Yemen remains the poorest country in the Middle East. The levels of unemployment and illiteracy of Yemen are the highest in the Middle East, and amongst the worst in the world. Following almost a decade of internal conflict, millions of Yemeni people have been forced to flee their homes and seek refuge internally or abroad. Half the population are unable to meet their food needs, three quarters do not have safe water, and over 80% need some type of humanitarian assistance, with marked increases in severe acute malnutrition and limited availability of vaccines confounding the situation. The health infrastructure in Yemen has been decimated, and the future recruitment of healthcare professions has become even more precarious.
The authorities in Yemen recognize the importance of public health programs in reducing the incidence of disease, disability, and the effects of aging and other physical and mental health conditions. However, as with many other countries, public health in Yemen generally receives significantly less government attention compared with clinical medicine. Ideally, collaboration between local health and government agencies would improve public health; however, such
coordination arguably remains weak in Yemen. The lack of intertwined public health work means that practitioners continue to struggle, for example, in the provision of vaccinations which has led to an increase in the morbidity and mortality associated with communicable diseases. With the introduction of COVID19 in Yemen, many of these issues have become magnified.
The World Health Organization (WHO) has previously identified the objectives of public health as: providing leadership on matters critical to health and engaging in partnerships where joint action is needed; shaping a research agenda and stimulating the generation, translation and dissemination of valuable knowledge; setting norms and standards and promoting and monitoring their implementation; articulating ethical and evidence-based policy options; monitoring the health situation and assessing health trends. For Yemen in particular, the lack of resources allocated to public health surveillance programs has led to the detriment of early warning systems in the numerous public health emergencies present; therefore, this has led to serious challenges in implementing interventions towards meeting the necessary goals in averting or minimizing such risks. This is compounded by the fragility of systems to monitor and clarify the epidemiology of health problems, allow priorities to be set, and inform health policy and strategies; and thence to diagnose, investigate, and monitor health problems and health hazards within Yemeni society.
The weakness of public health surveillance has led to difficulties in identification and prioritization of many public health issues facing Yemen today, including not only communicable diseases such as cholera and diphtheria, but also non-communicable diseases which are increasing in prevalence in Yemen, such as diabetes and cardiovascular disease. For many in Yemen, focus on communicable diseases risks not underestimating the forthcoming rise in population level morbidity that is likely to develop due to non-communicable diseases.
As with many low resource countries, there is a significant disparity in health spending between Yemen and its richer neighbours in the Middle East: $73 per capita per annum in Yemen (less than that of the average for sub-Saharan Africa), compared to $1800 in UAE. Challenges to effective healthcare are as with many other low resource countries: fragility of public health infrastructures; lack of trained health workers; lack of governmental resources; and all this is multiplied of course due to conflict. Furthermore, expenditure on public health care is not the same as expenditure of healthcare; Yemen’s authorities must, like many others, make difficult choices as to their budget allocations.
The health of members of vulnerable groups in Yemen is further endangered by the pre-existing structures of health, and now more so by the conflict: maternal and child health, exacerbated by malnutrition and poverty, remain precarious; refugees and displaced people continue to struggle with adequate access; and the disparities between urban and rural setting becomes more apparent.
Training and continued clinical education (CCE) in public health and epidemiology (PHE) is vital for Yemen’s present and future aspirations of being able to prevent disease, promote health and provide cost-effective healthcare to its population. The cost-benefits of investing in public health initiatives, based on an adequately trained PHE workforce, would be significant.
We know that Yemen’s healthcare professionals are dedicated and knowledgeable but often lack opportunities to develop in areas that are needed for improving patient outcomes. We believe that the future of the health of Yemen’ population resides in the capacity of its healthcare professionals, and the more prominent the need for capacity building in a particular speciality to improve patient outcomes, the higher it ought to be as a priority for training; hence the need to prioritise public health and epidemiology (PHE). INTERYem does not wish to, and cannot replace, the training of PHE colleagues in Yemen, but rather hopes to identify gaps in expertise and training, and then to try to fill those gaps by exchanging ideas, sharing expertise, and building friendships, with partners from other countries.
The identification in gaps in expertise and training needed by colleagues in Yemen is very much demand-driven; training courses must be recognised as being required for the improvement of patient outcomes. The development of training courses in PHE should involve all stakeholders, including ministries of health and education, medical schools, universities, hospitals, students/trainees, and patients, so that a comprehensive understanding of the objectives for training can be met and delivered. However, PHE courses need to be resource-efficient and realistic in their ambitions. To ensure quality, PHE courses should be developed using appropriate training models and accreditation from external bodies sought (although the latter can be very expensive and time-consuming, and decisions need to be made as to the best use of spending funds). A key aspect of INTERYem’s PHE training is dissemination of the knowledge and skills developed by participants to other PHE colleagues within Yemen who are unable to attend courses.
Anticipated Audience