1. (U) An official ceremony was held March 16 in the rural
community of Goubetto, located 25 miles south of the capital,
to open a newly rehabilitated health facility. The
Goubetto Clinic previously was defunct until the USAID program for
health sector reform began rehabilitation of it in December 2004.
The ceremony formally announced to the public that USAID's effort to
assist the Djiboutian Ministry of Health in reforming the health
sector had completed the first of many rural health facility
rehabilitations in their program.



2. (U) Although Goubetto is "officially" a referral clinic, screening
and advising patients who may require more help and sending them to the
district hospital in Ali Sabieh, it is capable of attending to normal,
uncomplicated deliveries; treating common ailments that the nurse can
identify such as normal cases of malaria; and providing community
services such as routine vaccination of children under five and
ante-natal services for pregnant women.



3. (U) Two other clinics, located in the north of the country, are in
the final stages of rehabilitation, and should be ready for opening in
mid-April. There are, in total, 21 remaining health clinics to be
rehabilitated over the next two years under the USAID program.



4. (U) Dr. Mohamed Ali Kamil, Minister of Health, opened the
ceremony with USAID Representative Schulman in attendance.
The Minister cited the achievement of the community and thanked those
who to complete rehabilitation. He asked the community to take advantag
of this clinic since those who work here will receive refresher trainin
to improve their skills. USAID Representative thanked the Minister for
his support of the health sector reform program USAID was implementing
and said the clinic was the first of many fruits borne of this
collaboration. She challenged the community to embrace the
clinic as their own, to take care of it and use it by brining their
children to be vaccinated and mothers to deliver their babies.



5. (U) During a tour of the facility afterwards, the nurse in charge,
Ismail Ahmed, explained that until rehabilitation began, the health
clinic was comprised of only two small rooms. The renovation not only
added on an entirely new section, the maternity ward, but also included
an adjoining wing where the head nurse and his family would
live. This would make him available, virtually 24 hours a day. The
renovation added running water, fed by a reservoir located in the
enclosed backyard of the clinic, a sanitation system, as well as solar
powered electric lighting. New beds and a maternity table, as well as
examination equipment and storage containers for vaccines and
medicines completed the rehabilitation. In addition, a radio
communication system would be installed which would permit the
announcement of emergency transfers to the district hospital.



6. (U) Comment: Although it was very heartening to see the positive
reaction of the community to the new health clinic, its rehabilitation
was a reminder of the lack of investment in Djibouti's health sector.
All rural health clinics, like the one in Goubetto, are in a state of
disrepair and disuse. It is clear that the Ministry of Health will nee
to commit to rural health clinics, since their staff requires not only
medical supplies and refresher training, but salaries to motivate them
to work, too. One of the challenges of the USAID funded health sector
reform project will be to assist communities to be able to better
address their ability to support these clinics not just by using
them, but also to look for creative ways to financially support them.
This creation of demand may help the Ministry of Health better address
the issues of maintaining supplies and staff competency. End comment.
RAGSDALE