Where health comes in [Archives:2004/759/Opinion]

August 29 2004

The Yemeni Constitution guaranteed adequate health care for all citizens, with the government footing the bill if necessary. We have indeed made tremendous strides in making a significant amount of health care available to the Yemeni people. The father of this observer was the first General Manager of the first hospital in Yemen, the embryo of what is now the Republican Hospital in Sana'a. In the Early 1950s, this hospital was no more than a few mud brick buildings of a few rooms each and a small administration at the entrance way. There were a couple of Italian doctors manning the hospital, as there were not even any Yemeni nurses. The best that any Yemeni health staff could do then was maybe administer a syringe (There were no disposable syringes yet, so the syringes had to be sterilized and boiled and used over and over again. Over time, many Yemenis were under the impression that if you were not given a needle, you were not given proper medical attention. This may be the reason why Hepatitis is widespread in Yemen.
In any case, now we are fortunate to find quite a significant number of doctors in Yemen, many of whom are proven good doctors. On the other hand quite a lot of them are quite exploitative, and some have managed to establish many private hospitals which have done quite a lot to alleviate the burden on already overcrowded government health and medical facilities. Most of these public hospitals are poorly equipped and furnished and going through the ordeal of obtaining treatment there is a nightmare for some, especially the poor and deprived, who do not have any connections in these hospitals.
It used to be said that the only way you can get sick in Sana'a is if you forced yourself to be sick. The air in Sana'a was so clean and with the humidity so low, you do not have suitable breeding grounds for germs and bacteria. But now with Sana'a so overpopulated and crowded, and with inadequate sanitation facilities make some neighborhoods a health disaster area, the rate of affliction is increasing and one is not surprised to see all the public and private medical clinics and hospitals crowded with whining sick people, each with about five people accompanying them. One is rather amused at seeing so many people accompanying sick people at these clinics. One wonders if this does not make the ill more uncomfortable and even might frighten the sick to think that these people are just here to see them pass away. Whatever the case, health service in the country definitely needs a giant overhaul. Public health service should be for the poor and the deprived. Standards need to be set up for proper health care and for this the medical profession needs to get its act together to set up the oversight mechanisms that will insure both public and private ethical conduct in meting out medical services. The government alone is incapable of oversight of this nature. The government health sector also needs a significant boost in their budget allocations, since the percentage of the budget for the health sector does not exceed 5%, in the best of years. The observer is inclined to believe that channeling much of the irrelevant and mostly political expenditures to the health sector would do a lot to improve the situation in the public health sector.
Much of the work in spreading health care is being carried out by some of the Social Safety Net schemes, especially the Social Development Fund and the Public Works Project, both funded by donors. The former is doing outstanding work in this area in far remote areas of the country and is indeed fulfilling its social protection component with a greater finesse than most of the other schemes.
One is also aware of the great strides that the public sector has made in providing health care to a substantial element of the population, who would otherwise have had to go overseas-a very taxing undertaking for most Yemenis. Now most overseas medical trips are carried out by senior government officials, who will somehow manage the appropriate budget allocations from which to pay for their expensive medical expeditions abroad for the most minor of illnesses. Albeit, this is happening when, in fact, most of these officials can pay for such expeditions out of their pockets without denting their net worth.
We now come to an important element that is still missing in Yemen in health care provision. We need the private sector to come with a health insurance scheme for many of the Yemenis, who are reliant on fixed salaries and thus cannot afford to meet serious health emergencies when they arise. There are already good developments in the insurance market, including pension schemes and car insurance and other risk protection, but the health sector has been mostly closed to the insurance business. There are some minor schemes that have developed here and there, but they do not cover large elements of the population and their rates would be unaffordable for most salaried employees.
The observer is inclined to agree with the observation that the private health sector needs to be regulated, but the medical profession should be encouraged to set up and manage the regulating mechanisms. Most Yemeni doctors have proven that they have strong ethical standards and would be best able to institutionalize ethical medical practice to the benefit of all the medical profession and their growing clientele of Yemeni patients.