YemenRapidAssessmentReportforDecember2016:

Measuringtheimpactofthepublicsectorwagesuspensiononbasicservicedeliveryinthehealthcareandeducationsectors

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TableofContents

- ExecutiveSummary 2- ScopeoftheAssessment 3- Challenges 4- Generalbackground 5

SectionI–Healthcare

‐ Background 7‐ Characteristicsofrespondentsandinterviewees 9‐ StudyFindings

‐ Summary 10‐ KeyFindings 11‐ Absence,disciplineandpsychologicalstress 11‐ Ministrysupervision/coordination 12‐ Servicefeesanddemand 13‐ Dependenceongovernmentsalariesandtheprivatesector 14‐ Availabilityofmedicines 15‐ Internationalorganizationsrespondingtothecrisis 15‐ Impactofliquiditycrisisoninternationalorganizations 16

SectionII–Education

‐ Background 17‐ Characteristicsofrespondentsandinterviewees 19‐ Studyfindings

‐ Summary 19‐ Breakdownindiscipline 20‐ Impactofnon‐paymentofwagesonpublicschoolteachers 21‐ Heightenedcorruption 22‐ Theimpactofbudgetarycutsoneducationactivities 22‐ ChildFighters 23‐ Alternativerevenueraising 23

SectionIII–SolutionsandRecommendations 24

Recommendationsforfuturestudies 25

Appendix

‐ i‐Notesonthescopeofassessment 26‐ ii‐Listofinterviewees 26‐ iii‐Listoffigures 27

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ExecutiveSummary

Yemeniscurrentlyfacinganunprecedentedhumanitarianandeconomiccrisisasaresultoftheconflictthathasgrippedthecountrysincelate2014.Inadditiontothearmedviolence,theutilizationofeconomicwarfarebypartiestotheconflicthasresultedinacrippledcentralbank,depletedforeignexchangereservesandaliquiditycrisisinphysicalbanknotes.Governmentbudgetshavebeenslashed,andbeginninginAugust2016theCentralBankofYemenceasedpayingpublicsectorwages,resultinginmorethanathirdofworkingYemenis,andtheirfamilies,losingtheirprimarysourceofincome.Thishasexacerbatedthehumanitariancrisis,hadknock‐oneffectsacrosstheentireeconomyandfurtherdevastatepublicservicedeliveryinYemen. Thisrapidassessmenthassoughttomeasuretheimpactofthenon‐paymentofgovernment wages on the health and education sectors specifically. For eachsector a questionnaire surveywas implemented alongsidemultiple qualitativeinterviews,assessingtheimpactacrossalllevelsofservicedelivery,fromcentralministriestolocalhealthofficesorschools.

Inshort, thecessationofwageshasbeencrippling.Thisassessment foundthateven when staff have continued to work there has been a significantdeteriorationinthequalityofthatworkinboththehealthandeducationsectors.Absenteeism has not been as high as might be expected, especially in Houth‐Saleh controlled area, due to disciplinary threats De facto power . In areascontrolled by the internationally recognized government, protests and strikeshavebeenmorecommon.Theassessmenthasfoundthatduetotheimpactofthewage crisis there has been significant deterioration in the capacity of centralministries forboth thehealthandeducationsectors togatheraccuratedataorassist in targeting emergency responses. Significant political interference hasalso been witnessed at the ministry level, adding challenges to accurate datacollection.

In the health sector many workers have sought work in the private or NGOsectors,evenwhilecontinuingtoworkingovernmenthospitals.Thoseonshorttermcontractshaveoftenleftgovernmentworkcompletely,whilethoseonfulltimecontractshavestayedinthehopeofkeepingtheirjobsandreceivingbackpay in the future. Increasingly hospitals are covering budgetary shortfalls bypassingcostsontopatients,withsomeareaswitnessingsignificantfeeincreases.Hospitals still in operation havewitnessed significant increases in demand forservices as other healthcare facilities have been forced to close or drasticallyreduce services. Significant reductions in the availability ofmedicines has alsooccurred.

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Increasinglyinternationalorganizationsarebeingreliedupontosupportpublichealth services.Theseorganizationshavealsobeenhamperedby thedifficultyand cost of making financial transactions within Yemen and by the financialdemandsofthecoordinatingministries.

Theeducationsectorhaswitnessedseveredeteriorationinthefaceofbudgetarycuts and the cessation of wages. During the course of this assessment ourresearch identified significant increases in absenteeism, low motivation ratesamongeducationworkers,reductionsinclasshoursandhigherratesofconflictamongworkers.Learningoutcomeshavedecreasedsignificantly,whilecorruptpracticesareontherise,suchaswiththesellingofgradesandschoolcertificates.Due to the severity of the economic crisis, it has also been reported largenumbersofschool‐agechildrenhavebeenforcedto leaveschool towork,withmore than a thousand documented as having becoming fighters in order tosupport their families.Our findings showthatschoolshaveattempted tocoverbudgetary shortfalls and salaries through requesting fees and donations, bothfromthepublicandinternationalorganizations.

In responding to the crisis, international organizations should 1) advocate forand support a solution to the challenges being faced by the Central Bank ofYemen,notablythepayingofpublicsectorsalaries2)Supportthecontinuationofbasicpublicservicesintheeducationandhealthsector,throughmeanssuchas providing robust and well targeted incentives for public sector workers inaffectedareasof thehealthandeducation.3)Workwith local civil societyandprivate sector groups to provide community focused solutions to the publicsectorwagecrisis. This assessment, undertaken in 15 days, should be considered a preliminaryoutline of an immense and deeply complicated crisis, one that outlines theimportanceoffurtherstudyanddatagatheringtogarneramorecomprehensiveassessmentofthesituation,whichcanthenbeturnintoanactionableresponsestrategy.

ScopeoftheAssessment ● Temporalscope:Thisassessmentcoversthefourmonthperiodfollowing

the suspension of public sector wages, from September to December,2016.

● Geographic scope: This assessment looks at national level information,depending on the availability and reliability of pre‐existing data. Threegovernorates (Sana’a, Lahij and Al Hodeidah) were also selected for

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interviewsandquestionnairedistribution.Thesethreegovernoratesweretaken to be a fairly representative sample of the situation facing thecountryatlarge.

● Sectoral scope: This rapid assessment is to measure the impact of thesuspension of public sector wage payments on basic social servicesdelivery,particularlyinrelationtothehealthcareandeducation.

Challenges

● Timeconcerns: theassessmentwas conducted in15days.Thiswasnotenoughtocollectsufficientdata.

● Severe logisticandsecuritychallengesexistedwhilesurveyingthethreegovernoratesselectedforfieldvisits.

● Resistance to research and data collection from many respondents forpolitical reasons. Many health workers feared that sharing informationwouldjeopardizetheirjobs.Inthefaceofthesechallenges,datacollectionhad to be facilitated through the networks and connections of theconsultants.

● The lackof any functional centralizeddataauthoritymade itdifficult togather data quickly and efficiently. This is due to several governorateoffices that stopped reporting to the ministry's head office when theconflictbegan.

● Manyministrymanagersandemployeeswere absent from their offices,addingconsiderable timecosts to theresearchas theyhadtobesoughtoutindividually.Ministryworkerswerealsohesitanttosharewhattheyconsideredconfidentialdata.

● Newmanagementhasbeenestablishedat theministryandgovernoratelevel and this hasmade proceduresmore complicated, especially whendealing with international organizations. The establishment of the new“Government of National Salvation” in Sana’a has added to the generalsense of disorganization and confusion, and this has made employeeswaryofoutsideresearch.

● Thereisalackofpublisheddatainsidetheministries.Duetotheconflict,the General Department of Information and Statistics lacks significantdataregardingthehealthcaresectorfortheyears2015‐2016.

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Generalbackground

The humanitarian situation in Yemen was dire even before thesuspension of the government salaries. Prior to the 2011 political crisis thatprecipitatedthecurrentconflict,Yemenwasoneoftheleastdevelopedcountriesintheworld,thepoorestintheMiddleEast,andhighlyfoodinsecure.Sincethestart of the conflict millions have been displaced from their homes, and UNreports indicate that at least 10 out of Yemen’s 22 governorates are currentlyfacinganemergency food insecuritysituation.1Between2014‐2016, theWorldBankreportedthatpovertylevelshadessentiallydoubled,from34%to62%ofthepopulation.2InJuly2015,theUnitedNationselevatedthehumanitariancrisistolevel3–thehighestdesignation,placingitinthesamecategoryasthecrisesin Syria, Iraq and South Sudan. In September 2016, according to theUNmorethan370,000childrenweresufferingfromseveremalnutrition,withmorethan1.5 million facing life‐threatening malnutrition. Roughly 50% of Yemenis faceseverefoodinsecurity,withhalfoftheseneedingimmediatelifesavingassistanceand four out of five requiring humanitarian assistance in some form. As ofDecember 2016, 2.2 million people remained internally displaced by theconflict.3Inparallel,aSaudi‐ledmilitarycoalitionhasbeenenforcingaland,sea,andairblockadeonYemensinceMarch2015,severelyrestrictingthevolumeofcommercialgoodsandhumanitarianaidenteringthecountry(,althoughthishasbeen somewhat mitigated by the United Nations Verification and InspectionMechanism (UNVIM) for Yemen, which has been attempting to facilitate thetransitofcargovesselsthroughtheblockadesinceMay2016).

Thecurrentliquiditycrisis,andresultingwagecrisis,stemsfromthechallengesfacing the Central Bank of Yemen (CBY). Yemen is overwhelmingly a casheconomyandinJune2016theCBYbegananticipatingaliquiditycrisis,inthatitforesawhavinginsufficientphysicalbanknotestofacilitatenormaltransactions.DueinlargeparttothefinancialblockadeonYementhatpreventedthecountry’scommercialbanksfrominteractingwithforeigninstitutions,tradersandwealthyYemenishadgrownincreasinglyreluctanttoletthebanksholdtheirmoney.Asaresult, largesumsofdomesticbanknoteswerebeingpulledoutof thebankingsystemandheldprivately,orcirculatedonthecountry’sblackmarket.TheCBY

1IPC Analysis Summary of Findings, Republic of Yemen, June 2016 http://www.ipcinfo.org/fileadmin/user_upload/ipcinfo/docs/1_IPC_Yemen_June2016_AcuteFoodInsecurityAnalysis_CommunicationBrief.pdf 2 Country Engagement Note for the Republic of Yemen for the Period FY17-FY18, The International Development Association, International Finance Corporation and Multilateral Investment Guarantee Agency, The World Bank Group, June 2016, P. 6 3 Task Force of Population Displacement 11th report, Yemen, October 2016 www.globaldtm.info/dtm-yemen-tfpm-11th-report-October-2016/

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was not able to print new banknotes because the internationally recognizedgovernment was denying the central bank access to the printers, which arelocated in Russia. Between January andMay 2016, some 160 billion YERwaspulledfromthebankingsystem,withanother140billionYERleavingthesystemin June alone.4 Without rials themselves the commercial banks had none todeposit at the CBY, and by August the central bank had begun to run out ofphysical banknoteswithwhich to pay civil servants. In seeking to address thecurrency shortage, the CBY attempted to reintroduce damaged banknotes thathad been previously removed from circulation; many businesses refused toacceptthedamagednotes,however,leavingthecivilservantswhoreceivedthemwithworthlesssalarypayments.

Untilmid‐September2016, theCBY facilitated, to theextentpossiblegiven thewar,thefinancingofbasicpublicservicesacrossthecountry,regardlessofwhichside was in military control of any given specific area. Through most of theconflict the neutrality of the CBY had been generally respected. This began tochange significantly in Spring 2016, when the president of the internationallyrecognizedgovernment,AbduMansourHadi,begantopubliclyattacktheCBY’simpartiality and integrity. On July 30, in a letter signed by representatives ofHadi’s government to the InternationalMonetary Fund (IMF), the governmentrequested that theCBY’saccountsbe frozenand that the IMFno longeracceptthesignatureofCBYGovernorMohammadAwadBinHumamorhisdeputy. InearlyAugust, theHadi‐ledGovernment followed this request to the IMFwithageneralrequestto internationalfinancial institutionstodenytheCBYaccesstocash reserves held in accounts outside Yemen, claiming that the CBY hadfunnelled state funds to the Houthi rebels and allied forces. The internationalfinancial institutions complied and the effect has been tantamount to a majoreconomicsanction,inthatitseveredtheCBYfrommostofitsremainingforeigncurrencyreservesandpreventeditfromcarryingoutitsprimaryfunctions.

In September 2016, Hadi ordered the CBY governor replaced and theheadquarters moved from the capital, Sana’a, under Houthi control, to thesoutherncityofAden,whichisunderthenominalcontrolofHadi‐alliedforces.Prior to the central bank's transfer, however, the institutional expertise,information archives and financial reserves necessary for it to becomeoperational in the new location had not been secured. Hadi’s decision thuseffectively left the country without an institution capable of carrying out the

4 For more on the challenges facing the central bank, see: Sanaa Center for Strategic Studies, Yemen Without a Functioning Central Bank: The loss of basic economic stabilization and accelerating famine, November 2016 http://sanaacenter.org/publications/item/55-yemen-without-a-functioning-central-bank.html

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essential functions of a central bank, a move that has since been a majoraccelerantof thecountry’shumanitariancrisis,withneither the internationallyrecognized government nor theHouthi‐allied rebels displaying the capacity orwillingness to address the fallout. The utilization of economicwarfare by bothsides, and the relocation of the CBY, indicates that the warring parties areprepared to sacrifice the welfare of the population to achieve political andmilitaryends.

TheCBYhasnotprovidedfundstogovernmentministriestopaythefullsalariesofmostpublicservantssinceAugust2016,withthoseworkingfortheMinistryofDefensenotreceivingfullpaymentsinceJuly.5Some1.2millionpeople–morethan a third of Yemen’s workers – dependent on these public sector salaries,which have been one of the few stable sources of income available to manyYemenisduringtheconflict.GiventheaverageYemenifamilysize,thecessationofpublicsectorsalarieshasmeant6‐7millionYemenishavebeenwithouttheirprimaryincomesinceAugust2016.6

The liquidity crisis and suspensionof governmentwageshasalsohadmassiveknock‐on effects for thewider economy, resulting in the equivalent ofUS$360millionUSD(90billionYemeniRials)permonthbeingremovedfromcirculation,crippling demand for goods and services. This is especially damaging in areassuchasthecapital,wherepublicservantsareclustered.Smallandmedium‐sizedbusinesses that typically extend lines of credit to government employees forcommercial goods, such as groceries, have been particularly affected, with acorrespondingsurgeinunemployment.TheWorldBankestimatedYemen’sGDPcontracted28% in2015.7The suspensionof governmentwages is expected tohavecausedafurther20%contractionin2016.

5 There were limited payments in September, and in areas controlled by the internationally recognised government some salaries have been paid by foreign governments such as the UAE or through locally raised revenues, although this has been limited and case by case. Some specific sectors have received partial payments, as with health workers receiving half of September’s wage at the end of October. In Aden, electricity workers have received full payment of their wages from the UAE government, as part of its efforts to return electricity to the city.The Ministry of Defense is the largest public sector employer, with over 400,000 Yemenis on the payroll. It is worth noting that Yemen is generally understood to have tens of thousands of ‘ghost’ employees on the government payroll due to corruption and poor record keeping. 6 In addition, the social welfare fund, the main mechanism for assisting poor Yemenis, hasn’t made cash disbursements since December 2014. The Social Welfare Fund gave financial assistance to over a million Yemenis before it ceased to operate. 7 Yemens’ Economic Outlook- Spring 2016

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SectionI‐Healthcare

Background

Evenbeforethecurrentcrisis,healthcareinYemenfacedhugechallengesandlimitations.Beforethe2011politicalcrisis,theYemenigovernment’shealthcare delivery suffered a lack of physicians and work capacities in somegovernorates,aswellasinequalitiesintermsofhealthcareaccessthroughoutthecountry.8Thesechallengeshavebeenmadevastlyworsebythecurrentconflict.

Figure1:Workforcedistributioninhealthcareacrossallgovernorates(2014)*

*Included inthisgraph is“Amana”,which isnotagovernorate itselfbutthecapitalregion insidetheSana’agovernorate.ThefiguregivenfortheSana’agovernorateisfortheentiregovernorate,excludingAmana.

In2016 therewas severe economic stagnationandahugegovernmentbudgetdeficit. This resulted in across‐the‐board cutbacks by the authorities in Sanaa,especiallyinoperationalexpenditures,whichcomprisethebiggestproportionofthe health sector’s budget. This situation deteriorated significantly when theCentral Bank of Yemen became unable to pay state salaries. These newdevelopmentsnegativelyaffectedthequalityandquantityofhealthcareservicesavailable and will most likely catalyze a considerable worsening of thehumanitariancrisisinthenearterm.

Thousands of Ministry of Health staff – doctors, nurses, and other healthcareworkers – have not received salaries since August 2016. Labor strikes haveoccurred in some hospitals, and others are witnessing high rates of staffabsenteeism.Increasingly,hospitalsareunabletooperateinthecontextoffuelandmedicineshortagesandthenon‐paymentofsalaries.Manyareclosingdown

8 Ministry of Public Health and Population. 2011. Annual Health Statistical Report. http://www.mophp‐ye.org/arabic/docs/Report2011.pdf.

7288

5253

3626

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1791

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or operating at diminished capacity.9 Only 45 percent of health facilities inYemen are considered operational. It has been reported that in a number ofgovernorates, suchasAlBayda’,Al Jawf,Marib,Sa’dah,andTa’izz, less than30percentofhealthfacilitiesarefunctional.10Thishasleftanestimated14.8millionpeoplewithoutadequateaccess toevenbasichealthcare,whileparallel factorsresulting from the conflict, such as the declining access to potable water, areresulting in higher rates of preventable disease, as witnessed in the recentoutbreakofCholera,11

An October 2016 study conducted by the World Health Organization, incooperation with the Ministry of Health, assessed the emergency servicesavailability and functionality of 3,507 health facilities across 16 governorates.The study, which is based on the HeRAMS Approach (Health ResourcesAvailabilityandMonitoringSystem),found1,579oftheevaluatedfacilitieswerefunctional, 1,334werepartially functional, and594werenot functional.Therearealsocriticalshortagesinmedicaldoctorsinmorethan40%ofalldistricts.12This in turnhasresulted inan increaseddemandontheremaininghealthcareinstitutions, as well as a rise in instances of preventable health complicationscausedbythelongandcomplextravelnecessarytoreachoperationalfacilities.

The employee resentment and dissatisfaction arising from being deprived offinancialcompensationis,incombinationwithalltheotherchallengesfacingthehealthcaresystemduetotheconflict,contributingtothedeteriorationofhealthcareinYemen.

Many hospitals andhealth facilities are reacting to these challenges by raisingrevenues through other means, by reducing services or simply closing down.Manycostsarebeingpassedontopatients throughservice feesor fundraisingcampaigns. Many hospitals have prioritized resources away from certaindepartments. The district and governorate hospitals have been the worstaffected as compared with the capital and have warned that without urgentfundingtheymayhavetoclosedown.

9 For instance, by the end of November 2016 dialysis machines were only providing two sessions per-week, instead of the usual three, with patients suffering a corresponding increase in negative complications. 10 USAID Yemen- Complex Emergency Fact Sheet #3, Fiscal Year 2017, December 8, 2016 http://reliefweb.int/sites/reliefweb.int/files/resources/12.08.16%20-%20USG%20Yemen%20Complex%20Emergency%20Fact%20Sheet%20%233.pdf 11 Cholera cases have now been reported in 15 governorates, with 6,016 suspected cases in 86 districts and 76 deaths, according to the UN Office for the Coordination of Humanitarian Affairs. 12 Service Availability and Health Facilities Functionality in 16 Governorates, based on Health Resources Availability Monitoring System for October 2016 (Published 2016-12-22)

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Characteristicsofrespondentsandinterviews Thisanalysis isbasedonquestionnairesandinterviewswith83medical

doctors, doctors’ assistants, and administrators working in the health sector.Also interviewedwereseniorofficial staff in theMinistryofHealth, andhealthoffices in three governorates. In order to maintain a common institutionalcontext,thestudycoveredthreedifferentgeographicalregionsandawiderangeof health facilities in order to give a clear image on the state of healthcareservicesacrossthecountry.

StudyFindings Summary

Interviewees reported that while most full time employees generallycontinue to be present forwork out of fear of losing their jobs, the quality ofwork has deteriorated substantially. Some are continuing to work in publichealthinstitutions,butareincreasinglytakingabsencesandsupplementingtheirincomethroughparttimeworkinprivateorganizations(Hospitals,Clinics..)orNGOs.Thoseonshorttermcontractshaveleft,manyseekingworkintheprivatesectororlocalorinternationalNGOs.Asignificantnumberofhealthcareworkershavealsoleftthecountryorthegovernoratealtogether.13Anumberofthosethatchosetoleavetheirpositionshaverejoinedthehealthinstitutionstheyworkedfor but under contract from outside NGOs, although they face the risk of notbeingabletoregaintheirgovernmentsalariesinthefuture. 48 out of 76 interviewees have reported that many workers have relied onfamilysavingsandthehelpofrelativestosurviveandcontinueworking,butthelongerthecrisispersiststhehigherthelikelihoodtheywillhavetostopworkingaltogetheroutofnecessitytoseekalternativesourcesoflivelihood.

After the suspension of wages, the role of supervisory and monitoringdepartmentshasdecreased significantly, and theministry is unable to identifydeficienciesandweaknessesinhealthinstitutions,withacorrespondingdeclineinitsabilitytotargetinterventionsappropriately. Duetotheconflict,andpoliticalsensitivitiessurroundingservicedelivery,manyrespondentscommentedonthehighlevelofpolitical interference,especiallyattheministrylevel. Thisinterferencetakestheformofappointingemployeesinadministrativepositionsloyaltothedefactopowerorthepreventionofsharinganydatatooutsidersespeciallytointernationalorganizations.

13 From interviews with health care workers and international organizations working in the sector.

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Interviewees reported thatwhilemanyhospitals administrationshave tried tocovercostsby increasingfees, insomeareas feeshaveactuallydeclinedin linewiththeabilityofpatientstoaffordthem.Thequestionnaireresultsalsoclearlyshowedthatinthefaceofashrinkingavailabilityofservices,patientdemandhasincreased.Atthecentralhealthministryoffices, intervieweesreportedseeinganoticeable decline in performance and high rates of abstentions, with thisimpacting the abilityof authorities to react to and target responses, aswell asaccuratelygatherdata. KeyFindings

● Worker absenceand indiscipline athospitals and clinics hasbeen to anextent counteracted by government disciplinary efforts, notably thethreatofhealthsectorworkerslosingtheirjobsortherighttoclaimtheirowedsalaries.

● Quality of work in general has declined drastically, even where healthcareworkershavecontinuedtoworkwithoutpay.

● Manyhealthcareworkershavereliedonsavings/family/sellingassetstosurvive.Thiswillbeincreasinglyunsustainableshouldthecrisispersist.

● The activities of supervisory and monitoring departments has beenseverely affected and theministry is unable to identify deficiencies andweaknessesinhealthinstitutions.

● Inmanylocationstherehasbeenasignificantincreaseinhealthcarefeeschargedby public institution, though in certain others there hasbeen adecreaseinlinewiththedecreasingabilityofpatientstopayforservices.

● 85% of the questionnaires reported there has been an increase in thenumberofdailypatientstreatedatfunctioningpublichealthinstitutions.

● Theministryofhealthlocatedinthecapitalhasbeenseverelyaffectedbythewagecrisis,withvisitsrevealinglargescaleabsencesbyworkers.

Absence,disciplineandpsychologicalstress

The questionnaire contained a number of questions assessing absencesand discipline amongst employees in hospitals and health centers after thesuspension ofwages in September of 2016. Of the responses, 55% reported ahighormoderate increase, though interestingly, in regard tonight shifts thereappearedtobelowerincrease.

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Figure2:Reported increase in absences and indiscipline amongsthealthsectorworkersfollowingthewagesuspension.

The statistical result obtained indicates a moderate increase of indisciplineamongemployeesafterbeingdeprivedoftheirsalariesforthelastfourmonths,whichislikelytheresultofthestrictdisciplinaryorcoerciveactiontakenbythecurrent ruling power toward the public workforce. According to a seniorgovernmentofficialworking in theministryofhealth, employees are forced toattend work and endure challenging financial conditions under the threat oflosing their jobs. Employees have essentially been given two choices ‐ workwithoutsalariesunder thehopeof receiving their financial compensationsoonor stay home and lose their jobs. This policy might will likely become lesseffectiveincomingmonthsasemployeesexploitallpossiblemodesofsupportinordertocontinuetomeettheirpersonalfinancialobligations.Forinstance,onemid‐levelgovernmentofficialinthehealthsectorsaidthathehasstartedtosellhiswife’sjewelry.

As figure 3 shows, our survey found a significant increase in conflict amonghealthsectorworkers.Interviewsrevealedthatmuchofthisconflictisbetweenhealthsectorprofessionalsandtheadministration.

Figure3:

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MinistrySupervision/Coordination

Thequalityandavailabilityofhealthcareserviceswasevaluatedthroughtwomechanisms;throughthequestionnaire,andinterviewswithhealthworkersand healthcare service beneficiaries. The shortage of financial resources,including the non‐payment of employees’ wages, was viewed by most seniorhealthcareofficialstobetheprimaryfactorresponsibleforthelowqualityandaccessibility of the healthcare services. The corresponding low level ofsupervisoryworkcarriedoutbytheconcernedsupervisorydepartments intheMinistryofHealthsincethewagesuspensionisalsoamajorcontributingfactorintherapiddecreaseinhealthservices.

According to an interview conducted with a high‐level official working in thehealth ministry’s supervisory departments, the supervision of health facilitieshasbeenpartially suspendeddue to the liquiditycrisis.Before thecrisis, thesedepartments were assigned to supervise and evaluate health activitiesperformedbypublicandprivatehealthfacilitiesandreporteddeficienciestotheministry in order to target improvements inmedical services. The substantialdecreaseinsupervisoryandmonitoringactivitieshaslefttheministryunabletoidentify deficiencies its health facilities or to know how and where it shouldintervene.Thechallengesfacingthecentralhealthministriesisposingsignificantchallenges for organizations seeking to identify needs gaps and target theirinterventionseffectively. Servicefeesanddemand

Inmeasuringwhethertherehasbeenanincreaseinhealthservicefeeschargedbypublichealthinstitutions,42%ofthesurveyrespondentsreportedtherehadbeenanincreaseinhealthcareservicefeeschargedbypublicinstitution.Thisisespecially the case with hospitals in Sana'a, notably Al Thawra Hospital. TheoppositewasfoundinsomehospitalsinAlHudidahandLahij,wheredecreasedhealth service fees have been reported. These conflicting findings can beunderstoodasreflectingtheabilityofhealthcarebeneficiariestopay.Healthcarepatrons in Sana’a aremoreable to affordhigher fees,while thedire economicsituationinAlHudidahandLahijhasforcedhospitalstolowerfees.

Figure4:Increaseinfeeschargedbyhealthinstitutionsinthecapital

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In gettingmore specific data on changes in health sector fees, interviewswithSana’a based public sector health authorities revealed that public hospitals inSana’a city have witnessed fee increases ranging between 30‐70%. In the AlThawrahHospital,thebiggestpublichealthinstitutioninthecountry,oursurveyresponsesindicatedincreasesrangingfrombetween50%to70%.

Around 85% of the respondents reported there had been an increase in thenumberofdailypatientstreatedinpublichealthinstitutions.Accordingtohealthcareworkers,thishaspartlybeentheresultofthelargeandgrowingproportionof the population that can’t afford private healthcare. Many health insurancecompanies have also suspended contracts with the government since thebeginningoftheconflict. Dependenceongovernmentsalariesandtheprivatesector

Ascouldbeexpected, thequestionnaire results indicate thatworkers inthepublichealthsectordependhighlyongovernmentsalaries,and86%of thepopulationsampleshowthattherehasbeenasubstantialdecreaseintheincomeofthestaffworkinginthehealthsector.Thisismorenoticeableinruralareas,asin cities there is usually better private sector alternatives for those doctorsattempting to findwork opportunities outside of their government work. TheMinistryofHealth,locatedinthecapital,wasvisitedontwooccasionsduringthisrapidassessment,andonbothoccasionsmostemployeeswereabsentorhadlefttheministryfortheirhomesinthemorningafterbeingpresentforonlyacouplehouse.Managerswere askedabout this absenteeism, and they replied that themainreasonisthesuspensionofsalaries.

The questionnaire found that there is a moderate increase in public healthworkerstakingworkinprivatehospitalsorlaboratoriestocompensateforlostincome. This statistical finding is supported by the interviews conductedwithsomehealthmanagersandemployeesinhealthfacilities.Basedontheresponseofahigh‐levelofficial, theMinistryofHealthissufferingagradualmigrationofphysiciansandspecialistsfromthepublictotheprivatesector.

Although the questionnaire found that a number of health careworkerswerefullyorpartiallysubstitutingwork inpublichospitalswithwork in theprivatesector, itmustbenotedthatmanyhealthphysiciansalreadyhadparttimejobssupplementing their income.Thisphenomenonpre‐existed the current conflictand had been negatively affecting public health care service delivered undernormal conditions, with staff being less motivated or focused on their publicsectorwork;thishasbeenmadesignificantlyworsebytheconflictandeconomicstagnationassociatedwithsalariescrisis.Thisaccesstoalternativeincomeinthe

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private sector could also be a reason for public healthcare workers’ relativeresiliencethroughthecurrentwagecrisis. Availabilityofmedicines

For the availability of essential medicines, 63% of the questionnairerespondentsreportedthattherehasbeenextremedecreaseintheavailabilityofessentialmedicinesprovidedbypublichealthinstitutions(seefigure5).

Figure 5: Reported decreases in the availability of essential medicinefollowingthewagesuspension

The shortages of drugs andmedical supplies resultingmainly from the lackofresourcesisoneofthemajorchallengesfacedbythepublichealthsectoroutsideofthewagecrisis.InaninterviewwiththeMinistryofHealthUndersecretaryforCurative Medicine, he declared that the public health sector has beenexperiencing fatal deterioration and rapid unrecorded shortages of drugs andmedical supplies since the liquidity crisis. Many health centers and publichospitalsthatdeliverdiabeticsanddialysisservicesarethreatenedbyclosureorreduced services. Until now, about seven health centers delivering dialysisservices in different governorates have been closed due to the shortage ofmedicalsupplies.About5,000patientsdiagnosedwithliverfailureand120,000diagnosed with diabetes are threatened by severe deterioration in theircondition,ordeath,duetotheshortageofavailabletreatment.

Internationalorganizationsrespondingtothecrisis InterviewswithmajorINGOsfocusingonthehealthcareresponsepainta

grim picture of the impact this is likely to have on humanitarian operationsfocusingonhealthandnutrition.Yemen’shealth facilitiesarenow increasinglydependent on international aid organizations to maintain some form offunctional healthcare. In the face of this, INGOsmust tailor their response notonly towards supporting the continuationof essential facilities and supplies inthe health sector, but will increasingly have to take on the costs of paying

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incentives toMOHstaff. Thishas inmany casesbecome theprimary sourceofincome for these staff members and is essential in allowing them to continueworking. Other organizations operating programs reliant on, or in partnershipwith, facilities dependent on public salarieswill increasingly have to bear thecostofallowingthesestafftocontinueworking–throughincentivespaidtotherelevantministriesordirectly to the staff themselves –or face theprospectoftheseprogramsoperatingatlimitedcapacityorceasingcompletely.

INGOprogramsmayfindthatprojectsdeliveredincoordinationorcooperationwith governmentministries will face increasingly aggressive interference. Notonlywill thesebodiesdemand incentives tohelpcover theirown labourcosts,buttheymayseektoredirectprogramsandaiddeliveryinanefforttoaddresstheirownneeds. Interviewswith INGOsreveal thatpublicsectorstaffworkingwith INGO fooddistributionprogramshavebegun to request that they receivefoodaidpackagesforthemselves,friendsorrelatives.WithmorethanathirdoftheYemeniworkforcehavingbeendependantongovernmentsalaries,thepublicbodieswhichare chargedwith cooperatingoroverseeing theaid responsearenowthemselvesinneed.

Impactofliquiditycrisisoninternationalorganizations Throughthequestionnaireseveralinternationalorganizationsconfirmed

thattheliquiditycrisishashadstrongnegativeeffectsontheiractivitiesandinsome cases this has led to the scaling down or suspension of activities. Thisincludes delays in delivering funds to partners and corresponding delays inimplementation.Theliquiditycriseshasplacedadditionalpressuresonnationalstaff.INGOsrespondedthatnationalstaffhavehadunexpectedpressuresplacedon their salaries in order to support their families, relatives and friends,especially from those who have lost their government salaries. The limitedresourcesavailable tomitigatetheemergency impactof thegovernmentsalarysuspensionhasforcedtherelocationofsomeNGOstaffandoffices.

TherehavebeensignificantincreasesinthecostofmakingfinancialtransactionsforINGOs.Forexample,accordingtointerviewswithAlamalbankstaff,thecostof transferringmoney internallyhas increased from1%, tobetween3‐5%asaresult of the liquidity crisis. The movement of money through the interbanksystem is no longer available, and banks have refused to clear transactionsunlessthebeneficiariessignawaivercommittingtonotwithdrawingcashfromtheaccounts.Increasinglydesperategovernmentministriesorlocalbodieshaveresorted to demanding that international organizations pay or subsidize theiremployeesoractivities.RecentdemandsbytheYemeniMinistryofPlanningand

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InternationalCooperation (MOPIC) that INGOs in the country subsidizeMOPICsalariesarebutoneexampleofthefallout.

SectionII–Education

Background

(As noted by the Yemen Education Sector PlanMid Term Results Framework2013‐2015 :) “Over the past 40 years, Yemen has performed relativelywell inexpanding formal education opportunities, but important challenges remain.Enrolmentatall levelshas improvedsubstantiallyand illiteracywashalved from90 per cent in 1973 to 45 per cent in 2004 (World Bank, 2010). Despite thecontinuing challenge of rapid population growth, gains in coverage at all levelshavebeenmade,especiallyforgirls.However,therearestillabouttwomillion,out‐ofschoolchildrenofprimaryschoolage.Manyoftheseliveinruralareasandarepartofmarginalizedcommunities;some900,000ofthemare located inso‐calledfragileareas.Genderparity isstill far frombeingachieved;retention throughoutthe grades is a serious problem due to both social factors and administrativeconstraints;andimprovingtheoverallqualityofeducationremainsachallenge.”14

The share of education expenditure was between 13 to 20 percent of totalgovernment expenditure over the past decade. However, total governmentexpenditure has fluctuated significantly with changes in government revenue,with fallout fromthe2008global financialcrisis leading toa18%reduction inspending,anddomesticpolitical turmoil in2011 leading toa12%reduction.15General education,which is the core focusof this rapidassessment reportandwhich encompasses primary, elementary and secondary school education,wasabout12%and16%ofthetotalgovernmentexpenditureintheyears2014and2015,respectively.

Despite the conflict in Yemen taking a severe toll on the fiscal health of theYemeni state, the government was able to protect education expenditurerelativelywell in2015.Educationenduringonlya6%reductioninspendinginthe state budget for that year (2% ofwhichwas eliminated from salaries andwages),whileoverallbudgetspendingfellbymorethan20%.

14 Ministry of Education, “Yemen Education Sector Plan, Mid Term Results Framework 2013-2015”, 2013 15 Ministry of Education, “Yemen Education Sector Plan, Mid Term Results Framework 2013-2015”, 2013

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Figure6:

Source:GovernmentBudgetDepartment‐CentralBankofYemen

Despite this, the escalation of the conflict inMarch 2015 severely exacerbatedYemen’s pre‐existing humanitarian crisis and resulted in a correspondingdeteriorationoftheeducationsector.16UNICEFreportedonOctober4,2016thatattacks on school children, teachers and education infrastructure had adevastating impact on the country’s education system and on the chances ofmillionsofchildrentoaccesslearning.Duetoviolence,manyschoolswereclosedandmore than350,000childrenwereunable to resume their education in the2015‐2016schoolyear,bringingthetotalofout‐of‐schoolchildreninYementoover2million.

WhentheCBYdeclareditsinabilityinSeptember2016topaythesalariesofpublicsectorworker,approximately300,000employeesworkinginthepubliceducationsystemwereimpacted.Inaddition,thegovernmenthasbeenunabletocoverotherpubliceducationoperationalexpenses,suchasmaintenance,suppliesandstaffhousing.(Alargeproportionofeducationexpenditureisusedtocoverteachers’salariesinthefieldandonlyasmallpercentageisdirectedtocoveradministrativecosts.

Thefollowinggraphshowshowthetotalexpenditureinpubliceducationwasdistributedoverdifferentsectionsoftheministrybudgetfortheyears2014‐2015:

16 http://reliefweb.int/report/yemen/yemen-education-cluster-strategy-2016-2017-enar

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Figure7:

Source:GovernmentBudgetDepartment‐CentralBankofYemen

Characteristicsofrespondentsandinterviewees

This analysis is based on 66 questionnaire responses by teachers andschoolmanagers.AnumberofqualitativeinterviewswerealsoundertakenwithseniorofficialsattheheadofficeoftheMinistryofEducation,aswellasregionaloffices of the MoE in three different governorates. In order to maintain acommon institutionalcontext, thisstudy focusedonthreegovernoratesaswellas different levels of the education system, from the centralministry down tolocalpublicschoolteachers,inordertogiveageneraloverviewofimpactoftheconflict on the quality of education across the country. The following graphshows how the questionnaires were distributed in the three targetedgovernorates:

Figure 8: Distribution of survey responses across the three targetedgovernorates

Al‐Amana Al Hodeidah Lahej

14%

34%

52%

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Studyfindings Summary

The education sector has witnessed severe deterioration in the face ofbudgetarycutsandthecessationofwages.Duringthecourseofthisassessmentourresearchidentifiedsignificantincreasesinabsenteeism,lowmotivationratesamongeducationworkers,reductionsinclasshoursandhigherratesofconflictamongworkers.Learningoutcomeshavedecreasedsignificantly,whilecorruptpracticesareontherise,suchaswiththesellingofgradesandschoolcertificates.Due to the severity of the economic crisis, it has also been reported largenumbers of school age children have been forced to leave school to work orbecome fighters in order to support their families. Our findings show thatschools have attempted to cover budgetary shortfalls and salaries throughrequesting fees and donations, both from the public and internationalorganizations. Breakdownindiscipline

Teacherattendancehasbeennegativelyaffecteddue to insecurity sincetheconflictbegan,especially for teachersworkingor residing inactiveconflictareas. This assessment, however, is focused on nonattendance stemming fromthecessationofwages.Thegeneralfindingisthatthesuspensionofgovernmentwageshashadanegativeimpactonthequalityofeducationandonlearningandteachingprocesses.Wemeasuredthe levelofcommitmentshowedbyteachersand school staffs through the questionnaire, in addition to examining theattendance records of school teachers andnon‐teaching staffmembers (wherethe researchers were able to access such records). This was an importantindicatoroftheimpactofthesuspensionofwagesontheeducationsector.

The following graph shows respondents’ answers to the question: “To  what extent has there been an Increase in absences among teachers?

Figure9:Reportedincreasesinabsencesandindisciplineamongteachersafterwagesuspension

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Questionnaire responses show a small increase in the level of teacher non‐attendanceaswellasadeclineinthenumberofdailyclasses.About41%ofthetargetedpopulationblamedtheincreaseinthelevelofteachers’non‐attendancewith the suspension of their wages. Thirty‐six responses (54%) reported adecline in the number of daily classes,while a senior teachers’ unionmemberstatedthatteachersinHouthi/Salehareas,muchlikeotherpublicservants,arelesslikelytoprotestthesuspensionoftheirsalariesoutoffearofreprisalsorofbeingaccusedofsupportingtheSaudiArabianwaragainstYemen.Duringdatacollection in areas held by the internationally recognized government,researchers foundthatteachersandhealthworkers inthegovernorateofLahijhavegoneonstriketoprotestnotreceivingtheirwages. Impactofnon‐paymentofwagesonpublicschoolteachers

Of questionnaire respondents, 56% reported an increase in conflictamongworkersinpublicschoolsbecauseofpsychologicalstressrelatedtonon‐paymentoftheirwages.Interviewsconductedwitheducationsectoremployeessupport thequestionnaire findings that therehasbeenasignificant increase inconflictamongeducationsectoremployeesinschools.Therehavebeenreportsof teachersbeinghumiliated in front of their students by creditorsdemandingdebtrepaymentsduringworkinghours.17

Based on interviews with teachers and students, there has been a significantdecreaseinlearningoutcomesfollowingthesuspensionofpublicsectorsalaries.Ithasbeenreportedbysomeschoolsteachersandadministrationstaffthatforstudentswhoareabletoattendschool,thequalityofteachingandlearninghasfallenas schoolhourshavebeenshortened,andoften teachersarenotableormotivatedtoteach.Thesupervisionofschoolperformancehasdeterioratedandschool managers, aware of the high levels of stress on school teachers, havebecomemorepermissivewiththeabsenceorunpunctualityofteachers.

Figure10:Correlationbetweenpsychologicalstressamongsteducatorsandstudentlearningoutcomes

17 It is common for goods such as groceries to be bought on credit in Yemen, and then paid for when salaries are received every month. Many vendors exposed themselves to significant financial risk in extending months of credit to buyers after the cessation of salaries.

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The questionnaire also found elevated stress levels amongst educational staffwasalsohighlycorrelatedwithdecreasedstudentlearningoutcomes. Heightenedcorruption

The non‐payment of wages and other budgetary challenges facing theeducationsectorhasresultedinanincreaseincorruption.Accordingtoaseniorgovernment official in the Ministry of Education, cheating in public schoolsnationwide has become pronounced following the wage crisis. 30 out of 66intervieweesamongthemarestudentsandteachers indicatethat thesellingofgrades has increased substantially. In some institutions it has been reportedconfidentiallythatofferingbribesiscommonpracticeamongstudentswhowanttoobtainprimaryorsecondarycertificates.Insomecasesstudentswhohaven’tattended classes or taken the required exams are able to pay their way intograduation.Thisispromotingasystemwherebywealthandaffluenceisawardedover meritocratic achievement, which is having a negative impact on studentmotivation,withagrowingsenseamongstthestudentbodyregardingthefutilityofstudyingandattendingclass.Thegovernmenthastakennoseriousmeasuresto combat this phenomenon. The Ministry of Education was already sufferingfrom weak education management information systems to maintainaccountability before the conflict; the budget reduction and unpaidwages hascompoundthisissueandthuscorruptionhasbecomeacommonplacemeanstocompensateforlostincomeintheeducationsector. Theimpactofbudgetarycutsoneducationactivities

The education budget contains other types of expenditure allocated toeducationandpublicschoolactivities,allofwhichhavewitnesseddrasticcuts.Inthe year 2015, the budget subchapter allocated for covering school activityexpenditureswascutbyhalfandthentotallysuspendedinmid‐2016.Itshouldbe noted that the basic education sector in Yemen is characterized by a highdegreeof donorharmonization, however, thepresenceof international donorsdecreasedaftertheconflictstartedinMarch2015.

Figure11:Reporteddeclineinschoolactivitiessincewagesuspension

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Questionnairerespondentsshowthattherehasbeenadeclineintheavailabilityofschoolactivitiessince the liquiditycrisisandthesuspensionofpublicsectorwages;roughly69%oftherespondentsstatedthattheywitnessedasignificantdeclineinschoolactivitiesthroughtheautumnof2016.

Expenditures on goods, services, and properties in the second chapter in thestate budgetwere substantially reduced in early 2016when the CBY declaredthatonlysalariesandwagesclassifiedunderthefirstchapterweretobepaid.Asindicatedbysomehigh‐rankingofficials in theMinistryofEducation,economicstagnationhas negatively affected school activities and education in thepubliceducationsector,andthesituationworsenedsignificantlywhentheCBYbecameunabletopaycivilservantsinAugust2016. ChildFighters

Since the conflict escalated in March 2015, the United Nations hasdocumentedatleast1,210children,someasyoungaseightyearsold,whowererecruited to fight.18 According to interviews with school principals in Sanaa,militaryservicehasbecomeoneof the fewavenuestosecureasteady income,resultinginsomefamiliespullingtheirchildrenoutofschoolandsendingthemtofighttosupportthefamily.Militaryservicehasinsomecasesbecometheonlyway to secure access to food baskets or cooking gas. Education workers areconcerned about the impact this will have on an entire generation of Yemenichildren. Alternativerevenueraising

Schoolshaveattemptedtokeepfunctioningbyraisingrevenuethroughfeesordonations.Ithasbeenreportedthatanumberofschoolshavestartedrequestingfeesfromstudentstocoverteacherswages.High‐rankingofficialsworkingintheMinistryofEducationstatedininterviewsthatinternationalorganizationssuchasUNICEF,GlobalPartnershipforEducation,andGIZaresupportingsomeeducationalactivities,incooperationwiththeMinistryofEducationinthevariousgovernorates,throughestablishingprogramsthataremostlydirectedatincreasingthenumberofchildrenjoiningschools.However,theseactivitiesareinadequatetomeetthedemand.Despitethelackofprecisedataonthenumberofchildrenthathaveleftschoolsincetheliquiditycrisis,itisapparentthattheongoingconflictandfinancialcollapseareheavilycontributingtothisphenomenon

18 UNICEF Calls for Safety of Schools in Yemen as the New School Year Opens https://www.unicefusa.org/press/releases/unicef‐calls‐safety‐schools‐yemen‐new‐school‐year‐opens/31008 

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SectionIII–SolutionsandRecommendations Ultimately, a sustainable solution for the current humanitarian crisis

facingYemencanonlybesecuredwitharesolutiontotheconflict.Itshouldalsoberecognizedthat it is thegovernmentofYementhatisultimatelyresponsibleforprovidingfundsforpublicservicesandpublicsectorwages.However,giventhe scale of the humanitarian crisis and the extent of economic decline, in theshorttermthereisaneedforinternationalorganizationstostepinandprovidealternatives to, or support for, public sector service delivery, especially inhealthcareandeducation.

Inrespondingtothecrisis,internationalorganizationsandforeignstatesshouldconsiderthreeoptions: Option1

Advocate forsolutionstothechallenges impedingthecentralbankfromresuming itsprimary functions.Thesewould includepushing the internationalcommunity to facilitate coordination between the CBY’s Aden and Sanaabranches,andprovidingresourcestohelpendthe liquiditycrisisandallowforthe resumption of payments for civil servants in both Hadi and Houthi/Salehcontrolledareas.ItisimportantthatinternationalandregionaldonorspushforfundstobeprovidedtotheCBYregardlessofwhereitisheadquartered,andthatthepayment of salaries is applied to all regions of Yemen regardless ofwhichsideisincontrol. Options2

Support service delivery in the health and education sector throughincentives andwage support for governmentworkers. These should take intoaccount thecomplexityandpolitical sensitivitiesof thecurrentconflict.And indoing so should support currently existing government structures rather thanreplicatingthem.Thiswouldinclude,forinstance,supportingworkersandatthesametimeallowingthemtokeeptheirgovernmentemployment.

In doing this INGOs should recognize that the most efficient method ofimplementing wage support and incentives is to provide them directly tobeneficiaries, and this can be done through signing a memorandum ofunderstandingwiththerelevantgovernmentauthority.

Wheredirectfinancialsupporttopublichealthcareandeducationworkersisnotfeasible,assistanceshouldtakeparallelforms,suchasfoodbaskets.

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Option3

Make all efforts to ensure effective coordination between internationalorganizations,localcivilsocietyandtheprivatesectoratthecommunitylevel,inorder to ensure effective targeting of incentives supporting the education andhealthsectors.Forexample,privatesectorbodiesmaybebestabletoimplementeffective foodbasketdelivery to teachers. Effective coordinationbetween localcouncils, theprivatesectorand internationalorganizationscouldensurepublicsectorworkersingreatestneedaresupportedinspecificareas.Thiswouldallowfor localeducationandpublicsectorworkerstobesupportedevenifeffortstorestartgovernmentwagesfail.

Recognize that supporting individual beneficiaries in both sectors could becombinedwithsocietybased initiativesanda jointcooperativepolicybetweencommunity actors and international organizations. This can be through, forexample,proposingasmallportionofcoststobecoveredbycommunityactorsincoordinationwith internationalorganizations. Inaddition,communityactorscancommittosupportingawarenessprogramsandlocalfundraisingefforts.

Recommendationsforfuturestudies It is important that better data is gathered onhow the current crisis is

affectingtheentirecountry.Amorecomprehensiveassessmentthantheonejustundertakenofthehealthandeducationsectorsiscriticallyneededtoidentifythepriorityofneedsacrossthecountryandhowbesttoaddressthese.

A comprehensive review of the efforts being undertaken currently byinternationalorganizationsworkinginthefieldtoaddressthechallengestothehealthandeducationsectors isalsonecessaryto identify lessons learnt,gatherdataandfacilitateeffectivecoordination.

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Appendix

i‐Notesonthescopeofassessment

Al Hodeidah governorate received the highest proportion of questionnairesbecause it isconsideredtohavebeenmoreaffectedbytheconflictandcurrenteconomiccrisis,especiallytherecentsuspensionofteachers’wagesandsalaries.Inaddition,AlHodeidahgovernoratecontainsareasthatsufferfromhighlevelsof poverty, and where teachers are likely more dependent on governmentsalaries.AmanatAlesmah(SanaaCity)waschosenbecauseitisthecapital,witha population base that is a representational cross‐section of Yemenis fromthroughoutthecountry,makingitagoodsampleforthisrapidassessment.Lahejgovernorate is located in the southern part of Yemen and was chosen asrepresentativeofthisgeographicalarea.

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ii‐Listofinterviewees

Sana'a: 1‐Thesecretaryoftheteacher’sassociation 2‐AlamalBankdeputymanager 3‐DoctorsinAlThwaraHospital 4‐Microfinancecustomers 5‐ManagerofHumanResources,MinistryofEducation

6‐ManagerofPlanningandStatistics,MinistryofEducation

7‐ManageroftheUndersecretary,MinistryofEducation8‐ManagerofHumanResources,MinistryofHealth9‐ManagerofFinancialAffairs,MinistryofHealth

10‐ManagerofEmergency,MinistryofHealth11‐ManagerofMonitoringandEvaluationUnitofHealthDevelopmentProgramsandPlans12‐ManagerofStatisticsandInformation,MinistryofHealthHodeidah:

1‐Manager,MinistryofHealth,Hodeidahoffice 2‐DeputyManagerofHealth,HodeidaOffice(alsooneofthemostfamous

activistinthehumanitarianandhealthissuesinHodeidah,D.AswaqMoharam) 3‐Managersofvarioushospitalsandclinics 4‐EducationofficeDeputyManager 5‐Variousschoolmanagers.

Lahij: 1‐LahijGovernor 2‐HealthofficeManagerinLahij 3‐StatisticalManagerinLahijHealthoffice 4‐ManagerofAebnKhaldoonHospital. 5‐Managersatvarioushospitalsandclinics 6‐Educationofficemanager 5.Managersatvariousschools

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iii‐Listoffigures ‐ Figure1:Workforcedistributioninhealthcareacrossallgovernorates

(2014) 8‐ Figure2:Reportedincreaseinabsencesandindisciplineamongsthealth

sectorworkersfollowingthewagesuspension 11‐ Figure3:Conflictlevelamonghealthworkforceafterwagesuspension12‐ Figure4:Increaseinfeeschargedbyhealthinstitutionsinthecapital 13‐ Figure 5: Reported decreases in the availability of essential medicine

followingthewagesuspension 15‐ Figure6:Expenditureoneducationincomparisonwithtotalgovernment

expenditureinYemeniRialforyear2014‐2015 18‐ Figure7:Distributionofexpenditureoneducationbudgetfortheyear

2014‐2015 19‐ Figure8:Distributionofsurveyresponsesacrossthethreetargeted

governorates 19‐ Figure9:Reportedincreasesinabsencesandindisciplineamongteachers

afterwagesuspension 20‐ Figure10:Correlationbetweenpsychologicalstressamongsteducators

andstudentlearningoutcomes 21‐ Figure11:Reporteddeclineinschoolactivitiessincewagesuspension22