By: Ismail Ali
Al-Ghabri
Yemen Times

Despite the reasonable improvements in health conditions in Yemen over the last two decades, the health sector is still facing huge challenges. These include a persistent high fertility rate (per woman high population rate of 3.7%) and a chronic shortage of health services (population per doctor ratio is 4348 to 1).
These challenges are reflected in the alarming health indictors, which recently revealed that the maternal mortality rate is between 80 and 100 per 1000 live births, and the infant mortality rates are 78.8 per 1000, which makes them among the highest rates in the world, attributed mainly to complications during pregnancy, child birth and malnutrition related diseases, hygiene, lack of sanitation and safe water supply.

The health sector is facing many pressing issues, especially difficulties in reaching rural populations, organization and management problems.
Only 55% of the population has access to medical facilities, while public health services in many rural areas are almost non existent.
The total patient-beds in 1996 in public hospitals were estimated at 11,337 nation wide, with significant disparity between urban and rural areas.

The government has made it a priority to make health services more effective and accessible to the most needy segments of the society, with emphasis on preventive health care such as immunization programs covering all the nation, family planning, nutrition and health education.
Public expenditure on health is relatively low, in 1996 the health care expenditure accounted for only 4% of the total public expenditure, and the re-current expenditures constitute more than 90% of the total, leaving only a marginal 10% for investment. Funds allocated for maintenance accounted for only 1% of the re-current expenditure.
Among the obstacles working against the efforts of the ministry of health are the growing sewage and sanitation problems facing major cities. Inadequate sewage treatment facilities result in the outbreak of diseases such as malaria and diarrhea.

Similarly, a clean water supply has become less available in urban concentrations due to the unsustainable exploration of ground water.
International assistance agencies and donor countries are heavily contributing to the health sector, especially in sponsoring nation wide immunization campaigns against the 6 main diseases, as well as disease control campaigns, but on the other hand too much aid is given for management upgrading and direct medicinal assistance which have not born their expected fruits.

In recent years, the private sector has invested in private hospitals and clinics. Their contribution is indispensable, but the standard medical service they offer is relatively low. This can be attributed to poor management skills and short experience, low qualification levels and in-consistency of the medical staff.
The low capital levels for investment are mainly due to the low income segment of the society. This is reflected appropriately by the low purchasing power of the patient, and subsequent relatively low profit margins made by these medical enterprises.
In contrast, the higher income segment of the society seeks very expensive medication abroad for even simple illnesses which can be cared for locally.

The government has allocated more than 300 million dollars annually to provide medical financial assistant for patients in need of treatment abroad in addition to providing these people with air tickets.
It is estimated that more than one billion dollars a year in hard currency is sent abroad for medical treatments.
There isn't a single world class private hospital in the whole country. A well organized and equipped hospital run by an international medical company would be a prime investment capable of reaping huge profits. The opportunity is open, and the government should provide facilities and permission. The oil companies, embassies and international companies travel abroad for simple problems due to the absence of a service they can trust.

As a conclusion, Yemen is in great need for good health services. We have one of the lowest standards in health and medical care in the world. The economic conditions of the country is one of the main obstacles of having health insurance and medical care provided by the state. In this case, the best and easiest alternative is to establish and run private enterprises that provide health care for the public. Prices may be high, but with more investment, there will be competition, and with more competition, there3 will be better services, and lower prices. Health care must be taken seriously and should be one of the most important focal points of the investment program of the government. If we want a better nation, we ought to make it a healthier nation, and for that to happen, the next step should be investment in health services.

It is self-evident that smuggling is one of the destructive and dangerous phenomena in our society. It has a negative impact on the economy of the country, and on development in particular. This phenomenon is really a haunting nightmare that has become part of our lives. What we find is that there are many smugglers who smuggle enormous numbers of goods that are against the regulations and laws of the country. What aggravates the situation is that there is no observation and accountability from the people in charge. This very much damages the economic situation of the country and affects the Yemeni consumer as well. On the other hand, it makes fortunes for those people who smuggle, and, induced by the great amount of money they get from it, they will do anything: bribing, killing, threatening, etc., to maintain and secure their self-interests. As a result of smuggling goods, we find that our products suffer much, and that is mainly because of the low prices of the equivalent smuggled goods and the heavy taxes imposed on our local ones.

Smuggling has lots of negative consequences in the economic and social areas. It can lay low the economy of the country. The effect of smuggling on the country at the economic level is estimated at around 60-75 billion Yemeni riyals in comparison with what would be gained from equivalent local goods. Moreover, the country loses around 5-6 billion Yemeni riyal in taxes that are not paid on the smuggled goods every year.

Smuggling takes different forms, such as smuggling cars, electrical devices, textiles, alcohol, drugs, various foodstuffs, etc. According to many studies we reached the conclusion that the ratios of smuggling goods may come to the following:
1- Cigarettes. The amount of smuggled cigarettes that exist in the Yemeni market is around 15-25%. This happens at a time when the local producer pays 42 riyals for each packet as taxation while the smuggled packet is sold for 30 or 40 riyals. Therefore the taxation income from cigarettes has halved from more than on billion riyals during the first half of the year 1998.
2- Various foodstuffs
The amount of smuggled goods existing in the Yemeni market is around 20-35%
3- Biscuits and chocolate.
The amounts of smuggled goods existing in the Yemeni market is around 30-45%.

Moreover, around 21 types out of 30 types of medicine are categorized among smuggled medicine. The amount of smuggled medicine over sea and land is around 75% of the total amount of the medicine coming to Yemen every year, indicated by some studies. This constitutes three times what Yemeni official organizations' import and equals one billion riyal. Smuggling has also resulted in the closing of around 27 companies and is mainly due to their products inability to compete with the smuggled ones. This is harmful in view of the growing taxation imposed upon them. As figures also show, we find that there is a reduction in the oil production in Yemen from 8700 ton in 1996 to half that in 1997 for the same reason. One of the Yemeni businessmen indicates the harmful effects of the smuggling on the economy of the country by saying that he used to pay 32 million riyal per month as taxation, but what he pays now is not more than 2 million riyals. The problem is that no one has ever asked why and how this reduction happened.

We used to have hopes that the private sector would help to enhance the economic situation of the country, as its interest in 1996 reached 350.8 billion riyals. However, smuggling and chaos became dominant, and the situation has really become hazardous. This is best seen in a report introduced by the manufacturing committee in the Parliament that indicates that this phenomenon is wide-spread, and the indifference of the people in charge constitutes a major obstacle in the prosperity of investment. What has been dealt with so far is the economic effects of smuggling, the social effects of this phenomenon can be pointed out in the following:
1- Reports indicate that 50-70% of sick people receiving treatment in Jordan are ill due to those smuggled drugs. Other reports show that 70-80% of common diseases in the country are caused by those smuggled diseases.
2- The closure of 27 factories and the horrible conditions of other ones that are in their way to be closed, will increase the burden of unemployment on our society and worsen the conditions of the sacked employees.
3- Seeing such conditions, so many investors tend to ignore and shun Yemen and look for other countries where they can safely invest their money. This makes the social problem more difficult and complicated.
In my point of view, if we want to put an end to smuggling, there should be sincere efforts to eradicate this phenomenon. In case the government is not able to do so, there is no need to put such high taxation on local products. This will be very beneficial in protecting our businessmen, our products, and the economic situation of the country as a whole.

Dr. Mohammed Abdu Al-Rasheed Ali
Aden University