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“Our Cooperation with Other Countries in the Health Sector Focuses on the Development of Our Human Resources:” President Isaias

It is to be recalled that President Isaias Afwerki conducted a 3-day extensive interview from the 6th to 8thof September 2013, with local media outlets on pertaining domestic regional and international issues. Excerpts of the fifth part of the interview follow:

Mr. President, the role of communication and especially telephone and internet service is evident in this era of technology. Is there any plan to expand and develop these communication technologies?

We can see this issue from two points. The first one is the service that is being provided by Eri-Tel. Comparing the ability to communicate now with the past few years, we can say that Eri- Tel is doing a good job. But we have yet to reach to our intended goal. Communication service can be used for individual purposes and it can also be used in various development programs. In any case it is a great facilitator technological infrastructure. Our long held view is that there must be an effective communication web or system inside the country. The land line and mobile telephone service is progressing well. But ultimately the whole system needs to be interconnected with fiber. We could employ the service of micro-wave but in this era the best option has been found to be fiber. There is a fiber line in Asmara that passes through the Red Sea. There were also some projects targeting Africa and there are also other services owned by other companies. As service provider or consumers we have many options and we need to select the most effective and affordable one. We need to make a study of the market to determine the most appropriate one for us. We don’t have the fastest and more reliable internet service in this country that we can use for everything we need. Experts can study this but we have the fiber web or microwave as options. This is needed in order to make Eri-Tel expand its services in the country. Eri-Tel has employed this in certain cities. There are some technical reasons for it not to expand as needed. There could also be financial constraints but if the technical issue is solved, the financial aspects couldn’t be that difficult. At the moment the priority remains connecting all educational institutions and colleges through micro-wave. Communication is of great importance in educational institutions. Hence without being tied up by the issue of fiber, we need to first and foremost put in place a plan where computer labs all over the country’s educational institutions could develop and give satisfactory service. There is of course shortage of quality and number of teachers; there are schools that are not getting proper service due to their remoteness; there is shortage of libraries, workshops, laboratories, books and the likes. So to compensate for these shortages, communication and information technologies can play decisive role. We can transfer knowledge to 20 or 30 thousand students at a time through these technologies, as they can multiply our resources. To use these technologies to give such service in education we can increase the band width of the micro-wave while exploring the possibilities to employ fiber. So we are working toward connecting educational institution through micro-wave web.

Since one of the important use of internet is to form a connection within and outside the country, where educational institution form relation with each other and with other institution from outside the country; it is the priority of the country. The quality of education is the outcome of the endeavor towards improving it. And technology is one aspect of the endeavor that can make up for the shortages there of. There is a computer assembling facility and we are trying to equip every school with computers. So while the ultimate solution will come through stages of development, we are making efforts to alleviate, albeit temporarily, the shortages of communication technologies in our educational institutions for better outcomes.

Let’s pass to mining. There is an investment made in this sector. Can you give us a picture of those sites that are in production stage and the future plan in the sector as a whole? Also there is a lot of information from the web-sites of the companies involved in mining in Eritrea. But the government of Eritrea has chosen to be cautious in dealing with the issue. Can you give us your explanation?

I have commented a lot on this issue though I am not keen to do so. To give hope and to deceive are two different things. Do we really have to talk about some of these issues? The companies can talk about it as they want. The point ultimately is how much is the dividend of the government from the profit the companies declare? And how much can that cover from the government’s expenses? It is not difficult to guess just how big and costly all the projects we have mentioned before are. People would be left amazed if we talk about the sector in numbers. It is pointless to talk about high hopes without reasonable estimates and evaluation. We can talk about what the companies are saying or writing about. As a policy we should focus on programs that can bring about permanent and sustainable solution to our challenges than focusing our attention to the misconception that these resources will solve all our problems and become idle. We can’t put aside the major infrastructure projects that are underway just to alleviate temporary problems. The development programs we have mentioned and not mentioned so far demand 4 up to 5 billion dollars. To carry out all these depend on our income. The number the companies display cannot even cover the budget for fuel expenses for half a year. I can debate anyone who claims to have information on the matter if necessary. But what’s important is that no matter the magnitude the resources are being used for the right purposes and that there is no corruption or wastage. There needs to be careful plan as to use this resource for essential current and future programs. For instance we have mentioned about Massawa and Assab earlier. If we try to engage on programs that are not our priority we could incur opportunity cost. In light of our relation with the global and regional economy, this cannot be our priority. We cannot put this in the same level of importance as those of building water reservoir, road construction and energy programs. The execution of the program therefore can take time according to our capacity and ability. 

We don’t want to talk about it much but we are not getting our fair share from the mining because we didn’t have strong capacity all along from exploration to extraction, and hence we lose many shares we should have gotten. The countries engaged in mining are right to do so because it is very profitable. We don’t have any option as we have no expertise, technologies or facilities. Every expense is included in the cost and the share becomes less. This is one of the policies and issues that need to be revised. We need to have a clear picture about the management of our mines. There were explorations during the Italian colonial period and afterwards, and there are also an ongoing exploration projects. In order to determine our resources and manage them better we have to have strong institutions and system. We need to evaluate our experienceto determine the way ahead. How can we work with the companies in partnership? We will work towards developing our resources to improve our people’s livelihood by getting our fair share of the deals we are going to make in the future. We have acquired the expertise; we have technology, machineries and facilities. We learned a lot. We have managed to do this with the entire belligerence forwarded against us to curb the development of our mining activities. We will revisit our experience so far with the different companies we have engaged with or will in the future. But I can only wish that what people talk about all the money being made from projects like Bisha be true. Giving hope to people is one thing but deceiving them is wrong. The government doesn’t intend to deceive people with its policy. We don’t have government that steals or squander the resources.

Mr. President, the government has been subsidizing on basic consumer goods in a bid to facilitate people’s livelihood. Just to have a better understanding, how much do these subsidies amount to? And what is being done to mitigate rising prices, inflation and fluctuating markets?

We can talk in figures. In 2013 for instance, we had an expenditure of over USD 320 million for diesel, petrol, furnace and gas. This is a big chunk from our electricity and energy programs. How much furnace does the Hirghigo power plant consume in a month? And how much is paid for one kilowatt/hour? Customers, businesses, factories and industries, big or small they consume power but they can’t pay for it in dollars. We are selling in Nakfa what is bought in dollars: do the tariffs being charged cover expenses? You have to provide fuel in spite of the price fluctuations worldwide, but you can’t but fuel in Nakfa. These subsidies pose a big burden and challenge on the economy.

Most of our agricultural projects are run by the government. All the tractors require fuel to operate and so do the dozers and other machineries employed in the construction of roads, dams and other infrastructure. There are no immediate returns of all this fuel consumption but we are working with a belief that it will have contributions to the future economic development.

We should not look at the government as an abstract entity with unlimited resources. Many of our services are flabby but we are continually trying to improve them. If we take buses for instance, anybody can attest to the improvement of transportation services in the past 2-3 years. It may not be a big thing, because we don’t even have adequate road systems, but we are trying.

Subsidy is not charity; it should only be regarded as a long-term investment.

For obvious reasons, there are different social responsibilities in this country. There are the disadvantaged sections of society who fall under the government’s responsibility. Education for example is free for all. And so are health services. Apart from the locally produced medications, the price of drugs that the government imports in dollars doesn’t even come close to the revenues it gets. This is not something that the government does because it is generous. You shouldn’t even differentiate saying that it’s the job of the government or the people or the nation. All policies issued by the government belong to the people.

The solution at the end is to boost the productivity in every sector. There is no such thing as “for free,” the nation as a whole needs to work and avoid unnecessary expectations.

The national commercial revenues have a significant role in creating great job opportunities for citizens. Is the existing policy concerning business license really geared toward that objective? How will it be handled in the future? And in line with this, what plans are there to refine the taxation system?

This issue would need its own program because the rumors are too many. I was talking with various concerned authorities in the past 2-3 weeks. There should be a reference as to who is qualified to obtain a business license.

There is this document I wrote in 2009. “The question of who is entitled to a business license should be revised; the conditions that must be met for obtaining a business license should be known; all details should be pointed out, including the legal obligations that should be met; policies and even the forms used should be enhanced and redrawn…” this was the gist of the document. Had it continued in the way it was going, it would have probably gone astray.

Trade has to be purely trade and not that something you do in the sidelines. Anybody has the right. If one wants to engage in trading he can do so, as long as there is transparency and he fulfills all obligations and pays proper taxes.

In the end, you need to have the mechanisms to monitor the policies and procedure guidelines issued. If there are no monitoring bodies, you can’t say trade or investment activities are going well just because you have put in place good policies or good strategies. The worst thing is when those monitoring partners get involved in embezzlement and corruption. This has been discussed upon since 2009.

There is also the issue of contraband goods and illegal trading activities. It has already been 4 years since this became a serious topic. Because it’s a topic that demands more attention, I would rather not just touch the issue in a 5 or 10-minutes answer. And since it’s an issue that directly involves the people’s livelihood, I think it should be given more ample time for discussion with the people so they can have a clear image.

Mr. President, previously there have been two conferences held to promote investment. What has been done in their aftermath? Could you give us an elaboration on the investment opportunities, the nation’s unexploited resources, and the expected domestic and foreign investments?

There should be not only an interview but an open forum for discussion. There is nothing like transparency. If the population at home and abroad is to participate in development, it has to do so aware and sensitized. You should not only issue policies but provide suitable ground and favorable environment as well. The past conferences set a good initiative in terms of that.

One can say I’ll invest in anything but he should be asked what his capacities are. He doesn’t need to necessarily have millions. The good will doesn’t hurt but it’s not enough. The concerned government bodies and the line ministries in particular need to draft roadmaps of the different investment opportunities in their respective sectors. And the media needs to focus on these lenient points.

The investment opportunities do not concern only those in the Diaspora or those with foreign currency or generally those with money. There are also those who can invest their intellect, profession or knowledge. If one has ideas but is short with money, and provided he finds someone who can lend him, then there is no reason why that person shouldn’t invest, work hard, return his loan and move forward.

Therefore, the investment opportunities are vast and the citizens at home should participate at large. I think it is a timely and important issue for you to organize an interactive discussion with the different concerned bodies and ask them for their investment roadmaps and what offers they have so far obtained following the conferences, so as to get a general image.

We will now move on to the health sector Mr. President. Eritrea has been lauded for showing commendable progress in the eradication of polio and malaria as well as in mother and infant healthcare with respect to the Millennium Development Goals. Yet, Eritreans are nowadays traveling to neighboring countries for better and advanced medical services. What is being done to improve or expand the existing health services?

The number is not that significant. Health service is among the principal demands and surely needs to improve in number and kind. There is a referral hospital in every region, with adjunct health centers everywhere. These could be fitted with the necessary medical equipment and medicines. But in the end it all comes down to the human resources. That’s the biggest challenge. What is the current status? Is the demand being met? When it comes to some grave illnesses or health problems that cannot be treated here, patients must be provided with services here. There were cases where patients were sent to the Middle East, Italy, Germany and other countries, apart from patients who went on their own for medical treatment. The government has the responsibility to look after the life of its citizens. If a medical service cannot be provided here then definitely that patient has to go abroad. And this applies to everyone and not a few privileged only.

The rumors that “there is no good health service here but abroad” are simply emotional and basically associated with perception. Just because you go abroad doesn’t necessarily mean you get the best treatment.

But what is the best alternative? With which countries can we collaborate? We can work together with Sudan in developing our human resources. There is a medical college and various training programs in this country. There is also the skill we acquire on top of the collaborations we have with Sudan, Germany, Italy, China and other countries. That’s the primary aim of these collaborations. The question of adequate medical equipment might come next.

We can share experiences by bringing foreign doctors and their equipment so they can work here and sending our doctors to work over there; their students coming here and ours going there and so on. It’s easier to send people to Sudan instead of sending them to far places and pay for their transportation and living expenses. Going to Sudan is like going to Tesseney, on top of its cultural advantages. The principal aim of these programs is like I mentioned before: the advantage of professional exchange.

However, this is not solving the basic medical needs at the national level. Therefore, if we are to boost our capacity in terms of medical supply, equipment and human resources at all levels, we need to incorporate them with the other development endeavors.

While in the same topic, Mr.President, private clinics are not permitted in this country. There are hospitals with excess number of physicians, negatively resulting in the hoarding of people in one place. Shouldn’t private clinics be allowed to operate?

I would rather you directed this question at the officials in the Ministry of Health. I can only share my observations. Medical profession, just like any other profession, has ethics and professionalism. The ethical side is much stronger.

Private clinics can function well. I say that the private clinics in Sudan are among the most successful experiences. But it’s quite ineffective to attempt doing so here just because it succeeded over there. First of all, there is no capability. A doctor can be called fully capable only when he has worked for several years under an experienced doctor after graduating from medical college. Otherwise, anybody will be able to open a clinic.

There are stories that doctors neglect you in hospitals but welcome you with open arms in their private clinics. Ethically speaking, why would you harm the public service? Why would you want to abandon it in favor of working elsewhere (in your clinic)? Is money all you care about? Why would you put people’s lives at risk? Do you even have the aptitude of a doctor? So many topics can be raised so it would be better if they were raised at another time.

One of the interesting television shows is I think the “Doctors on the Studio” program. Amid its challenges, I think it endorses the concept “prevention before cure.” It plays a role in raising the awareness of people. The advices the doctors give in the studio is like they are giving it to you in their clinics… so it should be encouraged. But this doesn’t mean that there should not be private clinics. If a private clinic can provide the services that public health institutions cannot, and if it makes its due contribution to the public heath, then there is no problem. But in our case, it should be handled carefully because it’s an issue that raises a lot of questions.

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