties of the local health centers, and mentioned the fact that sabotage and disruption of more than 50% of equipment and devices and wasting money in the health system is the reason for change and activating health areas as soon as possible.

2- Dr. Abdel Moneim Al-Kumishi – Health Financing and Cluster Budget.

He presented mechanisms for financing and purchasing services, which included the need for a clear strategy to define the targeted services and estimation of the cost of these services for each citizen.

As for the third section of the conference, it included:

  • Ibrahim Al-Jubail – Health Facilities Re-mapping Committee – Medical Staff Reorganization Committee.

The presentation included a classification of performance rates and an estimate of Libya’s human resource needs and the ideal geographic distribution mechanism of it.

  • Anas Zarmouh – Medical Colleges Curriculum Committee and the Teaching Health Standards and Specifications Committee.

In this presentation, an introduction about the committee, the reason for its establishment, its role and its tasks  was presented. Dr. Anas finished his section with talking about some of the work that has been done so far by the committee.

 

The second and third sections were ended with a discussion, in which some points were appointed and discussed between the participants in the previous presentations and attendance.

The Second Annual Conference of The National Center of Health System Reform

Hend Mselati

The annual conference of the National Center for Health System Reform was held on the third of October 2018 and was titled the health system between planning and implementation.

The conference was honored with the presence of the Prime Minister of the National Accord Government, Mr. Fayez Al-Sarraj, and the Ministers of Health and Education, as well as a group of great doctors and interested figures.

The beginning of the conference started with the speech of the President of the Preparatory Committee, Mr. Yusuf Arhumah, and was followed by the word of President Faiz al-Sarraj, and then by the Minister of Health, Dr. Omar Bashir.

Dr. Samir Saqer, President of the National Center for Health System Development then delivered a lecture on good governance, which included an introduction to the establishment and development of the center, as well as the center’s vision, plans and goals for achieving an effective health system. The lecture also included an explanation of the branches of the health system that included governance, financing and the service branch.

A visual advertisement was also displayed to promote a health service, which was previously announced.

Before the end of the first part of the event, and on behalf of the conference, Dr. Talal Ajaj honored both: Mr. President and Minister of Education Dr. Othman Abdel Jalil, head of the center, Dr. Samir Saqr, and finally Dr. Badraluddin Abu Hajar.

After the break, the conference presentations were resumed, the first of which was the speech of Dr. Talal Ajaj regarding the role of the health financing fund, and then Dr. Badraluddin Abu Hajar’s speech on the role of the partnership between the public and private sectors and the branch of service. Dr. Adel Al-Twaijer also participated in a lecture entitled Organizing Medical Institutions and Dr. Mhammed Sassi in a lecture on Organizing Human Resources for Health, then Dr. Mhamed Khasheba gave his presentation on the regulation of medicines and health equipment.

The conference’s sections were concluded with a panel discussion that included the participants and the attendees. Several inquiries and clarifications were presented in it, which included many points, the most important of which are:

-Clarifying the concept and role of governance and introduce the concept of health management into the health sector.
-Introducing the health insurance system as a financial source for the health sector.
-Emphasizing the importance of participation between health institutions of the public and private sectors.
-The importance of management and control of the pharmaceutical industry.

At the end of this event, the attendees were invited to a lunch banquet at Bab Al Bahr Hotel, which hosted the conference, where the guests continued their discussion on the topics that were presented during the day.

The Third Annual Conference of NCHSR

Hend Mselati

The National Center for Health System Development (NCHSR) is pleased to announce its third annual conference entitled “Decentralization in Governance, Financing and Delivery of Health Service”.

The event will take place on Thursday-3rd October 2019

Bab Al-Bahr hotel – Tripoli – Libya

Electronic Health – NCHSR Meeting

Hend Mselati

 

The National Centre of Health System Reform manager dr Samir sager had a meeting on the 8th May 2018 with the Director of Planning and Logistics, the Director of Projects and programs, Director of Information management and the Director of Advertisement and Publicity,  to discuss the project of electronic health program by investing the communication technology and using the electronic services for the benefit of developing the health system

Public Private Partnerrship Workshop

Hend Mselati

On the 1st Jan 2019 the National Centre of Health System Reform had organized the PPP (Public-Private-partnership) Workshop based on the reference of The National Health Strategy Conference 2017, to discuss the basics of the PPP generally and the ability to apply it on the health sector in Libya.

The PPP Workshop day was divided in to two sections, each ended with a discussion and parted by a coffee break:

Section 1

The concept, Basis, Legislations:

  1. Mahmoud Fteasy ………………. The Concept Of Partnership
  2. Badr adeen Al-toumy …………. The Legislations For Partnership Enhancement
  3. Ahmed Zikry …………………….. Partnership Success Requirements
  4. Mohammed Raead ……………. Pros and Cons Of Partnership
  5. Maan Hamada …………………. The Partnership in A Mechanical Scientific Concept

Section 2

 Implication of PPP on Health System:

  1. Aimen Seaf-Annasr ……………. The Reasons for Health System Partnership
  2. Dr . Ali Khaleel ……………………….. Service Charge in Both Public and Private sectors
  3. Talal Ajaj ………………………….. Health Insurance Role
  4. Randa Hamada …………………. Partnership International Attempts
  5. Bdr Adeen AbuHajar …………… Health System Partnership Envision

On behalf of NCHSR  Dr. Hend Msalati had started the event by greeting the attendance after  they listened to verses of the holy Quran and the national anthem and welcomed  Dr. Samir Sagar to give a brief presentation on the Sensible Governance. .By that, the following lecturers have started their speeches of the workshop’s first section.

Ideas in this event were shared and PPP was discussed from different angles and fields. Presenters and guests contributed to the topic with international examples along with many original plans, they also assured that PPP at this point is a necessity not a choice especially when noticing the crisis of the public health system which led the private sector to control and monopolize the health field.

But the main reason behind this partnership is to guarantee luxurious sustainable health service to the patients, and since the partnership shifts the duty of the ministry from offering the service to supervision and observation this will defiantly lead to the precision and speed of projects accomplishment. But it can’t be denied that the limited number of contributors and the cost estimation difficulty are negative sides of this partnership.

The Outlines of the legal basis of the partnership were also laid out in this workshop and the need to empower the Libyan legislations depending on a national policy and plans was explained. As importantly, contributor’s rights such as currency exchange and sensible management should be outlined and guaranteed in this partnership for both parties.

The new perspective discussed in the event suggests that the health sector budget will be reorganized, instead of being government dependant it will receive its main budget from the Health insurance fund, insurance companies and national fund in general, while the 3rd levelled health service will stay directly under the funding of the government.

Even though there is many international examples for PPP such in Britain , France and Canada but the high service cost is still a letdown, and the Libyans both patients and partnership parties should have their country benefit as a apriority and move forward as soon as possible.

 

The workshop’s conversation lead to  a conclusion of the necessity of ending the tense relationship between the private and public sectors and the importance of starting the cooperation between the two sectors in order to develop the health institutions in the country.

The Second Annual Confrence of The National Center of Health System Reform

Hend Mselati

0n October 3rd, the second conference of the The National Centre for Health System Reform was held in Tripoli, under the title of Health System Between Planning and Execution.

The conference was pleasured to host the president of the presidential council MrFaiz Al-Sarraj, the minister of health, minister of education and many others interested.

 

The Opening of the event was with verses of Quran, followed by the national anthem.

The starting word was by the presenter of the preparatory committee Mr Yusef Erhouma, followed by the word of the president of The National Accord government.Then the word of  Minister of health Mr Omar Bashir .

The director of the National Centre of Health System Reform Dr Samir Sager then gave his lecture about The Sensible Governance, which included:

  • an introduction about the initiation of the center and its development
  • vision, plans and targets of the center to achieve a complete functioning health system
  • health system sections including governance , finance and service branching

 

A video promoting ESehaty service was also presented after Dr Samir’s lecture wich introduced the idea of electronic health survises.

 

On behalf of the conference and Ending the first part of it, Dr Talal Ajaj  honored Mrfaiz Al-Sarraj , Dr Othman Abduljaliel minister of education , dr Samir Sager Director of the center , Dr Badradeen Abouhajar

 

After a coffee break, the rest of the conference sections were continued with a talk dicussing Health Financing Fund by DrTala Ajaj.

Dr BadradeenAbouhajar then presented his view about the role of public and private sectors in health service .

Followed by Dr badradeen ,Dr Adel Al-Twejer  spoke about The Organization of Health institutions .

Then Dr Imhemmed Sassi took part in the conference with his lecture on organization of health occupations.

Ending the words of the participants, Dr Imhemmed Khsheaba talked about Organization of Drugs and health equipment.

 

The event was ended with a discussion between the speakers and the attendance which included many questions and clarifications, which included :

 

  • The clarification of the role of governance and introducing health management to health service
  • Initiation of the health insurance system as an addition to the financial sources of the health sector , even though the center still needs the support of the health ministry to continue its purpose
  • The importance of cooperation between both public and private health institutions
  • The importance of supervision and inspection over the drug industry

 

The conference ended with a dinner feast in the Bab Albahr hotel where the host continued their discussions over the main points of the event