Based on the most recent statistics, the infant mortality rate per 1000 live births is 9.4 (1996) and the maternal mortality rate is 3.9 per 10 000 live births (1996). Also, the crude birth rate was 21.6 per 1000 population in 1996 and in the same year, the total life expectancy at birth was 72.4 years. Also in 1996, the under-5 mortality rate was estimated at 11.2 per 1000 live births.

The country’s constitution upholds the people’s right to good health. Although the initial national health policy was to provide health care services to all residents, citizens and non-citizens, free-of charge, a charge has been introduced lately for expatriates, who must now pay upon each visit to a physician, at primary health care centres and for deliveries at hospitals. Implementation of the national health policy has achieved an equitable distribution of care to all levels of the population, with special emphasis on targeted groups through the primary health care system. Both the private sector and the community contribute to providing health care services, but the main burden rests with the government. Much of the health system and the administration of the health services used to be quite centralized. However, there has been a very strong trend towards regionalization in order to achieve better managerial, economic and technical implementation.

In 1997, there were 0.4 health centres per 10 000 persons. The Bahrain Health Care Plan for 1989-93 was formulated by a group of senior staff members from the Ministry of Health. The plan will serve as an overall guide in the development of the health care system in Bahrain over the next few years.

Mechanisms for involving the community in the implementation of health strategies are not well established, but measures are being taken to strengthen such involvement. Nongovernmental organizations are an important aspect of community involvement at all levels. For example, youth clubs together with the primary health care centres, are conducting health education campaigns; the Bahrain Family Planning Society is actively engaged in workshops, seminars and lectures on family planning; and the Bahrain Red Crescent Society has been providing courses on first aid for several years. These nongovernmental organizations receive full encouragement and financial support from the Ministry of Health and the Ministry of Social Affairs. In addition, there are joint committees representing health centres and youth clubs in each area; they exchange ideas and execute programmes on topics such as health education. The main drawback to community involvement is the lack of public awareness of health issues and problems.

The Salmaniya Medical Centre is the main health centre in Bahrain; it is allocated a large percentage of the Ministry of Health’s budget and provides most secondary and tertiary health care. There are also 19 other health centres on the island as well as five rural maternity hospitals, one psychiatric hospital and one geriatric hospital for the Bahrain Defence Force, and three private hospitals. Only one health centre has been built since 1984, and the total number of beds increased from 1603 in 1984 to 1633 in 1989, with a ratio of 23.3 beds per 10 000 population in 1997. The College of Health Sciences provides training to students in nursing and allied health sciences.

Sectors that have an impact on health frequently interact in planning, implementation and evaluation. Until now there has been no organized mechanism for systematic analysis and evaluation of the impact on health of major development projects.

Most WHO support has been directed toward primary health care. The United Nations Development Programme has supported research on the health of the elderly, nutrition and dental care.

The health problems of Bahrain are those generally found in countries passing through the transitional stage of development. There is a declining trend in the occurrence of communicable diseases and neoplasms. Diseases of the circulatory system are still the highest cause of mortality in Bahrain, accounting for 28% of total hospital deaths. Neoplasms, diseases of the respiratory system, infectious and parasitic diseases and diseases of the digestive system are next in descending order as the main causes of mortality.

The entire population is now covered with health care, safe drinking water and adequate sanitary facilities. Moreover, maternal and child health care services cover the targeted population, with immunization coverage reaching almost 100%. Essential drugs are available in all health centres and community involvement, as mentioned previously, is becoming stronger.

The psychiatric community service was started in 1979 with the aim of extending psychiatric care to all those who need it in their own environment. This is an important method of reaching the community.

There are 22 psychiatrists, 3 clinical psychologists, 6 psychiatric social workers, and 79 psychiatric nurses.

A retrospective analysis of the psychiatric inpatient population in Bahrain (1983-87) was published in 1991. The patients admitted were predominantly male (71%), with schizophrenia (32%), affective disorders (20%) and drug dependence (20%) most prevalent. Important differences were noted among the groups. The salient findings were: rural residents were admitted less frequently; drug dependence was chiefly a problem among males (male to female ratio was 44:2.5); single persons had more affective disorders diagnosed; and more than half of the patients were self-referred to the hospital.

Analysis of psychiatric hospital data for 1994 showed levelling off of admission rates; increasing outpatient and community care; increase in the number of psychogeriatric patients; decrease in the use of electroconvulsive therapy; and very low rate of use ( < 0.2%) by non-Bahrainis.

A diploma programme in psychological medicine (DPM) has been available since 1991. This is organized in collaboration with the co-joint board of the Royal College of Physicians and Surgeons of Ireland. The psychiatry department is also involved in the training of the family physicians as part of a one-year diploma course on a regular basis.

Primary health care is well advanced in Bahrain. There are 19health centres and each of these is within 5 km of its catchment area. All Essential psychiatric drugs are available at all the health centres, and any new requirement can be met within 24 hours of need. A recent development is budget decentralization so that each health centre will handle the money at its own level.

Bahrain presents an ideal situation for integration of mental health in primary health care, promotion of mental health, to understand the natural course of mental disorders and to monitor the historical trends and their association with socioeconomic changes. There is a possibility of evaluating the various mental health initiatives at the level of primary health care, schools, nongovernmental organizations and public education.

• normal psychological and social development of children during the first five years of life

• how to cope with the daily routines of children in a positive way

• behavioural problems of children and how to approach them at an introductory level

• strengthening the relationship between mother and child carers.

Public educational and training materials on mental health have been produced. A joint meeting by the Royal College of Psychiatrists was organized in October 1991. WHO support has been used for the formulation of the Bahrain mental health programme, initiating programmes of mental health nursing, mental health research, school mental health and training in cognitive therapy.

There is a proposal for the institution of a national register of drug abusers with the aims of continuously monitoring the trends in and consequences of drug abuse.

Mental health research is a continuous activity. Research has been done on medical education; use of services; drug abuse; clinical drug trials; electroconvulsive therapy; ; attempted suicide; and child mental health.

A study has been done on prevalence of schizophrenia among relatives of schizophrenia patients.