Health and productive health care [Archives:2002/25/Health]

PREPARED FOR PUBLISHING
BY ISMAEL AL-GHABRI
YEMEN TIMES STAFF
The estimates of the Ministry of public Health indicate that health care services cover only 50% of the population. Besides, there exist several health institutions that are not functioning due to lack of human or financial resources, or both. Reproductive Health services are only available at 25% of existing health facilities.
The role and effectiveness of health services still far behind the desired level, despite the widespread targeting of communicable and endemic diseases, particularly malaria and child diseases. The statistics of the expanded Immunization Program reveals achievement of 50%-60% immunization coverage of the six diseases in the recent past. On this basis, the international and regional commitment to reach at least 80% coverage of the targeted group by the year 2000 has not been met. Nevertheless, the positive aspect of this situation can be seen in the launching of campaigns for polio immunization and the addition of a new vaccination against hepatitis.
Based on the results of the DMCHS of 1997; diarrhea still affects 28% of children under five years old; sever respiratory diseases affects 23% of children; 46% of children suffer from malnutrition; 52% suffer from stunting and 13% are wasted.
These are among the highest percentage in the world, let alone the region. In contrast with these percentage, only 34% of the diarrhea cases are treated by Oral Dehydration Solution, 32% of sever respiratory diseases are treated in health facilities and only about 17% of newly born infants are naturally breastfed during the first months of life, while 19% of infants are born under weight.

Maternal Health
Maternal health is considered to be the central part of Reproductive Health Care. Previous surveys suggest a continuos improvement in maternal health care, but at very slow pace. However, not all aspects of safe motherhood are included in reproductive health services at its different levels. A system has not yet been developed to ensure access to all emergencies and specialized maternity services for all women of productive age, or beyond that age. Maternal Mortality is estimated to be in the range of 800-1000 deaths per hundred thousand live births, while the DMCHS shows, indirectly, a much lower estimate (351). This is a discrepancy, which requires further investigation. Clearly, an improvement in maternal mortality and morbidity indicators is directly linked to improved health care, including safe maternity services. Surveys results show slight and gradual improvement in the use of services that lead to reduction in maternal mortality and morbidity. Access to pre-natal care (at least one visit during the period of pregnancy) has increased from 26%in 1992 to 34% in 1997,meaning that 66% did not have access to this service. This may be due to unavailability of the service entirely or to its remoteness. There is also a significant portion of these women who do not see a real necessity for such services. This reflected in the fact that most of the visits for prenatal care were carried out to women symptom of ailments and not routinely on the basis of preventative care. With regard to health care at delivery, or delivery under skilled qualified health care, during the period 1992-1997 the increase was only 5 percentage points (from 16% to 21%), most of which is attributed to real demand rather than as a preventative requirement. The 1997 DMCHS also shows that about 25% of women in the age 15-49 age group suffer from malnutrition and 47% of all deliveries are accompanied by side effects due to poor reproductive health practices. It was also found that 37% of births occurred at intervals of less than 24 months between pregnancies and 18% at intervals of less than 18 months, and that 16% of mothers give birth prior age 20 years.
In light of the above conditions, it is clear that the resources required for the provision of appropriate health services will be very large. For example, assuming that there will be an improvement in the ratio of people per doctor from 3,333 in the year 2000 to 1,000 per doctor in year 2025 and in the ratio of people per nurse from 1667 to 333, in both years respectively the number of required doctors and nurses in 2025 will exceed 35,000 doctors and 106,000 nurses (Yemen National Strategies vision for the year 2025).

Sources: National Population Council, document.

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