174. The law of 31 January 2001 redefined the structure of the health system in Djibouti which is based on
a district-approach and a primary healthcare strategy. From an administrative standpoint, there is the
central level (Office of the Minister, General Secretariat and central departments) and the peripheral
level (5 rural districts and 2 urban districts in Djibouti-city).
175. Healthcare facilities are organized in a three-tier pyramidal structure. In the public sector, at the base of
the health pyramid are Health posts (PS) in rural areas and Community health centres (CSC) in urban
areas, at the middle level are Medical hospital centres (CMH) which play the role of both regional and
district hospital, and at the top level are national referral facilities (CHN) and specialized facilities
(CNRS).
176. Following adoption of the public health policy, Djibouti established a strategic healthcare development
policy framework for the 2002-2011 period. Two 5-year plans were developed for its implementation.
The 2002-2006 and 2008-2013 National health development plans (PNDS) are an indication of the firm
determination of national authorities to give priority to the health sector for the benefit of populations.
177. In this regard, the Government significantly increased its budget allocation to the health sector in 2006
and is progressively moving towards realizing the Abuja commitment of allocating 15% of the national
budget to the health sector.
Period
2002
2003
2004
2005
2006
2007
2008
2009
Proportion health
budget / National
budget (%)
9.96
10.17
9.50
10.44
12.59
13.98
11.90
12.21
Source: PNDS 2008-2012 updated
178. To address the ever-increasing needs of the population, Djibouti has paid particular attention, with the
support of technical and financial partners, to ensuring the delivery of high quality healthcare that is
accessible to all through construction of healthcare facilities in both rural and urban areas. These efforts
help to bring users closer to healthcare facilities and reduce the dependence of inland regions on the
capital city.
179. In an effort to fully implement its community-based healthcare policy, regional hospitals have been
built and equipped with drugs and the necessary equipment. These facilities now have high quality
technical equipment including internal medicine, paediatric, gynaecology, emergency and ICU services.
They will contribute to addressing referral needs along with top-tier facilities in each region in
accordance with the standards of the health map.
180. Furthermore, health posts constructed in rural areas are supplemented by mobile teams to reach
populations in remote areas as well as nomads.
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