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

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

Support for UNRWA's survival

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides life-saving humanitarian aid for 5·4 million Palestine refugees now entering their eighth decade of statelessness and conflict. About a third of Palestine refugees still live in 58 recognised camps. UNRWA operates 702 schools and 144 health centres, some of which are affected by the ongoing humanitarian disasters in Syria and the Gaza Strip. It has dramatically reduced the prevalence of infectious diseases, mortality, and illiteracy. Its social services include rebuilding infrastructure and homes that have been destroyed by conflict and providing cash assistance and micro-finance loans for Palestinians whose rights are curtailed and who are denied the right of return to their homeland

(Re-)Emergent Orders: Understanding the Negotiation(s) of Rebel Governance

The concept of order is often neglected in the study of conflict – seemingly such a ‘disordering’ process. With the recent increase in the examination of rebel governance however, bringing order back into our understanding of rebel and insurgent groups has much to offer in exploring the everyday politics which connect authorities, rebel movements and the population itself, in a complex mass of intersubjective and power-based interactions and negotiations. Rebels both shape and are shaped by existing forms of order in complex and ongoing ways. This article explores how varying elements interact in the negotiation, framing and enforcement of order and develops an original analytical framework to examine the perpetual negotiations of rebel movements in their attempts to cement their control

Replication data for: Bricks and Mortar Clientelism: Sectarianism and the Logics of Welfare Allocation in Lebanon

This dataset includes information about Lebanese welfare institutions, including public and non state-institutions, and some associated information on population endowments. The dataset includes the following: - Data on affiliations and spatial locations of hospitals, primary care centers and dispensaries, and schools run by public and non-state actors, including political parties and politicians, religious charities, and non-governmental organizations (NGOs). This includes more than 3,000 institutions, of which more than half are run by non-state organizations that are not directly administered by the public sector. All are linked to a zone (manataqa 'iqariyya), which is roughly comparable to a census tract and corresponds to a rural village or specific a neighborhood in towns and cities. - Data on the sectarian identities of registered voters at the zone-level. Information on the sectarian composition of the Lebanese population is drawn from voter registration data from the Ministry of Interior and is measured at the zone level. (Note that the district of voter registration is derived from the family's district of origins (or, for women, the father's or husband's district of origin) and does not always correspond to place of residence, particularly in the Greater Beirut area. - Data on administrative and electoral boundaries, including zones, districts (qaza) and governorates (mohafaza) as well as electoral districts (used in the 2000 and 2005 national elections). (Note that the capital city of Beirut is divided into twelve neighborhoods that encompass sixty zones and contains three electoral districts.) - Data was collected in 2006-2008

Replication data for: Informal Politics and Inequality of Access to Healthcare in Lebanon

Data are from an original national household survey designed by Melani Cammett and conducted in spring 2008 by Statistics Lebanon. The survey includes information on individual and household access to primary and secondary healthcare, financial aid for health and other forms of social assistance, religious identity and observance, political preferences and participation, and standard demographic questions. The sample was designed as a cross-section of all citizens above the age of 18 in Lebanon. Based on a stratified, multi-stage, area probability sample, households were selected randomly based on probability proportionate to population size (PPPS). The sample was stratified by province, reducing the likelihood that distinctive regions, which tend to have varied concentrations of religious or ethnic groups, were left out of the sample. Next, a PPPS procedure was used to randomly select primary sampling units (PSU) in order to guarantee that more populated geographical units had a greater probability of being chosen. Households were then randomly selected within each PSU. The response rate for the national survey was 67 percent (1911 out of 2859 individuals)

Replication Data for: Compassionate Communalism: Welfare and Sectarianism in Lebanon (Cornell University Press, 2014), chapter 5 ("Political Loyalty and Access to Welfare")

The data used for the analyses in Chapter 5 of Compassionate Communalis