Health in Djibouti

The first point of contact is usually a health post (poste de santé), a health center (centre de santé) or mobile teams. A health post often works with a health technician (Technicien de Santé) and provides basic care, prevention, health education and follow-up. A health center is generally medically staffed and can take on more complex examinations and treatments. When more extensive care is needed, a referral (référence) is made to a medical and hospital center (centre médico-hospitalier, CMH), a district hospital or a regional hospital. These facilities treat, among other conditions, children, gynecological complaints and emergencies, and provide routine surgery as well as dental and eye care. National referral and specialist hospitals (CHUD) concentrate the most demanding care, which is particularly concentrated in Djibouti City. Preventive care includes routine vaccinations, antenatal and postnatal care, family planning, nutrition assessments, breastfeeding and infant-feeding support, and programs for HIV, tuberculosis and malaria. Depending on capacity, facilities also offer blood-pressure checks and other examinations for noncommunicable diseases. During treatment, services may include consultation, diagnostics, medicines, outpatient or inpatient care, obstetrics, surgery and emergency stabilization. In an emergency, the nearest suitable facility should be visited; the team there may stabilize the patient and refer them to a higher level of care. A single nationwide emergency telephone number or standardized ambulance service has not been documented for all locations. After discharge or treatment, further steps depend on the facility's instructions, the medication plan and the course of the illness. Chronic diseases, pregnancy, childhood illnesses, tuberculosis, HIV and nutritional problems often require repeated check-ups. Breaks in referral pathways, long distances, staff shortages or unavailable medicines can make follow-up care more difficult. When returning for care, treatment records, prescriptions and information about allergies and medicines already taken are helpful. The Ministry of Health (Ministère de la Santé) has central responsibility for health policy, regulation and supervision. Care is provided by public, semi-public and private providers. The 2023 national medicines list and central procurement through the central medicines procurement agency (CAMME) form the public supply system; pharmacies and private providers supplement it. Availability, substitute medicines and payment nevertheless depend on the facility, program and medicine. Formal mental-health services exist through the Ministry of Health, but capacity remains limited. An Atlas snapshot from 2020 lists one psychiatrist, one psychologist, 20 mental-health nurses and one social worker, as well as several outpatient facilities. It assessed integration into primary care as nonfunctional; during a mental-health crisis, access should therefore be confirmed directly with a suitable local facility. The legal system recognizes access to health care. AMU for employed people, AMO for active insured persons, PASS for certain households without income and a student AMU may, depending on eligibility, provide an access or payment pathway; registration and coverage should be checked with the National Social Security Fund (CNSS) or the relevant social-affairs authorities. According to available project documents, public services at the first and second levels of care are legally intended to be free for citizens and non-citizens, while tertiary treatment and medicines are often paid out of pocket. Current fees, exemptions and rules may vary by provider and program.