Perspectives on Aden’s private health sector [Archives:2006/908/Health]

January 2 2006

Nazeeh Abdullah
The private sector plays an important role in our country's health service. It cures and advises a broad segment of public health.

Aden's health sector is suffering some inability in furnishing health services to residents due to the unbalanced function of health units. Many doctors quit the Ministry of Health and begin private clinics to increase their earnings because Ministry of Health salaries often are not enough.

Unorganized investment in the health sector, which aims at profit, in addition to wrong diagnoses, makes patients suffer. After getting fed up with public hospitals, patients rush to private hospitals hoping to find a glimmer of hope in curing their illnesses.

A voice in the crowd

In Aden's Al-Mansoora District, a large crowd of aged, women and children, all from different places in the governorate, came seeking a doctor to cure their disease. They scan the doctors' signs to find the one specializing in their illness. One such sign says the doctor can cure many incurable diseases, that he is a graduate of a western university and that the best diagnosis devices are available in his clinic.

One patient from Lahj in Radfan District appeared to be in pain. “I came from Radfan in the early morning so I can register to see the doctor in the evening,” he said. He suffers severe kidney pain and has seen many doctors who diagnosed him differently. Some said he has kidney stones while others said there are precipitations due to Radfan's saline water, but until now, nothing is certain. He continued, saying he lost a great amount of money seeing doctors, having laboratory examinations and buying medicines. Each doctor prescribed a bagful of drugs, but all were in vain, he noted.

When asked if he has a job, he replied, “I was a retired sergeant before unification. My salary is only 1,300YR. I have seven sons and daughters who all are unemployed. We are suffering because of treatment costs. We used to borrow, but we find none who can lend to us now.

“We demand [the state] take care of public hospitals,” he said. “They should furnish doctors and drugs for patients. Public hospitals and clinics are quite neglected. Even if a patient is to have an injection, he must pay for that now in public hospitals.”

“My stomach is a pharmacy”

One woman said she became a virtual pharmacy due to the large number of medicines she used to have a child. “I saw many male and female gynecologists. Every one prescribes his own drugs. I had an operation in one of the private hospitals. Now I've ended up with a cyst in my ovaries. This disease now is spreading in Aden governorate, even among young ladies. It's due to foods sold in this country without control by the Ministry of Health. Traders sell their food, regardless of it being fresh or not.

“Health conditions in Aden are deteriorating,” she continued. “When you see a doctor in a public hospital, he often advises you to see him in his private clinic. This is not for the patient's good but for his own benefit. Another thing is there are some doctors who charge fees for operating in public hospitals. This is done after making a deal with the patient, the doctor and the hospital administration.”

Public hospital shuffle

Overcrowding is not confined only to public hospitals. Private hospitals also have their share. The only difference is the public ones are crowded during the day while the private ones are crowded in the evening.

At Khor Maksar Educational Hospital in the men's internal ward, Nasser Abdu Rabo from Loder District said he suffers severe chest and heartbeat pain. He was treated in Loder Hospital and then transferred to Al-Razi General Hospital in Abian. “Then I was transferred again to the Republican Hospital in Aden,” he said. “I hope I will find the right diagnosis for my case here. Today I had a number of diagnoses, including an x-ray.”

“They are all butchers”

At a private hospital in Al-Mansoora District, Um Mohamed Fadhl said, “I came here to receive hypertension pills.” She took a deep breath and then began telling her daughter's story. She visited all the public and private hospitals in Sana'a and Aden without finding a proper diagnosis. “They are all butchers,” she said. “Every hospital sets its price. After three years touring all clinics, public and private hospitals, we decided to get a medical report to go abroad.

“We went to India and showed the doctors my daughter's medical reports. She was diagnosed here as having a heart problem. They re-diagnosed her there and found no heart disease. All they found were worms in her stomach. She was given medicine and now she is very well, studying pharmacology in the school of medicine.”

The most rapidly spreading diseases

Medical studies indicate that some diseases now are on the rise. Of those, which were not known before, are cancer, heart disease, blood strokes, kidney failure, hypertension and diabetes mellitus. These diseases are attributed to economic hardship and a poverty increase of 37 percent and the spread of poisonous insecticides illegally smuggled into the country aside legal ones. This is in addition to expired and fake medicines. The absence of the role of the inspection authority in the Ministry of Agriculture and Irrigation is to blame in this respect. Contaminated well water also is to blame, affecting rural residents and causing diseases like kidney failure. Examples of such areas are Radfan and Tor Al-Baha in Lahj Governorate and other areas in Al-Dhale.

The study also attributed these diseases to absence of health awareness, poverty and lack of service recourses in hospitals, in addition to absence of the role of public media in addressing such threats.

Aden's private hospitals

There were no private hospitals in Aden before 1999's issuance of Law 60 aimed at organizing private medical and hygienic establishments according to modern scientific service standards. It also aimed to encourage the private sector to invest in specialized health services. The law organized supervision of private services and periodic checks on such establishments to make sure they abide by legal regulations. It also aimed at spreading private health services in urban and rural areas and making them within appropriate cost and reach of citizens. The law also sought to check unprofessional behavior that contradicts the career's ethics, as well as contribute to promoting health awareness and primary health services.

Jamal Mohamed Hassan heads Aden's Department of Private Health Establishments. When asked what his department's role is in implementing the law of private health establishments, he answered that his administration receives license applications for medical and health establishments. It then checks and approves them according to terms and procedures in 1999's Law 60. He said they make field tours of these establishments and report their views in license applications, clinical, hygienic and investment institutions. They also periodically inspect each private institution, making sure it carries out its activities according to law.

However, during these tours, they discovered some institutions not abiding by the law. A law regulating the bylaws of 1999 was issued April 2004, four years after the 1999 law. “Consequently, we made a month-long tour, resulting in closure of 143 private medical establishments not abiding by specifications,” Hassan said. “We gave warnings to 172 others.”

Technical institutions managers reviewed the number of private hospitals in Aden. There were five hospitals, 12 clinics, 12 medical centers, 271 medical clinics, 85 laboratories, eight x-ray centers, 27 optic centers, 220 pharmacies, 49 medicine stores and 60 medicine selling agents, totaling 749 medical establishments. Hassan added that private medical institution investment in Aden Governorate reached YR 1,466,480 billion during 1991- 2004. Other investors offered YR 1,438,341 billion, but so far, no decision has been made on these applications.

Aden's public hospitals

There are a limited number of hospitals in Aden. The Republican Educational Hospital is one of these, furnishing medical services for patients in the vicinity of Aden, as well as practical studies for Faculty of Medicine students at Aden University. However, the hospital suffers a shortage in operational funding, as does Aden General Hospital and Unity Hospital (formerly Friendship), which specializes in gynecology and obstetrics. 22nd May Hospital in Al-Mansoora District is the only hospital in Aden built after unification.

Ba Suhaib Military Hospital improved its services a bit following the arrival of the Kuwaiti mission, which pays great attention to patients. However, it cannot be compared to Sana'a Military Hospital. The biggest problem the oldest hospital in the governorate now suffers is its poor road, which is greatly destroyed and causes much suffering to patients and visitors trying to reaching the hospital.

Pharmacies and lack of observation

A large number of private pharmacies have spread inside the hospital, at the gate and in the Aden's streets. Many do not conform to pharmaceutical specifications and those working in them are not qualified graduates. Dr. Abdulla Naser Bin Naser, director of Aden's Provision and Pharmaceutical Administration, was asked why his administration does not make field tours to check private pharmacies not abiding by legal regulations.

He answered, “According to the Ministry of Health's regulating law, observance, follow-up and provision are the duties of our administration. We issue the license of pharmacies in Aden according to Law 60 of 1999. The basic terms in these regulations stipulate that the pharmacist should be a graduate and a member of the Pharmacology syndicate. He should also be a resident in the district where the pharmacy is to be established.”

He added that the law also stipulates a pharmacy's area should be 24 square meters, but some establishments are overlooked because many of Aden's buildings are very old. A pharmacy should be air conditioned, have a refrigerator and, Naser pointed out, the pharmacist should be medically fit.

A medical supply and administration section recently was established, but it cannot make surprise intensive field tours due to lack of funding and cars. Despite this, some surprise tours of pharmacies are made. Many pharmacy owners were found to hire unqualified youth and provided an immense amount of faked and expired medicines. Measures were taken against these pharmacies and some licenses canceled. They also wrote commitments not to do it again. This observation resulted in hiring many pharmacy graduates.

Concerning tackling the problem of smuggled and imitation medicines, Naser noted that smuggling is encouraged mainly by lack of a clear Ministry policy deterring the phenomenon. “When a certain medicine disappears from pharmacies, the owner makes a deal with smugglers to get it. The price will be less, but this costs the treasury a lot.”

Uniting against smuggling

Dr. Abdulgadir Al-Bakiri, General Manager of Aden's High Authority for Medicines, spoke about his agency's role, saying, “The Authority's duty is to monitor medicines that reach this country through Aden's port or the airport. We make sure they are highly competent. We also make sure medicine factories abide by international regulations in medicine manufacturing. A team from the Authority visits factories for this reason. All medicine samples are registered and then examined in laboratories. There are other factors taken into consideration, such as price and quality. After registration, follow-up of imported medicines begins. The Authority takes samples of medicines arriving at the airport or at Aden Port. These medicine samples are examined in the Authority's laboratory. Chemical and physical sections now are under construction at the Authority and will be equipped with modern devices. Another section will open called micro petrology, which will examine drug quality and make sure they are free of residuals.”

Al-Bakiri said the most important achievement was inauguration of the new Authority building in 2005. The building contains the general administration in addition to a laboratory which examines more than 400 samples imported by companies and agencies. “We also examine skeptical drugs from workers in health establishments. Smuggled drugs also are examined to make sure they are good to use.”

Al-Bakiri said smuggled drugs generally are unacceptable due to quality or the method used in getting them into the country. “There should be a serious effort to fight it because it affects the economy and citizens. Smuggled drugs unknowingly taken by citizens could either be ineffective or aggravate their diseases.” Al-Bakiri added that smuggled drugs are a national problem requiring joint attention from all. Drug smuggling in Aden decreased 70 percent following official concern. President Saleh visited the Ministry of Health and urged all to fight this phenomenon.

Aden customs also plays an important role in catching smuggled drugs. On Dec. 12, customs agents destroyed YR 5 million worth of smuggled and imitation drugs seized May 28, 2005 on a ship arriving in Aden port from Djibouti. With the help of Coast Guards, the drugs were discovered among a shipment of fireworks and other materials.