After over 40 years of working experience in the medical, academic and management fields, Dr. Abdullah Abdulwali Nasher decided to retire and spend his time as a freelance consultant. Throughout his career, he has worked as a chief surgeon and director of several hospitals, minister of health and ambassador of Yemen to Canada. Nadia Al-Sakkaf interviewed Nasher during his recent visit to Yemen from Ottawa, Canada, where he lives most of the time.

As a former ambassador to Canada and an expatriate there, can you tell us what the image of Yemen is among Canadians?

Throughout my five years as ambassador and [those of] my friend Mustafa Noman before me, we tried to strengthen relations between Yemen and Canada and to get aid projects to support Yemen’s development.

There are Canadian companies investing heavily in the oil sector in Yemen and Canadian Nexen has done a remarkable job of introducing Yemen to Canadians and Canada to Yemen, whether through the educational scholarships, or the annual medical teams who come to Yemen to operate for free.

However, the Yemeni community in Canada is really not much. We do not exceed 2,500 people, and the number of highly educated Yemenis living in Canada is a small percentage of this number. Not many Canadians are in Yemen, and although last year the Canadian government agreed to increase its representation in Yemen to embassy level, because of the security situation this decision is on hold.

Perhaps when Canada has a fully operational embassy in Yemen and the number of active educated Yemenis in Canada increases, the relations would strengthen further and the two people would come to know each other in a better way.

We also do not have a Yemeni-Canadian friendship society, and perhaps creating one would help bring the two communities together. H. E. Khaled Bahah, our ambassador to Canada, now is doing his best and I am very optimistic that soon relations will be promoted and strengthened between the two countries to a new level.

But let me tell you that the Canadians who know or visit Yemen fall in love with our country. Last year the speaker of the senate visited Yemen and went back with very good impressions and was all praise for Yemen and Yemeni people. In February 2004, I thought of my friend Tim Mackintosh-Smith, one of the best travel writers in the world and who has being living in old Sana’a since 1982. I decided to invite him to Canada to speak about Yemen. He did come, gave lectures in Ottawa and Calgary Universities as well as in the Canadian Parliament. He also showed his and Badr bin Hersi’s film, “The English Sheikh and the Yemeni Gentleman.”

Tim spoke to Canadians with a western mind but from the heart of a Yemeni. He left them with best impressions about Yemen, the land and the people.

Also while I was an ambassador in Ottawa, I arranged for three Canadian journalists to come to Yemen on a tourism mission. Yemenia airlines took care of their tickets and the Shaher Abdulhaq group (Sheba Hotel) and Universal Group took care of their lodging and internal travel expenses. To date, not a single month passes without one of them writing something about Yemen.

How was your experience as minister of health from 1997 to 2001 and what were the ministry’s priorities in the health sector then?

I was enjoying a much simpler life as an academic and a surgeon before my appointment as minister of health. It was a great responsibility and, for a poor country like Yemen, there was much to be done in the health sector.

I am indebted to the trust President Saleh has put in me when he appointed me as minister. I also had a lot of support from friends inside and outside the country.

When I first started, I needed consultative and technical support and was given that through the help of experts through the British, Dutch, German and American embassies, as well as the World Bank. So I surrounded myself with a group of national and international experts on health planning and with my three deputies, Ali Al-Salami, Mohamed Garama and Abdulkarim Rasae, who is now minister of health, we created the first national reform strategy for the health sector.

We started this strategy in mid 1998 and it contained 12 components. We focused on decentralization as a main concern, whether financially or administratively.

I wanted to make sure that the ministry’s role was only policy, strategy, quality control and supervision and not implementation. And we could only achieve this if we strengthen the local and district level health institutions.

Our team, minister and three deputies believed in the strategic role of the ministry and not getting into details at district level. The ministry was responsible for primary health care and infectious disease control while making sure that executive bodies at the government and district levels were doing their jobs.

Another priority was to create and strengthen community participation. We installed a system whereby the patients pay 15 percent of the cost of check up, lab tests, x-ray and operations. Obviously the poor were exempted.

Also a priority was creating a system for community co-management, whereby the local community elects three of its members as part of the five member health district council. The other two members are appointed from the government. This council would manage the health affairs in the district and the local members, being the majority, had the power to change the government staff if they saw necessary.

By 2001, this system was operating in about 50 districts across several governorates and was working very efficiently, especially through coordinating the work of the health unit- center and district hospital.

Another component of the strategy is to grant autonomy for state hospitals. Instead of the director being appointed by the ministry, we created a board of trusties made of people who were interested in the health sector but had no interest in it to manage the hospitals. The board nominates a director and supervises the operation of the hospitals. We had started this system with one hospital before the project failed because of several factors including lack of support from concerned authorities for the idea.

We established a drug fund and the responsibility of managing medicines across the health sector was delegated from the ministry to the fund. We established four regional medical stores in Sana’a, Aden, Mukalla and Hodeida and we created an operating system for the fund similar to a private sector company.

The seed money for the medicines in the fund worth USD 18 million was donated mainly from the Dutch government and the rest came from the World Bank and the German government. We bought the medicines through international tenders for generic drugs so as to save in the budgets and we created bank accounts for all health institutions whereby the budget for medicines coming from the ministry of finance goes to the accounts.

The health institutions cannot withdraw from these accounts. What happens is that they request medicines and the fund provides them with the medicines and recovers the cost from the accounts automatically. We kept a margin of 40 percent for non-recoverable costs considering that the poor were exempted from paying for their medicines and at the time poverty rate was at 40 percent of the population.

Using this mechanism, we ensured an increase of at least 60 percent in the allocations for medicines each year is returned. This meant in seven years the allocation of medicines per capita would have reached USD 1.5, which is the international standard for poor countries like Yemen. Unfortunately, today this system is not working and the drug fund is almost dysfunctional.

Most of the strategies you mentioned sound great, but did not last. Why?

When we started the health sector reform we had great support from the president, prime minister -who was Dr. Abdulkarim Al-Eryani at the time- and from the various sector ministries. The team worked with national and international experts and the challenges were less drastic than they are today.

The Ministry of Health’s priorities today are the same as before and it should focus on the implementation of the health sector reform strategy, raising the standard of curative medicine, taking care of preventive medicine and primary health care, and reproductive health care.

You should keep in mind that the population today has increased significantly since 1997. Population growth is a great concern for me and I feel that this issue is like a time bomb. I must congratulate all Yemenis -and especially Yemeni women- on the passing of the minimum age of marriage law stipulated at 17. Because early marriage is one of the health hazards Yemen is facing and a direct cause of high fertility among women.

Today’s challenges are extreme and with the population growth and dwindling resources it becomes harder and harder to create change. But mind you, access to health facilities and coverage of basic health care has increased tremendously since 2001 and there have been many achievements since.

For example we started the polio eradication campaign in 1996. By 2002, WHO announced Yemen almost free. Today, it is announced as a completely polio-free country.

I want to take this opportunity to thank the president personally and all those who supported me during my work as minister of health.

You mentioned that challenges are greater because of dwindling resources. Do you mean that if more money came to Yemen, problems would be solved?

Money is important and is the basic issue for the implementation of any strategy. But an equally important issue is investing this money or resources in development. It is my belief that the one most important priority for Yemen today to solve its problems is investing in education, and especially basic education.

We should also focus on improving the standard of living of the people. This will only happen if there are more resources, whether financially or human, invested in the country and development projects are made a priority.

We also have to concentrate on technical education and vocational training. Currently, Yemen’s workforce structure is an inverted pyramid with many people with high degrees at the top and few vocational professionals at the bottom. There should be some strategic filtering in the educational system and not everyone should go to university or do higher studies.

Proper education will help improve the standard of living and poverty alleviation. And all this will eventually help make Yemen a more stable country with educated people whose concern is how to improve their lives and communities instead of going into distractive actions that are not natural.

How can Yemen work out its problems with the Southern Movement? And what about the war in Sa’ada?

Yemen today is facing a critical problem in the north with the Houthi rebellion, and I am optimistic that the government’s decision to end that rebellion this time will be final. This is the sixth war and enough is enough. We cannot afford a seventh or eighth war. I always believed in dialogue to solve problems but when the other side demands’ are not acceptable, you have to be firm in dealing with this.

As for the southern secessionist movement I am with the Yemeni unity with my heart and soul. Yemen should never be re-divided. Yes there are complaints about injustices and some are true while others are alleged but separation is not an option and differences should be solved within the unity. Separating Yemen will be a disaster which nobody can afford to have.

There was never a borderline throughout the history between North and South Yemen until the revolution of the North in 1962 and the independence of the south in 1967. The country was divided in two, with artificial borders and two governments were created. Brothers, sisters and husbands and wives could not see each other, and families were separated depending on which part they were in. On May 22, 1990, a dream came true and families reunited. There is no future for Yemen except united.

To solve our problems today we need to bring all stakeholders -the ruling party, opposition parties, wise independent individuals and civil society representatives- together to analyze, diagnose and come out with what is needed to be done. Violence and rebellion is not an option.