hsr2020 IBO PE of NCD in Lebanon

The Political Economy of Non-Communicable Diseases in Fragile Lebanon: Identifying Challenges and Opportunities for Policy Change and Care Provision Reform

Presented at 6th Global Symposium on Health Systems Research, November 8-12, 2020

Dr Ibrahim R. Bou-Orm; Dr Karin Diaconu; Dr Pol deVos

Institute for Global Health and Development, Queen Margaret University – Edinburgh, UK




• Lebanon is a middle-income country facing substantial fragility features.

• Non-Communicable Diseases (NCD) accounts for an estimate of 91% of all deaths in Lebanon with an increasing burden of NCD risk factors in urban settings.

• Adoption of evidence-based NCD policy and systemic reforms for targeting this burden is challenging in Lebanon

• Analysing the political economy of NCD is essential recently to identify gaps and opportunities for NCD policy change.


• The study research design is an embedded single-case based on a literature review using a problem-driven political economy analysis framework.




• Lebanon’s political instability and fragile governance negatively affect its capacity to adapt a Health-in-All-Policies approach to NCD prevention;

• Those factors also enable the blockade of NCD prevention policies by opposed stakeholders and their interests.

• Limited economic growth and reform failures imply weak financing, resulting in compromised health coverage (with high out-of-pocket expenditures as a major symptom) and health inequities.

• NCD care provision is twisted by the powerful private sector towards a hospitalcentred care model, implying healthcare commercialization.

• Stakeholders like the MOPH, UN agencies, and NGOs have been pushing towards changing the existing care model towards a comprehensive person-centred primary care model and implementing policy change.

• An incremental reform has been adopted to strengthen a network of primary care centres, support them with health technologies and improve the quality of PHC services.

• Nevertheless, outpatient services that are covered by other public funds (serving almost half of the population) remained specialist-led without much institutional regulation.


• The political economy of NCD in Lebanon shows a gap in the prevention policy landscape due to an unbalanced power relationship between policy promoters and blockers.

• Despite initiatives to strength primary care in Lebanon, a collaborative mechanism among health funders is lacking and therefore impeding major care model reforms.

This research is funded by the National Institute for Health Research (NIHR) (16/136/100 NIHR Research Unit on Health in Situations of Fragility) using UK aid from the UK Government to support global health research.