There are between 100-150,000 Bedouins in Lebanon residing largely in rural areas andunderprivileged neighborhoods who are generally affected by poor health care provision. In addition, although native, many of the Bedouins in Lebanon remain non-citizens and therefore cannotbenefit from public health services. Their irregular nationality status is the single-most influential factordistinguishing them, health-wise, from other marginalized groups in Lebanon. Consequently, a community-based research project, focusing on one Bedouin community in Lebanon, was undertaken between 2007and 2010 at the Faculty of Health Science (FHS) at the American University of Beirut (AUB) in Lebanon. The project was concerned with assessing and improving reproductive and child health among marginalized rural communities, specifically the Bedouin communities in central Bekaa in Lebanon
The Lebanon Bedouin Health Project, initially based at the Community Research and Population Health (CRPH) at Faculty of Health Sciences (FHS) in AUB, was a European Commission funded project led from the University of Oxford and coordinated by the University of Warwick in the UK. The project mainly aimed at assessing the scope of reproductive and child health care delivery for Bedouin women and children in Lebanon, improving reproductive and child health among marginalized rural communities, specifically Bedouin and developing model interventions including a community health volunteer system that takes into account stakeholder priorities and caters to the realities of Bedouin reproductive and child health.
The first phase of the project consisting of data collection and analysis was completed in the summer of 2008. By the end of June 2008, researchers had conducted intensive fieldwork with Bedouin women, key figures in the Bedouin community in the Beqaa, health service providers, and policy makers. Anthropological qualitative methods were used to collect the data, such as in-depth interviewing, focus groups, and participant observation. In addition a socio-economic survey (clinic screenings) and clinic audits were conducted at six purposively selected clinics frequented by the Bedouin community.
A sample of the collected data was then prepared for a workshop on NVivo, a software application specializing in quantitative data analysis. The Lebanon and Oxford teams took part in an interactive demonstration delivered by Dr. Marie-Hélène Paré from Oxford University. The team learned to structure, import and code their data in order to permit the computer assisted analysis of relationships among variables. In September 2008, findings were presented to the Project’s National Advisory Committee. The preliminary findings of the qualitative analysis revealed three main issues: policy and social exclusion of the Bedouin; discrimination and inequity in health care provision leading to inadequate utilization; and the overall negative impact of their nationality status on access to health care. Policy makers had poor knowledge about Bedouin issues and had no future plans on health policies or programs regarding the Bedouin community. Results also revealed dissatisfaction and discrimination of Bedouin women with health care, as well providers’ limited sensitivity to Bedouin cultural and health issues.
The second phase of the projects’ work plan was to disseminate its preliminary results to all stakeholders. The aim of these dissemination meetings was to use the preliminary finding to brainstorm around the subject of developing ‘model’ interventions. Through a participatory dissemination program with all stakeholders, the project team negotiated a set of pilot interventions to address the perceived shortcomings in reproductive and child health. These included: organizing workshops with health care providers to raise awareness of Bedouin culture and to improve their quality of care; establishing a program of “Community Health Volunteers” (CHVs) selected from the Bedouin community and trained in basic first aid and reproductive and child health principles. These CHVs were trained to act as “promoters” of health awareness and health care.
After the two phases (the research and the data dissemination) currently, the Bedouin Health project goes through its third and final phase, the intervention. In this phase of the project we aim to implement such model interventions as agreed upon by the various stakeholders. This participatory approach to developing interventions with the communities aim at the creation of sustainable solutions for improving reproductive and child health care service for marginalized populations, such as Lebanon’s Bedouin community.
As a continuation of the project, during this phase a number of Community Health Volunteers (CHVs) were trained to act as health promoters and a link between the community and the local healthcare centers. The training topics and materials which entailed First Aid, Family Planning, Reproductive Health and Maternal and Child care, were compiled, edited, reviewed and produced as a manual. The manuals were provided to the CHVs to use them as a reference/guideline during their forthcoming community work (read more in the activities section).