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Health Sector Reform in the Republic of Yemen: Strategy for Reform (2000)

Yemen Ministry of Health Country Resources General Health Strategies and Plans Yemen October 2000 Policy document

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The Ministry of Public Health (MoPH) has put forward a Health Sector Reform (HSR) Strategy, designed to address the failures of the current health system. In this volume, the current health care situation is described, health system failures are analyzed, and the strategy for reform resulting from this analysis is outlined.

The government's health system is in a state of prolonged crisis, a crisis that has worsened dramatically in the past decade. Long term underfunding, poor management, and a health system model poorly suited to Yemen's needs have combined with a downturn in the economy and with a high population growth rate, to create a health system increasingly unable to meet the health care needs of the Yemeni population. Mortality and nutrition indicators remain high compared to other countries in the region, and the quality of health services as well as the coverage of the population with these services remains low. The following are indicators of the crisis the government health sector is in:
• The worsening of some health indicators, such as malnutrition, in this decade;
• A government per capita health care budget of only $3.60 in 1996, which covers only a fraction of the health care need, according to international benchmarks;
• Lack of essential drugs and services in government health facilities, leading to a bypass rate of between 42 to 73%;
• An immunization coverage rate of only 28%;
• Lack of geographic access, with only 30% of the rural population having access to health care, and with only 50% access overall;
• Out-of-pocket contribution of households to health care costs of 75%, with the government's contribution only 25%.

This is the lowest government contribution in the region, with other governments contributing between 33 and 86% of total health care costs. The crisis of the health system has long been recognized by the MoPH and donors alike, and technical input solutions and piecemeal reforms have been attempted in order to improve the system. For example, in the 1990s, partial solutions such as experimentation in cost sharing, and encouragement of the private health sector through economic incentive programs, were instituted. However, these measures have not produced the improvements hoped for in terms of health care quality, coverage, and accessibility. In order to bring about these improvements, the MoPH has, in the end, found it necessary to engage in a detailed analysis of the current health system in order to understand where the essential problems lie. This analysis has resulted in the proposed strategy for reform. Overall, the reforms concentrate on greatly improved management systems, decentralization of numerous management functions to the level of the district, cost sharing with the users of health services, a stronger policy and management role for the MoPH, and a smaller role in direct service provision.


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