Yemen - What is GIS - World Health Organization

Health Systems Profile- Yemen Regional Health Systems Observatory- EMRO
not clear. Earlier this year, the MoF completely cut off financing for the Drug Fund,
noting that it had accumulated debts said to be over YR 2 billion for drugs it had
distributed and was supposed to have been paid for. After convening a workshop to
deliberate on the problems and alternative solutions, the MoPHP was able to achieve
a consensus on drug Drugs are to be given free-of-charge to persons suffering from
certain chronic diseases, like diabetes, tuberculosis, and malaria (it was estimated
that 30% of the total spending for “drugs and medical supplies” would be taken up by
these drugs);
2. Consumable supplies and medical appliances (disposable syringes, bandages, etc.)
would be supplied free-of-charge and would not be supplied from a revolving fund (it
was estimated that about 20% to 30% of total spending for “
drugs and medical supplies” would be taken up by these items); and Drugs from the
essential drug list would be supplied on a revolving basis and must be paid for, with
an exemption made for the poor (after exemptions for the poor, it was estimated that
an amount equivalent to 20% to 30% of the total drug bill would be recovered—and
revolved towards purchase of new stocks of the same drugs).
It was noted by one observer that this consensus was essentially an approximation of
practices that had developed up until that time. The Drug Fund, however, continues to
have no responsibility for ensuring that funds collected for its drugs are used only to
repurchase drugs from the Fund. In any event, the by-laws drafted by the MoPHP to
implement these policies have not yet been finally approved by the MoF.
Cost Sharing
In Yemen, as in many other countries, the health services are under a severe financial
strain, which cannot be resolved with the present budgetary allocations. The funds
provided for health care provision are insufficient and the burden of obtaining adequate
quality care is left to the individual patient, often at high cost. Budgetary allocations and
donor subsidies are spent to temporarily and partially alleviate the burden on the health
care consumer but the funds do not circulate back into the system to maintain even the
most basic services. To complicate matters, the funding available to the system is often
inappropriately allocated under inflexible budget headings, which often do not correspond
to local needs. Also, it is an open secret that there are hardly any health facilities where
the staffs, due to their low salaries, do not solicit "under the table" contributions from
patients. Cost recovery in Yemen is being initiated in order to resolve these issues and to
create the possibility to deliver essential health care services to the people at an
affordable price, with a fee system, which is both transparent and public.
In Yemen, the introduction of cost sharing has been facilitated by the publishing of the
official document, "Forward Looking Policies and Strategies for Health Development in the
Republic of Yemen", produced after the First National Conference for Health Development
in February, 1994. Following the publishing of this document, a task force of the Donors'
Coordination Committee in the Ministry of Public Health has elaborated the details of an
appropriate cost sharing system for the district level, and the draft for the law, which
covers this innovative policy. A Cost Sharing Guide has been prepared by this task force
in which the system has been described.
The objective of the cost sharing strategy in Yemen is to secure sufficient funds through
revenues from fees and charges for services in order to improve maintenance of facilities
and supply of drugs, as well as the motivation and performance of health personnel.
In contrast to private facilities, the government does not expect full cost recovery
through user charges. The government remains fully responsible for personnel costs,
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