US embassy cable - 05DJIBOUTI976

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.