Country profiles

Libyan Arab Jamahiriya

Overview

The Libyan Arab Jamahiriya has a surface area estimated at 1 775 500 km² with a population of 4.7 million in 1997. Most of the population, however, is concentrated in the main cities on the coastal plains, namely Tripoli, Benghazi, Misurata and Zuwarah.

About 85% of the population are urban. Population growth in urban centres is 7% per year. In 1995, the percentage populations below 15 years of age and above 65 years of age were 39% and 2.2%, respectively. In 1996, it was estimated that 82% of the total adult population and 74% of the female adult population were literate. The crude death rate was estimated at 7.0 per 1000 population in 1996, and in the same year, the crude birth rate was estimated at 40 per 1000 population. In 1995, infant mortality was 24.4 per 1000 live births, maternal mortality was estimated at 4.0 per 10 000 live births, the total life expectancy was 66 years and the under-five mortality rate was estimated at 30.1 per 1000 live births.

The main causes of hospital mortality in 1987 were as follows: injury and poisoning (15.5%); diseases of the circulatory system (11.6%); certain conditions originating in the perinatal period (11.4%); diseases of the respiratory system (7%); and neoplasms (4.4%) The per capita GNP in 1996 was US$ 6760, which is the highest in Africa.

The motto of Libyan health policy is "health for all by all". The goal of this policy is to create a society in which every member can play a active role, both socially and economically, and in which services are equally distributed among the whole population.

The five-year development plan (1991-95) reflects the health strategy during this period and can be summarized as follows:

• Restructuring of medical and paramedical human resources through redistribution of human resources and training of necessary cadres.

• Improving, updating and developing health facilities, including developing some health delivery points into health centres.

• Improving the management of hospitals and forming specialized bodies to support health services such as a technical centre for environmental protection.

• Focusing on public health programmes. The main pillars which support primary health care are health education, maternal and child health services and school health services, nutrition programmes and environmental protection programmes and programmes on control and prevention of communicable and endemic diseases.

• Supporting the health infrastructure to meet the needs of the increasing population.

The health system operates on several levels. The first level consists of the basic health care units, which each provide curative and preventive services for 5000 to 10 000 citizens. The second level comprises the basic health care centres, which serve from 10 000 to 26 000 citizens. The third level consists of the polyclinics, which play an important role in cities. Staffed by specialized physicians and containing laboratory as well as radiological services and a pharmacy, these polyclinics serve approximately 50 000 to 60 000 citizens, and there are 18 of them throughout the country. At the fourth level, are the hospitals in rural areas and the central hospitals in urban areas. The fifth level comprises the specialized hospitals. Per capita health expenditure of US$ 274, is among the highest in the Eastern Mediterranean Region.

In 1990, there was a total of 39 369 health professionals working in the country, including 7234 physicians and 13 849 nurses. The rates per 10 000 population of physicians and nurses were 12.8 and 36.0, respectively in 1996.

In 1990, there were 726 basic health centres, 138 maternal and child health centres and 18 urban polyclinics. At the end of 1990, there were 99 hospitals, 75 of which were functioning, 14 of which were still under construction and 10 of which were newly built and not yet functioning. Of the 75 which were functioning, 28 were rural hospitals. The overall number of functioning beds at the end of 1990 was 18 503, giving a rate of 38 beds per 10 000 population. The distribution of beds is more or less equitable, with the highest rate per 10 000 population being only less than twice the lowest rate.

MENTAL HEALTH

The first psychiatric facility in the country was a traditional hospital at Al Marj Al Qadim which was destroyed by an earthquake in the 1960s, leaving only the psychiatric hospital in Tripoli. Following the Al Fateh revolution in 1969, more attention was paid to general and psychiatric health services. Specialists and nurses were recruited from Egypt and Sudan. In 1974, a psychiatric hospital of 200 beds was established at Dar Al Shifa. A new hospital of 250 beds was built in the early 1980s. This includes a hospital, a mosque and a farm for the rehabilitation of patients.

The Serganish Mental Hospital, in Tripoli, is the big state mental hospital with a capacity of 1200 beds. It accepts patients from all over the country. The number of patients is now 350., basically because of lack of staff. Mental health care in the Libyan Arab Jamahiriya is rooted in a centralized and institution-based system. There are two major mental hospitals and three hospitals for the mentally retarded and centres for geriatric care and drug dependence care.

Benghazi Psychiatric Hospital, has 350 beds. It started as a station for treating acute cases, with 20 beds for males and 15 beds for females in an old building which used to be a chest disease centre during the Italian occupation of the country. In 1988, the psychiatric hospital was transferred to a new building while the old hospital was changed to a section of the new hospital for chronic care. There is a rehabilitation department and provision for recreational and occupational therapy.

There are outpatient psychiatric units in general hospitals across the country such as Al Marj (20 beds), Al Bayda (20 beds), Denna (40 beds), Al Korfa (geriatric outpatient department), Home (10 beds). There are psychiatric clinics connected to general health facilities, but at this stage, their effective functioning is altered by the social conditions.

Care for the mentally retarded is provided in three institutions. In Tripoli, there is Al Swani Sanatorium with 450 beds; at Benghazi, there are 235 beds; and at Al Jabal Al Akhdar, there are 76 beds.

Al Amal Sanatorium in Tripoli has 130 beds for geriatric services.

There is a department of child psychiatry in the Paediatric Hospital at Benghazi.

There are eight qualified psychiatrists in Libya, four in Tripoli and four in Benghazi. There are residents from other countries working in the two hospitals. There are nine social workers and eight psychologists in Tripoli and similar numbers in Benghazi.

Students undergoing undergraduate training in psychology at Gar Ounis University get their training in clinical psychology. Social workers graduate from the High Institute for Social Study. There is a school for psychiatric nurses at Tripoli Mental Hospital. It gives a degree equivalent to a high school diploma. Most of the nurses are general nurses. There is an acute shortage of occupational therapists.

The undergraduate medical students receive psychiatric theory teaching (30 hours) in the fourth year of study. They are also given practical training at Benghazi and Tripoli Mental Hospitals.

Official recognition for mental health was demonstrated in the form of ministerial resolution No. 654 in 1975, which regulated the treatment of the mentally ill in mental hospitals. The national mental health programme was put forward in November 1988. Ministerial Resolution No. 172 of 1989 formulated a board to look after a national mental health care programme.

The objectives of the national mental health programme were to provide essential mental health care for all in the Libyan Arab Jamahiriya and to provide mental health principles in other spheres of life such as work, family, community participation and national growth. The national mental health programme identified the strategies and the administrative mechanisms. The goals for 1990-95 were clearly outlined. The anticipated activities in 1990 for the five-year period were: starting of postgraduate training in psychiatry and clinical psychology; short courses for training of social workers; training of primary care physicians; establishment of day hospitals and occupational therapy units; a general hospital psychiatry unit with 25 beds; and research.

• Mental health legislation. The current legislation was introduced in 1975. It needs to be revised.

• Research. Studies on the phenomenology and treatment of hysteria, utility of electroconvulsive therapy and clinical studies of epilepsy have been completed. The country lacks data on epidemiology of mental disorders.

• Drug abuse. This is becoming a major health, social and economic problem. The government has recently formed a high committee to combat drug abuse. Many drug abusers are injecting heroin abusers. In the psychiatric hospital of Tripoli, there is a 50-bed detoxification facility. It is voluntary. No replacement medication is given. Patients are accepted only once and in case of relapse, they are not readmitted.