The EU has been contributing to the health system in Libya since 15 years, staying focused especially on health service delivery but also contributing to other pillars of the system. In the absence of an active national health plan and/or strategy the EU will continue to support primary healthcare service delivery aiming at contributing to the universal healthcare coverage values shared by both Libyan authorities and the EU.

Libya’s epidemiological profile has shown since some years a trademark transition typical of upper middle-income countries, i.e. infant mortality has decreased. The relative prevalence of communicable diseases has also decreased, although they have been recently re-emerging. Lifestyle related non-communicable diseases (NCD) and mental health conditions have become more prevalent. The country is also in the midst of a nutrition transition, where we see both under and over nutrition coexist. The outbreak of COVID-19 in March 2020 has added to this dire situation. Although the number of cases reported in Libya is limited, risks linked to this pandemic are particularly high in the country, notably due to the weak capacities of the health system, the current conflict and the situation of migrants and Internally Displaced Persons. Amongst the health determinants, Libya is among the world’s most water-scarce countries and water services and sanitation capacities are rapidly deteriorating, including for health facilities.

Libyans are suffering from a critical lack of access to health care: while accuracy of data may be challenged, there is a general agreement on the worsening trend in the offer of services at alarming levels. Most services typically found in primary health care clinics are seldom available. Further, there are important inequalities urban/rural and between regions. Previous progress is being reversed because PHC facilities lack inputs, are unable to meet the demand, or have been closed. It is worth remembering that historically the health system has developed around hospitals running on high budgets rather than on a local basic network. In an environment where the most vulnerable, less wealthy and less mobile population is increasing, it is vital to strengthen a health system model where the most prevalent health needs of the population can be met at a local level.

At the institutional level, in early 2020 we saw the establishment of the Primary Health Care Institute (PHCI) as well as the transfer of competencies following the 2012 law on decentralization, assigning competencies to Municipalities also for primary health care. It is acknowledged that from a health system point of view a classic organization by health districts is still patchy and thus for the purpose of this call for proposals we will use the Municipalities as a proxy to health districts. Ministry of Health is committed to the principles of Universal Health Care (UHC).

The global objective of this call for proposals is: to improve the health status of the population in targeted areas.

The specific objective of this call for proposals is: to strengthen health care system at local level.