Healthcare System in Libya. Factual Report

Transcription

1 Healthcare System in Libya Factual Report January 2012 Hani Benamer 1

2 Contents I. Introduction...3 II. Population of Libya...4 III. Human Resources...5 IV. Health Care Expenditure...7 V. Health Care Facilities...9 V. Life Expectancy, Mortality and Disease Burden...11 VI. Medical Education...13 VII. Medical Publication

3 I. Introduction The main objective of this report is to present statistical data related to various health issues in Libya. In compiling this report the following points have been taken in consideration: 1. Libya was divided into the following geographical areas Tripoli Benghazi Jabal Gharbi (From Gharyan to Nalut) Jabal Akhdar & Marj Darnah & Albetnan Misratah & surrounding areas Marqab Jifarah Zawiyah & surrounding areas Zuwarah & surrounding areas Mantiqa Wusta (Adjabyia, Wahat, Sirte, Jufrah & Kufrah) Mantiqa Janubiya (Sabha, Murzuq, Ghat, Awbari & Adiri) 2. To put some of the data in context, Libya was compared with the United Kingdom (UK), Canada, Sweden, Malaysia, Oman, Tunisia and Egypt. 3. The report is factual and hence the author completely restrained from making any comments or drawing conclusions. That is left to the readers. 4. The data were carefully referenced. All references are available in the public domain, but the author will be happy to supply the readers with any reference on request. 5. The data available on health care in Libya are related to quantity NOT quality. 6. Medical education and publication were included as they are major contributors to the health service. 7. The report is not comprehensive; it is design just to give you a flavour about health indicators in Libya. 3

4 II. Population of Libya Over the last 40 years there were 4 censuses (1973, 1984, 1995, and 2006). The population grew from 2,249,237 in 1973 to 5,657,692 in 2006, making the average growth rate 2.85% per year. However, the growth rate dropped from 4.48 during to 1.56 during The number of non-libyans changed from 196,865 (8.75% of the population) in 1973 to 359,540 (6.35% of the population) in Libyan males composed 50.7% of the Libyan population in About 85% of the Libyan population is urban. 2 The age distribution of the Libyan population shows that 31% of the population are below 15 years (Paediatric age group), 42% are below of age of 20, 38% are years old, 52% are years old and only 6% are above age of 60 years. 1 Table 1: The population of various regions of Libya according to 15/04/2006 census Region Population Tripoli 1,065,405 Benghazi 670,797 Jabal Gharbi 397,383 Jabal Akhdar & Marj 389,004 Darnah & Albetnan 322,887 Misratah & surrounding areas 550,938 Marqab 423,202 Jifarah 453,198 Zawiyah & surrounding areas 290,993 Zuwarah & surrounding areas 287,662 Mantiqa Wusta (Adjabyia, Wahat, Sirte, Jufrah & 420,871 Kufrah) Mantiqa Janubiya (Sabha, Murzuq,Ghat, Awbari 363,729 & Adiri) Total 5,323,991 4

5 III. Human Resources In 2010 there were 113,631 employees (Libyans and non-libyans) in the ministry of health. 1 These employees were distributed as follows: 11,323 doctors, 40,926 nurses and midwives, 3176 dentists, 1100 pharmacists, 16,640 health professionals (? allied healthcare professionals; author), and 34,533 service management (not sure what this includes; author) making a total of 107, The other 5933 personnel are not accounted for. Libyan doctors in diaspora Clemens and Pettersson reported a total of 585 Libyan physicians when they used the destination-country census data of 2000 to estimate the number of African-born doctors who had immigrated to the UK, the USA, Australia, Canada, France, Spain, and Belgium. 3 Mullan, when examining physician immigration to UK, USA, Australia and Canada in 2004, reported that 624 Libyan doctors were practising in these countries and that 63% of them were in the UK. 4 Mullan estimated that 8.9% of all Libyan physicians were practicing in the USA, UK, Canada or Australia. 4 Moreover, Libya was among the top five African countries when Arah calculated physician migration density, i.e. the number of migrating physician per 1000 population. 5 Recently, the General Medical Council (GMC) confirmed that there are 707 doctors registered in the UK who obtained their primary medical qualifications in Libya. 6 Of these, 211 doctors are registered in the GMC's Specialist Register and 20 are in the General Practitioner Register. 7 5

6 Figure 1. Human resources per 10,000 population, international comparison 8 UK Canada Sweden Malaysia Oman Tunisia Pharmaceutical personnel Dentistry personnel Nusing and midwifery personnel Physician Egypt Libya Libya Egypt Tunisia Oman Malaysia Sw eden Canada UK Pharmaceutical personnel Dentistry personnel Nusing and midw ifery personnel Physician

7 IV. Health Care Expenditure Libya spent 3.13 billion Libyan Dinars (LD) on health in 2010, of which 1.3 billion were spent on salaries and 700 millions on drugs. 1 Libya spent about 3% of its Gross Domestic Product (GDP) on health in 2008, less than the 3.3% it spent in

8 Table 2. Health expenditure in Libya: international comparison 8 Total expenditure as % of GDP Government expenditure on health as % of total expenditure Government expenditure as % of total expenditure on health Private expenditure as % of total expenditure on health Out-of-pocket expenditure as % of private expenditure on health Per capita total expenditure on health (US$) Per capita government expenditure on health (US$) Libya Egypt Tunisia Oman Malaysia Sweden Canada UK

9 V. Health Care Facilities There are 1382 primary healthcare units (each of them serve citizens) and primary care centres (each of them serve 10,000-26,000 citizens). 2 There are 37 polyclinics (each of them serve 50,000 to 60,000 citizens). 2 There were 20,689 beds in public hospitals (table 3), and 2088 in private sector in Libya has 37 hospital beds per 10,000 population, which is very high by international standards (table 4). 8 However, the bed occupancy rate in Tripoli Medical Centre averaged 65.8% in the years There are 40 CT and 20 MRI in the public sector and 20 CT and 12 MRI in the private sector. 1 There are also 5 radiotherapy unites, 9 Echo and 201 X-ray machines in the public sector. 1 There are 8 angiography units in the public sector and 3 in the private sector, all of them are in Tripoli and Benghazi. 2 There were 925 dialysis machines in total in Table 3. Hospital beds in Libya in 2010 by region 1 Region Hospital beds Tripoli 6497 Benghazi 3645 Jabal Gharbi 1662 Jabal Akhdar & Marj 1367 Darnah & Albetnan 1172 Misratah & surrounding areas 1360 Marqab 864 Jifarah 402 Zawiyah & surrounding areas 616 Zuwarah & surrounding areas 843 Mantiqa Wusta (Adjabyia, Wahat, Sirte, Jufrah & Kufrah) 1061 Mantiqa Janubiya (Sabha, Murzuq,Ghat, Awbari & Adiri) 1200 Total

10 Table 4. Health infrastructure in Libya, international comparison 8 Hospital beds per 10,000 population Radiotherapy units per 1,000,000 population Libya Egypt Tunisia Oman Malaysia Sweden Canada UK

11 V. Life Expectancy, Mortality and Disease Burden The top three causes of mortality in Libya are cardiac diseases (37%), tumours (13%) and road traffic accidents (11%), while the top three causes of morbidity and disability are antenatal and postnatal care and delivery (?pregnancy, delivery and postnatal related problems; author), cardiovascular diseases, and road traffic accidents. 2 In 2009 the prevalence of tuberculosis was 55 per 100,000 population and its incidence was 40 per 100,000 population. 8 The number of reported cases of hepatitis B was 2437 and 1437 for hepatitis C in About 30% of the adult male Libyan population are regular smokers. 2 About 15% of students use some form of tobacco and 6% of them smoke cigarettes. 2 Road fatalities are 31.5 per 100,000 in comparison with 6.1 in the UK. 2 Life expectancy and mortality in Libya are shown in table 5. 11

12 Table 5. Life expectancy and mortality in Libya (2009), international comparison 8 Life Stillbirths per Neonatal Infant mortality rate per Under five mortality Adult Maternal* expectancy at 1000 live births mortality rate 1000 live births rate per 1000 live mortality rate mortality rate birth per 1000 live births per 1000 per 100,000 births population live births Libya Egypt Tunisia Oman Malaysia Sweden Canada UK *Year

13 VI. Medical Education The first two medical schools in Libya started in the 1970s and a big expansion in the number of new schools followed in the 1990s. 9 There are medical students in 2007/ All medical schools use traditional curricula, 9 except the Libyan International Medical University who have introduced problem-based learning. 10 The medical schools in Libya are listed in table 6. In the mid 1990s the Libyan Board of Medical Specialties (LBMS) was established with the aim of training doctors to specialist and consultant levels. To date, 536 doctors in various specialities graduated from the Board (table 7). 1 Table 6. List of the medical schools in Libya ( ) 9 Name City Year of establishment Number of students Number of academic staff Number of graduates Benghazi Benghazi University Tripoli Tripoli University Sebha university Sebha Sirte University Sirte Misturata Misurata University Zawia University Zawia Elmergib Khums University Omar Almukhtar Bayda University Ajabal Algharbi Ghayran University Libyan International Medical University Benghazi Total

14 Table 7. Number of trainees and graduates of Libya Board of Medical Specialties 1 Speciality Trainees Graduates General surgery 73 Orthopaedics 29 ENT Urology 24 Plastic 11 General medical Paediatric Obstetrics & Gynaecology Anaesthesia & ITU Ophthalmology Family medicine Radiology Diagnostic radiology Radiotherapy - 9 Dermatology Laboratories medicine 62 - General pathology - 4 Emergency medicine Total

15 VII. Medical Publication Libya did not appear in the top 20 African countries when the total number and the average annual number of biomedical publications were counted for each African country from 1996 to Also, in the same study Libya was not ranked among the top 20 countries in Africa when the number of biomedical publications was normalised to annual publication rate per million inhabitants. 11 Libya ranked lower than Morocco, Tunisia and Yemen in total number of PubMed publications between 2002 and The same result was found when the data was normalised to GDP. 12 Shaban and Abu- Zidan studied the medical publications from 20 Arab countries. 13 Libya ranked 12 th in the average annual publication rate, 10 th when the data was normalised to the population, and 15 th when normalised to GDP. 13 PubMed and the Science Citation Index Expanded were searched for original biomedical studies affiliated with Libya up to December 2007 and found 329 original papers. 14 The first study was published in Publication rate peaked between with an average of 15.2 studies per year. 14 From 1997 to 2007 the production rate decreased to an average of 8.8 studies per year (p<0.001). 14 Of 166 first authors, 41% were Libyans and 59% were non Libyans. The latter contributed 104 studies between 1986 and 1996, and 36 studies between 1997 and 2007, while the Libyans contributed 63 and 61 studies in the two respective periods. 14 Authors affiliated with Benghazi produced 67% of the published studies, while authors from Tripoli produced 30%, and other medical schools, hospitals and research centres from other Libyan cities produced only 3%. 14 Another study analysed the publications record of the Libyan medical schools in international journals indexed in PubMed between 1988 and Of 417 papers affiliated to Libya, 348 (83.5%) are affiliated to the medical schools and related hospitals. More than 60% of the 348 papers are affiliated to Benghazi medical school, while Tripoli medical school contributed 103 papers (29.6%). 15 The rest of the papers (n=25, 7.2%) were published by medical schools in other parts of the country. 15 The publication rate declined by 2.6% annually between 1988 and The decline was mainly due to a decrease in the publication rate by Benghazi medical school. 15 Overall, nine departments produced 10 or more papers each. 15 Of about 1675 staff members, only 148 show up as first authors and 15

16 207 as last authors. The estimated annual publication rate is 0.72 papers per 100 academic staff members in Libya 15 compared with 27.3 papers in Tunisia 16 and 45 in the American University of Beirut, Lebanon. 17 The first medical journal in Libya, Garyounis Medical Journal, was published by Benghazi medical school in The last volume of this journal was published in Several other journals appeared in the last two decades: Alfateh Medical Journal, Sebha University Journal of Medical Sciences, Libyan Journal of Medical Research, Zuara Medical Journal, Libyan Orthopaedic Journal, El-Razi Medical Gazette, Jamahiria Medical Journal, and Libyan Journal of Infectious Diseases. 9 Most of these journals have not survived. 9 Two journals were established mainly by Libyan doctors practising in Europe and North America: Libyan Journal of Medicine 18 and Ibnosina Journal of Medicine and Biomedical Sciences. 19 Recently, the Libyan Journal of Medicine has been indexed in PubMed Central/PubMed

17 VIII. References 1. Health Information Centre Tripoli, Libya. Health & Environment Annual Statistical report Eastern Mediterranean regional health Systems Observatory. Health System profile: Libya. World Health Organization Clemens MA, Pettersson G. New data on African health professionals abroad. Hum.Resour.Health 2008;6:1. 4. Mullan F. The metrics of the physician brain drain. N.Engl.J Med 2005;353: Arah OA. The metrics and correlates of physician migration from Africa. BMC.Public Health 2007;7: Sarah Leigh, Information Access Team Administrator in GMC. Number of Libyan doctors in the UK Communication 7. Sarah Leigh, Information Access Team Administrator in GMC. Number of Libyan doctors in the UK Communication 8. World Heath Organization. World Health Statistics Benamer HT, Bakoush O. Medical education in Libya: the challenges. Med Teach. 2009;31: Libyan International Medical University Uthman OA, Uthman MB. Geography of Africa biomedical publications: an analysis of PubMed papers. Int.J Health Geogr. 2007;6: Bakoush O, Al-Tubuly AA, Ashammakhi N, and Elkhammas EA. PubMed Medical Publications From Libya. Libyan J Med. AOP: Shaban SF, Abu-Zidan FM. A quantitative analysis of medical publications from Arab countries. Saudi.Med.J. 2003;24: Benamer HT, Bredan A, Bakoush O. A negative trend of biomedical research in Libya: a bibliometric study. Health Info.Libr.J 2009;26: Benamer HT, Bredan A, Bakoush O. Scientific publication productivity of Libyan medical schools: A bibliometric study of papers listed in pubmed, Eductaion for Health 2009;22: Ben AA, Abdelali M, Khmakhem A. Bibliometric profile of Tunisians medicals publications indexed in Medline from 2000 to 2003 party 1: productivity and cartography. Tunis Med 2006;84: Dakik HA, Kaidbey H, Sabra R. Research productivity of the medical faculty at the American University of Beirut. Postgrad.Med J 2006;82:

18 18. Libyan Medical Journal Ibnosina Journal of Medicine and Biomedical Sciences Libyan Medical Journal; PubMed. 18