Investing in the Health Sector [Archives:1999/29/Business & Economy]

By: Ismail Ali
Al-Ghabri
Yemen Times
Despite the reasonable improvements in health conditions in Yemen over the last two decades, the health sector is still facing huge challenges. These include a persistent high fertility rate (per woman high population rate of 3.7%) and a chronic shortage of health services (population per doctor ratio is 4348 to 1).
These challenges are reflected in the alarming health indictors, which recently revealed that the maternal mortality rate is between 80 and 100 per 1000 live births, and the infant mortality rates are 78.8 per 1000, which makes them among the highest rates in the world, attributed mainly to complications during pregnancy, child birth and malnutrition related diseases, hygiene, lack of sanitation and safe water supply.
The health sector is facing many pressing issues, especially difficulties in reaching rural populations, organization and management problems.
Only 55% of the population has access to medical facilities, while public health services in many rural areas are almost non existent.
The total patient-beds in 1996 in public hospitals were estimated at 11,337 nation wide, with significant disparity between urban and rural areas.
The government has made it a priority to make health services more effective and accessible to the most needy segments of the society, with emphasis on preventive health care such as immunization programs covering all the nation, family planning, nutrition and health education.
Public expenditure on health is relatively low, in 1996 the health care expenditure accounted for only 4% of the total public expenditure, and the re-current expenditures constitute more than 90% of the total, leaving only a marginal 10% for investment. Funds allocated for maintenance accounted for only 1% of the re-current expenditure.
Among the obstacles working against the efforts of the ministry of health are the growing sewage and sanitation problems facing major cities. Inadequate sewage treatment facilities result in the outbreak of diseases such as malaria and diarrhea.
Similarly, a clean water supply has become less available in urban concentrations due to the unsustainable exploration of ground water.
International assistance agencies and donor countries are heavily contributing to the health sector, especially in sponsoring nation wide immunization campaigns against the 6 main diseases, as well as disease control campaigns, but on the other hand too much aid is given for management upgrading and direct medicinal assistance which have not born their expected fruits.
In recent years, the private sector has invested in private hospitals and clinics. Their contribution is indispensable, but the standard medical service they offer is relatively low. This can be attributed to poor management skills and short experience, low qualification levels and in-consistency of the medical staff.
The low capital levels for investment are mainly due to the low income segment of the society. This is reflected appropriately by the low purchasing power of the patient, and subsequent relatively low profit margins made by these medical enterprises.
In contrast, the higher income segment of the society seeks very expensive medication abroad for even simple illnesses which can be cared for locally.
The government has allocated more than 300 million dollars annually to provide medical financial assistant for patients in need of treatment abroad in addition to providing these people with air tickets.
It is estimated that more than one billion dollars a year in hard currency is sent abroad for medical treatments.
There isn’t a single world class private hospital in the whole country. A well organized and equipped hospital run by an international medical company would be a prime investment capable of reaping huge profits. The opportunity is open, and the government should provide facilities and permission. The oil companies, embassies and international companies 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 conditions of the country is one of the main obstacles of having health insurance and medical care provided by the state. In this case, the best and easiest alternative is to establish and run private enterprises that provide health care for the public. Prices may be high, but with more investment, there will be competition, and with more competition, there3 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 investment program of the government. If we want a better nation, we ought to make it a healthier nation, and for that to happen, the next step should be investment in health services.
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