Experiences of Communities with Lebanon’s Model of Care for Non-Communicable Diseases (NCD): A Cross-Sectional Household Survey from Greater Beirut

Abstract IntroductionHealth systems in fragile settings face multiple challenges in the implementation of responsive Non-Communicable Disease (NCD) care models. Models based on comprehensive person-centred primary care approaches can improve health system responsiveness and trust in healthcare. In Lebanon, NCDs dominate the health profile, but the health system is fragmented with evidence suggesting varied experiences with the care model. This study aims to identify people’s perceptions of the Lebanese care model for NCDs and trust in the health system among others, and test association between them. MethodsThis study is a household survey using multistage random sampling and targeting adult community members (both Syrian and Lebanese) living with NCDs in Greater Beirut. Three main outcomes (barriers to care seeking, perceptions of the care model and trust in healthcare) were assessed including by multiple linear regressions. ResultsA total of 941 respondents participated in this study. Reported NCDs were hypertension (51.3%) and diabetes (34.5%), followed by chronic respiratory conditions (21.9%) and other cardiovascular diseases (20.0%). Communities reported seeking care from different sources. While 78% of Lebanese participants had visited private clinics at least once within the 6 months preceding the survey, 56% of Syrian refugees had done so. Determinants of access to care were health coverage, gender, and employment among Lebanese, and socio-economic status among Syrian refugees. Lebanese community members had more positive perceptions of the care model compared to Syrian refugees and determinants included socio-demographic characteristics and the type of providers. Trust in the health system was higher among Syrian compared to Lebanese participants and was significantly influenced by the care model score and barriers to care seeking. ConclusionOur study generated evidence about the experience of people living with NCDs with Lebanon’s care model, and can inform service delivery reforms towards a more inclusive person-centred approach. What is already known on this topicHealth systems in fragile settings struggle to implement responsive care models for NCDs with limited quantitative evidence exploring community perceptions of care models.What this study addsLebanese and Syrian communities living with NCDs in Greater Beirut experience challenges in access to care along with gaps in the continuity and comprehensiveness of services affecting trust in the health system.Inequities based on socio-economic characteristics exist with vulnerable groups being more affected by barriers to care and negative experiences with services.How this study might affect research, practice or policyThis study identifies reform opportunities of Lebanon’s care model for NCDs and provides a baseline assessment of the care model.