EFFECTS OF A REFUGEE-ASSISTANCE PROGRAM ON HOST POPULATION IN GUINEA AS MEASURED BY OBSTETRIC INTERVENTIONS

Background Since 1990, 500 000 people have fled from Liberia and Sierr a Leone to Guinea, west Africa, where the government allowed them to s ettle freely, and provided medical assistance. We assessed whether the host population gained better access to hospital care during 1988-96. Methods In Gueckedou prefecture, we used data on major obstetric inte rventions performed in the district hospital between January, 1988, an d August, 1996, and estimated the expected number of births to calcula te the rate of major obstetric interventions for the host population. We calculated rates for 1988-90, 1991-93, and 1994-96 for three rural areas with different numbers of refugees.Findings Rates of major obste tric interventions for the host population increased from 0.03% (95% C I 0-0.09) to 1.06% (0.74-1.38) in the area with high numbers of refuge es, from 0.34% (0.22-0.45) to 0.92% (0.74-1.11) in the area with mediu m numbers, and from 0.07% (0-0.17) to 0.27% (0.08-0.46) in the area wi th low numbers. The rate ratio over time was 4.35 (2.64-7.15), 1.70 (1 .40-2.07), and 1.94 (0.97-3.87) for these areas, respectively. The rat es of major obstetric interventions increased significantly more in th e area with high numbers of refugees than in the other two areas. Inte rpretation In areas with high numbers of refugees, the refugee-assista nce programme improved the health system and transport infrastructure. The presence of refugees also led to economic changes and a ''refugee -induced demand''. The non-directive refugee policy in Guinea made suc h changes possible and may be a cost-effective alternative to camps.