US embassy cable - 05DJIBOUTI936

UNCLAS SECTION 01 OF 02 DJIBOUTI 000936 
 
SIPDIS 
 
 
STATE FOR AF AND AF/E 
STATE ALSO PASS USAID 
NAIROBI FOR AID/REDSO 
PARIS/LONDON FOR AFRICA WATCHER 
 
E.O. 12958: N/A 
TAGS: PREL, EAID, SOCI, DJ, UN 
SUBJECT:  HEALTH MINISTER FOCUSES ON REFORM AND GLOBAL FUND 
OPPORTUNITIES FOR DJIBOUTI 
 
 
1.  (U)  Summary:   In separate meetings September 13 with 
USAID Representative and Ambassador, Minister of Health, 
Abdallah Abdillahi Miguil, focused on health development 
and reform of Djibouti's Ministry of Health.  Cost recovery 
for renovation of Peltier and improving health services 
and human resources would be a major issue for his ministry 
and for the government.  The Minister also expressed 
disappointment that Djibouti's application to the Fifth 
Round of the Global Fund for AIDS, Tuberculosis and Malaria 
had been turned down by the Global Fund. 
Ambassador pledged assistance of USAID staff in helping 
the Ministry address issues raised in the Global Fund's 
technical evaluation of the proposal.  End Summary. 
 
2.  (U) In a meeting September 13 with USAID Representative, 
accompanied by USAID/Djibouti Senior Health Advisor and 
USAID/Djibouti Health Specialist-FSN, Minister of Health 
Abdallah Abdillahi Miguil reviewed his plans for 
health reform in Djibouti. These plans include renovating 
and reviewing functions of its primary hospital, Peltier, 
improving human resources, and improving the quality of 
health services.  For the Minister, cost recovery was a 
major issue.  He said the Ministry of Health had developed 
a plan for it and the plan would be shared with USAID.  In 
addition, Miguil said, the Ministry had already begun 
implementing a cost recovery program at two hospitals, 
including Peltier, and that a briefing meeting on the 
subject would be held by the end of October. 
 
3. (U) The Minister also voiced his concern about the 
small percentage of the national budget that goes to 
support his Ministry. Currently only 4% of the budget 
is allocated for the Ministry of Health. He suggested 
that USAID exert all pressure possible on the central 
government to assist in convincing the government to 
increase his ministry's budget. 
 
4. (U)  USAID representative asked the Minister about 
his views on the joint health and education program 
with the Ministry of Education to fight drug usage, 
including khat. She wanted to know if the Minister 
was still on board for the program and sought additional 
ideas he had about the approach, including the role 
envisaged for USAID. She cited USAID's many years of 
experience in other African countries developing and 
using telemedia to educate the public about health 
issues such as HIV/AIDS and other diseases. The Minister 
said that at this time, his Ministry does not have a 
clear policy on health education, but that he would 
convene a small planning team to look into the matter. 
The Minister added that he intended to launch a 
large anti-drug campaign on November 20, during 
the worldwide "Day of the Child" celebration. 
 
5. (U) The Minister also indicated that he will 
seek technical assistance from USAID as well as 
other partners to help the Ministry of Health evaluate 
whether or not it can achieve the objectives of its 
"National Health Reform Strategy".  The evaluation 
might help the Ministry make slight adjustments, as 
needed, in order that overall objectives are more readily 
attained. 
 
6. (U)  Miguil noted to USAID representative that the 
next health "Donor Coordination" meeting would be held 
during the first week of October. He voiced his 
concern that the World Health Organization (WHO) 
holds the presidency of this committee rather than 
himself.  USAID representative agreed that the 
Minister should chair this committee, and that USAID 
would work to see that the change was made. It 
was reported, as well, that the technical committee 
on human resources of the "Donor Coordination" group, 
met in June to discuss progress and efforts made 
to improve human resources within the Ministry of 
Health. Another meeting will be held later in 
October. 
 
7. (U)  USAID representative noted during the meeting 
that her agency was working to help create an improved 
health information system, that was computer-based, but 
many obstacles to its development remain. A similar 
program was developed within the Ministry of Education 
with USAID assistance, and that the same could be done 
within the Ministry of Health. 
 
8. (U)  During a separate meeting the same day with 
Ambassador and USAID Representative, the Minister 
conveyed his disappointment over the failure of Djibouti 
to secure additional resources from the Global Fund 
for Djibouti's Tuberculosis and Malaria prevention 
and treatment proposal, which was submitted for the 
5th round of funding. He gave a copy to the Ambassador 
of the technical evaluation provided by the Fund.  The 
Ambassador pledged the assistance of the USAID team in 
working with Ministry of Health officials to help 
them address the issues raised in the technical evaluation. 
She, with the Minister, wanted to ensure that a 
proper and comprehensive response could be submitted 
before the deadline of September 22, 2005.  Although 
the Minister said he thought USAID representatives had 
been consulted in the initial round of preparation of 
Djibouti's proposal, it was subsequently learned that 
USAID had not been asked to provide input into the 
original application for this round. 
 
RAGSDALE