More prevention, less treatment / by Olivia Zemor

More prevention, less treatment "Wly job is to kill off the doc- tor!" Algeria's outspoken Minister of Health, Dr Djam- ai-Eddine Houhou was certainly exaggerating, but this is how he summed up his country's spec- tacular reversal of health pol- icy. "We have let ourselves be led astray by the old French sys- tem of health care, which we copied without seeing that it was inappropriate for Algeria," he explained . After the country's independ- ence in 1962, Algeria stepped up its constructions of hospitals and its purchases of medical equip- ment and drugs, and at the same time laid emphasis on university- level professional training for its physicians. Yet the country's 250 hospitals, 350 polyclinics, 1 ,000 dispensaries and 12,000 doctors trained in European or Algerian medical schools did not succeed in solving the public health prob- lems of a society which-despite its revenue from petroleum- still suffered from under-devel- opment; nor did the two billion francs spent annually on health services have any greater success. Infant mortality, though halved over the past 20 years, still stands at 80 per 1,000 live births, and one child in ten, a total of 86,000 per year, still dies before the age of five . One Algerian in two has no access to running water, and the water supply usually carries a high risk of diarrhoea! infection for babies. Vaccination coverage is low and , as recently as 1984, measles was still killing 10,000 children each year. Forty per cent of pregnant women give birth at home with- out help from qualified personnel, and mothers have an average of 6.4 chi ldren each, with conse- W oRLD HEALTH, April1987 by Olivia Zemor quent grave risks for the health of both mother and child. Dr Houhou commented : "The French population is an ageing one and has special needs as a result whereas in our country 73 per cent of the population is aged under 30, so we must concentrate on maintaining good health rather than filling hospital beds." He went on : "I know that a policy of prevention meets with a lot of resistance . Local authorities much prefer to inaugurate hospi- tals or schools rather than digging drains, and the people themselves prefer to look after their own ill- Few doctors want to practice preven- tive medicine-which none of them learnt at medical school. Photo CIRIC © nesses rather than taking steps to maintain their health. The doctors themselves refuse to get out of crowded hospitals and have no wish to practice preventive medicine which none of them learnt at medical school." So the Algerian government has given priority to tackling infant mortality, with particular emphasis on diarrhoea, infectious diseases and water pollution. lt has also stepped up childhood vaccinations against the six diseases, diph- theria , tetanus, whooping cough, polio, measles and tuberculosis. Henceforth, Algeria's public health policies will be geared to- wards preventive medicine, deli- vered through the primary health care approach, and the country will be thus better equipped to attain the goal of Health for all. •