---
title: "Municipal Health Committee pilot in Majdal Anjar, Lebanon: strengthening local health governance"
id: "pubmed-42550488"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42550488"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42550488/"
doi: "10.1093/heapol/czag096"
published_at: "2026-09-18T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Municipal Health Committee pilot in Majdal Anjar, Lebanon: strengthening local health governance
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42550488
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42550488/)
- **DOI:** [10.1093/heapol/czag096](https://doi.org/10.1093%2Fheapol%2Fczag096)
- **Published At:** 2026-09-18T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Study evaluated a pilot **Municipal Health Committee (MHC)** in Majdal Anjar, Lebanon, as a model for local health governance in a fragile, shock-prone setting. - Context: Lebanon experienced compounded shocks (economic collapse, COVID-19 pandemic, armed conflict) that strained an already fragmented health system and highlighted the need for sub-national governance. - Design: Participatory action research and implementation research methods were used, including process documentation, field observations, six critical reflective meetings, and nine key informant interviews. - Analysis: The TAPIC framework (transparency, accountability, participation, integrity, capacity) guided qualitative analysis of the MHC's operations and governance practices. - Participation: The MHC enhanced **inclusive participation**, strengthened local legitimacy, and built trust between stakeholders and the municipality. - Transparency and evidence use: The committee progressively embedded **transparency** and evidence-informed decision-making, including efforts to generate local health data to inform decisions. - Integrity challenges: Institutional integrity and adherence to ideal practices were persistently undermined by **political interference**, patronage networks, and weak enforceability of accountability mechanisms. - Accountability constraints: Accountability mechanisms were fragile and hard to enforce in the face of local political dynamics and financial precarity. - Capacity and support: Sustained mentorship by the research team improved governance practices and the MHC's ability to fulfill its mandate; capacity development was essential for functionality. - Sustainability factors: Long-term sustainability depends on local ownership, protection from political capture, and continued capacity development and autonomy. - Implication: Municipal committees can strengthen equity and **health system resilience** through inclusive, evidence-informed processes, but success requires addressing political, financial, and capacity barriers. - Keywords highlighted: fragile and shock-prone settings; health system resilience; local governance.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Epidemiology and Population Health, American University of Beirut, ReBUILD for Resilience, Riad El-Solh, Beirut 1107 2020, Lebanon. * 2 Department of International Public Health, Liverpool School of Tropical Medicine, ReBUILD for Resilience, Pembroke Place, Liverpool L3 5QA, United Kingdom. * PMID: **42550488** * DOI: [ 10.1093/heapol/czag096 ](https://doi.org/10.1093/heapol/czag096) Free article Item in Clipboard # Local solutions, local governance: the municipal health committee initiative in Majdal Anjar, Lebanon Joanna Khalil et al. Health Policy Plan. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Health Policy Plan Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Health+Policy+Plan%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Health+Policy+Plan%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42550488/) . 2026 Sep 18;41(8):1461-1472. doi: 10.1093/heapol/czag096. ### Authors [Joanna Khalil](https://pubmed.ncbi.nlm.nih.gov/?term=Khalil+J&cauthor_id=42550488)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550488/#short-view-affiliation-1 "Department of Epidemiology and Population Health, American University of Beirut, ReBUILD for Resilience, Riad El-Solh, Beirut 1107 2020, Lebanon."), [Rouham Yamout](https://pubmed.ncbi.nlm.nih.gov/?term=Yamout+R&cauthor_id=42550488)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42550488/#short-view-affiliation-1 "Department of Epidemiology and Population Health, American University of Beirut, ReBUILD for Resilience, Riad El-Solh, Beirut 1107 2020, Lebanon."), [Wesam Mansour](https://pubmed.ncbi.nlm.nih.gov/?term=Mansour+W&cauthor_id=42550488)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42550488/#short-view-affiliation-2 "Department of International Public Health, Liverpool School of Tropical Medicine, ReBUILD for Resilience, Pembroke Place, Liverpool L3 5QA, United Kingdom."), [Fouad Fouad](https://pubmed.ncbi.nlm.nih.gov/?term=Fouad+F&cauthor_id=42550488)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42550488/#short-view-affiliation-2 "Department of International Public Health, Liverpool School of Tropical Medicine, ReBUILD for Resilience, Pembroke Place, Liverpool L3 5QA, United Kingdom."), [Joanna Raven](https://pubmed.ncbi.nlm.nih.gov/?term=Raven+J&cauthor_id=42550488)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42550488/#short-view-affiliation-2 "Department of International Public Health, Liverpool School of Tropical Medicine, ReBUILD for Resilience, Pembroke Place, Liverpool L3 5QA, United Kingdom.") ### Affiliations * 1 Department of Epidemiology and Population Health, American University of Beirut, ReBUILD for Resilience, Riad El-Solh, Beirut 1107 2020, Lebanon. * 2 Department of International Public Health, Liverpool School of Tropical Medicine, ReBUILD for Resilience, Pembroke Place, Liverpool L3 5QA, United Kingdom. * PMID: **42550488** * DOI: [ 10.1093/heapol/czag096 ](https://doi.org/10.1093/heapol/czag096) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract In fragile and shock-prone settings, where political instability, economic crises, and institutional fragmentation weaken central authorities, strengthening local health governance has become critical for health system resilience. Lebanon represents an example, having faced compounded shocks including economic collapse, the COVID-19 pandemic, and armed conflict, all of which have strained an already fragmented health system. Despite increasing recognition of the importance of sub-national governance, limited empirical evidence exists on how municipal-level health governance structures function in practice under such conditions. This article evaluates the establishment and functioning of a Municipal Health Committee (MHC) as a pilot model of local health governance, analysing factors influencing good governance practices. Using participatory action research and an implementation research design, qualitative data were collected through process documentation and field observations, six critical reflective meetings, and nine key informant interviews. Data were analysed using the TAPIC framework to examine transparency, accountability, participation, integrity, and capacity in the MHC's operations. Findings indicate that the MHC enhanced inclusive participation thereby strengthening local legitimacy and trust. The committee progressively embedded transparency and evidence-informed decision-making, including efforts to generate local health data. However, compliance by formulated ideal and institutional integrity was persistently challenged by political interference, patronage networks, weak enforceability of accountability mechanisms, and financial precarity. Sustained mentorship by the research team strengthened governance practices and enhanced the MHC's ability to implement its mandate effectively. Municipal committees can strengthen equity and resilience in settings through inclusive, evidence-informed processes; however, sustainability depends on local ownership, functional autonomy from political capture, and capacity development. **Keywords:** fragile and shock-prone settings; health system resilience; local governance. © The Author(s) 2026. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. 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