Last month, the Orotta College of Medicine and Health Sciences (OCMHS), located in Asmara, held its annual commencement ceremony. In total, there were 252 graduates (52 percent females) across several levels and different areas of specialty. In addition to being an extremely proud moment for the graduates and their families, representing the happy culmination of years of hard work and tremendous support, the day was also a special occasion for the entire and yet another powerful reflection of the country’s unwavering commitment to health.
Expanding capacity of health systems and training health professionals are national priorities.
Key planks of Eritrea’s national health policy, which aims to maximize the health and well-being of all citizens at all ages and seeks to ensure equity and access to essential health services, include broadening accessibility, expanding health infrastructure, and strengthening human resource development.
Over the years, the country has constructed and substantively renovated many health facilities: today, there are 335 health facilities distributed across the country (comprising hospitals, health centres, health stations, and clinics) – a nearly fourfold increase from 1991. Eritrea has also considerably increased the number of doctors and health professionals. The number of doctors has been raised from 100 in 1997 to 291 by 2021, while across the same time period, the number of dentists rose from 6 to 59, nurses from 625 to 1,474, assistant nurses from 1,220 to 2,918, dental therapists from 11 to 165, pharmacists and pharmacy technicians from 97 to 486, laboratory technicians from 99 to 517, radiologists from 28 to 132, physiotherapy technicians from 6 to 140, and specialized doctors from 5 to 74. Notably, the government covers the full costs of education, training, and salaries for all health workers, and there are no recruitment ceilings or constraints.
Health workers are at the core of Eritrea’s health success.
The improvement in the quality and quantity of health professionals, unfolding closely alongside the expansion in health-related infrastructure, has played a positive, significant role in Eritrea’s progress within the health sector.
For instance, the maternal mortality ratio has been reduced from 998 per 100,000 live births in 1990 to 184 in 2019 – an overall reduction of 82 percent. Also, from 1990 to 2022, the under-five mortality rate was reduced by 75 percent, dropping from 153 to 38, with the average annual rate of reduction estimated at above 4 percent – among the fastest in the world.
Similarly, tremendous progress has been registered in HIV/AIDS prevention and control. HIV prevalence among adults (aged 15-49 years) was approximately 0.4 percent in 2022, down from 1.1 percent at independence in 1991, while in terms of incidence, it has declined from about 1.37 per 1,000 uninfected population (across all ages) in 1991 to 0.06 in 2022.
The country is also transitioning from pre-elimination towards elimination of malaria, and there have been major inroads made against tuberculosis, hepatitis B, and neglected tropical diseases. Additionally, tremendous strides have been made with regard to national vaccination. The proportion of the target population covered by all vaccines included in the National Immunization Programme is nearly universal, with more than 95 percent of children fully immunized for their age. According to the United Nations Statistics Division, life expectancy at birth has shown improvement, rising from 49.6 years in 1990 to over 67 years at present.
These health-related developmental successes did not simply arise out of thin air. They did not unfold by casually wishing them to be. Rather, they are directly rooted in the nation’s longstanding commitments to and substantial investments in improving national health and well-being, as well as the tangible outcome of the selfless hard work shown by its health professionals. For instance, approximately 80 percent of the population lives within a 10-kilometer radius of a health facility and 70 percent within a 5-kilometer radius, which basically translates into greater levels of access – and well-being – for the population. Similarly, the expansion in the number of health professionals effectively means that there are more available in facilities nationwide, and that they are able to bridge the historically massive gaps that have prevailed between need and supply in many areas across the country.
The focus on health is key to fulfilling rights and closely associated with development.
Another important dimension of the nation’s investments in expanding health-related capacity and infrastructure is their close interlinkage with rights, as well as their strong association with socioeconomic growth and development.
The right to the highest attainable standard of physical and mental health is enshrined in several international legal instruments. It is recognized as a part of the right to an adequate standard of living, and it includes several essential, interrelated elements, such as availability, accessibility, acceptability, and quality. While there is considerable work remaining, Eritrea’s efforts and progress within the health sector are significant reflections of promoting and actualizing rights to health.
In addition to its rights dimension, Eritrea’s commitment to strengthening the health sector is also a strong step for securing the country’s future. During his opening address at the graduation ceremony, Professor Yemane Seyoum, Dean of OCMHS, elaborated on this point, stating that, “Globally, medical education is considered a vital field of study and it is one of the most significant investments that any nation can undertake in terms of its development. With good medical education, the health and livelihood of societies improve substantially. Quality medical education contributes to a country’s social stability and its long-term economic growth.”
Indeed, while a large body of work exists showing how wealthier nations and individuals tend to have better health, on average, than poorer nations or individuals, it is also well-known that healthier individuals are more productive and that better overall health can help drive socioeconomic growth.
Thus, Eritrea’s focus on strengthening the national health system is not only the “right thing to do”, in terms of its rights dimensions, but also the “smart thing to do”, in that it makes good socioeconomic sense and will help to underpin the nation’s development ambitions.