Valoración de la inversión de las mejoras que se van a acometer

So, currently Libya, under an interim constitution drafted by the National Transitional Council (NTC) is undergoing political reconstruction. On the 7th July 2012, elections were held for a General National Congress (GNC) and on the 8th August the NTC duly handed over power to the newly elected GNC. For the first time, the people of Libya had been able to go the election boxes and choose their representatives fairly; the GNC consists of 200 representatives elected from across the country. Previously, the country had been under a dictatorship that had no constitution, no elections and with the prohibition of political parties. As such, the new assembly has the responsibility for the formation of a constituent assembly for the drafting of a permanent Libyan constitution to be put forward for a referendum. Now, the country is run by a system of ministries and every ministry has their own agency in every region (Grifa, 2012).

The current system of health care was evaluated by the Ministry of Health through the organisation of a conference that was held in 2012. Expert delegates from the WHO were invited along with 500 Libyan health care professionals. Conference participants summarised some of the issues that needed to be addressed in order to bring about changes to the responsiveness and effectiveness of the Libyan health care workforce. It is considered that patient safety is a sensitive indicator for the evaluation of health care quality and the following factors were considered to have a potential negative impact upon patient safety (El Oakley et al., 2013). Firstly, there is an inconsistent distribution of the health care workforce, with an unjustifiable overstaffing of some facilities and a severe understaffing of others. Secondly, a significant proportion of the workforce, particularly non-medical groups, have low levels of skill or are unqualified to cope with the

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responsibilities and tasks that are allocated to them. Thirdly, there is a lack of a transparent and/or credible programme for development of the workforce. Fourthly, many within the current workforce have poor levels of motivation and are demoralised because of the poor working environment, the low levels of pay and the poor prospects for progression of their careers. Fifthly, there is a lack of effective regulation of professionals at all levels of the health care sector and this linked to poor performance and is a major contributory factor to the lack of confidence that the general public has in the medical profession (El Oakely et al., 2013).

Further problems that could lead to negative effects on the patient safety is the lack of availability of certain equipment. Some ‘headline’ pieces of equipment, such as CAT scans and MRI machines are available in the central hospitals of the major urban centres; however there is often a lack of basic equipment, especially in areas that are more outlying. This can lead to difficulties for both diagnosis and effective treatment. Even where there is equipment in place, a lack of qualified technicians can lead to a failure to conduct repairs and maintenance. Also, despite the vital role played by accurately maintained health information systems and the importance of knowledge transfer within the health systems of other countries, there are inadequate levels of computerisation throughout the public health systems of Libya (Taguri et al., 2008).

There may also be a high level of risk for patient safety within Libya because the health care system is suffering a severe shortage of health care workers. The WHO (2006) has noted a significant lack of medical technicians, trained paramedics and pharmacists. Moreover, there has been a failure to derive the optimum benefit from the skills acquired by Libyan doctors who have pursued expensive postgraduate specialisations abroad. Often, doctors have chosen to work abroad and the importing of replacement foreigners to work

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in Libya has been expensive and inefficient. Even though there are huge numbers of medical students and funds spent on scholarships for specialist study abroad, there is still a lack of specialists in Libya in various key areas, such as radiology, anaesthesia and cardiology (WHO, 2006).

A study undertaken by Mullan (2005) for instance, concerned with the emigration of medical doctors from developing countries to more developed ones, reported that from the destination-country census data of 2000, around 585 Libyan physicians had emigrated to the United States (USA), the United Kingdom (UK), France, Australia, Spain, Belgium and Canada. Moreover, the report from Mullan (2005) of the phenomenon reported that a total of 624 doctors from Libya were actually practising in those countries with as many as 63% working in the UK. The exploratory study undertaken by Benamer (2009) has concluded that reform of the Libyan health care system could induce the return of some of those doctors that had moved abroad for predominantly economic and educational reasons, so that they would practice medicine within Libya.

It has also been noted that the standard of nursing care in Libya is inadequate because of the poor standard of education for nurses and this could have a direct effect upon patient safety practices (Mohapatra & Al Shekteria, 2009). The practice of nursing has been reliant upon expatriate staffing; with most qualified nursing staff not actually Libyan. The country is reliant on expensive foreign nurses for almost all midwifery, specialised and quality nursing care. In addition, there is a critical need for the establishment of independent regulatory bodies to regulate and oversee the nursing and medical professions (Mahmud et al., 2013). Generally, there is a lack of clarity over the regulation of doctors and nurses within Libya. Indeed, currently, there are no professional, independent bodies

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for the granting or revoking of licenses for doctors and nurses to practice, based upon international standards. As such, the context for patient safety in Libya is one within which an absence of a transparent, objective, robust mechanism for the processing of licenses may mean that the credentials and credibility of the doctors practising in the country go unchecked (WHO, 2007c). The following section covers the effect of the revolution on the patient safety situation in Libya which could become worse and more dangerous for patients.