181. Implementation of the new health policy is supported by a human resources development strategy.
The State has thus stepped up the recruitment of paramedics, enhanced pre-service training courses at
the Faculty of Medicine and at the Higher Institute of Health Science, ensured further training of
national physicians in various specialities and in public health and increased as well as realigned salary
levels.
182. This resulted in a rapid increase in the number of healthcare workers which rose from 509 in 1999 to
2,353 in 2012 as indicated in the table below.
Evolution of medical and paramedical staff
General practitioners
Specialists
Registered nurses
Registered midwives
Laboratory technicians
Skilled technicians
1999
2012
23
10
53
31
15
10
149
58
285
175
75
260
Perspectives
2012-2013
75
13
207
114
63
171
Source: Ministry of Health
183. The general health situation has developed favourably since implementation of the five-year plans
particularly during the first PNDS as illustrated in population surveys (PAPFAM 2002 and EDIM
2006).
184. The health status of children has improved through Integrated Management of Childhood Illness
(IMCI) and progress made in certain vaccination programmes. As a result, there has been a decline in
the infant mortality rate (99.8 for 1,000 live births in 2002 to 67 in 2006), infant and child mortality rate
(127 for 1,000 live births in 2002 to 94 in 2006) and the incidence of fever (22.4% in 2002 to 5.9% in
2006).
185. Maternal health has also improved particularly in terms of contraceptive prevalence, all methods
included (9% in 2002 to 17.8% in 2006), pre-natal consultations (81% to 96.3%) and delivery at a health
facility (74.1% to 87.4%). It is also worth noting that the maternal mortality rate has dropped from 546
for 100,000 live births in 2000 to 300 for 100,000 live births in 2011 according to data provided by the
Ministry of Health.
186. The Ministry has also implemented successful programmes to combat communicable diseases and
hence reduce population morbidity and mortality rates. Regarding the fight against HIV/AIDS,
screening and care activities which were previously provided only in Djibouti-city have now been
extended to all regions since 2005. The HIV prevalence rate has thus been stabilized at 2.9% since 2003.
187. The decentralization of activities to combat tuberculosis has been essential in reducing national
prevalence. The number of directly observed treatment centres has increased from 8 to 20. Despite the
quality of care to patients, efforts to lessen the impact of this disease have been subdued by the
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