Towards Achieving Health Security: MoH Launches NHP-2021

The Ministry of Health (MoH), Health Division at that time, first publicized its National Health Policy (NHP) in November 1991 through Hadas Eritra newspaper. The health policy focused on developing primary health care system and was based on the guiding principle of ensuring social justice. The MoH launched a health policy not more than six months after Eritrea’s liberation and has been developing and refining its policies further since then.

The 1991 health policy was based on the principles of social justice, equal distribution of services and opportunities, self-reliance and active participation of the people – guiding principles of the EPLF during the struggle for independence. After the liberation of Eritrea, these were the basic approaches followed for the delivery of a primary health care system.

Although building healthcare facilities and equipping them with qualified personnel and medical supplies is key to ensuring the provision of quality healthcare service, it is not sufficient. What is also needed is clearly stated policies and strategies whose implementation should be supervised and reviewed after which the policies are then improved.

When the 1991 NHP was reviewed it was found to be not comprehensive. In 1996 the MoH drafted a more detailed NHP that initiated the successes in healthcare that Eritrea has achieved. The policy and policy guidance of primary health care system was reviewed in 1998 based on the feedback and experience obtained from health facilities all over the country.

The 2010 Eritrean National Health Policy (NHP-2010) has served well in guiding the healthcare sector in its five-year strategic and annual operational plans at the sector and program levels. Now, almost ten years later, taking into account the new era of development that we are embarking on, the challenges of health care, including epidemics and pandemics, we face, the demographic changes that are happening as well as other national and international issues, it is high time that the 2010 policy is reviewed to see its progress and determine Eritrea’s next ten-year health policy direction that responds to the country’s national development aspirations. To do this, a newly drafted health policy has been in use since 2019. After it was reviewed extensively, the NHP-2021 has now been completed, awaiting publication.

NHP-2021 will be the third of its kind and will guide Eritrea’s healthcare for the next ten years, until 2031.

It promotes the enjoyment of the highest attainable standard of health for all as one of the fundamental rights of every citizen. The policy prioritizes the health and wellbeing of all, through universal access to affordable, quality and essential health services delivered through resilient and responsive health systems. Its mission is ensuring physical, mental and social aspects of health of the people of Eritrea by providing universal health coverage.

Right after independence, one of the priorities of the government of Eritrea was replacing the incapacitated health facilities it inherited and building new ones in areas where there had been none. NHP-2021 stipulates that the building of new health facilities by identifying areas where they are needed and expanding services to reach all citizens will continue.

The health sector’s goal and objectives cannot be met without making substantial progress in Universal Health Coverage (UHC), which is constituted by three policy directions. Hence, achieving UHC lies at the center of the policy priorities. The UHC aims to ensure that the country is able to (a) identify and plan to make available the full range of essential health and related services that the population requires, (b) progressively increase coverage with these essential health and related services by addressing access and quality of care barriers, and (c) progressively reduce the financial barriers that populations are facing when accessing these essential health and related services until there is equity and financial risk protection in the financing of services.

Achieving UHC will, in turn, require strengthening the health system to deliver effective and affordable services to prevent ill health and to provide health promotion, prevention, treatment and rehabilitation services. The strengthening of a Health system requires a coordinated approach involving improved health governance and financing to support the health workforce and access to medicines and other health technologies in order to ensure the delivery of quality services at the community and individual levels. As part of this, health information systems will be vital in informing decision-making and monitoring progress. Investments in these areas should seek to increase responsiveness, efficiency, fairness, quality and resilience based on the principles of health service integration and people-centered care. To strengthen the health sector and help attain its goals and objectives, the policy identified policy priorities in four action areas — inputs and process, outputs, outcomes and impact levels. These four priority action areas are rooted in an integrated approach toward the strengthening of the system and appropriate sequencing of actions for the best possible outcomes.

Health service in Eritrea is given on a three tier system. The primary level constitutes community health services, health stations, health centers and community hospitals. The secondary level includes regional referral hospitals and first contact hospitals while the tertiary level covers national referral hospitals.

Community based health service facilities are administered under the local administrations and local health representatives to serve 500-2000 people by a trained community health representative. The service they provide focuses on healthiness and preventing diseases, and they are mandated to give certain medications in accordance with their level and to oversee prescriptions.

A health station is an elementary health facility that provides basic health service and focuses on enhancing health, giving medication and preventing diseases. It is designed to serve from 5,000 up to 10,000 people. Some of the units that it comprises include delivery unit, OPD rooms, temporary inpatient rooms, pharmacy and laboratory. Based on NHP-2021 the health stations will be upgraded to health centers.

A health center is similar to a health station but with an increased capacity. It is designed to serve 50,000 – 100,000 people.

Based on NHP-2010, a number of health centers have been upgraded to community hospitals. And based on the new NHP-2021, the functioning health centers will be upgraded to community hospitals where they are needed. The remaining will continue to provide service with qualified health professionals as the lowest tier of the health facilities.

A Community hospital is the first contact hospital that oversees, supports and controls health institutions below (health centers and community-based health services) and is the highest health institution within the first tier of health system. It is designed to serve people between 100,000 to 200,000. Some of the services provided in this system include delivery units, operation, radiology, OPD, laboratory, inpatient units and pharmacy.

The second tier of health service includes regional referral hospitals and national referral hospitals. Regional referral hospitals are administered under the auspices of MoH regional branches and provide all kinds of medical services as the highest referral hospitals to the health institutions within their region. They can serve more than 200,000 people.

The tertiary level of health service includes the National Referral Hospitals in Asmara. At this level specialists give medical aid to patients who come from regional referral hospitals for higher medical service. Tertiary level health institutions serve as the highest level of medical institutions, training centers of health professionals and research centers.

Eritrea aims to achieve UHC, and the progress on several fronts is very encouraging. The following indicators demonstrate that Eritrea has been moving towards the attainment of UHC.

Eritrea has also been notably successful in the Expanded Program on Immunization (EPI), achieving virtually universal (98%) immunization coverage. It was awarded by Global Alliance for Vaccine Initiative (GAVI) on October 17, 2009 in Hanoi, Vietnam, for its high and sustained immunization coverage. In 2016, Eritrea was also given the 2016 UNICEF award in recognition of its outstanding achievement in vaccine management.

Eritrea has made a significant progress in securing mother and child care and in controlling and preventing communicable diseases. The plan is now to improve the quality and coverage of health services by retaining what has been achieved.

In 2019, virtually all women (96%) attended Antenatal Care (ANC) during their most recent pregnancy. This has shown significant improvement from 19% in 1991 to 98% in 2019, which is a 416% increase (five-fold). Moreover, around 71% of mothers gave birth in health facilities with the help of health professionals, a 1083% increase from 1991. A 2015 health and demographic study by the MoH shows that maternal mortality ratio was reduced by 69%. Child mortality rate for children below five years of age was 153 from 1000 in 1991 and was reduced to 40 out of 1000 in 2019, which is a 74% decrease. The mortality rate of children below age one was 94 out of 1000 in 1990, and a 2019 data reveals a 68% decrease. These remarkable achievements are among the few best in Africa.

As shown in the World Health Statistics Annual Reports (WHO, 2016), during the same period, the average reductions in Africa were 45%, 38% and 54% for maternal, neonatal and under-five mortality respectively. Life expectancy at birth, which is considered as a summative health indicator, increased by 35%, from 48 years in 1990 to 65 years in 2016 (62.9 years for males and 67.1 years for females), while the healthy life expectancy at birth was estimated at 57.4 years in 2016.

Eritrea was among the ten countries in the WHO Africa region that have achieved MDG4 in 2015, by reducing under-five mortality by two-third. If current trends continue, Eritrea is also one of the countries that are expected to achieve under-five mortality SDG target before 2030.

The prevalence of HIV in the general population was 0.93% in 2010. At this time HIV prevalence (in ages above 15) is estimated at 0.6%. Moreover, in malaria control, Eritrea is working towards pre-elimination phase. From 1999 to 2020, malaria-caused death was reduced by 98%. As a result, HIV and malaria prevalence has not only reduced to the lowest level, but are on the elimination phase.

But this doesn’t mean nothing remains to be done in controlling communicable diseases. Although most of the common communicable diseases have been significantly reduced or eliminated, some hygiene-related diseases continue to pose health risks. By gaining momentum from what has been achieved, the plan is to pay due attention to controlling and preventing communicable diseases. Moreover, the coronavirus pandemic has taught countries that communicable diseases can appear anytime and cannot be ruled out.

On the global level non-communicable diseases have been on the rise and caused 71 percent of deaths last year. Similarly, the trend is evident in Eritrea as the prevalence of non-communicable diseases and injuries are increasing, already posing a challenge to our health service delivery.

There are now emerging issues related to communicable and non-communicable diseases which include cardiovascular diseases, cancer, respiratory diseases, psychiatric conditions, congenital anomalies leading to double burden of diseases’. Road traffic injuries are high, mainly affecting the productive and young population, with increasing mortality levels over the years. There is no evidence of reductions in the trend of these diseases. On the contrary, malaria, tuberculosis and HIV-AIDS and pregnancy and delivery related deaths are projected to be retained at the current level or be reduced.

A life course approach is one of the methods the NHP- 2021 will work on to achieve a secure health for all citizens in all ages. This method is aimed at giving treatment starting from pregnancy, during the early childhood, adulthood to aging. The risk of non-communicable diseases increases with aging and other causes and a life course approach reduces this risk.

NHP-2021 aspires to increase not only the number of health facilities but also the quality of service provided. This is measured by the competence of health professionals, capability of health institutions and facilities, quality of medicines and medical instruments, demand and usefulness of health services, health policies, directions, plans and their implementation, capability of controlling and informing systems, administering, researching and studying.

The MoH has been working not only in expanding health service coverage but ensuring a clean and quality health service. It is important to acknowledge that a clean and quality health service is not a specific time target but a continuous process.

The third Sustainable Development Goal (SDG-3) of the UN is aimed at achieving “health and wellbeing for all citizens in all ages.” This has been primarily a mission of the MoH and is included in the NHP-2021. The fundamental aim of this goal is to achieve UHC by strengthening the health system at all levels (health facilities infrastructure, health professional training, medical supply, quality services and information systems).

The MoH will work in cooperation with other stakeholders to achieve the SDG goals directly related to the health and wellbeing of citizens. It will endeavor to respond to the Eritrea’s Vision to become a nation that is economically, politically, socially, culturally and psychologically well developed by building a resilient health care system.

Source: Ministry of Information Eritrea

Cameroon Clears Illegal Miners from Border Village after Landslide Kills 27

Cameroonian authorities say they are deporting more than 1,000 illegal gold miners on the country’s eastern border with the Central African Republic after 27 miners died in May due to landslides. Those being expelled include 400 Central Africans and Senegalese in the village of Kambele.

At least 300 illegal miners were forced by Cameroonian police and military to sit on the floor at the Kambele market square on Tuesday night this week. Among them are Cameroonians, Central Africans and Senegalese.

Alfred Kamoun is a 31-year-old father of two from the neighboring Central African Republic. He says he was forced out of a mining site called Boukarou in Kambele village.

He says he and his two brothers will no longer be able to raise $50 each night from digging and selling gold. He says while at the mining site they could dig at least 7 grams of gold each night. Kamoun says his son will no longer be paid $4 every night for supplying water to wash gold.

Kambele is a village in Batouri, an administrative unit located about 700 kilometers from Cameroon’s eastern neighbor, CAR.

On Monday local authorities at Batouri said 27 illegal gold miners died in Kambele village in May. Auberlin Mbelessa, mayor of Batouri says an emergency crisis meeting recommended the deportation of at least 1,000 civilians from the risky mining area.

He says no one can be indifferent when civilians are dying in gold mines, yet thousands of people continue to rush to mining sites which from every indication are dangerous. He says while deporting the illegal gold miners, rescue workers and Cameroon military will also search to remove corpses and save the lives of people who may still be trapped in the collapsing mines.

Cameroon said it deployed its rescue workers, military and police to Kambele to clear the area of illegal miners and make sure foreign illegal miners either obtain their residence and mining permits or leave.

The military is prohibiting miners from visiting risk zones where trenches dug to harvest gold are collapsing. Baba Bell, traditional ruler of Kambele says some civilians may have drown in trenches filled with water from heavy rains.

He says every year during the rainy season as from the months of April, so many gold mines collapse leaving many people severely wounded or dead. He says a majority of the victims are unemployed Cameroonian youths who flood his village in search of opportunities. He says several hundred foreigners from Congo Brazzaville, Central African Republic, China and Senegal are in his village.

Hilaire Kembe is a Cameroon illegal gold miner at Kembele village. He says it is impossible to know the exact number of dead or wounded people in May in Kambele.

He says miners do not report when they discover fresh corpses and human bones at mining sites because of fear that they will be held for several weeks at police posts for interrogations. He says several hundred villagers and foreign miners whose identities are unknown prefer digging for gold at night when Cameroon police and military retire to their barracks. He says it is difficult to know when the night miners are buried by collapsing soils.

Cameroon says some of the illegal miners are displaced persons fleeing the conflict in CAR and fleeing from Boko Haram terrorist groups on its northern border with Nigeria. Some are escaping from the Anglophone separatist fighters in the country’s English-speaking western regions.

The government has always prohibited unauthorized people from digging in the area. But many youths ignore the order saying that they are unemployed.

Source: Voice of America

Zimbabweans Protest COVID-19 Vaccine Shortages

Hundreds of Zimbabweans protested Wednesday about a shortage of COVID-19 vaccines as the country awaits more doses from China. The government wants to inoculate at least 60% of Zimbabwe’s more than 14 million people by the end of the year but has struggled to get the necessary supplies.

Claudina Maneni brought her 60-year-old mother to get her second vaccine dose Wednesday at Wilkins Hospital, Zimbabwe’s main COVID-19 vaccination center.

She was among people who arrived at 4 a.m. but waited in vain for hours.

The crowd demanded to see authorities and began to protest but dispersed upon hearing police were on their way.

Maneni says she wonders why Zimbabwe’s finance minister, Mthuli Ncube, has not imported more vaccines to avert shortages.

“That’s the problem with freebies. Shortages must affect those who want their first jabs,” she said. “I hear some private points are selling it. I will pass through to check. It must be them — government officials — taking vaccines to those places. They are not ashamed at all. There will be chaos here. Why did they call us to come for vaccination?”

On Wednesday, Dr. John Mangwiro, Zimbabwe’s junior health minister, refused to comment. Tuesday, he told state-controlled media that government would redistribute COVID-19 vaccines from areas with lower demand to those where uptake has been high to avert current shortages.

He said Zimbabwe still had more than 400,000 doses from the 1.7 million COVID-19 vaccines it got from China, Russia and India since February.

Updating media Tuesday about Zimbabwe’s COVID-19 situation, Information Minister Monica Mutsvangwa was mum about the shortages.

“As of 31st May, 2021, a total of 675,678 people had received their first dose of the COVID-19 vaccine and about 344,400 their second dose — this is across the country. Priority is being given to second doses,” she said.

After speaking, she did not field questions from reporters.

Calvin Fambirai, executive director of Zimbabwe Association of Doctors for Human Rights, says his organization is worried about the COVID-19 vaccine shortages with winter season approaching the region.

“The vaccine shortages could have been avoided if there was proper planning on part of the government,” he said. “Although we understand the limited availability of vaccines on the market, we have some countries like South Africa, which entered into bilateral deals with manufacturers. We cannot afford to rely on donations, government must be proactive and secure the vaccines for all Zimbabweans.”

Last week, Dr. Matshidiso Moeti, the World Health Organization’s director for Africa, appealed for at least 20 million vaccines of second doses for everyone who received their first shots on the continent to curtail a potential third wave of COVID-19.

Zimbabwe has 38,998 confirmed coronavirus infections and just under 1,600 deaths, according to Johns Hopkins University, which tracks the global outbreak.

Source: Voice of America

350,000 Victims of Goma Volcanic Eruption Urgently Need Aid, UN Says

Aid agencies say 350,000 people affected by the eruption of Mount Nyiragongo near the city of Goma in the Democratic Republic of Congo are in need of urgent assistance.

Mount Nyiragongo erupted on May 22, turning the sky a fiery red and spewing lava into nearby villages. More than 30 people were killed.

Fears of a second volcanic eruption caused a mass exodus from Goma of most of its 450,000 residents on May 27. Around a quarter of that population fled to the neighboring town of Sake in the eastern province of North Kivu.

The U.N. refugee agency left behind a team of nine people in the area to evaluate the needs of the displaced. The agency and partners immediately began distributing plastic sheeting, water and other aid.

The head of the UNHCR office in Goma, Jackie Keegan, says she and her team since have returned to Goma. Speaking on a video link, she describes the situation in the city as one of uncertainty and unease.

“Yes. I am scared of the aftershocks, of course. Less scared now than I was when the windows were shaking every minute, which was happening about four days ago. But—yeah, it is scary. We are living on an active volcano… Like everybody else who ran away from the volcano, we are trying to figure out how to be as useful as possible in a challenging time,” she said.

The International Organization for Migration reports the eruption has displaced more than 415,000 people, nearly half of them minors. Most have travelled to towns in the eastern DRC, while roughly 52,000 have crossed the border into Rwanda.

IOM spokesman Paul Dillon says about a quarter of those who have fled Goma are very vulnerable and in need of special aid. These groups, he says, include breastfeeding women, the chronically ill, pregnant women, unaccompanied children, the elderly and the disabled.

“Should the displacement last, it is essential that we consider how we are going to prevent the spread of epidemics, facilitate humanitarian assistance and get kids back to school. IOM is particularly concerned by the health hazards linked to the eruption itself, the displacement to areas with pre-existing outbreaks, the lack of access to clean water and the increased burden placed on health facilities,” he said.

Aid agencies warn that people in Goma are at increased risk of cholera, which is endemic in the region and easily spread in areas with poor hygiene and sanitation and insufficient clean water.

The World Food Program reports it has started providing emergency food rations to thousands of people displaced from Goma. Based on assessments carried out over the past week, the WFP says it aims to reach 165,000 people in three cities of refuge. It says additional emergency food assistance is being provided to Congolese who have gone to Rwanda.

Source: Voice of America

At least 55 Killed in Eastern Congo Massacres, UN Says

At least 55 people were killed overnight in two attacks on villages in eastern Congo, the United Nations said on Monday, in potentially the worst night of violence the area has seen in at least four years.

The army and a local civil rights group blamed the Allied Democratic Forces (ADF), an Islamist armed group, for raiding the village of Tchabi and a camp for displaced people near Boga, another village. Both are close to the border of Uganda.

Houses were burned and civilians abducted, the U.N. office for humanitarian affairs said in a statement.

Albert Basegu, the head of a civil rights group in Boga, told Reuters by telephone that he had been alerted to the attack by the sound of cries at a neighbor’s house.

“When I got there I found that the attackers had already killed an Anglican pastor and his daughter was also seriously wounded,” Basegu said.

The Kivu Security Tracker (KST), which has mapped unrest in restive eastern Congo since June 2017, said on Twitter the wife of a local chief was among the dead. It did not attribute blame for the killings.

“It’s the deadliest day ever recorded by the KST,” said Pierre Boisselet, the research group’s coordinator.

The ADF is believed to have killed more than 850 people in 2020, according to the United Nations, in a spate of reprisal attacks on civilians after the army began operations against it the year before.

In March, the United States labeled the ADF a foreign terrorist organization. The group has in the past proclaimed allegiance to Islamic State, although the United Nations says evidence linking it to other Islamist militant networks is scant.

President Felix Tshisekedi declared a state of siege in Congo’s North Kivu and Ituri provinces on May 1 in an attempt to curb increasing attacks by militant groups.

Uganda announced earlier this month that it had agreed to share intelligence and coordinate operations against the rebels but that it would not be deploying troops in Congo.

Source: Voice of America

Tanzania Activists Urge Government to Begin COVID-19 Vaccinations

The president of Zanzibar, a semi-autonomous region of Tanzania, has said his government will soon import COVID-19 vaccines. This puts the region at odds with the national government, which has yet to approve any COVID vaccine. Opposition parties are urging the government to allow vaccinations to begin.

Zanzibar’s President Hussein Mwinyi said Saturday that he will allow COVID-19 vaccines to be administered in the semi-autonomous region. He said the vaccinations, when they begin, will be both optional and safe.

Mwinyi said there will be nobody who will be forced to get a vaccination they don’t want. He added we should not accept people’s sayings that if you get vaccinated would die; all over the world, people have been vaccinated. He said we will bring in the vaccine and those who want it will be vaccinated and those who don’t won’t take the shot.

Former Tanzanian president John Magufuli, who died in March, denied the presence of COVID-19 in the country and dismissed the vaccines as unproven and risky.

The new president, Samia Hassan, accepts that the disease exists and has said she is looking to import vaccines. But still, weeks have gone by without any sign of vaccines being delivered to or administered in Tanzania.

Rights activists like Deogratias Mahinyila say it’s high time the government to follow the world’s approach in handling the infections.

He says what is being done in Zanzibar and here on the mainland should be done quickly and go with this pace. Mahinyila adds that Tanzania is not an island; whatever we are doing should match with other countries in the world how they are handling this.

Some citizens say vaccinations will reduce the fear of infections.

Dar es Salaam resident Jackline Thomas thinks the government should speed up allowing vaccination to be brought in Tanzania “because we all know that vaccination is the main weapon to avoid a person getting ill.” She says if a person gets the COVID-19 vaccine, that means the infections will not spread and we won’t live under fear.

After more than a year of pandemic, Tanzania still has no figures on the numbers of COVID-19 cases or the deaths caused by the disease.

Zanzibar’s president says he’ll import the vaccines by Saturday, although the details of the plan remain unclear.

Source: Voice of America

Morocco, Spain Trade Accusations of Violating Good ‘Neighborliness’

Morocco and Spain traded new accusations on Monday in a diplomatic row triggered by the Western Sahara territorial issue that led this month to a migration crisis in Spain’s enclave in northern Morocco.

Spanish Prime Minister Pedro Sanchez described Morocco’s actions in appearing to relax border controls with the enclave of Ceuta as unacceptable and an assault on national borders.

Morocco’s Foreign Ministry meanwhile blamed Spain for breaking “mutual trust and respect,” drawing parallels between the issues of Western Sahara and Spain’s Catalonia region, where there is an independence movement.

The dispute was sparked by Spain admitting Western Sahara independence movement leader Brahim Ghali for medical treatment without informing Rabat.

“It is not acceptable for a government to say that we will attack the borders, that we will open up the borders to let in 10,000 migrants in less than 48 hours … because of foreign policy disagreements,” Sanchez said at a news conference.

Most migrants who crossed into Ceuta were immediately returned to Morocco, but hundreds of unaccompanied minors, who cannot be deported under Spanish law, remain.

The influx was widely seen as retaliation for Spain’s decision to discreetly take in Ghali.

Morocco regards Western Sahara as part of its own territory. The Algeria-backed Polisario seeks an independent state in the territory, where Spain was colonial ruler until 1975.

Describing Spain as Morocco’s best ally in the European Union, Sanchez said he wanted to convey a constructive attitude toward Rabat but insisted that border security was paramount.

“Remember that neighborliness … must be based on respect and confidence,” he said.

Morocco’s foreign ministry said in a statement that Spain violated good neighborliness and mutual trust and that migration was not the problem.

Rabat added that it has cooperated with Madrid in curbing migrant flows and in countering terrorism, which it said helped foil 82 militant attacks in Spain.

The case of Ghali “revealed the hostile attitudes and harmful strategies of Spain regarding the Moroccan Sahara,” the ministry said in a statement.

Spain “cannot combat separatism at home and promote it in its neighbor,” it said, noting Rabat’s support for Madrid against the Catalan independence movement.

Separately, Ghali, who has been hospitalized with COVID-19 in Logrono in the Rioja region, will attend a Tuesday high court hearing remotely from the hospital, his lawyer’s office said.

Morocco, which has withdrawn its ambassador to Madrid, has said it may sever ties with Spain if Ghali left the country the same way he entered without a trial.

Source: Voice of America