BISSAU, 15 December 1999 (IRIN) - The "Hospital 3 de Agosto" in Bissau is yet to recover from the pounding it received during the war between forces loyal to then president Nino Vieira and the Military Junta that rose up against him in June 1998 and ousted him 11 months later.
The main wing of the institution - viewed here as one of Africa's best before independence in 1974 - is now a deserted building, its walls damaged by bullets and shells. Much of its roof has gone. Its few remaining window panes are just jagged bits of glass. Before its front door stands the chassis of an ambulance that looks, too, as if it took a direct hit. Last year's shells also ripped into two orthopaedic referral wings, the national drugs depot and the national laboratory, located in the hospital's compound.
Only the orthopaedic, ear-nose-and-throat and stomatology sections of the hospital - which had already been going downhill before the war - are functioning, and they need rehabilitation, an orthopaedic technician and humanitarian sources told IRIN.
Like the Hospital 3 de Agosto, Guinea-Bissau's health system as a whole took a battering during the war.
The fighting led, for example, to a breakdown in the country's epidemic prevention system and by the end of December 1998, meningitis had broken out in Guinea-Bissau. About 2,900 people contracted the disease and 336 of them died, according to Fernando Larrauri, humanitarian affairs officer at the UN Office for the Coordination of Humanitarian Action (OCHA) in Bissau. The death toll could have been higher but about one million persons were vaccinated between February and May 1999.
Some cases of measles were reported as
well as respiratory diseases and communicable ailments such as scabies
that thrive on crowded conditions. Such conditions occurred when the bulk
of Bissau's 300,000 inhabitants fled the capital in September-November
last year. The displaced found shelter mainly in individual homes and,
according to a humanitarian
worker, as many as 45 people lived in the same house.
"Fortunately there was no cholera epidemic," Larrauri said.
The conflict interrupted a 'Plano Nacional do Desenvolvimento Sanitario' (PNDS-National Health Development Programme) launched not long before the hostilities broke out and patterned after the Bamako Initiative, a framework created by West African nations with a view to improving access to health care.
Under the Bamako Initiative, people pay symbolic sums for the use of public health facilities. This money goes towards covering the needs of the health centre at which the patient is treated. The centre can then use part of its proceeds to provide financial incentives for its workers.
However, the PNDS did not get off the ground and, as a result, people in Guinea-Bissau have had to continue paying the normal prices for services that many cannot afford.
The war also caused many professionals,
including health workers, to flee to Portugal and other countries, and
some have not returned, sources told IRIN. Not least among the incentives
to remain abroad is the fact that state-employed doctors have been earning
as little as 24,000 CFA francs - less than US $40 - per month, which is
equivalent to the price of two
50-kg bags of rice.
The low salaries have been one of the main problems facing the health sector in Guinea-Bissau. Another challenge is the low level of training of health personnel and those working in areas outside the capital have often complained that they need refresher training, according to Larrauri, who is himself a medical doctor.
Lack of equipment is another major handicap. Bissau's hospitals do not have any ultrasound scanners so people who need such services have to go to the town of Bafata, about three hours away by road. Some regional hospitals lack X-ray equipment and many health centres do not have basic facilities such as functioning wells and electricity.
OCHA found in its health situation report for July 1999 that in the northern region of Sao Domingos, for example, two out of seven health centres had no electricity, while the solar panels at four of the others were damaged. Only the largest centre, a 22-bed facility in the main town of Sao Domingos, had electricity.
The situation appears to have undermined confidence in the health services. "You can do anything in Guinea-Bissau but don't get sick," a local professional linked to an international non-governmental organisation told IRIN. "It's dangerous." Anyone who can afford it goes abroad, mainly to Dakar or Lisbon, if he or she needs medical attention, she said.
Various international institutions have been helping Guinea-Bissau's government to tackle the health sector's problems.
The UN Children's Fund (UNICEF) has, among other things, helped to strengthen primary mother-and-child health care, contributed to the rehabilitation and equipping of hospitals and health centres, and maintained and repaired transport vehicles and communications equipment.
The World Health Organisation (WHO) has, for example, provided scholarships enabling local professionals to attend training courses, conferences and seminars, helped to buy essential drugs and vaccines and assisted the country's AIDS/STD programme.
The UN Population Fund (UNFPA) has supported training, education and other programmes in the areas of reproductive health, family planning and AIDS/STDs. The UN Development Programme (UNDP), French Cooperation and Medecins sans Frontieres are also among the bodies that have been helping out.
At a roundtable held on 4-5 May in Geneva, bilateral and multilateral donors agreed to provide a total of just over US $13.2 million for the health sector in Guinea-Bissau in 1991-2001 as part of an overall package of about US $200 million.
However, the package was put on hold after Vieira's overthrow, pending presidential and legislative elections, which were held on 28 November.
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