Italian Cooperation in the country

Since 1980 Italy has been involved in the management, professional training and upgrade of services offered by the Balbalà Hospital, which is nowadays a reference health center of one of the poorest and most populous districts in the country. The initiative involved a considerable investment within thirty years (about 20 MEUR), allowing a marked improvement in the provision of basic health services and an increase in specific services (monitoring and treatment of chronic diseases, child & maternal services and therapy in a hyperbaric chamber) that make the hospital a center of excellence in the entire Horn of Africa. The activity of the Italian Cooperation focuses on the reconstruction of the existing hospital structure, on its expansion (building of a new in-patient and common services pavilion) and on its equipment (supplies and training on the new equipment), with an investment of over 9 MEUR only in the last years

At the moment additional 400,000 euros have been approved for the project entitled "Technical assistance for the improvement of the quality of the health services of the Balbalà Hospital", with particular attention to the provisions of pediatrics and maternal and child health services.

In addition, Italy participates to the initiative in favor of the Republic of Djibouti on the debt swap. The Debt Swap Agreement, signed in February 2006 and amended in June 2009, converted a substantial portion of the country's debt to Italy (over € 14 million out of approximately 50 total) in development projects.

The Italian strategy and the areas of intervention

The initiative "Technical assistance for the improvement of the quality of the health services of the Balbalà Hospital" was conceived to address operational and efficiency problems of Balbala Hospital health services in a systematic and integrated way, with particular attention to the departments of pediatrics and maternal and child health. The initiative is identified as the natural continuation of the project "New Balbalà Hospital" (AID 7923), in order to ensure the improvement of the quality of the services provided by the structure, particularly referring to maternal and child health, through a strategy that it moves on several levels: 

i. Reinforcement of the training program delivered to pediatric and gynecology-obstetrics staff, including frontal training on specific topics, on the job training, monitoring of the use of internationally recognized diagnosis and treatment protocols in the departments of pediatrics and maternal-infant health. In particular, thanks to the presence of the doctor responsible for the training, the program can provide an adequate response to the training shortages of local staff. This figure will be responsible for the selection and preparation of the training material, the selection of hospital personnel who will receive training, the logistics of meetings, the introduction and monitoring of the correct use of diagnosis and treatment protocols accredited by the scientific community and internationally recognized for the reference departments;

ii. support for the hospital management system in terms of human and financial resources; the first for the coordination of clinical activities and the empowerment of the role of the hospital as a reference health system of the Balbala district, the latter in order to ensure a constant availability of medicines, health and administrative staff, as well as equipment health and medical devices. The selection of an expert coordinator for hospital management will facilitate, among other things, the monitoring of equipment, pharmaceutical materials and health facilities for the proper performance of outpatient and inpatient activities in the departments of the new Hospital. In addition, this professional figure will work on the development and implementation of a health personnel regulation and on the setting up of a system for managing financial resources and hospital services in order to obtain an efficient system. The health information system will be strengthened and consolidated, improving the timeliness, reliability and quality of data collection. Indicators of quality monitoring, in particular of maternal and child health services, will be introduced in the data collection system. The local staff will be sensitized to the importance of data collection and trained on the methods of collection through training sessions;

iii. support to the development of instrumentation, medical devices and health technologies, as well as a guarantee of good functioning and maintenance in order to respond adequately to the needs of maternal and child health services. With the aim of guaranteeing the functionality of the equipment, a repair and maintenance team will be activated and will operate under the supervision of the biomedical engineer.

This approach will be possible by giving support and training to the local hospital staff and collaborating with local government authorities.

Alignment with the local government strategy and harmonization with donor community interventions

In Djibouti, almost 290,000 people, about a third of the total population of the country, need better and fairer access to basic health services. This number includes 222,088 most vulnerable people (those living in rural and peri-urban areas without or with limited access to health services, children under five, pregnant women), 32,500 asylum seekers and refugees and over 34,750 migrants. Out of them, the majority dies each year due to preventable and treatable diseases, such as acute pneumonia, diarrhea, malaria, measles, tuberculosis, HIV and non-communicable diseases.

In fact, access to preventive and curative health care in Djibouti remains a challenge, especially for children under five and pregnant women. In this regard, the National Development Plan for Strategic Book for Poverty Reduction (PRSP) edited by the International Monetary Fund, the National Initiative of Social Development (PND) and the Health Development Plan 2013-2017, support the importance of: (i) improving the organization, management and operation of the health system; (ii) adapting the operation and quality of health services to the needs of the population; (iii) aligning the financing and use of financial resources to the needs of the health system; (iv) developing human resources based on the needs of the health system; (v) increasing the availability, access and rational use of quality medicines.

The support to the new Balbalà Hospital will contribute, in line with the above government strategies, to solve the main challenges that the structure is facing: the poor level of knowledge of health workers regarding the adoption and implementation of internationally recognized diagnosis and treatment protocols for pediatric and maternal and child health departments, which limits the ability to offer quality health services; the lack of an efficient hospital management, hindering the functioning of the system, from the coordination of financial resources, to the monitoring, to the use and supply of medicines, materials and medical devices, to the improvement of the hospital data collection system. In addition, the lack of medical equipment and the absence of a repair and maintenance team, obstacles to the proper performance of outpatient activities and inpatient maternal and child health services.

The need to strengthen the health services provided both in terms of quality and management has also emerged from the analysis of the trends of the main health indicators and on-site need assessments carried out in collaboration with the Ministry of Health and the INMP during various years of implementation of the initiatives, respectively, "Nuovo Ospedale di Balbalà" (No. AID 7923) and "Support for the Djibouti programs for the health of women" (AID No. 9506). Therefore, the proposed initiative fully responds to the needs of the local population and government health priorities.

Goals and expected results

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