The health system in Gabon includes: the traditional health
sector, and the two major types of service providers namely the civilian public
sector which is part of the public health and hygiene ministry, and the private
health sector (Bourgarel, 2010:9).In the traditional health sector, health
services are often provided by private individuals usually known as
`marabouts'. Traditional health services make use of traditional plants and are
practised in most villages within the country (Global Health, 2012).
In the public health sector, health services are usually
offered by the state or government. Medical personnel in public hospitals are
often employed by the government. The state is the main provider of resources
and finances in public hospitals; it ensures control over the delivery of
medical care to the people. In the private health sector, medical services are
delivered by private entities, different from the government. Private agents
have control over resource allocations and finances in private hospitals.
Employees in private health care are often employed and remunerated by private
units (National Department of Health, 2006).Despite massive transformations in
the medical industry to force executives of both private and public hospitals
to improve service quality in hospitals, there is still a huge gap between
quality service delivered by private and public institutions (Holder, 2008:59).
Given the fact that competition has increased in the Gabonese health sector and
that health service quality has become crucial to increase market share, this
study will focus on health services. It is worth investigating medical services
since it may help to develop strategies to enhance health services in hospitals
(National Department of Health, 2006).
2.4.1 Public health development initiatives in
Gabon
Public health is dominating in Gabon, however, accessibility
and availability of proper medical services are mainly found in urban districts
compared to rural regions. Hospitals in urban districts are more organised with
more resources and technical know-how (Bourgarel, 2010:10). Over 60 per cent of
public hospitals and clinics are located in major cities such as Libreville,
Port-Gentil and Franceville. These facilities also receive more equipment, as
well as human and financial resources from the state. However, small health
facilities like Mother and Child Centres, Primary Care Health and Health
Medical Centres are usually found in rural regions. They are usually
characterised by
24
lack of drugs and medical equipment availability. In fact over
70 per cent of medical personnel such as physicians, nurses, midwives and
pharmacists are located in urban districts' hospitals (National Department of
Health, 2006).
To fight the spread of HIV/Aids, tuberculosis, malaria and
sexually transmitted diseases (STDs), the government created 17 national health
control programmes in both urban and rural districts between 2009 and 2010. The
goal is to assess the spread of these infections and to establish an effective
vaccination programme of the population. In addition to these efforts made by
the government, the Public Health and Hygiene Ministry established the CENAREST
(National Centre for Scientific and Technologic Research) programme to promote
medical and research training in the industry (Bourgarel, 2010:10).
The CIRMF (International Medical Research Centre of
Franceville) is another initiative established in 1979.The programme was made
possible by various international agents such as the World Health Organisation
(WHO), the Centre de Coopération Internationale en Research Agronomique
(CIRAD), the Institut de Recherche pour le Development (IRD), the Pasteur
Institute, the American Centre for Disease Control and Prevention (US CDC) and
various European, American and Asian universities. The programme aims to
investigate factors causing infertility in people in the Central African
region. Additionally, CIRMF expanded its research to investigate regional
infections like HIV/Aids, trypanosomiasis, malaria and the fatal Ebola and
Marburg viruses that severely affected the country lately (Leroy &
Gonzalez, 2012:159). The international non-governmental agencies have also
taken part in research for diseases in the country. Such organisations include
the Wildlife Conservation Society (WCS) and the Zoological Society of London
which are investigating co-operatively on diseases affecting great apes
(Bourgarel, 2010:10).
2.4.2 Private sector development initiatives in
Gabon
Since 2010, various efforts have been made to support private
investment initiatives by increasing the number and the size of private
organisations. The country is aware that export of oil, its main natural
resource, will not be the source for economic expansion eternally. Recent
strategies have been made to encourage the development of the private health
sector. Private hospitals have been lacking and almost inaccessible over
25
the years. The reason was that these facilities often lacked
proper strategies. As a result, more policies to build collaboration and to
attract investors were developed. The aim was to provide more private,
ultramodern hospitals to the population (Health, 2007:22). As a result, the
country has built relationship agreements with emerging countries like China,
India, Morocco and Singapore to boost investment in the private sector
including private hospitals and to create more jobs (Gabon, 2011:11).
Despite efforts made since 2009 by the Agence de promotion
des investissements privés (APIP) to support private investment, the
business prospect in the country has been very slow. This has been caused by
corruption, poor governance and the increase in the informal sector (Gabon,
2011:11). Health services in Gabon provide geographic coverage to most regions
of the state. The aim is to give people better access to health information and
efficient controlling of emerging sicknesses. Though the population of Gabon is
dispersed equally between cities and rural areas, accessibility to health
services is better in cities compared to rural areas, as more resources and
medical infrastructures are located. Though healthcare infrastructures in rural
areas are lacking, the state is trying its best to enhance and supply adequate
health services to the population residing in these rural areas (Republic of
Gabon, 2008: 42).
In Gabon, patients are usually required to pay for the
services delivered by medical professionals. Drugs are often costly in the
country and are usually not available in rural areas. Medical facilities in
rural areas are often badly equipped; patients usually need to go to the
closest city to get their medication. Instead of going to a city doctor, some
people may rather choose alternative treatment, like going to a local
traditional healer instead. In the case of severe medical conditions, people
can only be given care in Libreville, the capital city, where proper hospitals,
clinics and equipment are accessible. Public hospitals in Gabon are usually not
up to international standards, compared to a few private hospitals such as El
Rapha or the military hospital in Libreville. As a result, public health
facilities generally provide poor medical services to patients in contrast to
private ones. There are currently 49 available doctors per 100 000 people in
the country; this makes Gabon to be positioned number 9 out of 52 African
states in terms of doctor to patient ratio (Global Health, 2012). Private
clinics and hospitals are accessible in bigger cities, and they offer a broader
range of superior health services. However, these facilities are costly to the
population and hospitals generally require immediate cash payment before
patients can be treated and/or admitted. People either pay cash for treatment
or use a medical cover plan to have access to medical services.
26
However, two out of three of the people in Gabon live below
the poverty line, as a result, only a few people can actually afford access to
private health care services (Gabon Poverty and Reduction Strategy Paper,
2012:21).
Malaria is regarded as the major pandemic that affects most
people living in the country. HIV/Aids is also perceived as a continuous threat
in Gabon. There are frequent occurrences of Ebola virus that strike people
living in rural areas. This is usually caused by individuals who maintain close
interactions with infected animals. Having a medical insurance plan in Gabon is
regarded as one of the best options to tackle accidents, sicknesses and
emerging pandemics that can affect the population at any given time. Medical
cover policies generally provide customised individual needs to suit
individuals, families and groups. In addition, they can provide benefits for
inpatient, outpatient, dental, maternity, travel and many more conditions
(Global Health: 2012).
Health indicators data reports 500 nurses, 30 general
practitioners, 20 laboratory employees, 5 dentists, 5 pharmacists and 10
medical specialists for every 100 000 people. HIV/Aids occurrence rate in adult
population (15-49 year-old) is 5.9% which is 0.9% above the average sub-Saharan
region. Among the 49 000 of the population living with AIDS, 27000 (15 years
and older) are females and 2 300 (0-14years) are children. About 18 000
children in Gabon have lost one or both parents due to HIV/Aids. The occurrence
of tuberculosis is 410 per 100 000 individuals, and 41 out of 100 000 of them
die of the disease. The occurrence of diabetes among the adult population (20
years and older) is 4.4% which is 1.2% above the average rate on the continent.
158 out of 100 000 people die of cancer and 410 out of 100 000 people have died
from heart-related sicknesses (Gabon, 2010:13).
The International Diabetes Federation (2010) reports that
over 33 000 people suffered from diabetes and over 600 died from complications
caused by the disease in 2010. The occurrence of obesity was 2.3% for men and
15.5% for women. Over 380 000 people contracted malaria and 1 255 individuals
died of the disease during the same period. In terms of maternity death rate,
the country is still far behind other African countries such as Mauritius for
instance. Maternal death rate ratio in Gabon was 470 per 100 000 women giving
birth in 2011, in contrast to 24 per 100 000 women in Mauritius. This raises
awareness of the World Health Organisation which indicated that the maternal
mortality rate in Gabon could decrease by ensuring that pregnant women
27
and children could have access to adequate health care
services. This suggested that providing each woman with skilled care through
pregnancy and emergency, this assistance could significantly reduce the rate of
women and children mortality in the country (Gabon Poverty and Reduction
Strategy Paper, 2012:20).
