JOURNEY - From ‘Ray of Health’ to ‘Health for All’

JOURNEY - From ‘Ray of Health’ to ‘Health for All’

By Seare Habtemichael

Many Eritreans, perhaps, are reminded of the horrific health situation of the country’s colonial past. Coupled with the acute sufferings of war and drought, the people of Eritrea underwent the worst health situation in the World. Most of us, for sure, remember young Eritrean brothers and sisters suffering from tuberculosis, malaria, measles, polio and other infectious diseases which are said to have resulted from low standard of nutrition, sanitation, water supply, and housing.

That time, in some parts of the low lands, 80 percent of the population had malaria, 34 percent of all children had marasmus (protein and calorie starvation) and 6 percent had kwashiorkor (protein starvation). As a result, according to the EPLF health estimates, more than 520 per thousand children died before the age of five. Meanwhile, in the highlands, thousands of children suffered from scurvy and rickets. On the other hand, typhoid and tuberculosis haunted the villages thereby bringing about the loss of thousands of Eritrean lives.

The aforementioned tragedy, nonetheless, was not without roots. According to historical accounts, Eritrea enjoyed a relatively advanced health service prior to the federal period, during the Italian administration. It had inherited a health system of the Italian colonial times, introduced at the end of the 19 century, primarily aimed at serving the Italian settlers. However, since the Ethiopian colonization, late 1950s, things began to cramp down. The Hailesselasie regime began to cut the Eritrea’s health budget. Again, as the Eritrean liberation movement became more active the regime dismantled and closed clinics. The result is clear: ill health in the country was inevitable and hence in the years that followed death and diseases aggravated.

Against this tragic background, the Eritrean People’s Liberation Front (EPLF) in the beginning of the 1970, began to introduce preliminary health service in order to safeguard its people despite a number of constraints: lack of trained personnel, medicine and clinical instruments, and buildings for clinics and hospitals. In the period 1975 to 1978, however, health service began to take off, as it was the period when skilled Eritreans including doctors, nurses, and paramedical staff fled the towns and joined the EPLF.

Thus after, the EPLF began to provide a wide ranging health service to settled population and the nomads in established and mobile clinics. Not long, it established central hospital in a dry mountain valley floor with wards carefully camouflaged under the mountains in the then Sahil Province to avoid air attacks. It served as the main training center for operating theatre assistants, radiographers, anesthetists, pharmacists, and laboratory technicians. It is also said that the central hospital, apart from providing training, served as the main hospital where wounded fighters, wounded captured Ethiopian soldiers, and wounded civilians were treated. More importantly, under a slim budget and without any external assistance, the EPLF produced medical supplies including intravenous fluids, a variety of tablets, calipers and crutches there in the central hospital.

Again, so as to provide its health service to the general population while fighting a major war, the EPLF established regional hospitals, health centers, and health stations. And in order to reach the remote communities, and nomads who were neglected by the health service of the country’s colonial past, the EPLF organized mobile teams and barefoot doctors. Not only this, the EPLF also conducted awarenes programs to the population about prevention of diseases to improve living conditions by means of health committees of the people’s assemblies. Also the EPLF distributed publications under the theme of “Ray of Health”, dealing with the transmission and prevention of diseases, first aid, hygienic food preparation, and contraception, the need to get early advice from health workers, and the use and dangers of traditional medical practices. Hence, as history would put it: “providing a health service to satisfy the demands of both the fighters and civilians is a key feature in the process of revolutionary change in Eritrea.”

No wander, after independence of Eritrea in May 24, 1991, establishing a nation of healthy society and environment was one of the key priorities of the young government of Eritrea. Under the political commitment of “Health for All”, the health policy of the government of Eritrea, from the ashes, was straight for ward - - establishing a national health policy with a mission of building a productive and quality population set up in a situation of sustainable and excellent health care that is effective, efficient, accessible, acceptable and affordable to all citizens.

Based on these policies and programs, the government throughout the rest of independence days worked determinedly so as to achieve the mission of “health for all”. Hence, it has constructed several referral hospitals, maternal and pediatric health centers. At the regional level, referral hospitals have been constructed in Asmara, Barentu, Mendefera, Ghindae, Assab. Accordingly, since the day of independence, 1991, the number of hospitals has increased from 16 to 28, whereas the health centers have grown to eleven folds.

Prior to independence they were only 5 of them, and after independence, amid a variety of challenges and aggressions, the number has increased to 56. Surprisingly enough, the number of health stations has moved up from 72 to 256.

Grossly looking, however, the number of health facilities has grown from 127 in 1991 to 335 in the year 2010, which means that it has increased by 180 percent in just 20 years. As compared with the number of health facilities constructed in the whole colonial times from 1890, Italian occupation of Eritrea, up until the overthrow of the Derg regime of Ethiopia, the number of health facilities constructed by the government of Eritrea in just the past few years of independence exceeds by two and half folds.

On the policy of the human resource development, with the few resources available to it and even in the midst of war, Eritrea in the last 20 years has been able to take commandoftheeducationalcapacity of its health professionals. So as to fulfill this situation, the government established a variety of medical school facilities which include the School of Nursing, and the school of Medical Technology. So far, this schools have trained more than 5,404 health professionals. Out of the total, the 1851 are nurses, 2648 associate nurses, and 905 of them include technicians and others. This is quite surprising to see such a newly born war devastated nation, in its own terms and without anyexternal help, increasing its health personnel capacity by such folds.

Moreover, since 2002, the government of Eritrea came with a new idea of establishing a tertiary level education in the field of health. Hence, in 2003, the government established the Orotta School of Medicine and the college of Health Sciences in the year 2005. At the moment, both are working in closer cooperation with the Orotta Surgical Hospital, and the Orrota Pediatric and Maternity Hospital, both of which are the nation’s renowned and well-respected hospitals. During its inception in 2004, the number of students was 32, but it moved up to 334 in 2010. It, thus, appears quite promising to see more than 10 folds increase in just six years.

The doctor to population ratio has increased by more than 100percent. Likewise, the nurse to population ratio of the country has grown by 100 percent from one nurse to around 10,000 people service in 1991 to 3 nurses to 400 people in current year. The Ministry of Health, putting the current rate of medical school graduates into account, seems confident to meet the WHO recommended figure of doctor for population ratio, one to 10,000 people as the figure has raised from 1 doctor to 37,500 people in 1991 to one doctor 13,000 people in the present year. Far more importantly, the participation of women in the field of health as compared to men is also another success of the ministry, making 40 percent of the total work force.

In just few independence years the government of Eritrea has made an intensive effort in providing quality, and accessible health care system and made a commendable achievement on the prevention of communicable diseases including malaria, HIV/Aids, and the immunization of children against the most deadly childhood diseases. Subsequently, according to reports by the Ministry of Health, annual trend of malaria cases, 1998-1999, showed a very significant reduction from 250,000 to 100,000 in 2001, and 20, 000 in 2009, accounted for just one percent of death of children under the age of five in Eritrea, and this is attributed as a measure success story as compared with countries of sub-Sahara Africa.

Similarly, HIV/AIDs has been one of the epidemic diseases the government is struggling to halt its spread. The disease showed a steady progress since it was identified for the first time in the country in Assab in 1988. The government of Eritrea, understanding this disease may pose a heavy problem in the development of the young nation, responded hurriedly. Based on four sentinel surveys; the Eritrean national AIDS and TB Control Division has found out that the HIV/AIDS prevalence in the country is low. For instance, according to the year 2010 estimates of the Ministry of Health, trends in HIV/AIDS cases in the country have stepped down to less than one percent, which is a good signal of the government’s dedication in safeguarding the people’s health status.

Another key success of the Ministry of Health is the reduction of maternal and prenatal deaths.As presented by the Ministry of Health, Eritrea has reduced child mortality from 81per 1,000 in 1991 to 42 per 1,000 live births in 2010. Again under the age of five, mortality has reduced from 148 per 1,000 live births in time of the country’s independence to 63 per 1,000 live births this year. This is quite surprising to hear such a success from a young nation, struggling hard on the road to development and progress without any external assistance. Hence, according to reports, the United Nations in 2008 identified some 69 countries, which should have dealt with the reduction of maternal mortality, child mortality, and neonatal, out of which 16 countries including Eritrea registered the track to success.

The success for the young nation of Eritrea happened as the government, since independence, made ready quality health care that includes health facilities, schools, and a comprehensive package of low-cost, high—impact intervention to improve child health and quality survival. The breakthrough of the country’s great progress on the child mortality, therefore, happened as a result of a combination of methods. Normally, it was the responsibility of the Ministry of Health to immunize and care of children. Studies have revealed that the Ministry of Health immunized and reached 99 percent of children all across the country. Based on studies by the Ministry of Health, without immunization, two percent of children would have died from whooping cough, three percent from measles; one percent from tetanus and point five percent would have been crippled from polio; and 20 percent of children would have missed their lives from neonatal tetanus. However, with an intensive effort made by the government, Eritrea is now Polio free country.

Measles, on the other hand, has been the major cause of children’s mortality in the world making the death of millions of children between the ages of five and 14. As to the case of Eritrea, there used to be high death rate of measles before independence, took the lives of thousands of children. Whereas, after independence, the number of immunized children steadily increased, bringing down the presence of the disease to almost zero at the moment, to the level where Eritrea received an award, in Hanoi, Vietnam in 2008. Measles, therefore, has been effectively controlled. It poses no more threat. Thanks to the Ministry of Health of Eritrea and its counterparts. To date deaths from many communicable diseases has become history.

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