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A new report, entitled “Relationality in community engagement: its role in humanizing healthcare and achieving quality integrated health Services” has been developed in collaboration with the Qatar Foundation for Education, Science and Community Development (QF) and launched at the Seventh edition of the World Innovation Summit for Health (WISH) taking place in Doha on 13–14 November 2024.

In the aftermath of the COVID-19 pandemic, community engagement has further resurfaced as a necessary condition, and a shared responsibility within health systems, for emergency preparedness, response and recovery efforts in global public health.

The new report introduces the background and current policy context for community engagement across different WHO regions. It presents an Integrated Change Framework (ICF) to embed and strengthen community engagement processes in health system functions and activities; explores eight selected country case studies, highlighting common success elements incorporated into the ICF; and concludes with recommendations for applying the ICF to improve health system performance.

Relational community engagement emphasizes improving relationships among health and care workers, between them and with the people they care for. To enable this, governments are encouraged to focus on the following aspects.

1. Promote relational leadership, management, and governance

• Invest in adaptive, transformative leadership models to drive whole-system learning.
• Develop political commitment to adopt a relationship-focused approach to community engagement as an inherent way of working in health systems and across sectors.
• Engage the health and care workforce and civil service across sectors to develop a renewed vision for public sector values and ways of working.

2. Strengthen relationship-building capabilities in health systems

• Strengthen communication and collaboration in health systems, setting relational competency benchmarks and invest in local capacities of communities to address power imbalances.
• Develop participatory skills in multi-disciplinary teams and interprofessional practice.
• Integrate social and contextual data in health service design and delivery.

3. Invest in transdisciplinary research and practice development

• Fund research using the Integrated Change Framework (ICF) to foster collaboration across the sciences, technology, and the arts.

Relationality in community engagement is critical for improving today's health systems, since it represents a powerful way of enhancing patient care; promoting collaboration, connection and belonging; addressing the social determinants of health; improving equity; and integrating lived experience and holistic knowledge systems through community-centred approaches to health and well-being.

 

 

The ceasefire and the cessation of hostilities took effect on 27 November, offering temporary relief for the millions of civilians caught in the conflict in Lebanon. But Lebanon’s suffering did not end amid staggering unmet health needs. Bordering Syria and Israel, Lebanon’s overburdened health system is reeling from the impacts of an economic crisis, political deadlock, refugee crisis and now war.

The country is host to 1.5 million Syrian refugees: inevitably, events in Syria impact Lebanon and WHO operations. Syrian nationals are entering Lebanon at the same time as Syrian refugees are returning to Syria from Lebanon.

"An already decimated health system remarkably withstood this latest storm, but it has been further weakened. The challenges are complex and call for specialized, sustained support," said WHO Representative to Lebanon Dr Abdinasir Abubakar.

A rocky road ahead

The road ahead for Lebanon‘s health system is rocky and the future uncertain.

Lebanon’s cumulative real GDP has shrunk by 38% since 2019, according to the World Bank, with the war being the latest of many blows. As of today, more than 1 million people displaced by hostilities have returned to southern Lebanon where the physical and health infrastructure is in tatters. Several health facilities remain closed and most hospitals are running below capacity due to financial restraints and shortages of staff, long-standing challenges in Lebanon.

More than 530 health workers and patients have been killed or injured in attacks on health care and thousands of health workers have been displaced or have emigrated leaving the hospitals and the health centres grappling to meet the health needs of the populations. In order to keep hospitals running, the need for health workers is dire.

Water and sanitation systems have been severely disrupted, compounding the risk of disease outbreaks. With nearly 7% of buildings in ruins in the two southern governorates that were hardest hit, thousands remain on the move and won’t be able to return home anytime soon. Those who have returned face the risks posed by explosive remnants of war, as well as greater overall health risks. 

Growing need for specialized trauma care

Since 8 October 2023, more than 4000 people were killed and 17 000 injured in Lebanon alone. Since the ceasefire took hold and conflict-impacted areas have become more accessible, the death toll continued climbing as more bodies are found in the 16 000 buildings that have been partially or completely destroyed, leaving an estimated 8 million tonnes of debris.

"The physical destruction is similar to what you see after an earthquake – and that has resulted in complex injuries, open wounds and fractures. And since the treatment provided during the war was often not optimal, the injured end up needing multiple surgeries to prevent complications and disabilities,  " said Dr Ahmad Alchaikh Hassan, WHO Trauma Technical Officer.

One in 4 people with life-changing injuries will need long-term rehabilitation and, in some cases, assistive technologies and prosthetics. Specialized support will be required as the technical capacities in Lebanon cannot cope with the increasing numbers of people in need for these services and commodities.

"This need for specialized health care will persist for months and years to come. Lebanon needs reconstructive surgeons to treat the severely injured, eye doctors to treat the thousands of people injured in the pager attack, physiotherapists to start rehabilitating amputees and prosthetists to assist users of assistive devices," said WHO Representative Dr Abubakar.

WHO’s response

Ensuring a sufficient number of trained health workers with expertise in war-related trauma and plastic reconstructive surgery is a priority.

Three weeks into an 8-week ceasefire, WHO and the Ministry of Public Health are working on replenishing medical supplies and restoring health services country-wide.

"WHO and national health authorities have carried out several mass casualty management trainings across Lebanon – resulting in stronger, more life-saving assertive responses.  Without these timely interventions, the outcomes would be unconscionable," said Dr Hassan, WHO's Trauma Technical Officer.

The ongoing WHO operations include scaling up trauma care capacity, training surgeons on specialized trauma care in conflict areas, providing mental health trainings to health workers, capacity building for rehabilitation in post-conflict settings, replacing damaged equipment, identifying gaps in health coverage, and preparing for future scenarios and the subsequent health impact.

WHO also provided 5000 contingency blood bags and reagents to blood banks and developed awareness material on unexploded ordinances and other health risks for first responders and civilians. WHO and the Ministry of Public Health run strong country-wide surveillance for disease outbreaks which pose a heightened risk in post-conflict settings.

"The road to recovery will be long and windy. Our aim is to assist the health system to bounce back, and be resilient and prepared. We are grateful to our many partners who have supported this response but this is not the end of it. This is the start and the need for technical and financial support has never been greater," concluded WHO Representative Dr Abubakar.

The WHO Academy in Lyon, France, officially opened its doors today with a high-profile inauguration ceremony. The Academy aims to tackle the growing global shortage of health and care workers, projected to reach 10 million by 2030, by training thousands of health professionals each year.