There are good reasons to believe that iron deficiency anaemia is a serious problem and that clinical and sub-clinical vitamin A deficiency may contribute to both child and maternal morbidity and mortality. It is also suspected that iodine deficiency is a public health problem. Public health services are inadequate in terms of coverage and the quality of care mainly as a result of severe limitations in management and financial resources. This has led to a large unregulated private sector offering services which, in many cases, are of dubious quality. The health sector operates without a policy framework or regulations, thus without safeguards for patients.
Public services are heavily dependent on donor funding.
Poor hygiene and environmental sanitation are major causes of disease among children, including the transmission of cholera, which is endemic. General standards of personal, food and water hygiene are observed to be very poor, as are urban sanitation and refuse management. Natural water scarcity has been aggravated by the destruction of water supply installations and by inadequate maintenance. Less than 30 per cent of the population have access to safe water. Less than 20 per cent of school-age children are enrolled in primary schools.