Bridging crisis recovery and long-term transformation of the health system in Lebanon: evidence from key informant interviews and global lessons

BACKGROUND: Since late 2019, Lebanon’s health system has faced immense strain an unprecedented financial and economic crisis, aggravated by the COVID-19 pandemic, and the Beirut Port explosion which damaged or destroyed a third of the capital, Beirut. This has created an urgent need for reform, heightened by the subsequent conflict (2023–2026) and its additional toll on health infrastructure and personnel. METHODS: A purposive sample of 27 key informants was chosen, based on their expertise in public health, hospital management, healthcare financing, and policy-making. Informants included policymakers, academics, directors of hospitals and primary care centers, and health leaders. This study was conducted in 2022. Semi-structured interviews were held with informants, and thematic analysis was used to analyze the data collected. RESULTS: This study identified six themes and 26 subthemes. The analysis reveals the challenges in health reform, financing, healthcare access and delivery, health personnel, information systems, and transitioning to a people-centered health system. These challenges are attributable to key challenges including sectarian clientelism driving political interference, accountability deficits, financial system failure, economic collapse, fragmented financing and services, personnel crisis and infrastructure gaps. CONCLUSION: There is an urgent need for transformative reforms for Lebanon’s health system. A list of 22 impactful and scalable recommendations is proposed, including foundational measures and immediate stabilization measures. Foundational measures include unifying public payers (harmonization initially), creating a National Health Council, defining clear roles for public and private hospitals, and improving personnel working conditions. Immediate measures include adopting electronic prescriptions and telemedicine licenses; centralizing emergency dispatch, creating a National Patient Association, and implementing national electronic health records. Achieving such reforms hinges on separating health governance from political interference and empowering technical leadership.