Health conditions in YemenFrom bad to worse! [Archives:2003/630/Health]
Prepared by Ismail al-Ghabery
Yemen Times Staff
The existing government health system since the 1970s is based on a traditional system for the provision of health services. This system consists of health units, centers and hospitals. It has witnessed noticeable expansion over the last decade, as the number of health units expanded from 912 to 1,821, the number of health centers rose from 392 to 574, and the number of hospitals increased from 74 to 116 with a bed capacity of over 11,000 beds. The number of doctors during 1995-2000 also rose by an average rate of 7.3% per annum, and the number of nursing staff rose by 6.7%. However, the number of people per doctor is still 4,810, whereas for the nurses it is 2,400 per nurse and the number of people per hospital bed is 1,664. These rates are by all standards considered very poor, even when compared to developing countries and other Arab States such as Syria and the Sultanate of Oman, where the same comparative figures are seven times higher than they are in Yemen.
The government health sector still suffers from poor service provision, quantitatively and qualitatively, due to the low expenditures on the sector, in general, and on investment, operations, and maintenance in particular, and the inequitable distribution of facilities and manpower, which are concentrated in cities, until coverage of health service reached 80% in urban areas compared to 25% in rural areas, not to mention the absence of rational use of the health services.
Illness and death rates due to prevalent diseases are greater than the rates for non-endemic diseases. The situation becomes worse due to the population's lack of access to safe drinking water (40% of the population), due to the low percentage of coverage of the sewerage network, to which only 6.2% of the population have access, and from an environment that helps to make diseases and endemic ailments widespread, like malaria and schistosomiasis. The most widespread and most serious diseases in Yemen are diarrhea, malnutrition, complications of pregnancy, severe respiratory diseases, malaria, schistosomiasis, liver diseases, and tuberculosis, with an increasing number of the AIDS carriers and infected patients.
Extreme centralization in the health sector also resulted in affecting the regulatory and control functions of the Ministry of Health and Population, the weak capacities of regional health departments to plan and execute health programs and services to the people effectively and efficiently, apart from the poor participation of the local communities in the health system. Despite poor efficiency of the service and the resources, which are limited to start with, and the lack of confidence in the primary health facilities at the village and district levels, inhabitants in those areas are compelled to bypass the primary health facilities and resort to government health facilities and the governorate or central levels, which adds to strain on the central services.
The increase of demand for public general and specialized medical and health services and the inability of the government sector to meet needs also led to the rise in the number of private hospitals and clinics, which rapidly became widespread, with an increase from the modest numbers in the early 1990 to 90a private hospitals and 550 clinics in 2000, with the concentration of most of them in the major cities, especially in the Capital Secretariat. However, the high cost of their services make them inaccessible to the majority of people, not to mention that the poor control of these facilities and the lack of application of the regulations against malpractice contributed to the general deterioration of the standards of quality of services.
Text from the Poverty Reduction Strategies paper