Health and Welfare
At independence the Algerian health care system was skeletal, consisting of one physician per 33,000 people (or an estimated 300 doctors in all) and one trained paramedic per 40,000. The approach at the time was primarily curative rather than preventive.
Since then the country has made tremendous progress in health care. From 1975 onward, a new system of almost free national health care was introduced. Hospitalization, medicines, and outpatient care were free to all. In 1984 the government formally adopted a plan to transform the health sector from a curative system to a preventive one more suited to the needs of a young population. Rather than investing in expensive hospitals, the government emphasized health centers and clinics, together with immunization programs. The results were impressive: whereas the infant mortality rate was 154 per 1,000 live births in 1965, it had fallen to sixty-seven per 1,000 live births by 1990.
By 1991 Algeria had about 23,000 physicians, or one for every 1,200 inhabitants, and one nurse per 330 people. About 90 percent of the population had access to medical care, and only in remote rural areas did people have difficulty reaching health care services. Algeria also had 2,720 basic health units, 1,650 health centers, thirteen university hospitals, 178 general hospitals, and eighteen specialized hospitals. Overall, there was one hospital bed for every 380 people. The average occupancy rate of hospitals was 55 percent, while the average length of stay was six days.
In 1993 most health services were provided by the public sector, although a small private sector comprising some 20 percent of Algerian physicians also existed. A network of hospitals and ambulatory facilities was organized into health districts. The districts consisted of a general hospital, one or more urban and rural maternity centers, health care centers, and dispensaries. These facilities were complemented by specialized clinics and teaching hospitals. Three regional public pharmaceutical enterprises oversaw the wholesale purchase and distribution of drugs, a public company imported and maintained medical equipment, and a number of pharmaceutical units produced a limited quantity of serums, vaccines, and other drugs.
Expenditures for this health care system increased at an annual average rate of 14 percent during the 1980s. Estimates for health services expenditures were 5.4 percent of Algeria's gross domestic product, compared with a 5.2 percent average for countries with similar middle income, and 7.2 percent for some of the lower income Organization for Economic Cooperation and Development (OECD) countries. Funding came from the state budget (20 percent), the social security system (60 percent), and individual households (20 percent).
Tuberculosis, trachoma, and venereal infections were the most serious diseases; gastrointestinal complaints, pneumonia, diphtheria, scarlet fever, and mumps were relatively common, as were waterborne diseases such as typhoid fever, cholera, dysentery, and hepatitis among all age-groups. Tuberculosis was considered the most serious health hazard, and trachoma ranked next; only a small minority of the population was entirely free from this fly-borne eye infection, which was directly or indirectly responsible for most cases of blindness. Malaria and poliomyelitis, both formerly endemic, had been brought under control. The incidence of disease was related to nutritional deficiencies, crowded living conditions, a general shortage of water, and insufficient knowledge of personal sanitation and modern health practices.
Medical training has been a priority for the Algerian government since independence. In the mid-1980s, the University of Algiers and the Algiers University of Science and Technology had schools of medicine, dentistry, and pharmacy; the University of Constantine had schools of medicine and pharmacy; and the University of Oran maintained a medical school. Medical training was also available at the university center at SÚtif. In addition, the government maintained public health schools for paramedical personnel in Algiers, Constantine, and Oran that recruited from secondary schools for their programs.
Medical schools have been graduating a large number of physicians: 800 to 1,000 annually in the first half of the 1980s, and even more in the second half of that decade. Several thousand women are enrolled in medical school. It is estimated that between 1990 and 1995 some 25,000 new doctors will graduate, the majority of whom will probably be unable to find work in the public health sector. The private sector was expected to expand significantly to absorb the large number of graduating physicians.
The Algerian government has made major efforts to train women as nurses and technicians since the mid-1970s. Two-year nursing courses at the secondary level are offered in Algiers and at several regional centers. Training for midwives is available in Oran and Constantine. Problems exist, however, with the paramedical staff. Since the mid-1980s, the ratio of nursing staff to physicians has dropped from 5.7 percent to one to 2.7 percent to one, in part because of low salaries, little opportunity for advancement, difficulty in recruiting good teachers for paramedical schools, and low compensation for those teachers. Furthermore, in an effort to reform the training system for medical personnel a number of those schools were temporarily shut down in the latter 1980s, further reducing enrollment in those programs.
Despite the threat of oversupply of medical personnel, a small percentage of foreigners has always practiced in Algeria. They come from France, Russia, Eastern Europe, and Vietnam. Their number, however, is declining rapidly. In 1986 there were 1,724 specialized physicians, 241 general practitioners, eight pharmacists, and nineteen dental surgeons who were not Algerian; by 1990 only 767 specialized physicians, sixty-seven general practitioners, one pharmacist, and ten dental surgeons who were not Algerian remained in Algeria.
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