MINISTER OF HEALTH LEADS NATION-WIDE

UNCLAS DJIBOUTI 000976

SIPDIS

STATE FOR AF AND AF/E
STATE ALSO PASS USAID
NAIROBI FOR REDSO

E.O. 12958: N/A
TAGS: PREL EAID SOCI DJ
SUBJECT: MINISTER OF HEALTH LEADS NATION-WIDE
TOUR TO DJIBOUTI'S HEALTH CENTERS



1. (U) From June 15 through July 22, Minister of Health Abdallah
Miguil, led an important and large delegation on a tour of rural
Djibouti, visiting all rural health posts and district hospitals. His
delegation included the Minister of Women's Affairs, Acha
Robleh, Representatives of WHO, UNICEF, WFP, UNFPA,
UNDP, and UNHCR, the Chief of Party of the USAID-funded
"Expanded Coverage of Essential Health Services" project, as well
as other Ministry of Health officials.


2. (U) The Minister of Health outlined the five main reasons
behind the tour:


--To have the central authority at the Ministerial level, as well as
donors and partners, see first hand the population and the
conditions that exist in rural areas of the country.

--To see what the main problems were, so that better decision
making could take place. For instance, the four most common
problems observed were lack of medicine, lack of personnel, no
functioning health information system, and no dialogue between
health personnel and the community.

--To have all stakeholders see and discuss together, what might be
done in order to remedy the above, observed problems. As a result
of a lack of personnel in many rural health posts, the Minister, in
consultation with Ministry officials, partners and donors, decided
to appoint new nurses to all health posts that lacked them. These
appointments were made immediately upon completion of the last
tour to Obock district, in late July. These nurses are all trained at
the central level, with diplomas in hand.

--To claim the title of first Minister of Health in Djibouti to visit
the entire country.

--To confirm that the need for water is one of the greatest needs in
the rural areas of the country. Through this tour, he and his
delegation saw that water was one of the most pressing needs for
all communities, and of extreme importance in order to have a
properly functioning health post.


3. (U) The Minister's tour was important in revitalizing
Djibouti's health sector, in particular the rural health posts and
district hospitals. In addition to the central themes of the tour,
outlined above, the Minister is re-evaluating health care delivery
policy at all levels. For instance, his Ministry has already begun t
train district hospital doctors and staff on obstetric procedures, as
lack of complicated-delivery service at district hospitals was cited
as a serious problem in rural areas.


4. (U) After discussing the report as well as details of the trip w
the Chief of Party for USAID's "Expanded Coverage of Essential
Health Services" project, USAID and the Ministry developed the
following recommendations:

--The Ministry of Health needs to review and assure the supply, as
well as the kind of medicines available in health posts.

--The Ministry of Health needs to assure the supervision of both
health posts and district hospitals. Currently, there is no
supervision or even a plan to supervise. The district teams do not
know how to organize themselves, which would facilitate
supervision, so a training plan is needed as well as strong central
leadership to see it through.

--The Ministry of Health needs to reinforce district management of
the rural health infrastructure. This would assist in plans for
decentralization, and to make the health care delivery system at the
district level, work better.

--The Ministry of Health needs to reinforce and build-up the health
information system. Currently, the health information system is
non-existent, except in a few health centers and hospitals, but not
in a systematic, and uniform manner, and particularly not in any
rural health posts.


5. (U) Comment: Through current USAID activities, an
opportunity exists to assist the Ministry of Health achieve some of
these outlined objectives and recommendations. Other objectives
and recommendations may be more appropriately addressed as part
of a new strategy, after discussions with stakeholders and partners.
End comment.