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Algeria
HEALTH AND WELFARE
Health
At independence the Algerian health care system was skeletal,
consisting of one physician per 33,000 people (or an estimated
300 doctors in all) and one trained paramedic per 40,000. The
approach at the time was primarily curative rather than preventive.
Since then the country has made tremendous progress in health
care. From 1975 onward, a new system of almost free national health
care was introduced. Hospitalization, medicines, and outpatient
care were free to all. In 1984 the government formally adopted
a plan to transform the health sector from a curative system to
a preventive one more suited to the needs of a young population.
Rather than investing in expensive hospitals, the government emphasized
health centers and clinics, together with immunization programs.
The results were impressive: whereas the infant mortality rate
was 154 per 1,000 live births in 1965, it had fallen to sixty-seven
per 1,000 live births by 1990.
By 1991 Algeria had about 23,000 physicians, or one for every
1,200 inhabitants, and one nurse per 330 people. About 90 percent
of the population had access to medical care, and only in remote
rural areas did people have difficulty reaching health care services.
Algeria also had 2,720 basic health units, 1,650 health centers,
thirteen university hospitals, 178 general hospitals, and eighteen
specialized hospitals. Overall, there was one hospital bed for
every 380 people. The average occupancy rate of hospitals was
55 percent, while the average length of stay was six days.
In 1993 most health services were provided by the public sector,
although a small private sector comprising some 20 percent of
Algerian physicians also existed. A network of hospitals and ambulatory
facilities was organized into health districts. The districts
consisted of a general hospital, one or more urban and rural maternity
centers, health care centers, and dispensaries. These facilities
were complemented by specialized clinics and teaching hospitals.
Three regional public pharmaceutical enterprises oversaw the wholesale
purchase and distribution of drugs, a public company imported
and maintained medical equipment, and a number of pharmaceutical
units produced a limited quantity of serums, vaccines, and other
drugs.
Expenditures for this health care system increased at an annual
average rate of 14 percent during the 1980s. Estimates for health
services expenditures were 5.4 percent of Algeria's gross domestic
product (GDP--see
Glossary), compared with a 5.2 percent average for countries with
similar middle income, and 7.2 percent for some of the lower income
Organization for Economic Cooperation and Development (OECD) countries.
Funding came from the state budget (20 percent), the social security
system (60 percent), and individual households (20 percent).
Tuberculosis, trachoma, and venereal infections were the most
serious diseases; gastrointestinal complaints, pneumonia, diphtheria,
scarlet fever, and mumps were relatively common, as were waterborne
diseases such as typhoid fever, cholera, dysentery, and hepatitis
among all age-groups. Tuberculosis was considered the most serious
health hazard, and trachoma ranked next; only a small minority
of the population was entirely free from this fly-borne eye infection,
which was directly or indirectly responsible for most cases of
blindness. Malaria and poliomyelitis, both formerly endemic, had
been brought under control. The incidence of disease was related
to nutritional deficiencies, crowded living conditions, a general
shortage of water, and insufficient knowledge of personal sanitation
and modern health practices.
Medical training has been a priority for the Algerian government
since independence. In the mid-1980s, the University of Algiers
and the Algiers University of Science and Technology had schools
of medicine, dentistry, and pharmacy; the University of Constantine
had schools of medicine and pharmacy; and the University of Oran
maintained a medical school. Medical training was also available
at the university center at Sétif. In addition, the government
maintained public health schools for paramedical personnel in
Algiers, Constantine, and Oran that recruited from secondary schools
for their programs.
Medical schools have been graduating a large number of physicians:
800 to 1,000 annually in the first half of the 1980s, and even
more in the second half of that decade. Several thousand women
are enrolled in medical school. It is estimated that between 1990
and 1995 some 25,000 new doctors will graduate, the majority of
whom will probably be unable to find work in the public health
sector. The private sector was expected to expand significantly
to absorb the large number of graduating physicians.
The Algerian government has made major efforts to train women
as nurses and technicians since the mid-1970s. Two-year nursing
courses at the secondary level are offered in Algiers and at several
regional centers. Training for midwives is available in Oran and
Constantine. Problems exist, however, with the paramedical staff.
Since the mid-1980s, the ratio of nursing staff to physicians
has dropped from 5.7 percent to one to 2.7 percent to one, in
part because of low salaries, little opportunity for advancement,
difficulty in recruiting good teachers for paramedical schools,
and low compensation for those teachers. Furthermore, in an effort
to reform the training system for medical personnel a number of
those schools were temporarily shut down in the latter 1980s,
further reducing enrollment in those programs.
Despite the threat of oversupply of medical personnel, a small
percentage of foreigners has always practiced in Algeria. They
come from France, Russia, Eastern Europe, and Vietnam. Their number,
however, is declining rapidly. In 1986 there were 1,724 specialized
physicians, 241 general practitioners, eight pharmacists, and
nineteen dental surgeons who were not Algerian; by 1990 only 767
specialized physicians, sixty-seven general practitioners, one
pharmacist, and ten dental surgeons who were not Algerian remained
in Algeria.
Data as of December 1993
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