Informal politics and inequity of access to health care in Lebanon

Introduction: Despite the importance of political institutions in shaping the social environment, the causal impact of politics on health care access and inequalities has been understudied. Even when considered, research tends to focus on the effects of formal macro-political institutions such as the welfare state. We investigate how micro-politics and informal institutions affect access to care. Methods This study uses a mixed-methods approach, combining findings from a household survey (n = 1789) and qualitative interviews (n = 310) in Lebanon. Multivariate logistic regression was employed in the analysis of the survey to examine the effect of political activism on access to health care while controlling for age, sex, socioeconomic status, religious commitment and piety. Results: We note a significantly positive association between political activism and the probability of receiving health aid (p < .001), with an OR of 4.0 when comparing individuals with the highest political activity to those least active in our sample. Interviews with key informants also reveal that, although a form of “universal coverage” exists in Lebanon whereby any citizen is eligible for coverage of hospitalization fees and treatments, in practice, access to health services is used by political parties and politicians as a deliberate strategy to gain and reward political support from individuals and their families. Conclusions: Individuals with higher political activism have better access to health services than others. Informal, micro-level political institutions can have an important impact on health care access and utilization, with potentially detrimental effects on the least politically connected. A truly universal health care system that provides access based on medical need rather than political affiliation is needed to help to alleviate growing health disparities in the Lebanese population

Sectarianism and the Ambiguities of Welfare in Lebanon

Nonstate providers are often more important in the everyday lives of the poor than outposts of the state. In this essay, I focus on one type of provider, sectarian organizations, which are an integral component of politics and welfare regimes in parts of the Middle East and other developing regions. Focusing on Lebanon, I describe how sectarian welfare providers emerge from and help to constitute political sectarianism while tracing what is at stake for the poor. First, by holding public offices and dominating informal channels that mediate access to public benefits, these actors mediate the experience of accessing the “rights” of citizenship. Second, while they provide benefits and services that might not otherwise be available, the modes of allocating welfare by sectarian parties can be discriminatory, notably along partisan and religious lines. Third, sectarian groups politicize the process of accessing social benefits while undercutting the political voice of the poor by weakening alternative channels of claim making. Finally, the crosscutting effects of sectarian organizations in welfare regimes suggest additional challenges to boosting local participation in development policy: while they are deeply embedded in the communities they serve, they produce and reinforce social inequalities.Governmen

The symbiosis of sectarianism, authoritarianism, and rentierism in the Saudi state

Saudi Arabia provides a compelling example of how sectarianism sustains the dynamics of authoritarianism, especially when bolstered by a rentier political economy. In this paper, I investigate three claims about the link between Saudi authoritarianism and sectarianism, as follows: (1) Governing with a sectarian ideology impedes political reform, since it disrupts cross-sectarian reform coalitions by attacking the sectarian outgroup. (2) The presence of multiple sects, as well as hydrocarbon wealth, allows regimes like that of al-Saʿud to use divide-and-rule tactics to maintain control; it also enables the funding of media and education outlets with the purpose of perpetuating authoritarianism, especially when the authoritarian dynamics are underpinned by a rentier political economy. (3) Despite the authoritarian and rentier dynamics in play, the Saudi government has at times sought at least a degree of inclusion of the Shia minority, depending on the political economy and the relative influence of Shia and Sunni Islamists. Using the existing literature on the Saudi state and historical examples, I aim to clarify the link between sectarianism and authoritarianism in a state in which the Sunni/Shia division, bolstered by a rentier political economy, has emerged as a powerful means of maintaining the political status quo