1. What is ERIPS, and what is Healthcare and Social services focus group?
The Eritrean research institute for policy and strategy (ERIPS) is an organization formed by Eritrean professionals and intellectuals in the Diaspora with a mission to establish research-based solutions to the social, economic and political calamities in Eritrea. ERIPS has organized its members by assigning them into areas of their profession and/or fields of expertise so that they would be more productive and induce meaningful impacts in the fields of their domains.
The healthcare and Social services focus group (think tank) is one of the 10 focus groups that constitute ERIPS. Its members are health care and social service professionals working together to research Eritrea’s healthcare and social service challenges and come up with recommendations that may contribute to mitigating the prevailing social and economic difficulties in the country. A substantial percentage of the Eritrean population is in the Diaspora. Hence, some of the potential recommendations and interventions could be applicable in our current circumstances; and others may constitute the long-term policies and strategies in a democratically elected future government of Eritrea.
2. What is the status of current Eritrean healthcare and social services?
The only definitive statement that can be made about the current Eritrean healthcare and social services is that it is very poor. Due to a very opaque system of governance, that does not permit independent verification and transparent review of any of its operations, detailed and reliable data is not easily attainable. However, there are several indicators that are evident from a distance. These include, the regime’s negative view of education and educators; exodus of skilled manpower including specialists; closure of health care facilities that were run by catholic nuns and prolonged economic misery and political oppression. These can be corroborated from family members still living inside Eritrea as follows:
A) People have difficulty of getting healthcare attentions in a timely manner. Most of the time people have to spend the whole day in line to see a doctor. According to publicly available data (Google) the physician to patient ratio stands at 6:100,000. The nurse and midwife to patient ratio stands at 75:100,000 as well. Follow up appointments are not easy to get and usually take months. In addition to closure of many heath care facilities, private clinics have severe restrictions in operations and limitations in spatial distributions. Moreover, these private clinics are not affordable for most, and neither easily nor timely accessible to those who may afford to pay the expenses. However, despite the multitudes of challenges and constraints they face, there is a strong sense of nationalism and commitment on the part of the health care providers that, they serve their people to the best of their abilities.
B) Lack of manpower seems to plaque the healthcare delivery in the country. Due to political hardships and mismanagements, most of the skilled workforce has left the country. Physicians trained in Ethiopia, pre-independence, who came to serve their country got discouraged and left the country in huge numbers. Those who came from around the world ended up leaving the country as well. The fate of the physicians, who graduated after independence inside Eritrea, is not any different either. Most of them have left the country with maybe less than 25% still working inside Eritrea. According to estimates of physicians who had been working in Eritrea until a few years ago, about 20% of graduates leave the country the first year after their gradation and in a matter of 5 years <20% remain in the country (it is anecdotal). Professionals such as nurses, pharmacists, Lab technicians etc. share the same story as well. This entails severe impact in the health care services in Eritrea, and it is evident that the Eritrean people are referred to the neighboring countries such as Sudan for relatively minor and major surgeries and treatments.
C) The quality of care as perceived by the population is poor. Examples given are:
a. There is lack of medical supplies and medications. Many people are told to ask their family members in the Diaspora to send them medications and other supplies as it is not available inside Eritrea.
b. Many times, the services (like some surgeries) are not performed in the country and those who can afford have to travel to neighboring countries to get some basic surgeries done. People, who cannot afford, which are the majority, must seek help from traditional healers or “holy water” and this exacerbates the treatable diseases.
c. There is very limited availability of advanced medical equipment (both diagnostic and therapeutic) and it is compounded by lack of skilled manpower to run and operate the equipment, if any. Example, according to physicians in the country, in the area of medical imaging, there is one MRI machine and one CT scanner in the whole nation (in the capital city Asmara). Electricity and water supply to healthcare facilities are not reliable either.
D) Transportation to healthcare facilities is a challenge and people especially in rural areas do not get the means to get to appropriate healthcare facilities in time. The healthcare centers near them cannot handle many medical conditions that, patients must travel to bigger cities (mostly to the capital city) for medical care.
E) There is lack of trained mental health providers. The only mental health facility in the country, St. Mary Psychiatric Hospital in the capital city, Asmara, is understaffed. The only psychiatrist, Rev. Dr. Futsum Gebrenegus, who was running the facility was arrested in November 2004 and has remained in prison, incommunicado, ever since. Currently, there is one other provider (a general practitioner who has spent many years treating mental illness) and probably few psychiatric nurses for the whole nation. Mental health is a worldwide contemporary issue. However, in Eritrea where: political oppression is rampant; economic misery is immeasurable; war and aftermath effect of war is a hallmark and family disintegration and human exodus is phenomenal, the Eritrean government did not invest in the mental healthcare of its citizens. Hence, the effect is evident everywhere including in the Eritrean communities in the diaspora.
F) Lack of peer review and quality assurance/assessment methods
G) Lack of formal accountability structure
3. How does this relate to the overall social and political situation of the country?
The overall health care and social services challenges are part and parcel of the overall challenges that plaque the country. They are interconnected and it is difficult to see one outside of the other. Lack of sanitation, water supply, economic development, social injustice, rule of law, freedom of movement etc. to name a few. While a tandem effort is warranted to alleviate all these hurdles, removing the brutally oppressive political system of PFDJ, which is the source of all the melancholies in the country, should be given priority. It is difficult to imagine a sound healthcare and social services to operate in a country where the political system is oppressive.
4. What are the available resources and infrastructure inside Eritrea?
Despite multiple assertions by the current president of Eritrea himself and many of his tentacles, Eritrea is not a very poor country as they want to describe it. At this time Eritrea is being impoverished by design: i.e. by the inefficient and misguided governance that it has. There are many indicators to suggest that this is purposeful. The healthcare infrastructure in Eritrea has not received attention as is the case in most of the institutions of the country. The hospital and health care buildings are mostly old and received minimal upgrading. It is undeniable that several health facilities were built and opened in different regions of the country. However, the overall political repression of PFDJ forced the health care professionals to leave their home country, and cross boarders to the neighboring countries and beyond. The fading and aging buildings remained overcrowded with patient and severely understaffed.
5. What is the role of Eritrean professionals, particularly those in healthcare and social service in solving these challenges?
The healthcare and social services focus group, as described above believe there are things Eritrean citizens and especially professionals can do to contribute to the betterment of Eritrea. Not all of them can be implemented at this time, but unless it is started now, it could be too late to fix many of these challenges. We believe that to treat a problem we need to diagnose it first (after all we are healthcare professional). Some of the challenges are apparent and many others are subtle and complicated. We do not think all will be approached at the same time, but one problem does not have to wait for the other to be diagnosed or treated, if possible. Hence; this is our suggestions for now:
i) Work with existing healthcare and social service-related Eritrean organizations and Poole our resources together. The Healthcare and Social Services focus group would support them in their efforts to address some apparent issues such mental health issues via education to Eritreans in diaspora and inside the country.
ii) Organize and/or support educational and training projects in the Diaspora.
iii) Gather data and establish database for research.
iv) Publish articles and scientific papers related to healthcare delivery with emphasis on Eritrean challenges.
v) Publish booklets, or electronic information to patients on major diseases and conditions affecting the Eritrean population. These booklets and electronic information will be based on established scientific data and international guidelines to inform and educate patients on their conditions, increase compliance and empower them in their healing process. These health education materials will be published in English and other Eritrean languages as much as possible.
vi) An attempt will be made to create a secure link with health care professionals who are still working inside Eritrea and support them with educational materials.