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WEEKLY NEWSLETTER
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Ivory Coast
Index
Economic progress since independence outpaced
improvements in
the general health status of the population, despite
substantial
improvements in health conditions. As in other areas,
nationwide
statistics mask sharp regional and socioeconomic
disparities. In
the mid-1980s, life expectancies ranged from fifty-six
years in
Abidjan to fifty years in rural areas of the south and
thirty-nine
years in rural areas of the north. The resulting overall
national
average of fifty-one years represented a marked
improvement over
that of thirty-nine in 1960.
Infant and child mortality rates remained high in rural
areas,
where access to potable water and waste disposal systems
was
limited, and housing and dietary needs often remained
unmet. An
estimated 127 infants per 1,000 births died in their first
year of
life, a rate that fell steadily from 1960 to 1985. In 1987
one-half
of all deaths were infants and children under the age of
five.
Infectious diseases--primarily malaria, gastrointestinal
ailments,
respiratory infections, measles, and tetanus--accounted
for most
illness and death in children. Unsanitary conditions and
poor
maternal health also contributed to infant deaths. Close
spacing of
births contributed to high rates of malnutrition in the
first two
years of life.
In 1985 the nation had a generally adequate food
supply,
averaging 115 percent of the minimum daily requirement,
but
seasonal and regional variations and socioeconomic
inequalities
contributed to widespread malnutrition in the north, in
poorer
sections of cities, and among immigrants.
Public health expenditures increased steadily during
the 1980s,
but the health care system was nonetheless unable to meet
the
health care needs of the majority of the population.
Medical care
for wealthy urban households was superior to that
available to
rural farm families, and the health care system retained
its bias
toward curing disease rather than preventing it. Chronic
shortages
of equipment, medicines, and health care personnel also
contributed
to overall poor service delivery, even where people had
access to
health care facilities. In many rural areas, health care
remained
a family matter, under the guidance of lineage elders and
traditional healers.
Staffing policies in the health sector led to low
ratios of
doctors to patients and even more severe shortages of
nurses and
auxiliary health care personnel in the 1980s. In 1985
there were
6.5 doctors per 100,000 people, and 0.7 dentists, 10.9
midwives,
24.9 nurses, and 11.2 auxiliaries. For this same
population, 158
hospital beds were available, 120 of them in maternity
care
centers. In the northeast, these ratios were much lower,
and rural
areas of the southwest also received less attention by
medical
planners.
Maternal Health Care (MHC) centers taught classes aimed
at
reducing maternal and infant mortality. The World Health
Organization (WHO) and the United Nations Children Fund's
(UNICEF)
also assisted in programs to vaccinate children against
polio
myelitis, diphtheria, tetanus, pertussis, tuberculosis,
yellow
fever, and measles, and to vaccinate pregnant women
against
tetanus.
In 1987 the government began to implement testing
programs for
antibodies to human immunodeficiency virus (HIV), which
causes
acquired immunodeficiency syndrome (AIDS). By the end of
that year,
it had reports of 250 AIDS cases nationwide, most in urban
areas.
Although this number was small in comparison with many
nations of
East Africa and Central Africa, it represented twice the
number of
reported AIDS cases one year earlier and posed a
potentially
serious health threat. The government neither repressed
reports on
the spread of HIV nor treated them lightly. With French
medical and
financial assistance, and in collaboration with WHO's
Special
Program on AIDS (SPA), it began to implement blood
screening
programs and to establish public information centers to
meet
immediate needs. By 1988, however, no medium-term program
to
prevent the spread of HIV was in place.
The Ministry of Public Health and Population, which
bore
nationwide responsibility for health care planning, lacked
adequately trained personnel and information management
systems,
and it shared the urban bias found throughout much of the
government in the 1980s. It sought private sector
involvement in
disease prevention and declared the improvement of health
care
standards a national priority. At the same time,
historical,
ethnic, socioeconomic, and political factors contributing
to the
nation's health problems continued to complicate policy
making at
the national level.
Data as of November 1988
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