Towards a national health insurance system in Yemen Part 1: Background and assessments

Since the unification and the economic crises of the early 1990s, health spending had declined dramatically with consequent deterioration of the state guaranteed services. Widespread poverty is exacerbated by the side effects of the structural adjustment programmes adopted by the government. Today, Yemen’s health situation is one of the least favourable in the world, and more than half of the Yemenite population lacks access to health care. This is partly due to the lack of reachable provider facilities, mainly in rural areas where more than two out of three citizens are excluded from health care. The other relevant factor that affects accessibility is the inability of the poor population to pay for health care. Only a minority has access to any type of pre-payment scheme for covering personal expenditure in case of illness. The cost of treatment, the main determinant for having access to health care services, makes poor people drop out of the health system, which entraps them in a povertyillness cycle and has significant public health implications.