2003年-世界发展银行全球_Eritrea___Health_Sector_Note_98页_6mb

Eritrea Health Sector Summary

Core Content

This document provides an overview of Eritrea's health sector, focusing on its current status, challenges, and recommended next steps for development. It outlines the country's socio-economic situation, demographic and epidemiological trends, and the structure and performance of its health system. The report is part of a three-step process initiated by the Ministry of Health (MOH) in 2001 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

Socio-Economic Situation

• Eritrea has a population of approximately 4.1 million (2002), with 62% in rural areas and 38% in urban areas.
• The country remains one of the poorest in the world, with a GDP per capita of US$200 (1998).
• About 60-70% of the population lives in poverty, and the unemployment rate in the non-farming sector is estimated at 15-20%.
• The border conflict with Ethiopia (1998-2000) significantly impacted the economy, especially agriculture, and displaced 300,000 to one million people.
• 90% of displaced households are headed by women, and nearly 1.6 million people require humanitarian aid for 12-18 months.

Demographic and Epidemiological Situation

• The population growth rate is projected to be less than 3% per annum.
• The Total Fertility Rate (TFR) in 2002 was 4.8, with only 7% of married women using modern contraceptive methods.
• Eritrea's infant mortality rate (IMR) and under-5 mortality rate are below the sub-Saharan Africa average, but high malnutrition rates remain.
• Malaria affects 75% of the population, with only 34% of households having mosquito nets.
• HIV/AIDS is the leading cause of adult in-patient mortality, with a sero-prevalence rate of 2.8%.
• Tuberculosis is the second leading cause of in-patient case fatality for those aged five years and above.
• Malnutrition, including stunting, underweight, and wasting, is prevalent among children under five.
• Diarrhea affects 74% of children under three, and only 50% of breastfeeding children receive complementary food.

Health System Overview

• The health system includes primary health care (PHC), community health services (CHS), and zoba health services (ZHS).
• The MOH has initiated a quality assurance program, focusing on technical efficiency and consumer satisfaction.
• Health infrastructure has expanded since 1990, with 70% of the population having access to primary health care services by 1999.
• There are 259 retail drug outlets in 2000, but most private sector involvement is in drug procurement and distribution.
• The public sector accounts for 65% of health spending, with donor contributions at 27% and household contributions at 8%.
• The health sector is heavily dependent on external assistance, with 53% of the 1999 drug budget coming from donors.

Key Challenges

• High Burden of Disease: Communicable and preventable diseases account for 71% of the burden of disease.
• Maternal and Child Health: High maternal mortality ratio (1,000 per 100,000 live births) and poor access to maternal health services.
• Health Infrastructure: Insufficient number of local doctors, low ratio of medical specialists, and inadequate infrastructure in rural areas.
• Human Resources: Low salaries, lack of incentives, and poor working conditions contribute to a shortage of trained health personnel.
• Sanitation and Water Access: Only 42% of rural dwellers and 63% of urban residents have access to safe water.
• Healthcare Utilization: Limited access to health facilities in rural areas and inadequate waste management systems.

Recommended Next Steps

Short-Term Priorities

• Establish baseline information for the Millennium Development Goals (MDGs) and set realistic targets.
• Evaluate the performance and cost-effectiveness of specific health programs.
• Estimate National Health Accounts (NHA) to understand the health sector's financial status.
• Explore alternative revenue sources, including user charges and insurance options.
• Develop a needs-based master plan for health facilities and equipment, including the private sector.

Medium-Term Priorities

• Conduct unit costing studies to assess the technical efficiency of public hospitals and ambulatory care facilities.
• Develop a comprehensive and coherent health sector strategy with defined roles for public, private, and NGO providers.
• Explore the potential for hospital privatization.

Long-Term Priorities

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

Conclusion

The health sector in Eritrea is at a critical stage of development, with significant progress made in expanding access to primary health care and implementing key public health programs. However, challenges such as high disease burden, inadequate human resources, and poor infrastructure remain. The report emphasizes the need for a strategic, sustainable, and equitable approach to health care, with a focus on improving maternal and child health, strengthening the health management information system, and enhancing the role of the private sector in the delivery of health services.