In part, the urban crisis in Africa can be attributed to the region's poor macroeconomic performance. Migration has also played a dominant role in Abidjan's growth. This rapid growth has far outpaced the government's ability to provide urban services. Most wastewater finds its way to the city's lagoons, which are highly polluted. Deteriorating quality of life has had adverse impacts on health, such as a marked increase since 1978 in citywide mortality rates for infants.
Conditions are the worst for the very poor in Abidjan.
Health infrastructure has also suffered from neglect. While Abidjan has the highest concentration of trained health personnel in the country, there are still only 2 doctors and 5 paramedics per 10,000 inhabitants. Costs of medicine and health care are prohibitive for the majority of the population. The need for health care is becoming more urgent in the face of the AIDS epidemic. In Abidjan, an estimated 10 percent of adults carry the virus.