WHO DPR Korea

Country profile 2007

Democratic People's Republic of Korea

Last update: 8th February 2007

Unless the underlying problems facing the health services in DPRK are addressed, the health gains of over a decade could be easily reversed particularly for the most vulnerable population.

Context

     The Democratic People’s Republic of Korea (DPRK) heath system is recovering after the setback the country suffered in the nineties. The population health indicators especially those of women and children started to improve. This was attributed to the improvement in the agricultural sector and to the humanitarian assistance of international agencies together with the Government’s thrust. However, with the limited capacity of the national health system to respond to the needs and the most recent economic and political developments including the imposed sanctions, sustaining the health gains remains a challenge especially for the most vulnerable population groups, women and children.

     Over almost a decade, the humanitarian assistance to DPRK achieved substantial progress towards meeting some of the very basic humanitarian needs of the population.  Chronic malnutrition was almost halved between 1998 (62%) and 2004 (37%). WHO’sassistance has supported the dramatic 95 % decrease in the number of malaria cases from 185,420 cases in 2002 to 9,300 cases in 2006. The TB (DOTS) treatment network was introduced and expanded to the whole country with a cure rate about 85%. This progress demonstrates that a well-targeted humanitarian assistance can have an immediate impact on the lives of vulnerable people.

      The most recent global health challenges like the SARS (Severe Acute Respiratory Syndrome) and the Avian Flu pandemics and, at the national level, Ryongchon Station train  accident  demonstrated the extreme needs in the health services which still requires substantial external assistance and extreme  preventive measures

     Despite the laudable public health indicators reached, the underlying problems facing the health services in DPRK are not yet addressed. For instance, in spite of the dramatic decline in the chronic malnutrition (stunting) rate, more than one third of children aged six and under in DPRK suffers from chronic malnutrition and about one eighth of children are severely stunted.

     Moreover, in 2005 the government decided to stop the humanitarian assistance and to move towards development-oriented collaborative programs. That resulted in difficulties for the UN agencies to raise the necessary funds to sustain the gains and respond to immediate needs.

Main Public Health Issues and Concerns

Health status

After years of progress in the field of health in the seventies, the health status of the population started to decline in the nineties. Many of the health indicators documented below have deteriorated and some of the morbidity and mortality figures increased by two to three-folds. Diarrhoeal diseases, acute respiratory infections and other childhood diseases together with malnutrition are the main reasons for childhood morbidity and mortality.

Diarrhoeal diseases

Contaminated water due to lack of sterilization materials, use of unsanitary latrines and unhygienic practices resulted in high prevalence of diarrhoeal diseases. That reinforces the cycle of malnutrition and contributes to high infant and child morbidity and mortality. The 2004 nutrition assessment did not indicate any improvement in the prevalence of diarrhoeal diseases. Piped water availability has been curtailed and is often contaminated because of the deteriorated infrastructure and distribution system. The treatment of piped water is no longer a regular practice due to lack of national budget. Women and children frequently have to seek alternative water sources.

Malnutrition

The 2004 nutrition survey results suggested an improvement on the nutritional status of young children since 2002 with the prevalence rates of stunting as 37%, underweight 23% and wasting 7%. However, malnutrition levels are still high as per the WHO standards. Furthermore, the nutritional status of mothers remained almost the same in 2004 as in 2002 with anaemia prevalence in more than 30% of women. The percentage of Low-birth Weight babies was estimated at 6.7% in 2002.

Maternal mortality

The maternal mortality rate is a major concern, doubling between 1993 and 1998. The reasons for this rise are attributed to deterioration of MCH service because of lack of supplies and equipment. The most recent figure is estimated at 97/100,000 live births.

Recurrence of Communicable diseases

     Malaria:Vivax malaria re-emerged in the Korean peninsula in 1998, starting from the borderline areas in the southern part of the country. Change in agricultural practices with less use of pesticides and the way the rice fields are irrigated, as an adaptation to the energy problems, might have contributed to the increased breeding of the vector. The number of malaria cases reached epidemic proportion in DPRK in 2001 with 300,000 reported cases, the number significantly dropped to 9,300 in 2006. This can, to a large extent, be contributed to the support provided to the malaria control programme, and is an example of how well-targeted humanitarian assistance was able to tackle an important public health concern in DPRK. 

     Measles: In 1999, the last nationwide supplemental measles vaccination campaigns were conducted in the Democratic People's Republic of Korea (DPRK), targeting children aged 9-23 months. Measles is one of the EPI vaccines and is delivered through PHC services.

     The most common child illnesses: in pediatric hospitals and wards were reported to be colds and flues, bronchitis, diarrheal diseases and meningitis in some institutions. Drug supplies are limited and doctors use traditional medicines to treat illnesses. Children suffering from malnutrition are provided with high-energy, fortified rice-milk-blend foods. The health institutions do not have sufficient resources to provide meals or snacks for in-patients and families are expected to bring food from home for their hospitalized children.

     Tuberculosis: TB is an important public health problem in DPRK. Following economic decline and natural disasters in the 1990s, there was a reported sharp increase of tuberculosis. The Government therefore decided to adopt DOTS as the national TB control strategy in 1998. A draft five-year plan for DOTS expansion was formulated in February 1998 with the assistance of WHO. A phased DOTS expansion began from November the same year. With GDF support, DOTS has, through five phases, been expanded to cover the whole country by the end of 2003. Additional financial contribution was received from CIDA but no more funding is foreseen beyond the end of 2006. There is an urgent need to find alternative funding sources.

The Health System

DPR Korea is geographically divided into 9 provinces and one municipality of the capital, 210 counties, and further sub-divided into smaller administrative units, as Ri (rural areas) and Dong (urban areas). DPR Korea historically has an extensive and comprehensive health system’s infrastructure. Under the management of the Ministry of Public Health, DPR Korea has a vast equitably distributed network of more than 800 general and specialized hospitals at the central, provincial and county levels, about 1000 hospitals and 6500 polyclinics at Ri and Dong, with an estimated staff of around 300,000. In addition to these health institutions, the Ministry of Public Health also manages the nurseries and the medium to large-scale pharmaceutical industries. At the very grass-root, a household doctor (section or family doctor) is providing health care for around 134 households in all aspects of health development, viz, curative, promotive, rehabilitative and preventive. Under each household doctor, there are 30-40 health volunteers representing each neighborhood, to assist him or her in health education and community mobilization. An overview of major health institutions and their relationships in DPR Korea is described in Annex 3. The economic downturn has led to the erosion of this extensive health care infrastructure. There are serious shortages of essential drugs and vaccines as well as essential medical diagnostic and surgical supplies and equipment.

Main Sector Priorities

The following health areas were agreed upon with the Ministry of Public Health as theNational Health Priorities set in for the next 5 years 2004- 2008

     Control and prevention of communicable diseases (malaria, tuberculosis, HIV/AIDS) including strengthening of the surveillance system and the public health laboratories;

     Immunizations and vaccines;

     Promote evidence based health policies and health care (clinical guidelines, rational drug use, traditional medicine);

     Strengthening of basic health services close to the community;

     Updating technical skills of health personnel and medical education;

     Blood safety;

     Strengthening of and technical and research capacity in public health and epidemiology;

     Health system development;

     Tobacco control;

     Increase the capacity of the MoPH to work in a partnership environment.

Water, Sanitation and Hygiene practices

Although all households have access to safe drinking water, safe drinking water is inadequately provided and time-limited due to the irregular power supply, malfunction of pumps and contamination of water due to erosion of water pipe. The Ministry of City Management (MoCM) noted that outbreaks of water-borne diseases, caused by secondary contamination of water in the pipelines, remain a major problem. Seepage during non pressurized hours is one major cause of decline in water quality. Testing and monitoring of water quality are regularly undertaken at anti-epidemic stations (AES) of the MoPH. Though standards for water supply and quality are comparable to the WHO guidelines, the AES lack updated and appropriate equipment and supplies, and their capacity is restricted due to lack of reagents. Moreover laboratory conditions are worsening and the staff capacity to collect and store water samples is limited.

All of the population is living in households with sanitary means of excreta disposal, but it is not perfect in quality in the view of design as well as sanitary science. The unfavorable sanitary conditions cause water-born diseases especially diarrhea.

People appear to be highly dependent on tap water and modern soap as a disinfectant. It remains unclear how the population is adapting to the shortages of both water and soap. Hygiene practices are likely to be compromised in urban areas that are most severely impacted by shortages in piped water supply. In rural areas, where human excrement is used as a fertilizer and regular washing is of utmost importance, hygiene is likely to be compromised by the shortages of water, soap and disinfectants The majority of the population relies on dug latrines. The danger of transmitting vector-borne diseases, overflow and contamination is significant with dug and open pit latrines. The location and flooding of open latrines contribute to the infiltration of sewage into water supply systems. In the early 1990s, the government made a concerted effort to replace dug latrines with flush toilets. However, water shortages have required the widespread change of flush toilets into pour-flush latrines.

Health Profile[1]

Health Actors

     Food security: WFP, FAO, UNDP, UNICEF, NGOs and bilateral donors;

     Health and Nutrition: UNICEF, WHO, UNFPA, IFRC, other international NGOs & bilateral donors;

     Water and sanitation: UNICEF, IFRC and other international NGOs;

     Education: UNICEF;

 Key documents

CCS-DPRK 2004-2008
WHO internal reports and updates (please also consult www.who.int/eha/disasters/)

UN-CAP-DPRK  200-2004 (www.Reliefweb.org)

 Disclaimer

The country profiles are not a formal publication of WHO and do not necessarily represent the decisions or the stated policy of the Organization. The presentation of maps contained herein does not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or areas or its authorities, or concerning the delineation of its frontiers or boundaries.

Annex 1: Contact details

Annex 2: Affected population

Populations of current humanitarian concern

Annex 3: Overview of the MoPH structure