Q: The Forum closed its doors a few minutes ago. What are your impressions of the event?
The subject was really timely and very important at this moment in time. The question is one of equity in the health service of any given community. It has been said that health is a right and if it is a right, it is a human right and if that is so, it should be accessible to all. Of course, there is always a difference between a wish list and reality; equity and reality. But it is a question of getting the best care possible to all. Forums like this one, I believe, are very important for addressing these kinds of issues. One approach is to talk about things, another to actually do them. I believe both aspects are needed when addressing challenges related to health. As a Minister of Health, I see how things are done in my country, but it is helpful to see how they are done elsewhere.
Q: This Forum has been an opportunity to hear health professionals and politicians talk about challenges and achievements in their countries. Dr. Frenk, Minister of Health of Mexico, talked for example about the health reform implemented in his country to make health services more accessible to people. How would you characterize the achievements and challenges in your country?
The situation in Eritrea is quite different from the one in Mexico. Indeed, for one, health services are available to all. Insurance is not an issue for the moment but will become one soon, because the cost is not sustainable. Also, Eritrea is one of the few countries in Africa where it has been possible to eliminate polio and to keep within a manageable range infectious diseases such as tetanus, measles, malaria and HIV/AIDS.
Now to the challenges... First, Eritrea is a transition state that has to increasingly deal with illnesses among its population such as diabetes, hypertension and cancer. These illnesses are very serious, extremely costly, very difficult to cure and constitute a huge burden to the health system. The best way to address them is to prevent them. If they occur, you have to manage them. As primary health care gets established, chronic disease becomes more an issue.
Second, the financing of municipal hospitals is a challenge. Indeed, hospitals represent the largest health expenditure of all in the national health budget. People talk about the cost of specific diseases, but in our case the overwhelming part goes to hospitals. Our greatest number of workers is in hospitals. This is one of the points that is least well understood, partly because it is complex and also because it is not easily accessible to theoretical work.
Third, health professionals, doctors, nurses need to be trained. If health facilities are not well run, you train health professionals in a way you would rather not. Training is fostering the future of health personal. It has implications not only for current issues at hand, but also for the future. Overall, applied research is very important as well.
And last but not least, when talking about the question of access, you are talking about enough beds, enough doctors, medications to respond to every need. Can catastrophic events be handled? This is a pivotal element and can be used as an indicator for services. On the other hand, such events can be so overwhelming other aspects might be forgotten, but in all events primary health care is important.
Q: Organizations such as Transparency International identify corruption as a stumbling block for the development of many African nations. How do you see the issue of corruption?
You are right: corruption is a major issue in many places, but not in Eritrea. I believe that in any institution, lack of accountability is poor management. If there is no proper evaluation, if there is no transparent result from any investment, you are opening yourself to abuse. This is true in wealthy countries. For countries that have less accountability is even more important. This means governance and intervention. But I believe that to some extent the question of accountability is also in the hands of donors. Indeed, those who are managing money do not always make sure that the money goes to the right people. Also, accountability is not only internal, but there also needs to be a method to measure it in a pragmatic way, in figures. This is so political that its impact and outcome is hard to measure.
Q: Another issue mentioned over and over again during this Forum is the brain-drain of health professionals. How can we stop it?
I am not sure that you can, but if you want to change something, you must look at the cause. The US and Western countries are in need of health professionals. They can get them. What can we do? We in the South need to make living in our countries viable. Many people moved from Europe to the US, because the conditions there were more interesting. This is also happening from Africa and Asia to Europe. If living conditions were better, if people saw that there is a decent living opportunity for them, they would be happy to stay. This is why we have got to work for a common cause together, for a better and brighter future. We have an obligation and duty to our country, but there are many reasons for people to move: insecurity, marriage and many more. Hence, there is not an easy answer to the brain-drain. Developed countries ought to help us train people. Developed and developing countries need to work together. There ought to be free movement of people. The brain-drain must be solved. Africa cannot continue to lose its best citizens. There is a lot of hardship. All of us are in this.