|
|
|
|
BY Dr. Nagi Giumma Barakat
The health services in Libya are suffering badly before and now. I was the director (Minister) of health services in Libya during the uprising till 30/11/2011. I was very close to everything at that time and I knew what the problems were. For those reasons I would like to share with my readers the challenges facing the health services in Libya. I am sure everyone knows what problems there are by listening to people, and also from the employees in this sector. Very rarely will you hear someone telling you what the solution could be. I have met many of the health services employees and the majority of them were talking about personal issues and what that person did or what that employee thinks about himself or herself.
I must admire the work done by the health services employees during the liberation and now. I really feel proud about their contribution and dedication to help patients, freedom fighters and the public. The majority of them worked hard and did what they could do with very limited resources and in unsafe environment. Many thanks to all of them and Libya needs even more dedicated people to build up these services and raise the standard of health care in Libya, where patient satisfaction will be the cornerstone of these services.
I met the newly MOH twice, one back at the end of September 2011 and one on 29th November 2011. At the first meeting she was apologising for her campaign against me since I had been appointed and asking to be appointed as the director of health office in Ireland which I did. The second meeting was a hand over meeting and we spent 150 minutes and she wrote down everything. The newly appointed MOH is trying very hard to put a face on health services in Libya with the help of very junior administrators. They are doing their best with what is available to them in very difficult circumstances and a very unsafe environment. They are not getting much support and they are struggling to cover all Libya due to lack of resources and no strategic planning in place.
The NTC and the government did not draw up a structured program with clear measured outcomes and left them alone to manage the health services without strict control and follow-up. They cannot be blamed for everything but they share the burden of failed system with all the employees of the health services in Libya. As we all know, there is no systematic approach to anything in Libya yet.
The ambulance services are not appropriate even to run a small city and Libya is totally dependent on importing everything from abroad to run the health services.
The challenges facing the health services in Libya: The absence of quality leaderships in health services and the recent choice of a minister of health with very little experience in management are the major challenges facing the government and NTC. There are no real changes in delivering any clear program and everything is still haphazard without real planning or thinking. There is no any credibility for the work the MOH is trying to do and this has brought on her too many problems. This was started by appointing family members to higher positions and then firing them after complaints were made and being asked by the prime minister to dismiss her sister and two other members of her team.
This was followed by changing every head of administration which is a fatal mistake and this is still going on. The majority of them are very experienced and they know everything in MOH and health services. Changing them now is a foolish mistake which indicates lack of experience and that she does not have a clue about the management system in the administration field. The leadership quality in health services management is absent from the MOH and other sectors of health services.
The Minister at the MOH never held any higher position, the prime minister and his team put the MOH in a very awkward position when they asked her to submit her CV for the Minister position. They share the responsibility and the Minister should not be blamed for all of her mistakes because she has no leadership quality and no experience in management. This is very obvious and no one can deny it.
The lack of leadership in health services is not new in Libya and it used to be run by a group of Gaddafi loyalists and no chances were given to develop this field and also to develop the management sector at the level of MOH and PHC and hospitals. It is time to search for young good quality managers and train them for potential lead on improving the administration part of health services. Leaders should be made not appointed.
The most important challenges are to get trust back to health services in Libya. This will take time and this will not happen overnight. The worst thing is to come out and say, I will do this and that and then you cannot deliver it. The current MOH did not set any priorities and if any were set, they are not yet out for the public to see and start believing there will be changes. If there are any, they should come forward now and start implementing them very quickly. The most important priority now is to speed up importing medication, consumables, and spare parts for equipments. There are severe shortages now as the MOH stopped all contracts done by the previous director and his team. The second important point is to establish 3 centres of excellence and 5 rehabilitation centres. If the MOH works on these I am sure public confidence will be restored in health services and building on this trust would began.
There are no national rehabilitation programs and everyone is talking about it and there are many proposals but nothing on the ground. This is because the MOH does not trust anyone and wants to start everything from scratch and not build on what the previous director and his team had done. It is another fatal mistake to try to scrap everything and start from zero. This is one area which has shown up the lack of experience from both the MOH and the advisors surrounding her, most of whom have never done any executive job or worked in leadership positions. These rehabilitation centres can be established as many of the injured and traumatised freedom fighters will be back, if they’re not already in Libya. Working with some credible NGOs will help to get it off the ground. The ownership of this program should be handled by the government and the Prime Minister or the NTC president should lead on this as well. This will give it strength and credibility. The current MOH will not be able to do that as she has not got the vision or the strategies to do that. This is the truth and not a personal issue.
The other challenge is to stop the corruption in MOH and other sectors. The worst corruption happens when buying medicine and medical equipment. The only way to stop it is to negotiate contracts directly with the producing companies as we did when we were in Benghazi to buy medicine worth 370 million dinar to cover Libya for 6 months and payments after 6 months. This was stopped by MOH for reasons we do not understand which have led to severe shortages of everything. The producing company will be happy and long term contracts should be agreed and this will prevent MOH employees as well as hospitals managers from doing any businesses/ deals. The other areas of corruption which we found were in the fields of catering, cleaning and maintenance in hospitals, clinics and health centres. Issuing one contract with clear guidelines and robust control and follow-up department will help. Quality is paramount for any services provided to hospitals and other sectors. Starting quality control programs across all departments at MOH and hospital levels should prevent corruption and will deliver good services.
All of these need a substantive budget built on clear planning and excellent financial control. At the moment the worst corrupted people are the finance controllers. I think we should get rid of them all and make the audit authorities (financial control) more robust and effective and punish anyone who is trying to steal from public money.
The health services need good quality leadership, experienced managers, dedicated working doctors, nurses and technicians. The management should be left to the managers who are trained to do that and doctors should keep away and they are the worst as chief executives for hospitals. I am sure some doing doctors are doing a fantastic job at running hospitals but the majority are not. The Libyan experts who are living abroad should make sacrifices and go back and help in treating patients, help in managing hospitals - not to become directors, but to help in training and to reform health services. Libya needs to make sacrifices as many freedom fighters sacrificed themselves to give all Libyans the freedom they dreamed about, doctors who are practicing and living abroad should go back whenever possible to settle there, take career break for a certain period or as frequent visitors aiming to settle there when the time comes. Gaddafi is gone and his revolutionary committees are also gone away from Libya and no excuses.
Health services in Libya have many problems and no need to solve them all now. It will take many years to correct many of them. It is important now to work on the priorities mentioned above and with new government and hopefully with the help of experts, a clear vision, with strategy and systematic planning plus a comprehensive budget over next 5 years, health services reform in Libya could start after 12 months from now.
The most important thing for the Prime Minister to do is to make courageous decisions about the health services and its leadership. If we leave everything as it is, I am sure the public and the health services employees will not be happy and many will come out onto the streets. We should all help in this situation and doors should be open to listen to experts’ views as well to the strategists. To continue to ignore what is going on is not a good idea and can be very counter-productive and patients will suffer and many lives will be lost because of poor quality of leadership and the absence of experts in this field.
Libya will be free and will rise up against all odds and Libyans will govern Libya and guard it from anyone who thinks he can harm the Libyan people. The writer is former Minister of Health. He contributed this article to The Tripoli Post.
|
|
|
|
|
|
|
|
|
|
Name:
Hussain Kreiba |
Date: 17/02/2012 23:52:41 |
Comment: I think the problems facing the health sector are not easily dealt with given that this sector needs reconsideration of all it's plans and strategies. The post-Gaddafi legacies still shows their effect on all sector. The sector may also be in a bad need of financial support, and we do not really know about the nature of that support. If the writer of this article is aware of all these issues with his previous experience in running the health, why didn't he offere all these solutions and what did he really do to tackle all the issues concerning the Health sector? I do remember a lot problems facing the sector when he was in charge and he did little to sort them out. Moreover, he was once expected to be on the telephone with Libya alahrar TV to discuss and talk about issues concerning the injured revolutionaries, but the programme presenter said later that he did not like to take part in that programme. Perhaps he stopped answering the calls from the channel according to the programme presenter. I do support all reforms, but we do really need to know the exact circumstances. Being in a leadership position is difficult in Libya because of many factors. I have discussed one in an article, it is tribalism. |
|
|
Name:
Husni Bey |
Date: 19/02/2012 23:29:05 |
Comment: Very surprised and shocked to read an article by an ex MoH Dr Naji Barakat criticising a newly appointed Lady MoH Dr Hamroush (Dr Barakat has not deigned naming Dr Hamroush by her name in the above article which is shameful). I wished to read an article by Dr Barakat with offers to help , recommend ,to assist , support , to advise , POSITIVE ACTION FOR THE BETTERMENT OF LIBYA 's HEALTH in general and the to newly appointed MoH Dr Hamrouch . We expected support and extending a hand to advise the youth being engaged to help in the system that Dr Barakat himself calls corrupt. -Dr Barakat ............. can you not realize and see yourself as the ones in the Health System that you are yourself criticising in this article?? -Dr Barakat attack on a person , if Dr Hamroush was no good why you accepted to name her as Libya's health coordinator in Ireland??your attack is regrettable and shameful to say the least . -We all agree with you that Managers need not be Doctors .Doctors are good at their professions , they have been trained to do medical care work , yet whoever is rightly or wrongly placed in charge anywhere , can circle himself with a TEAM of Managers or Managment Consultants. These managerial qualities are available on temporary hire if needed. Professional managers are expensive yes , but available on call ,they would save millions and help solve the problems. But the established civil servants in the MoH would boycot any such initiative. -Buying Medicines directly from manufacturers is not a recipe to stamp out corruption , I assure you that not all Pharma Companies are subject to strict ETHICAL CONDUCT, I would go to say that many are corrupt to the bone(You surely know this). To guarantee fair dealings we(Libyans) need..CLARITY of SCOPE ......Systems,Procedures,Fair Competition ,Equal Opportunities for all , Governance , Transparency , Rule of Law , respect of the contracted terms by the contracting parties (MoH + Suppliers) including the tender procedure , timing , terms of delivery and payment terms. These pre-conditions are the true guarantors of ETHICAL BEHAVIOUR and CONDUCT by all the stake holders (Manufacturers , Importers , Distributors , MoH, MoH employees). -Never buy or tender all your needs for the year in one tender ,never buy from one source , never let yourself be monopolized by anyone company. Must have three suppliers at anyone time. - We do have excellent CONSULTANTS and DOCTORS and we have the latest technology for dyagnostics. We can easely train our technitians to operate the equipment (Why are they not trained ??It is in the supply contract!! Is it not ??) -Our major real problems are in the MANAGEMENT of everything in Libya , with the following problems directly related to the Health Sector...... Poor NURSING quality (can train the staff) , FOOD (contro and improve quality), HYGENE (Use the proper producst, these are available , VAREKINA and DETTOL are not the true solution) and INFECTION CONTROL(Use the proper products, common house disinfectants are no more infection resistant). We need little effort to achieve a long leap forward, lots can be done with the available resources. We spend Billions and get little in return. CORRUPTION IS THE ENEMY OF US ALL. -My advise , URGENTLY introduce IT technology , IT technology can only be handled by under 35s . The older generation will make room to those that fought this war of Liberation. There is LITTLE or NOTHING to learn from OUR (MY Generation ) other than bad habits that we do not want to overcome. It is our confort zone to block the youth. -Dr Hamrouch do not let the so called expirienced stop the youth taking over through the introduction of IT technology. Our generation is lousy at technology. |
|
|
Name:
Husni Bey |
Date: 20/02/2012 11:55:35 |
Comment: -Dr Barakat is not naming Dr Hamrouch by name. Why?? -Dr Barakat complains the article about partisanship in the Health Sector , and he is being partisan himself -Dr Baraakat proposes to buy directly from Manufacturers , and he know that many foreign manufaccturerss are very corrupt and few abide by the ethical code of conduct they preach. -Dr Baraakat wants the estaablsihed status quo , that he himself is calling corrupt. -Dr Barakat is criticising , but is not offering solution , support , advise , assistance to the Minster or the Minsistry for the best of Libya. Dr Barakat , I do not know you or Dr Hamrouch , but than why you posted Dr Hamrouch in Ireland if Dr Hamrouch is no good?? Dr Barakat what we have at stake is Libya and not persons and personalities. -Our Libya problem is maanagement , ethical behavious , transparency , rule of law equal opportunities , respect of contractual obligations. -We lack systems , procedures , accountability , KPI evaluation , recognition of the better ones , And in the health in particular our probems are low quality NURSING , FOOD , CLEANLINESS , DESEASE CONTROL , HYGENE , MAINTENANCE........................the funds were always made available , but misused and abused so to result in low quality and poor service. -Dr Hamrouch , trust the youth the ones below 35 , they changed and are capable to change Libya. -Dr Hamroush , introduce high IT technology so that there is no room to the ones of my age. -Dr Hamrosh , we have best Doctors and Best Consultants , they need recognition for what they are. -Yes Doctors cannot be good managers ass maanagers cannot be doctors , but Doctors can circle themselves with TOP Brsass Managers or Management Consultants , These breed are expensive , but are worth avery LD or USD we spend on them. -Trust the local Libyans , not all are crooks or corrupt , the majority are NOT CROOKS or CORRUPT , corruption is in the minority. I believe in the 80% and 20% theory , I tell you 20% may be at most the corrupt , go and look for the 80% that all they want transparency , equal opportunity , rule of law , accountability , systems , procedures and fair pay for their services. |
|
|
Name:
Naaman Elbouri |
Date: 21/02/2012 00:02:47 |
Comment: I believe Dr Barrakat forgot to admit the problem we are facing today is a result of his mismanagement. - Instead of criticizing others, can he tell us what were his achievements when he was the minister of health????? - Thanks to his wise decisions, over 1 billion dollars have been misused |
|
|
Name:
adel khlat |
Date: 21/02/2012 00:51:09 |
Comment: in addition to what Mr Husney bey said, and i agree every word. Dr barakat, why u r writting about the issue of benghazi (your) tender and manufacturing companies contracts every now and then in different sites ? do you know why the MOH cancelled the tender? was there any smell of corruption ? was there mismangement in handling the tender? did it fulfill the MOH needs ? is there money available to spend on these orders and contracts? did you published the tender results (TRANSPARENCY)? you are pushing so hard to finish the deals ?????? we know nothing about them
please pubish the tender results , for us to support you and Libya against the MOH, rather than pushing us to an unkown direction, you, the only one, knows where it leads.
everybody is talking about manufactring compaines !! every manufacturing company has an agent or distributor, why ommitting these agents ? they can arrange for shipments faster than the MOH.
I can smell your fishy speech about your tender in benghazi a thousand mile away !!
Stop attcking others and come to Libya for doctors training as u said, better for you, Libya and Libyan patients. |
|
|
Name:
Ahmad Abu Najem |
Date: 21/02/2012 09:46:13 |
Comment: - First, I'm totally agree with the 1st & 2nd comments. - I may add this: It is true that in all sectors, there is a two generations conflict, the "old" one whom thought that their experiences and "great relations" to the foreign suppliers, and the new generation whom have the motivation and ambition to lead their country to the level they scarify for in this revolution. People like Dr. Barakat whom capsular themselves in luxury salons with the same businessmen whom been feeding the corruption in all sectors, then they became a "revolutionist" using Libyan stolen money, those whom believe that Libyan Doctor or Employee will never provide more, because they put him in "un-experienced" position to lead ... now they want to get benefit of what they paid to this revolution ... I'm responsible on what I'm talking about ... same generation .. whom feed the corruption in Ghaddafi regime "sure not all of them "... they are back now in new faces ... trying to convince us .. we are not suitable to rise our country to the level it should be ... so they came with the "Foreign" partners to roll it out ... Dr. Barakat .. please stop meeting these people .. and come down to your real people .. and help them to do the best ... Dr. Fatma or any other minster will be in charge of MOH .. we will, advice ... support ... and do our best to help ... because this is Libya .. not Hamrosh or Barakat country. |
|
|
Name:
Esam Abusaoud |
Date: 22/02/2012 15:46:47 |
Comment: I am totally agree with Mr.Husne bey and Mr. Ahmed Abunajem, I believe Dr Barakat is not telling the truth and he is not fair. Dr Hamrouch is working hard and doing her best and we all know the Health sector is a very complicated and full of corruptions may be more than other sectors and MOH spending every moment of her time fighting against these problems, we are supporting her and willing to do our best to help her and help LIBYA
|
|
|
Name:
saleem ul rehman |
Date: 29/07/2012 00:59:52 |
Comment: I have read all articles and comments and i sympathisewith the situation,what i am able to do is that i am trading a large amount of medical supplies and i will be able to give the Libyan health service supplies at a MASSIVE discount to help the cause, please contact me if you require HELP |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
More
Featured Articles |
|
|
|
|
|
Sabratha Blood Transfusion Workshop August 22-23, Establishing New Service in Libya
A blood transfusion workshop is expected to become the first milestone for the development of a safe, efficient and effective blood transfusion services in Libya after decades of neglect by the former corrupt regime. The workshop is sponsored by the Libyan Ministry of Health to accomplish many objectives. |
|
|
|
|
|
|
|
Saluting our 'Ladies with the Lamp' - By Prashant Bhatt
12th May is the birth anniversary of Florence Nightingale, who is widely regarded as one of the founders of modern Nursing. Another is from former Yugoslavia but Tripoli is home to her, a place where she lived and worked for 33 years. Still nursing is one of the key factors in determining the successful outcome of treatment. It can also be one of the weakest and neglected links in healthcare delivery. |
|
|
|
|
|
|
|
World for Libya Providing Training for Libyan Surgeons
In an effort to improve the quality of health care in Libya, World for Libya is working with both UK and Libyan surgeons to create the Virtual Interactive Surgical Training Academy (VISTA), which will allow senior UK and international surgeons to share new techniques and knowledge with Libyan surgeons by interacting over this online training platform. |
|
|
|
|
|
|
|
Tags |
|
|
|
|
|
|
|