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Introduction and Objectives: International agencies have recently assigned Lebanon to the group H of countries with "no national data on maternal mortality," and estimated a corresponding maternal mortality ratio (MMR) of 150 per 100,000 live births. The Ministry of Public Health addressed the discrepancy perceived between the reality of the maternal mortality ratio experience in Lebanon and the international report by facilitating a hospital-based reproductive age mortality study, sponsored by the World Health Organization Representative Office in Lebanon, aiming at providing an accurate estimate of a maternal mortality ratio for 2008. The survey allowed a detailed analysis of maternal causes of deaths., Methods: Reproductive age deaths (15-49 years) were initially identified through hospital records. A trained MD traveled to each hospital to ascertain whether recorded deaths were in fact maternal deaths or not. ICD10 codes were provided by the medical controller for each confirmed maternal deaths., Results: There were 384 RA death cases, of which 13 were confirmed maternal deaths (339%) (numerator). In 2008, there were 84823 live births in Lebanon (denominator). The MMR in Lebanon in 2008 was thus officially estimated at 23/100,000 live births, with an "uncertainty range" from 153 to 30.6. Hemorrhage was the leading cause of death, with double the frequency of all other causes (pregnancy-induced hypertension, eclampsia, infection, and embolism)., Conclusion: This specific enquiry responded to a punctual need to correct a clearly inadequate report, and it should be relayed by an on-going valid surveillance system. Results indicate that special attention has to be devoted to the management of peri-partum hemorrhage cases., Keywords: Arab, postpartum hemorrhage, development, pregnancy management, verbal autopsy

Lebanon has a highly fragmented health care system. The Lebanese population receives its health care services through a system dominated by the private sector that is dependent to a large extent on public sector financing. Lebanon spends about 83% of its Gross Domestic Product (GDP) on health. This study consists of observations on the utilization of the Ministry of Public Health (MOH) program of hospital care provision. The study population included all patients admitted for hospitalization in any of the 126 hospitals contracted with the MOH, between August 2008 and July 2009 (one full year). This review is limited to medical admissions only. The surgical admissions have been excluded since they are covered under a 'flat fee' reimbursement. Findings reveal that a significant proportion of the hospital admissions under this program are for conditions that may not need hospitalization. Moreover, most of these admissions receive care in relatively small and peripheral hospitals. The findings ought to lead to a further scrutiny of the ministry program of support to the hospitalization of its nationals. Measures may be indicated to improve the efficiency and effectiveness of hospital utilization, avoid waste and possibly fraud, and reconsider the role of small and peripheral hospitals within the health care system of the country.

The accumulation of national epidemiological data since the late 1990s has led to the adoption of evidence-based guidelines for breast cancer screening in Lebanon (2006). Almost 50% of breast cancer patients in Lebanon are below the age of 50 years and the age-adjusted incidence rate is estimated at 69 new cases per 100,000 per year (2004). This official notification calls for breast self-examination (BSE) every month starting age 20, and a clinical breast examination (CBE) performed by a physician every three years between the ages of 20 and 40 years. Starting age 40, and for as long as a woman is in good health, an annual CBE and mammography are recommended. Women with known genetic family history of breast cancer should start screening 10 years earlier than the first young patient in the family, or earlier depending on medical advice. The Breast Cancer National Task Force (BCNTF) recommends certification of mammography centers and continued training of personnel to assure high quality mammograms, and to minimize unnecessary investigations and surgeries.It recommends that a national program should record call-backs of women for annual screening and follow-up data on abnormal mammograms. BCNTF encourages the adoption of these guidelines and monitoring of their results, as well as follow-up of breast cancer epidemiology and registry in Lebanon, and scientific progress in early breast cancer detection to determine needs for modifications in the future.

From data collected in Lebanon by the 1999 National Household Health Expenditures and Utilization Survey an analysis was made of reported medication use (n = 14,142). Seventy-two percent of the population aged 25-64 reported taking a medication in the month preceding the survey. Medications with high frequencies of reported use were analgesics, psychotropics, antibiotics and vitamins. Women were more than one and a half times more likely than men to report taking any medication (OR = 1.6), and significantly more likely to report taking eight of the 19 medication types analyzed. Analyses of the association of medication use with socio-economic variables show different effects for education and employment (inversely correlated with higher use), and higher socio-economic status (positively correlated with higher use). Multivariate analyses were carried out on two of the frequently used medications, antibiotic and prescription psychotropic use, to further explore the simultaneous effects of socio-economic variables The results of the analysis high-light a number of potential areas which may be targeted for intervention, in particular the higher use of antibiotics in rural areas, the greater use of psychotropics by women, and the possible obstacles to obtaining needed medications for those with lower incomes.

The World Health Report 2000 considers "fair financing" as one of the three goals for assessing the Health Systems Performance. Fair financing cannot be dissociated from equity that implies traditionally getting the services one's needs in return for contributing within one's ability to pay. However, the calculation in the Report considers "fairness of financial contribution" which disregards accessibility to health services. In addition to their disagreement on the concept of fairness, the authors question the validity of the statistical method used. They notice that despite the absence of financial barriers to access health services, the scoring of Lebanon came unsatisfactory. They claim that the health system in Lebanon is rather contributing in redressing the inequity of the fiscal system.

The World Health Report 2000 has been the subject of extensive debate. The authors highlight in the following, what they consider as major limitations that are either inherent to methods followed and the validity of data used, or related to the particular situation of Lebanon. This article tackles the first two of the set goals i.e. level of health and responsiveness as well as the overall system performance. The Report clearly states that extensive use has been made of estimates of indicators, and that there were often conflicting sources of information on these indicators. In the case of Lebanon, data was not available for most of the values used. In fact, the last national population census was conducted in 1932, and vital registration is incomplete. Therefore, one would question the value of the estimates, based on which the calculations were made for Lebanon, such as Life tables, and Causes of Deaths. Finally, the authors conclude that despite the critics, embarking in this exercise is useful for Lebanon, particularly at this stage, for monitoring the reform process in the health sector.

This paper intends to analyze the health care system in Lebanon from the organizational and financial points of view. It allows for an understanding of the health services' market by tackling it from different angles: supply versus demand, private versus public sectors, curative versus preventive services, hospital versus ambulatory care. This study necessitated a review of all previous surveys made in this field, during the after-war period. It also needed the daily collection and follow-up of pertinent data with all private and public agencies and concerned ministries, over a one-year period. In addition, a critical analysis has been made to the survey Conditions de vie des ménages, en 1997, that was carried out by the Central Administration of Statistics, that came to complete the missing data concerning household expenditures on insurance and health services. Especially that this survey covered the same period (1997), subject of this study. The paper reveals that, although the private sector is the main provider of both hospital and ambulatory care, private hospitals are flourishing on public money, whereas outpatients care is mainly financed by the households. Evidence shows that the Lebanese health care system succeeded in resolving the problem of accessibility to primary, secondary and tertiary health care, responding thus to the value of equity. But, at the price of an ever escalating cost, threatening the sustainability of the system. This is what is attained in this paper, as it shows clearly that expenditures on health have reached an alarming level of the GDP share. Our purpose being providing solid arguments in favor of reforming the health system.