470 The role of health service providers in health system resilience amidst Lebanon’s multi-crisis situation

Abstract OP 8: Health Services 6, B304 (FCSH), September 3, 2025, 15:45 - 16:45 Aim Lebanon’s healthcare system has been severely impacted by economic collapse, the COVID-19 pandemic, the influx of refugees, and ongoing armed conflict, placing immense pressure on healthcare service provision. This study explores how healthcare providers at individual and institutional levels in both the formal and informal sectors navigate these challenges to sustain service delivery, and at whose expense, with a focus on the local response in crisis-affected regions. Methods A qualitative approach was employed, utilizing 10 key informant interviews with Ministerial officials, humanitarian officers, and various health stakeholders and providers from both formal and informal health sectors. Data collection focused on resilience strategies in service provision, access to resources, and the integration of informal healthcare workers. Thematic analysis was conducted using the ReBUILD health system resilience framework, categorizing responses into absorption, adaptation, and transformation. Results Findings highlight the critical role of healthcare providers in sustaining essential services amid systemic disruptions and Ministry of Public Health disengagement. Absorption strategies included reliance on international aid and NGO support to compensate for collapsing public healthcare funding and supplement salaries. Adaptation mechanisms involved task-shifting, tolerance of informal providers, and flexible service models to reach underserved populations, particularly refugees. However, structural challenges, including fragmented governance and inequitable resource distribution, along with the exodus of healthcare providers hindered effective adaptation and placed the burden on patients and non-physician healthcare workers. Transformation potential remained limited due to resistance to decentralization and the exclusion of informal providers from national health policies. Conclusion Ensuring sustainable healthcare delivery requires localization of healthcare governance, stronger regulatory mechanisms, an inclusive healthcare system, and commitment to equitable access to healthcare provision. Without policy reform to integrate all healthcare workers into the system, Lebanon’s healthcare sector risks continued fragmentation, compromising both provider well-being and equitable patient access.