Yemen is mostly in the news these days for its political transition. This has obscured a longstanding issue, the chewing of qat, which has equally important consequences for the country.
Qat is a mild narcotic leaf popular in Yemen and the Horn of Africa. Excessive qat-chewing has disastrous impacts on health, education, and productivity. We illustrated this for Yemen in a report we prepared in 2007 (see here). The situation today is probably just as bad, if not worse.
According to Yemen’s National Population Council, maternal deaths in Yemen are the highest in the Middle East. Barely a third of births take place with the help of experienced health workers, and barely a quarter in hospitals or clinics, meaning that most Yemeni women give birth at home with only the help of unskilled health workers, exposing them and their newborns to greater risk.
“Kefaya!” (“Enough!” in Arabic), was one of the main slogans in 2011 as people took to the streets and called for social justice. Although change has taken various forms across the region, the quest for social justice remains prevalent throughout.
One of the key ways to promote social justice is through better public services. As surveys suggest, social justice for citizens largely means equal access to quality public services such as healthcare and education.
It started with the first cries of “degage” that resonated across southern and central Tunisia to the streets of the capital in the winter of 2010. Through the ups and downs of Tunisia’s transition, one constant has been the citizens’ demand that the government listen to their voices and for greater accountability. Public opinion polls, banned under the former dictatorship but common today, rarely touch on bread and butter issues, such as how citizens feel about the most basic public services. One such issue is access to and the quality of health care, where systematic feedback from citizens has long been lacking.
Developing countries in the Middle East and North Africa (MENA) region spent 5.8 percent of their gross domestic product (GDP) on health in 2011, compared to 4.4 percent in 1995. On the surface, this rise in health spending may seem like MENA governments are prioritizing health. Yet, between 2006 and 2011 public spending on health as a proportion of government budget in the MENA region was the second lowest globally, after South Asia. As a result, the people are paying the price. Out-of-pocket expenditures on healthcare remained close to 47 percent of the total health spending throughout the period. These trends suggest that increased spending on healthcare is mainly due to increased private spending at the point of service and as such made health systems less fair and affordable for the people of MENA.
From the exhilaration of popular revolution to the tragedy of ongoing conflict, the Middle East and North Africa region has occupied a prominent place in the headlines. Yet there is another, often silent, drama that is not receiving the attention it deserves. It is playing out in both rich and poor countries, albeit in different forms. A series of alarming statistics reveal an ongoing deterioration in the overall health of the people of the region.
Blood pressures are rising in the Middle East and North Africa and they show little sign of cooling down. They began simmering over shishas in el kahawi (coffeehouses) in Tahrir Square, Eqypt; steaming over fried malsouka snacks in Habib Bourguiba Street, Tunisia; and bubbling over smoke filled debates at Pearl Roundabout, Bahrain. People from all classes and walks of life are equally affected.
Recently I attended a health strategy meeting, where indicators of health risks showed depression to be the top disease affecting women in the Middle East and North Africa but not men (where it was on average 7th place). In one sense, this is not too surprising because depression affects women more than men everywhere. On average, globally, depression ranks 6th for women and 16th for men. Still, MENA is unique.
What are the chances that Hania and Abdallah will have adequate access to basic services that are crucial for their growth and development? What are the difficulties that children like Hania face due to factors, such as gender, birthplace, and family wealth, which are beyond their control? How does Egypt perform in ensuring equitable access to basic services for all of its children?