A strong primary health workforce as a crucial foundation for quality care in post-conflict setting

A Libyan doctor consulting with a patient

The years of conflict and instability in Libya have had severe implications on the country’s health system and health workforce. The exodus of skilled health workers and acute shortages of medicines, supplies and equipment compromised service delivery at all healthcare levels. Primary care was no exception; even before the outbreak of COVID-19 in Libya, more than half of its primary healthcare facilities had been forced to close.

As primary care health workers ourselves, we strongly believe that everyone should be able to access high-quality healthcare in order to ensure they live healthy lives that enable them to achieve their full potential. This becomes even more critical in conflict and post-conflict settings. Primary care is where most people access their care most of the time. And for this care to be effective it needs to be delivered by skilled and resourced people: health-workers are a crucial pillar in ensuring a well-functioning and resilient primary healthcare system.

Supporting quality standards across primary care systems

PCI is working with the Ministry of Health in Libya to promote a strengthened primary healthcare workforce empowered to deliver high-quality, evidence-based care to its population.

Together with the Primary Health Care Institute (PHCI) of the Ministry of Health and accredited training institutions, and in consultation with Libyan health workers and key national and international stakeholders, we facilitated the development of an in-service training strategy for Libya by involving all of the key stakeholders in all the phases of this project, with the formation of a Technical Working Group led by PHCI (under the MOH) and facilitated by PCI. Upskilling the primary workforce was the priority intervention that stakeholders unanimously supported to have the greatest impact on strengthening the health system and improving quality of care for people.

This work will create structured opportunities for doctors, nurses and other healthcare workers in primary healthcare across the country. It will reduce fragmentation and duplication and establish agreed standards in continuous professional development within the primary healthcare sector. Ultimately this will maintain and enhance healthcare workers’ ability to deliver quality services to their patients and communities across Libya.

Our approach aligns with the WHO's Global Competency Framework for UHC, which aims to guide the standards for education and practice for health workers in primary care. The principle of competency-based education maps with PCI's approach to learning and our focus on facilitating multi-directional, context-specific learning rather than a hierarchical, fixed approach.
In our work with different groups in Libya it soon became clear that, despite the impact of the recent conflict, there was a significant knowledge base, a strong sense of commitment and determination to create a supportive environment for capacity building of primary health care practitioners across the country regardless of stability and resources available.

Nurturing a new generation of leaders

We are now co-developing training courses across a range of primary care themes - identified by PHCI, as well as focusing on healthcare worker leadership development. This is an opportunity to grow and nurture a new generation of healthcare leaders who are passionate about the power of primary healthcare to transform health outcomes for people across Libya well into the future.  
This work also has the potential to be shared more widely as an intervention model to scale-up quality standards in primary care via standardised educational packages for healthcare workers. We will seek to replicate best practice from this initiative in other settings - albeit with any re-modelling of packages that is necessary to ensure localisation to individual settings.

Prioritise strong, cohesive and resilient primary care in all settings

After the destabilisation and fragmentation of the Libyan health system through years of conflict, this programme will establish minimum standards and create a comprehensive and systematic national framework for training all primary care health-workers in Libya: providing a long-term impact for the health system – and therefore the people - across the whole country.
COVID-19 revealed that the health systems that withstood this shock better than others were the ones with stronger primary healthcare systems. As we slowly emerge into a post-COVID-19 era, we urge the global community to learn from this pandemic and invest in strengthening their primary care systems as the main building block to achieving UHC.

This opinion piece is part of a blog series by the Allies Improving PHC for the 75th World Health Assembly that aims to highlight Primary Health Care as the foundation for achieving universal health coverage, health security and healthier populations globally. Pieces will be posted throughout the week of the 75th World Health Assembly, read more here.