Health Problems in Yemen & Their Population Dimensions [Archives:2001/47/Health]
Three main factors are contributing to population growth in Yemen, that is rapidly rising birthrate, decreasing death rate, and emigration. The population growth rate in Yemen reached 3.1% in the 1980s and 3.7% between 1988 and 1994. The overall fertility rate, during that period, was 7.7% per woman according to demographic surveys conducted in Yemen for Mother and Child Hygiene and as mentioned in the population census carried in 1994. In comparison with the more advanced countries, fertility rate in Yemen appears to be one of the highest rates in the world.
Early marriages among the youths, rapid delivery, improper use of contraceptives, undesirable traditions prevailing in the country, preference of males over females, along with other factors are the main causes of backwardness of any country. We can say that, in the light of the recent changes in Yemen, the country has entered the second phase of demographic evolution which is characterized by the relative stability of fertility rates and the fall of mortality rates by the reduction of epidemics, malnutrition, contagious and children diseases, such as diarrhea and respiratory system troubles.
Clearly, the relative improvement of medical and preventive services, the high increase of health awareness on the importance of pure water and immunization all have led to the gradual decrease of mortality rates. Consequently, according to the demographic survey for Mother and Child Hygiene conducted in 1991 and 1992, the mortality rates have sharply dropped since the 1970s. It was at 194 in the beginnings of 1970s before diminishing to 185 in the midst of 1970s. At the beginnings of the 1980s, it reached 129 before dropping to 83 at the beginnings of 1990s. The number has fell to 81 according to the 1994 census.
The high increase of the population is the result of the growing gap between death and birth rates which can create serious problems. Demographic explosion, which needs resources, can further strain the already limited resources and weak human potentials.
The economic conditions of Yemeni population are getting worse. Indeed, one could easily notice that the number of people below the poverty line has significantly increased and unemployment has been on the rise, which is a direct correlation of the economic reforms.
Each year, we can see a new list of food supplies for which prices are higher than those of the previous year. The list is very different from the previous in terms of price increase of basic goods. Despite permanent attempts to ease up the situation by using treasury bonds and encouraging privatization, our currency convertibility has not stopped deteriorating.
Although reasonable improvements in health conditions have been noticed in Yemen over the last two decades, the health sector is still facing huge challenges. These include a persistent high fertility rate of 3.7% per woman and a chronic shortage of health services with a ratio of 1 doctor per 4,348 inhabitants.
These problems are reflected in the alarming health indicators which recently revealed that the maternal mortality rate is between 80 and 100 per 1,000 live births while the infant mortality rates are 78.8 per 1,000. This makes them among the highest rates in the world, mainly because of complications during pregnancy, child birth and malnutrition related diseases, lack of hygiene, lack of sanitation and safe water supply.
The health sector is facing many pressing issues, among them how to reach rural populations and how to solve the organizational and management problems.
Only 55% of the population has access to medical facilities, while in the meantime public health services in many rural areas are almost non-existent.
Among the obstacles, which are slowing down the efforts made by the Ministry of Health, the growing sewage and sanitation problems found in the major cities are the most alarming. Inadequate sewage treatment facilities result in the outbreak of diseases, such as malaria and diarrhea, in the urban areas. Similarly, a clean water supply has become less available in urban concentrations because it virtually impossible to further explore ground waters.
International assistance agencies and donor countries have been heavy contributors to the health sector, especially in sponsoring nationwide immunization campaigns and disease control campaigns. But too much aid is given for management upgrading and direct medical assistance, which so far has not been as successful as expected. The low capital investments are mainly located in the society’s low-income segment which has a low purchasing power. As a result, the medical companies providing services to this kind of patients make relatively low profit margins.
In contrast, the higher income segment of the society seeks very expensive medication abroad for even simple illnesses which can be cured locally. There is not a single world-class private hospital in the whole country. A well-organized and fully-equipped hospital run by an international medical company would be a prime investment able of reaping huge profits. The opportunity is there and, in this end, the government should provide incentives and permits. The oil companies, embassies and international companies make their employees travel abroad for simple problems due to the absence of a service they can trust.
As a conclusion, Yemen is in great need for good health services. We have one of the lowest standards in health and medical care in the world. The economic condition of the country is one of the main obstacles for having health insurance and medical care provided by the state. In this case, the best and easiest alternative is to establish private institutions that can provide health care for the public. Prices may be high, but with more investment, there will be competition. And, with more competition, there will be better services and lower prices. Health care must be taken seriously and should be one of the most important focal points of the government’s investment program. If we want a better nation, we ought to make it a healthier nation. For that to happen, the next step should be investment in health services.