Background
Lebanon currently hosts just under 1 million registered refugees who live both in urban centers and informal settlements. UNHCR is providing assistance and support to refugees through a variety of programs covering basic assistance, protection, shelter, WASH, education and health. The public health unit of UNHCR plays a role both in provision of health care services and institutional support through implementing partners and in coordination of the response together with the Lebanese Ministry of Public Health (MOPH) and the World Health Organization (WHO). The UNHCR public health programme aims to enhance refugee access to comprehensive health services within Lebanon. Primary health care (PHC) is the core of all health interventions and in partnership with local and international implementing partners UNHCR is supporting 10 PHC facilities where a basic package of health care services1 is provided for free or at subsidized pricesfor refugees. In addition, UNHCR supports two centersspecialized in mental health.
In total, there are 137 primary health care facilities2 countrywide supported by partners in which subsidized care is available for refugees. Referral care is an essential component of access to comprehensive health services for refugees. UNHCR supports deliveries and life-saving emergency care by paying a part of hospital fees depending on the cost of the admission. To facilitate the administration of referral care support, UNHCR contracts a Third Party Administrator (TPA) and since January 2017 this is NEXtCARE. In July 2018, in order to control utilization and high costs of the UNHCR referral care programme, a new cost-sharing scheme was introduced which meant that beneficiaries need to pay a higher proportion of low-cost admissions than before. At the same time beneficiary contribution to high cost admissions was reduced. This change is expected to increase beneficiaries’ expenditure on low cost admissions such as deliveries and might influence health seeking behavior for certain pathologies (common infectious diseases) towards primary health care rather than hospital emergency rooms (ER).
It is challenging to collect reliable routine data on the health service needs of urban/non-camp refugees when compared to those residing in traditional camps. For this reason, Household Access and Utilization Surveys (HAUS) allow UNHCR to monitor trends in how refugees access and utilize health services over time. The proportion of registered Syrian refugee households with telephone numbers in Lebanon is 98%.
Since 2014, UNHCR Lebanon has conducted annual telephone HAUS surveys which have provided important information on the challenges faced by refugees in accessing health care services. The survey results guide program delivery by providing timely and regular information in a cost-efficient manner on key variables relating to access and utilization.