Health and Welfare

Health and Welfare

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.

Social Programs

Social programs generally benefited the wealthy more than the poor, subsidizing those who had access to resources and an understanding of public services. Public housing, a high priority under successive development plans since 1960, was an example of this trend. Most available public housing was in Abidjan. It was generally of high quality, so even with subsidized rents, it was beyond the means of poorer families. The result was government assistance to relatively high-wage earners.

Some World Bank programs were helping redress this imbalance by providing funding for low-income housing and low-cost transportation programs. World Bank assistance in housing in the late 1980s was also aimed at providing low-interest loans to enable families to purchase their own homes.

Social Problems

Through the 1980s, Côte d'Ivoire shared the concerns over poverty, unemployment, and crime that plagued developing and industrial countries alike. Human resource management was complicated by the large urban-rural ratio, however, and by population growth and economic recession. The cultural expectation of assistance through the extended family helped offset problems of unemployment, but high mobility within the work force resulted in more dispersed families, and this dispersal, in turn, contributed to rising problems of poverty and unemployment.

Poverty, population mobility, and ethnic and cultural diversity contributed to rising crime rates during the first two decades of independence. During the 1980s, statistics on white-collar crime--embezzlement, fraud, and misappropriation of funds--rose at a faster rate, and urban crimes such as robbery and theft generated widespread concern. In 1987 the president declared dishonesty and fraud a public disgrace and proclaimed his intention to wage a vigorous war against them. Drug abuse--primarily involving cocaine, marijuana, and heroin--was also declared a scourge against society, but the appropriate public response to these problems was not defined.

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