“I had to work twelve-hour shifts, for seven days weekly in order to keep up with my son’s medication prices, which keep increasing every week. Only to later find out that, when I had the money, I could not find the drug. ” This was the story of Wafic, one more individual affected by the drug shortage and inflation. In this case, Wafic was looking for a drug to treat his schizophrenic son; however, he was unsuccessful, and similar cases to Wafic’s occur daily. Wafic and the many others who are affected by these circumstances are the inspiration to improve the pharmaceutical sector in Lebanon.
The team had the opportunity to discuss, although briefly, the current situation regarding the pharmaceutical sector in Lebanon with Mr. Karim Jbara, who is the head of medical imports in the country. During the sit-down, it was emphasized that Lebanon’s medical drug shortage issue stems from the currently unreliable subsidy system which is permeated with inefficiencies and compromises in the wrong instances. Hence, the team brainstormed on how to tackle issue by issue and proposed to implement a reform in the subsidy system, to target instead of medical drugs, the patients themselves. This ensures funding is reaching the right people, at the proper time, and improving the country’s overall access to medical drugs.
The shortage of drugs is a symptom caused by the current, unreliable, and inefficient subsidy system in effect until today. How so? At first, the decrease in funding, from $85 to 25 Million dollars dedicated to the import of medical drugs exacerbated the already-fragile system. Moreover, the dedication of 77% of the current budget to oncology drugs leaves little to subsidize other ailments such as hypertension, diabetes, psychiatric disorders, and other chronic diseases. What is the issue with prioritizing oncology drugs? Well, even though cancer is life-threatening and very much deserving of attention, it does not justify the neglect of chronic diseases. The reason is, chronic diseases might not seem fatal at first, but over the long run, without one’s due diligence, they develop into risky scenarios. For example, schizophrenic patients are likelier to become aggressive, and diabetics patients risk losing their vision or limbs. Hence, this allocation cannot be built as such, and there must be a better way to reach these people effectively, without compromising oncology spending. Lastly, the fact that biosimilar drugs at the same dosage, are subsidized at different price points and from different countries shows a lack of commitment to partition resources appropriately. It is not unheard of to renegotiate with partner countries during times of crisis, and at this point, the populace needs fewer brand options but richer diversity in treatment options.
The inefficiencies mentioned above are legitimate concerns, yet the aspect creating shortages is the unreliability of funding. Meaning that subsidies are not granted every month. Hence, pharmacies sell drugs in LBP, and at the limit stipulated by the Ministry of Health and must replenish periodically. However, there is no incentive to replace this medication in case it’s not subsidized, as it would be imported at its original price in dollars. This a loss for the pharmacies as even if allowed to be sold in dollars, prices are out of reach for locals. Even worse, Black-Market dealers exploit this shortage to profit over a greater margin, than that stipulated by the MOH.
After the team resumed the meeting with Mr. Jbara and brainstormed about the issue, it came to our attention that most of these inefficiencies and their consequences can be addressed by shifting focus to subsidizing patients instead of drugs. What justifies this idea is that funding on its own is not enough. For example, the USA is the greatest spender in healthcare but not necessarily the country with the best health indicators (e.g., life expectancy). Hence, the team proposed an app and database linking the patient, the MOH, and an international institution willing to grant funds aimed to subsidize people. Accordingly, importers and pharmacies will have a stable market to import to and sell. The government won’t need to stipulate prices monthly, and the populace, at any socioeconomic level, will be able to find and afford the medications desired.
Where there is energy there is life, but what if that same energy is the reason life is being destroyed? Non-renewable energy resources such as coal, oil, and natural gas have been abused extensively over the years; and not only are they detrimental to the environment, but they are bound to finish in the future. The switch over to more sustainable sources of energy has been something that has not been around for a hundred years yet, for that it could still be considered to be still in its infancy today.
Sustainable Development Goal 7 is one of 17 Sustainable Development Goals established by the United Nations General Assembly in 2015. It aims to “Ensure access to affordable, reliable, sustainable and modern energy for all.” According to “SDG7 Energy Compact of the Republic of Lebanon”, by the year 2030, universal access to affordable, reliable and modern energy services should be ensured, as well as increasing substantially the share of renewable energy in the global energy mix, and expand infrastructure and upgrade technology for supplying modern and sustainable energy services for all.
Energy in Lebanon, ever since the mid-nineties has been dominated by oil, which represents more than 95% of the primary energy consumed in 2019 (Julian & Salameh, 2022). According to Electricité du Liban (EDL), in 1995 thermal energy expenditure was 4,349 GWh only to spike drastically to 14,617 GWh in 2017. In 2019, though, there is a noticeable decline in thermal energy expenditure as it settles at 11,665 GWh; with an increase in hydraulic energy from 415 GWh in 2017 to 829 GWh, thus almost doubling in two years. As a result, we notice that slowly, but steadily, Lebanon has been shifting its focus to renewable energy sources, thus aligning with SDG 7.
Source: World Bank Global Electrification Database from “Tracking SDG 7: The Energy Progress Report” led jointly by the custodian agencies: the International Energy Agency (IEA), the International Renewable Energy Agency ( IRENA ), the United Nations Statistics Division ( UNSD ), the World Bank and the World Health Organization (WHO).
Energy consumption in Lebanon has always been at a loss. From 1995 until 2019, Lebanon’s consumption averaged at 10,845 GWh whereas only 8,936 GWh has been averaged in production. Hence, this is where the deficiency lies. It is impossible to claim sustainability where there is an undersupply.
Despite the lack in production, Lebanon does in fact import sources of energy in order to fulfill the needs of the country in terms of electricity. That, though, does not reflect the reality of most Lebanese citizens. “For decades now, electricity has been a major issue in Lebanon. State-owned Electricité du Liban provides only two hours of electricity per day. However, some areas experience complete shut-off. Until today, the Lebanese people’s main alternative to state-provided electricity is resorting to private generators that work on diesel. Two problems emerge from this situation, the first one being the price of petroleum-related products” (Muro, 2021). Surprisingly, according to the most recent World Bank studies, in the year 2020, 100% of Lebanese have access to electricity. The reality of the situation is very different as aforementioned with privatized energy distribution becoming the norm, consequently aggravating the environmental situation.
Source:Electricité du Liban (E.D.L)
As the economic crisis intensifies day by day and energy costs rise by the hour, the more well-off portion of the Lebanese society has been resorting to alternative energy sources; mainly solar energy. Although that does not solve the problem per-se, it has spurred a mass transition as NGOs have hopped on board to provide solar panels to less-abled communities. As a result, more and more people have been stopping their memberships with alternative providers (generators).
It comes as no surprise, switching to solar energy. It is a step that is long overdue, and as the saying goes “necessity is the mother of invention”. Even though it is not exactly an invention, but through necessity, Lebanon is slowly becoming more sustainable! Lebanon has a lot of natural resources such as wind and water. However, the most interesting and important natural asset is the abundant sunshine, making solar energy in Lebanon the ideal alternative to consider for Lebanon to get out of the electricity crisis. Using solar energy in Lebanon saves money for the Lebanese people whose private generators’ cost keeps on increasing. In fact, for 12 hours of electricity a day, the fuel cost for private generators can be as high as $550 per day. Although the installation of solar panels is expensive as well, it is an investment. If someone pays $550 per day on fuel, installing solar panels will reduce their cost to around $140 per day. (Monzer, 2022)
Yet another possible solution, straying from the tradition of utilizing natural resources, is the use of yet another crisis Lebanon suffers from. The trash situation has been plaguing the country for years now and it is possible, with the right funding from the right individuals and associations to begin collecting this trash and transferring it to specialized factories that will in turn use it in order to produce energy. This long term investment thus solves two issues simultaneously, while providing job opportunities for many locals.
It is of the utmost importance in Lebanon to deviate away from oil as a main fuel for energy and depend more on renewable energy from resources such as sun, wind and water. In Lebanon up to 4.5% of electricity comes from hydropower and up to 95.5% from oil. Abiding by the goals set in the SDG 7 is a surefire way to take the appropriate steps to building a society in which sustainable energy is the norm. Despite being a long way from sustainable; with the aid of the diaspora, concerned NGOs, and the local community, it is possible to make use of nature’s bounties, which are plentiful in the 10,452 km2 of mountainous rushing streams, gusting winds of the vast planes, and the showering sunlight reaching every corner of the nation.
