The Republic of Guinea : planning for the year 2000 / Alpha Télli Diallo

THE REPUBLIC OF GUINEA Planning for the year 2000 by Alpha Telli Diallo " H ealth for all by the year 2000" is a slo- gan to be found at the end of most speeches and publi- cations on health in the developing countries. But more and more coun- tries, including the Republic of Guinea, have decided to place the slogan at the head of their speeches on national health policy. The objective is thus stated from the outset, and speakers and writers then go on to define the strategies and activities that are needed to attain it. One of the strategies developed as a result of close cooperation between Guinea and WHO (that is through WHO headquarters, the Regional Office in Brazzaville and the national office in the capital Conakiy) is a detailed exercise in health planning: the prepar- ation of a "plan for the development of the health sector in the Republic of Guinea 1990-2000," accompanied by a financing plan for the three years 1990-1992. The health profile of this country is similar to that of others in West Africa. Infectious and parasitic diseases pre- dominate, and health indicators remain well below the levels which could be attained. The government therefore asked WHO to assist national experts to determine ways and means of achieving the best possible use of resources allocated to the health sector. Carried out in the third quarter of 1988 and the second quarter of 1989, this exercise did not in fact start from scratch. In 1984, a document entitled "Country resource utilisation" ( CRU) had been drawn up by the Ministry of Picturesque but hardly efficient grinding of sugarcane. A national recovery plan for the Republic of Guinea gives high priority to energy and rural development as well as health. 22 Health in collaboration with consul- tants from WHO. It described the primary health care policy and strat- egies adopted and practised by the country, the resources available to the health sector and an outline of planned activities, including how many facilities were to be opened each year in order to provide acceptable health care to all communities of 600 to 1,000 inhabitants, at a price they could afford. Particular emphasis was placed on the need for an extensive network of village health units. No budget for this network was proposed, but given the country's limited human, material and financial resources, it was obvious that this scenario was unrealistic. The CRU was revised in 1986 by a joint Ministry of Health/ WHO team. But the new version still presented the same problems of substance. More- over, nothing was done between times to mobilise additional resources to meet the needs set out in these plans. The Ministry of Public Health and Population decided to concentrate especially on health planning and to programme all its activities. It set up a division of studies, planning, training and research in the area of health, and put together step by step a general health policy and a health develop- ment plan (1986), followed by two health action plans (1987 and 1988). A further revision of the CRU document was then envisaged by the two parties. This time the idea was not simply to update the existing docu- World Council of Churches © ment but to innovate in substance and in form, so as to produce a basic document whose provisions could today be realised in the short term. The conventional CRU format was abandoned and a "national health development plan" looking forward to the year 2000 was produced instead. The need for a document of this kind was felt at all levels of the Ministry of Health and by all its partners from abroad or from outside the system. The government then attached a plan for financing to see what the full health development plan would cost the nation. This involved arranging a meet- ing of donors fqr the health sector. In view of the country's social and economic conditions, the government has drawn up a national recovery plan, giving priority to road infrastructure, transport, mines, energy, water and rural development (to promote self- sufficiency in food). Reconstitution of the country's economic fabric will enable it to raise its income in the medium term (three to five years) and thus to devote greater resources to the social sectors, such as health, in the long term. For the transitional period, however, the government will appeal for foreign resources to finance the vital investments needed to bring about an improvement in the country's situation, hence the addition of an investment plan for 1990-1992. Dr Alpha Telli Diallo is Director of the Offi ce of Studies in Planning and Research , Ministry of Public Health and Population . Conakry, Guinea . These documents were prepared by a multi-disciplinary team comprising the directors of Ministry of Health departments and consultants from WHO, Geneva, who undertook a thorough analysis of the health sector in the third quarter of 1988, identified needs and selected priorities in con- junction with the national health authorities. The consultants returned to Geneva with a vast stock of informa- tion and the general outlines of a number of projects which might attract funds at a meeting of donors. The first version of the plan was written up in Geneva and sent to Guinea, where copies were distributed at all levels in the Ministry of Health and the other ministries involved - the Ministry for the Plan and International Coop- eration, the Ministry of Economy and Finance, the Ministry of National Edu- WOR LD HEALTH, March 1990 REPUBLIC OF GUINEA has as its neighbours Guinea-Bissau. Sene- gal. Mali. Cote d' lvoire and Liberia. With 95.000 square miles. it has 6.147.000 population. and its capital is Conakry. • cation and the State Secretariat for Decentralisation. In the light of the responses received, a second version of the document was reviewed by an impor- tant WHO Mission (headquarters, re- gional and subregional offices), and it was decided to bring in a new team of consultants to improve the economic and budgetary part and produce the document in a form suitable for a meeting of donors. This work was undertaken in close collaboration with national experts from the health and other ministries, and offered a valuable opportunity for nationals to gain experience in drawing up such docu- ments - one of the major concerns of the Guinean authorities. The result is a national health development plan (1990-2000) with a financing plan for three years ( 1990- 1992). Primary health care will be introduced in the country with six specific additional goals: - the establishment of a national epi- demiological analysis centre; - reinforcement of the national public health laboratory; - the strengthening of communicable disease control; - better facilities for making nutritional surveys; - setting up of a personnel re-training and documentation centre; - a study of traditional medicine with a view to integrating it into the national system of primary health care. The next stages will be the final editing, printing and publication of the document; arranging a meeting of donors; and preparing detailed plans of action for each of the projects adopted so that activities can rapidly be started. The government has already been assured of WHO's support in all areas (human and material resources) both from headquarters and from the regional, subregional and national offices. Besides mobilising external resources, this exercise has proved its worth by providing the sector with a long-term development plan, while team-work with competent experts has helped to improve national skills in health planning and has resulted in basic documents being drawn up for the health sector. • WORLD HEALTH. March 1990 Just imagine! by Charles Boelen " ~ 'm doing fine, thank you!" We were surprised to hear that from the dental techni- cian of a rural African hospi- tal, especially after the litany of complaints we had heard from most of the staff in the other depart- ments, some lamenting the lack of resources and others the difficult working conditions. But this technician was a ray of sunshine - and it was easy to see why: the single room he had to use as waiting room, office and surgery had everything. The dentist's chair had been put together from car seats salvaged from cars abandoned beside the nearby national highway. The chair could tilt and swivel, it had a foot-rest and a head-rest, all home-made with the help of a blacksmith friend. It was a triumph of ingenuity. The drilling machine had been made from a discarded hand-drill. True, this is just one anecdote, but it does teach us something. We cannot help but think that the health system, and consequently the health situation, of the poorest countries would be much better if all the people in charge Or Charles Boelen is Chief Medical Officer for Educa- tional Planning . Methodol- ogy and Eva luati on. WHO 's Division of Health Manpower Development Facilities are minimal in this East African hospital. Could they be improved if the people in charge showed more creative imagination? of health care had such creative imagination. A country, like an individ- ual, is on the road to development when it controls its own destiny, when it is in full possession of its resources, when it is able to remove the obstacles to its full realisation. Do the countries generally desig- nated as "least developed" really con- trol their destiny; are they today in charge of their own health develop- ment? Probably not. This is due as much to wastage of human and material resources as to general shortage of such resources; it can be attributed even more to lack of imagin- ation, or lack of encouragement to use imagination to make the best of resources. Plenty of reports attribute the critical health situation of poor countries to political instability, inadequate infra- structure, incompetent management, absence or migration of managers, chaos, natural disasters, even general indifference or pessimism, or a com- bination of these factors. Such reports are certainly revealing, but they are too gloomy and do not offer enough hope. Let us look more positively at the real potential for development that those countries have. The one natural resource that all of 23