Access to health and coverage for health care facilities is high in Libya. Official figures on maternal health needs were close to 100% coverage for most indicators before the Revolution. Similarly, coverage in terms of primary health care facilities was estimated to be close to 100%. High availability indicators may have been the result of government attempts to embellish the overall picture, especially concerning southern regions where populations are highly dispersed. For most services however, high effective coverage was compounded by the fact all treatment is totally free of charge, rendering access extremely easy for all Libyans.
The main structural issue for the Libyan health sector is the lack of appropriate human resources. This reflects the emphasis on quantity versus quality as the main planning imperative for the previous government over the past decades. The list of challenges relating to human resources for the sector is long – the main elements are as follows though, as highlighted by the WHO and the Libyan Journal of Medicine (Taguri et al., 2001):
- 40% of Primary Health Centres were lacking sufficient numbers of qualified physicians, one of the main reasons for extensive self-referral to secondary centres;
- There is a shortage of trained midwifery staff to take care of antenatal and postnatal care;
- Outreach services are limited to school health services;
- Lack of quality continuous education for physicians due to past sanctions regime and no understanding of the need for it in past decades;
- Poor quality nursing because of insufficient training standards and high drop-out rates for nurses who finish their qualifications (as many as 30% of qualified nurses were deemed to be inactive before the Revolution). Sourcing of staff from abroad has been a major indicator of the shortfalls in availability of appropriate national human resources;
- Foreign staff has fled Libya because of conflict, leading to acute shortages, only partially compensated by emergency medical facilities set up by international support agencies and CSOs at the border with Tunisia and Egypt. Areas in the centre of Libya or in isolated areas are still heavily deprived of quality human resources.
Percentage of non-Libyan medical staff according to post, pre-Revolution: