2004年-世界发展银行全球_The_Health_Sector_in_Eritrea_116页_3mb

Summary of The Health Sector in Eritrea

Core Content

The document provides an overview of the health sector in Eritrea, focusing on its socioeconomic context, current health system performance, challenges, and recommended next steps for improvement. It is part of a broader initiative by the Ministry of Health (MOH) to develop a long-term Health Sector Policy and Strategic Plan (HSPSP) with the goal of ensuring equitable, quality, and sustainable health care.

Main Points

Socioeconomic Situation

• Eritrea has a population of approximately 4.1 million, with 62% in rural areas and 38% in urban areas as of 2002.
• About 30% of the population is semi-nomadic.
• Eritrea is one of the poorest countries globally, with a per capita GDP of US$200 (1998).
• Poverty affects 60-70% of the population, and the unemployment rate in the non-farming sector is 15-20%.
• The border conflict with Ethiopia (1998-2000) had a significant impact on the economy, particularly agriculture, leading to a GDP decline of 9% in 2000.
• Displacement of 300,000 to 1 million people (10-20% of the population) resulted in inadequate shelter, sanitation, food, and basic services.

Health Sector Overview

• Since 1991, the government has made progress in improving living conditions through health infrastructure development.
• In 1999, 70% of the population had access to primary health care services within 10 km of a health facility.
• Several public health programs, including child health, immunization, reproductive health, and community health services, are in development or implementation.

Health System Performance

• Strengths:
  • Expansion and rehabilitation of health infrastructure.
  • Active prevention and control of HIV/AIDS.
  • Initiation of a quality assurance program.
  • Several pharmaceutical-related initiatives, such as drug warehouse construction and improved logistics.
• Challenges:
  • High burden of communicable and preventable diseases.
  • Limited access to water and sanitation, especially in rural areas.
  • Inadequate waste management systems.
  • Insufficient number of local doctors and poor skills mix among health staff.
  • Low public sector salaries and poor infrastructure in rural areas.
  • High donor dependency in health financing.

Health Indicators

• Child Health:
  • 40% of under-5 children were underweight, with 12% severely underweight.
  • 38% were stunted, and 16% had severe stunting.
  • 13% were wasted, and 50% were anemic.
  • 76% of children aged 12-23 months were fully immunized in 2002.
• Women's Reproductive Health:
  • Maternal Mortality Ratio (MMR) is 1,000 per 100,000 live births.
  • Only 28% of pregnant women and women of childbearing age received full immunization against tetanus.
  • 28% of deliveries are attended by skilled personnel.
  • Low maternal nutritional status and lack of access to prenatal care in rural areas.
• Health System Structure:
  • The health system is decentralized, with zoba health teams playing a key role.
  • There is a need to improve the capacity of local and regional health administrations.

Health Sector Financing

• Public sector spending accounts for 65% of total health spending in 1999.
• Donor contributions account for 27%, and household contributions are 8%.
• Donor dependency is high, with 53% of the drug budget in 1999 coming from external assistance.
• User fees are not optimal due to high poverty levels, and alternative revenue sources, such as insurance, are being explored.

Pharmaceuticals

• All drugs and medical supplies are currently imported.
• Local production is expected to begin shortly, mainly for packaging.
• Drug storage, distribution, and transport systems need improvement.

Health Management Information System (HMIS)

• Data collection and analysis are relatively good, but feedback to service providers is limited.
• There is a lack of critical data for decision-making, including national health accounts and unit cost information.
• Private sector involvement in health data is not well documented.

Key Recommendations

Short-Term Priorities

• Establish baseline information for MDGs and set realistic targets.
• Evaluate the performance and cost-effectiveness of specific health programs.
• Estimate National Health Accounts (NHA) to better understand funding sources and uses.
• Explore alternative revenue sources, including user fees and insurance options.
• Develop a needs-based master plan for health care facilities and equipment, including the private sector.
• Improve HMIS through staff training and development.
• Assess health worker skills and training needs, especially in epidemiological surveillance and reporting.
• Develop a national health care waste management strategy with budget requirements and monitoring plans.
• Foster partnerships between public and private sectors, as well as civil society.

Medium-Term Priorities

• Conduct unit costing studies to evaluate technical efficiency.
• Create a comprehensive and coherent development framework for the health sector, defining the roles of public, private, and NGO providers.
• Explore the potential for hospital privatization.

Long-Term Priorities

• Develop financing options for universal health coverage, such as a national health insurance system.
• Implement modern incentive-based provider payment mechanisms.
• Promote private sector integration and develop a rational policy for private sector development.
• Improve case management quality, focusing on hygiene, provider-patient relations, and ICT integration.
• Increase financial and management autonomy of public health facilities.

Conclusion

The health sector in Eritrea faces significant challenges, including high disease burden, limited infrastructure, and donor dependency. Despite progress in expanding access to primary health care and implementing public health programs, there remains a need for more effective management, improved resource allocation, and stronger coordination between public and private sectors. The recommended next steps aim to address these issues through short, medium, and long-term strategies, with the ultimate goal of achieving equitable, quality, and sustainable health care for all.