Health in Comoros

The Ministry of Health and Social Protection sets national policy, standards and resources. Regional health directorates coordinate services and hospital care, while health districts provide the main local contact point. Community health workers, known locally as agents de santé communautaire or ASC, support prevention, health promotion, mass medicine distribution and community activities. Services are delivered by public institutions, private providers, faith-based organisations such as CARITAS and military dispensaries. The three islands have different facilities and access conditions. The national network includes three CHRI regional hospitals, two national hospitals, three medical-surgical centres, three public hospitals, six health centres, five health and family-planning centres, eleven district health centres and sixty-three health posts. A 2020 assessment recorded 134 facilities, including 96 public and 38 private facilities: 66 on Ngazidja, also called Grande Comore, 51 on Ndzuwani, also called Anjouan, and 17 on Mwali, also called Mohéli. Bed access was much higher in urban areas than rural areas, and the island figures differed substantially. The CHU El-Maarouf hospital remains a current national priority for operational development. A person commonly starts with a health post, health centre or district health centre. Regional hospitals and medical-surgical centres handle more complex diagnosis and treatment. National hospitals provide higher-level services, but specialist diagnosis and treatment remain limited. When the required service is unavailable, an EVASAN medical evacuation abroad may be considered. Island-to-island transfer, ambulance availability and referral coordination can make urgent treatment time-sensitive. A national emergency telephone number could not be verified; the number 1717 was documented during the 2024 cholera response, but its current status is unclear. Prevention includes the national vaccination programme, malaria control, family planning, nutrition services and community health activities. The vaccination strategy for 2023–2027 covers routine childhood vaccines. In 2023, reported coverage included about 72% for BCG, 62% for the third oral polio dose, 80% for the first pentavalent dose, 75% for the third pentavalent dose, about 70% for the first measles-rubella dose and 79% for the second dose. Tetanus vaccination is provided during pregnancy. BCG and oral polio vaccination for children under one year are fully state-funded, while other vaccines receive state and GAVI co-financing. Family-planning services were available in about 60% of facilities, but method choice and continuity were affected by frequent stock-outs. Adolescent-friendly reproductive services remained limited. Pregnancy, childbirth and newborn care require particular attention. About 76% of births took place in hospitals and 82% involved skilled birth assistance, but only 60% of facilities had basic obstetric and neonatal capacity, 25% had newborn-care capacity and 7% had comprehensive emergency obstetric and newborn services in the 2020 assessment. Main risks include severe bleeding, infection after birth, pre-eclampsia or eclampsia, complications after abortion, malaria, HIV and tuberculosis. Premature birth, birth asphyxia and infection are major newborn risks. Postnatal follow-up can be delayed by communication problems and the customary 45-day period during which mothers remain at home after childbirth. Children under five are especially affected by malaria, acute respiratory infections, diarrhoea, HIV, anaemia and chronic undernutrition. Integrated management of childhood illness was available in 79% of assessed facilities, pneumonia care in 69% and malaria care in 49%. Diarrhoea affected about 17% of children and malaria about 14% in the cited assessment. The 2024 SMART survey found stunting in 24.1% of children and acute malnutrition in 7.8%, with strong differences between islands and districts. Exclusive breastfeeding during the first six months was reported at 23%. The Comoros has a high burden of infectious and non-communicable diseases. A cholera outbreak began on 2 February 2024; from February to July 2024, 10,342 suspected cases were recorded, including 9,126 on Anjouan. Cholera treatment centres, treatment units and oral rehydration points operated at district level during the response. Malaria has pre-elimination status, but transmission remains concentrated on Ngazidja and imported cases can affect Ndzuwani and Mwali. Non-communicable diseases caused an estimated 53% of deaths, with coronary heart disease, cancer, diabetes and chronic respiratory disease among the leading conditions. Diabetes and cardiovascular services exist in many facilities, but specialist testing and treatment are limited. Mental-health care is particularly concentrated. The documented system included one psychiatrist and one specialist mental-health referral professional, two psychologists and three island-based nursing focal points. Older-person care has no dedicated national programme. Follow-up after childbirth, chronic illness, mental-health treatment, wounds or rehabilitation is fragmented, and medicine shortages can interrupt care. There is no verified universal free-treatment system or unified national patient-tariff and rights platform. Fees depend on the facility, sector and case. Universal health coverage and an Assurance Maladie Généralisée scheme are policy goals, with a national solidarity and social-protection fund envisaged, but these arrangements should not be treated as a confirmed universal benefit. Check the service, medicine availability, expected fee and referral plan with the chosen facility. Equality of access and protection of vulnerable groups are stated policy goals, while practical duties include vaccination, hygiene, disease surveillance and seeking care promptly when programmes or clinical circumstances require it.