The health sector in Djibouti has in recent years been characterised by wasteful spending, corruption scandals – and international media reports of clinics without (paid for) equipment, and consumables. One scandal involved aid-funded spending on HIV prevention and treatment.
It is true that those in Djibouti with money fly to Dubai or even Bangkok for treatment.
State hospital facilities have some good staff but are in a less than adequate condition.
The results are sadly evident. Infant and maternal mortality is unacceptably high for a country with such a level of GDP per capita. Support for the elderly is almost non-existent and many curable diseases elsewhere often prove fatal in Djibouti.
Prevention programmes are thin on the ground, and charitable organisations struggle to keep pace with demand for help.
First, a key step is to ensure that expats and the better off can access services in Djibouti, thus developing the sector and skill levels, and refocusing resources on state or subsidised provision.
A practical assessment needs to be made of what is currently being provided free and what members of the public are actually paying for. Reliable information on such issues is not yet available, yet this is key to the implementation of policy and for allocation of funds to the sector.
An important focus of resources will be training and bringing in professionals who can train doctors and nurses.
The reforms to the health sector will take time. Meanwhile, an urgent focus for state funds is the provision of mobile clinic services for villages, peri-urban areas and informal dwelling communities, focused on the most urgent problems – malaria, maternal health, serious infections and life-threatening stomach problems.
However, it should be remembered that in Djibouti, many illnesses arise from poor nutrition. Food related measures, including the lifting of food taxes, will contribute to health improvements.
Getting things done
In the shorter term, through collaboration with NGOs, the provision of mobile clinics specialising in key common problems will be prioritised.