Exploring the Effect of Multiple Crises in Lebanon on the Paid Work Environment, Unpaid Work, and Health of Primary Health Care Workers: A Qualitative Study.

Abstract

Introduction: Lebanon has been encountering numerous challenges since the start of the economic crisis in October 2019. This came along with the COVID-19 pandemic and the infamous Beirut Port Blast in August 2020. As a result, the healthcare sector has been hit at the core and many of the healthcare providers (HCPs) left the profession or the country overall. Additionally, inflation affected deeply the accessibility to and availability of healthcare services all over Lebanon, which resulted in a huge influx of patients in primary healthcare centers (PHCCs). This may have a potential impact on the quality of the services, work environment, and health of HCPs in these centers. Therefore, this study aims to explore the effects of multiple crises on the work environment, unpaid status, and health of HCPs in a purposive sample of Lebanese PHCCs. Methods: This study employs a qualitative descriptive design, utilizing secondary data analysis through semi-structured interviews. The research team carefully selected PHCCs that serve the entire Lebanese population, are free from political or religious affiliations, and represent diverse geographic regions. A total of seven PHCCs, one from each region, participated in the study. Interviews were conducted with 26 HCPs, including nurses, physicians, and health managers. The team made sure that saturation was reached. The analysis was guided by an adapted framework derived from Quick et al. (1997) conceptual framework, with particular emphasis on Maslach and Leiter's framework for assessing the work environment. Results: Twelve major themes were identified including food security and the ability to cover basic needs, workload, control, fairness, value, reward, interprofessional relationship, manager’s perspective, paid work, community services, mental health, and physical health. Findings revealed that HCPs faced significant challenges in securing basic needs, contended with heavy workloads due to an influx of patients and resource shortages, and struggled to maintain control over patient care. Issues related to fairness and compensation also emerged though positive aspects were found in the form of rewarding work environments and strong interprofessional relationships. Compensation for HCPs was found to be inadequate, with some individuals compelled to engage in unpaid community service. Despite these challenges, HCPs expressed a commitment to their work. However, the quality of care provided was expected to have been compromised. The study also highlighted a considerable negative impact on the mental health of HCPs. Conclusion: This study offers valuable insights into the perspectives of HCPs regarding the impact of multiple crises on their work environment, unpaid status, and overall health within PHCCs. The challenges faced by HCPs were the inability to secure food and basic needs, a challenging work environment with high pressure to meet the needs of a huge number of patients, low compensation, many community services, and negatively influenced mental health. By highlighting the numerous challenges faced by HCPs, this research provides a compelling impetus for administration and policymakers to recognize and address the pressing issues affecting primary HCPs.