Annual Referral Health Care Report 2023: A summary report for secondary and tertiary health care provided to refugees in Lebanon in 2023 – Lebanon

Overview

UNHCR’s role is to facilitate and advocate for access to its persons of concern through existing services and health service providers and to monitor access to health care services. While the primary health care strategy is the core of all interventions; referral care is an essential part of access to comprehensive health services (UNHCR Public Health Operational Guidance, 2013). Majority of the secondary and tertiary health care institutions in Lebanon are private and catastrophic costs are a significant barrier to accessing health care. UNHCR has put in place ‘Guidelines for referral health care’ in Lebanon and ‘Standard operating procedures’ (SOPs) to support access to life-saving and obstetric care to manage the costs of care for refugees effectively to avoid catastrophic health expenditures for the refugees. The costs covered by UNHCR vary according to the cost of service provided to the refugees by the health care provider. In the first half of the year 2023, 45.7% (N=35) of the referral health care providers were public hospitals. From August 2023, there were 33 hospitals which were officially part of the referral network with 54.6% of them being public hospitals. UNHCR contracts a third-party administrator (TPA) to manage and audit referral care processes and costs.

The 2023 referral care programme continued providing access to life-saving medical services for refugees who are not registered or in need of renewal of registration and linked them back to registration through the fast-track process up till 1 May 2023. From 1 May 2023, fast-track request to registration for accessing medical care was discontinued.

• The total number of approved referrals decreased by seven percent (7.3%) from 65,112 in 2022 to 60,353 in 2023. This decrease was noted significantly post 1 May 2023 and could be attributed to limiting the services to refugees and asylum seekers known to UNHCR.

• The composition of the UNHCR hospital network change in August 2023. The network hospitals reduced from 35 in the former half of the year to 33 in the latter half of the year. Throughout the year, ninety two percent (92.3%) of referrals took place to 20 of those contracted hospitals.

• Fifty six percent (56.4%) of referrals were for maternity care. This is an increase from 53% in 2022. The reason was a reduction in non-delivery referrals which proportionately increased the percentage for the delivery-related referrals.

• The proportion of births through caesarean section was 31% out of total deliveries showing a slight decrease in comparison to 32% in 2022.

• Out of the total approved referrals, there were 1,017 mortalities, of which 52.6% were in children under one year of age (48.6% in 2022). The trend in mortality rate from 2019 to 2023 shows that the mortality was highest in 2021, possibly due to direct and indirect factors related to the COVID-19 pandemic.
The mortality varied from 1.2% in 2019, 1.8% in 2020, 2.4% in 2021, 1.72% in 2022 and 1.69% in 2023. Further, the worsening economic crises and its impact on health sector in the country is also expected to be a contributing factor to this.