Nation’s Shocking Conditions; Ambitious Minister Pushes Reforms IN VERY POOR HEALTH [Archives:1998/34/Front Page]

August 24 1998

The picture is a grim one. The Yemeni people are indeed in very poor health. Look at the following statistics:
1) About 45% of the nation’s children suffer from malnutrition leading to stunted growth; with 15.7% suffering from severe wasting. Only two countries in the world have a worse rate.
2) Less than 50% of the population has access to health services, and the percentage in rural areas falls to 30%.
3) Government budget allocated for health sector is 2.7% of total. Government per capita health expenditure stands at US$ 3.70 (1997). Minimum benchmark stipulated by the World Health Organization is US$ 12.
Per capita government expenditures on medicines and drugs stand at US$ 0.3, of which 60% is wasted. Minimal required per capita, representing 10% of need, is US$ 1.
4) Infant and under 5 years child mortality rate per 10,000 is 110; Maternal mortality rate per 100,000 is 1,400.
5) Gross birth rate is 7.4. Only 16% of these births are attended by trained health personnel. Only 3% of pregnant women are immunized against Tetanus. Only 26% receive any kind of prenatal care. Only 5% receive any kind of postnatal care. Less than 10% of married women of childbearing age use contraceptives.
6) In spite of clear prioritization, less than 50% of Yemeni children are covered by the national immunization effort. Among these, less than two thirds complete the cycles.
7) An estimated 400,000 Yemenis travel abroad annually for various medical care. These patients spend an estimated US$ 1.5 billion annually.
8) Most senior government officials, top brass of the army and security forces, tribal leaders, and close associates of the regime, receive – often through presidential generosity – an average of US$ 12,500. Total of such generosity adds up to tens of millions of US dollars.
Dr. Abdullah Abdul-Wali Nasher, Minister of Health, in a lecture last week, outlined his on-going efforts to help the situation. “It is not just a matter of finding additional resources, it is more importantly a matter of better utilization of existing possibilities,” he said. The minister pointed out, as an example, that 60% of the government budget for medicine and drugs was being wasted.
He listed five quality problems:
1) Government laboratories are of unacceptable quality;
2) A serious of over-employment;
3) Low attendance and care of staff;
4) Badly maintained and equipped health facilities; and
5) Low standard and unsafe private practices.
The minister is addressing the medical supply issue as a priority. He has taken steps to improve drug management (selection, procurement, storage, distribution, etc.). Two other policy decisions include the introduction of cost recovery, and full autonomy of the supply system.
In terms of improving performance of the health sector in general, the minister has released many of powers to the local and regional offices in a clear decentralization bid. That intends to give the health offices in the governorates and districts more decision-making authority and budgeting, more hospital autonomy, and more autonomy of logistics.
The minister concluded message with three policy directives:
1) Internationalism: working as a team with foreign expertise;
2) Integrity: demanding of health staff and professionals direct responsibility;
3) Innovation: creating the environment for continued upgrading and enhancement of services.
The upbeat mood of the minister, in spite of a very bad health situation, is partly justified. He is making a difference, and he has internal and external support.