Over recent years, Lebanon has experienced a profound and protracted crisis marked by economic collapse, institutional erosion, and widespread social vulnerability. The deterioration of public services—particularly in healthcare and agriculture—has placed immense pressure on households already grappling with rising poverty, food insecurity, and limited access to essential resources. For many communities, the cumulative effects of inflation, shortages, and declining public provision have transformed routine needs such as medical care and agricultural production into daily challenges.
It was within this context that the Rebuilding and Strengthening of Health Care Services and Local Agriculture for Crisis-Affected Vulnerable Populations (LLP2) project was designed and implemented. The project aimed to respond to immediate humanitarian needs while reinforcing local systems capable of continuing to function amid instability. Rather than introducing parallel structures, LLP2 deliberately worked through existing community-based mechanisms, with a particular focus on strengthening primary healthcare services and supporting local agricultural livelihoods.
Implemented by the Order of Malta Lebanon (OML), with the support of Malteser International Lebanon (MI), LLP2 focused on improving access to affordable primary healthcare through OML’s network of Community Health Centers (CHCs). These centers provided subsidized consultations, diagnostic services, and medications, supported by targeted investments in medical equipment, laboratory capacity, and standardized procedures. Alongside service delivery, the project emphasized strengthening staff skills and internal systems, contributing to more consistent standards of care across different locations.
In parallel, the project supported small-scale agricultural producers through activities aimed at strengthening knowledge and practices under increasingly difficult conditions. Within the catchment areas of selected CHCs, LLP2 established and supported Agro-Humanitarian Centers (AHCs), which served as localized entry points for technical guidance and farmer engagement. Through these hubs, participating farmers received support related to crop management, pest control, and production planning, alongside broader efforts to strengthen adaptive capacity in the face of rising input costs and environmental pressures. Within a context shaped by volatile markets and structural constraints, these localized mechanisms supported farmers in improving decision-making and adapting practices to their circumstances.
Cross-cutting activities related to nutrition awareness linked the health and agricultural components, reinforcing an understanding of the relationship between diet, health, and livelihoods. By addressing these areas together, LLP2 reflected the interconnected nature of household well-being in crisis-affected communities.
As the crisis deepened during the project period, access to affordable healthcare became increasingly constrained. Public facilities faced acute shortages, private care became unaffordable for large segments of the population, and households were often forced to delay or forego treatment. In this environment, the role of CHCs supported by LLP2 became increasingly significant. For many beneficiaries, these centers represented one of the few remaining points of access to consistent and affordable care.
At the same time, agricultural producers contended with escalating input costs, currency volatility, and limited access to technical support. Small-scale farmers faced growing difficulty sustaining production, directly affecting household income and food availability. LLP2’s agricultural component responded to these pressures by strengthening knowledge, practices, and adaptive capacity, rather than attempting to overcome structural market constraints beyond the project’s scope.
Catalystas Consulting was commissioned to carry out the final evaluation of the LLP2 project to assess overall performance, document evidence of results, and identify actionable learning to inform future programming. The evaluation was conducted at a time when households continued to rely heavily on subsidized services, and when community health and agricultural support remained essential to mitigating the pressures of Lebanon’s ongoing crisis. It examined how the project responded to identified needs, how effectively activities were implemented, and what changes were observed at community and institutional levels. It also explored how LLP2 navigated Lebanon’s volatile operating environment and what lessons could inform future interventions.
Rather than assessing LLP2 against ideal conditions, the evaluation approached the project as an intervention operating within an ongoing crisis. Emphasis was placed on understanding how—and to what extent—the project contributed to maintaining access to essential services, strengthening local capacities, and supporting vulnerable populations under extraordinary constraints. The findings that follow reflect this perspective, highlighting both the project’s tangible contributions and the structural limitations shaping its outcomes.
The final evaluation was designed to generate a grounded, evidence-based understanding of how LLP2 functioned in practice and what it contributed within Lebanon’s volatile crisis context. Rather than approaching the evaluation as a purely technical exercise, Catalystas framed the process around operational realities, lived experiences, and institutional dynamics shaping implementation and results.
The methodology combined desk-based analysis with extensive primary data collection, structured around the project’s core outputs and lines of inquiry.
Document Review and Analytical Framing
The evaluation began with a structured review of project documentation, including:
Project proposals, workplans, and narrative reports
Monitoring data and internal tracking tools
Technical guidelines related to healthcare, agriculture, and nutrition
This review established an initial analytical baseline and informed the design of data collection tools, ensuring alignment with the project’s intended objectives and evolution over time.
Primary Data Collection Across Project Outputs
Primary data collection focused on capturing perspectives across institutional, operational, and beneficiary levels. The evaluation drew on:
30 key informant interviews (KIIs) with MI and OML leadership, Ministry of Public Health (MoPH) representatives, CHC and AHC staff, and other relevant stakeholders
4 focus group discussions (FGDs) with community members and service users
600+ structured surveys with CHC and AHC beneficiaries, capturing patterns of access, service use, and perceived change
Field visits to selected Community Health Centers (CHCs) and Agro-Humanitarian Centers (AHCs) to observe service delivery and operational conditions firsthand
Data collection was designed to assess how each project output functioned in practice, including access to primary healthcare, quality and consistency of services, agricultural knowledge transfer, and nutrition awareness activities.
Output-Level Lines of Inquiry
For each major project output, the evaluation examined:
Relevance of activities in relation to evolving community needs
Effectiveness of implementation under crisis conditions
Perceived changes at beneficiary and institutional levels
Constraints and adaptive strategies used to maintain continuity
This output-focused structure allowed the evaluation to move beyond activity tracking and instead assess contribution and added value within realistic constraints.
Adaptation and Context Sensitivity
Given Lebanon’s economic volatility, the evaluation explicitly examined how LLP2 adapted to:
Rising operational and input costs
Supply chain disruptions
Shifts in demand for healthcare and agricultural support
This lens enabled analysis of decision-making, flexibility, and problem-solving as core elements of project performance.
Analysis and Validation
Findings were analyzed across interconnected themes—relevance, effectiveness, institutional capacity, and sustainability—rather than as isolated indicators. Triangulation across interviews, surveys, focus groups, and field observations strengthened validity and credibility.
Limitations and divergent perspectives were explicitly acknowledged, particularly where structural factors constrained what the project could reasonably achieve. This ensured that findings remained balanced, evidence-based, and grounded in context.
The agricultural component addressed a different but closely interconnected set of vulnerabilities linked to livelihoods and food security. Participating farmers were operating under conditions marked by rising input costs, environmental pressures, and limited access to technical support. The evaluation found that agricultural activities contributed to improved knowledge and practices, particularly in crop management, pest control, and production planning. While broader market and structural factors continued to shape farmers’ options, the support provided strengthened farmers’ capacity to make informed decisions and adapt practices within existing constraints. These changes were incremental in nature, yet relevant within an uncertain and highly volatile economic environment.
An important cross-cutting insight emerging from the evaluation was the value of the project’s integrated approach. By addressing healthcare, nutrition awareness, and agricultural support in parallel, LLP2 reflected the interconnected nature of health, food security, and livelihoods within Lebanese communities. Nutrition-related activities in particular helped reinforce the relationship between diet and health, strengthening the combined effect of medical services and agricultural practices. Rather than operating as isolated interventions, the different components of the project collectively contributed to household resilience.
Project implementation was shaped by ongoing adaptation to external pressures. Rising costs, supply chain disruptions, and broader political and economic instability required regular adjustments to planning and delivery. The evaluation noted that flexibility, staff commitment, and close coordination between implementing partners supported continuity of services despite these challenges. While some agricultural activities experienced delays, overall implementation remained steady, and essential services were largely uninterrupted.
In terms of overall impact, LLP2 contributed to improved access to primary healthcare, strengthened institutional capacity, and enhanced knowledge and practices related to health, nutrition, and agriculture. These outcomes were not framed as systemic transformation in the face of Lebanon’s deep structural challenges. Instead, the project’s impact was understood as protective and stabilizing, supporting communities to maintain a baseline of access, dignity, and functionality amid widespread decline.
Our evaluation found that the project delivered credible, relevant, and contextually appropriate results in an exceptionally challenging environment. Its significance lay not in ambitious claims of large-scale change, but in its steady, grounded contributions to sustaining access, quality, and institutional capacity where these were most at risk. As such, these types of interventions offer a practical illustration of how context-aware programming can support resilience and continuity in protracted crisis settings.
LLP2 was implemented at a time when Lebanon’s economic and institutional crisis had significantly weakened access to both healthcare and viable agricultural livelihoods. The evaluation found that, within this environment, the project’s most important contribution lay in its ability to help stabilize vulnerable populations’ access to essential services at a moment when alternatives were rapidly diminishing. For many beneficiaries, the CHCs supported through the project were not one option among several, but a realistic and dependable point of access to affordable and continuous care.
The evaluation consistently highlighted the project’s strong alignment with evolving community needs. Rising out-of-pocket medical costs and the deterioration of public health services had reshaped how households approached healthcare. Against this backdrop, subsidized primary healthcare services enabled beneficiaries to seek care earlier, adhere more consistently to treatment, and better manage chronic conditions. These changes were not framed as transformative, but rather as meaningful improvements in daily coping capacity under prolonged crisis conditions.
A defining feature of the project was the high level of confidence expressed by communities in the services delivered through LLP2. Shaped by continuity of service provision, perceived reliability, and consistent standards of care, this confidence emerged as an important enabling factor for effective implementation. CHCs were widely regarded as accessible and dependable spaces where beneficiaries felt appropriately supported, contributing to sustained service use and continuity of care, particularly among populations experiencing heightened social and economic vulnerability.
Beyond access, the evaluation found that LLP2 contributed to improvements in the quality and organization of care. Investments in medical equipment, laboratory services, and standardized procedures helped strengthen consistency across CHCs. Training initiatives reinforced staff skills and professional standards, supporting more uniform service delivery despite variations in location and context. These improvements were especially significant within a health system under strain, in which maintaining quality had become increasingly challenging.
Amélie is a French-Canadian strategic development consultant with over 15 years of international experience on all continents, with the past six years focused on Asia Pacific and East Africa. Former social entrepreneur, regional NGO exec, researcher and lawyer-by-trade among other titles; she is a diverse professional currently based in Nairobi, Kenya. Amélie has worked in consulting on and off for 11 years across a range of industries and sectors, and has notably provided multiple market penetration and M&E analysis services, as well as risk assessments on the topics of forced labor and child labor in supply chains in Africa and in Asia.
Amélie completed her law degree in Quebec, Canada, and holds a Masters in International Law gained in Beijing, China. She has worked with organizations including the Thomson Reuters Foundation as Asia Pacific Manager (2019-2021), where she managed a portfolio of 250+ human rights research and advisory projects, prior to which she co-founded a social enterprise in the renewable energy sector in Rwanda, on the border of the DRC.
Amélie is proud to dedicate her time to driving social change through economic development and sustainable growth projects concretely in Southeast Asia and East Africa, and globally virtually. Amelie loves travelling, eating, and getting out of her comfort zone.
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