LIBREVILLE (Reuters) - The crowd of African women are tired and angry after hours waiting in the hot sun, but the officials will not vaccinate their children until the president inaugurates the campaign on state television.
When he finally does so, half a day has been lost from the five-day vaccination scheme. It is a small reminder that, for health care in Africa, politics can be as decisive as poverty.
Grasping her son by the hand, Marie Issa is determined despite the long wait to get him a measles vaccination and a free mosquito net which could save the two-year-old's life.
"Our children often fall sick, especially with malaria," Issa said. "Hygiene here is bad. When it rains, everything floods and the toilets are outside. We need to protect our kids against illness."
This is no isolated rural African backwater but a poor neighborhood in the glossy capital of oil-rich Gabon.
Although it ranks as one of Africa's few middle-income countries, Gabon's health record is poor. Less than half of its 1.6 million people have had any kind of vaccination, despite billions of dollars in oil revenues.
"Many people here are now in ill health," said the local representative of the World Health Organization (WHO), Andre Ndikuyeze. "It is really a surprise. If they had invested more in health and education, it could be much better."
Gabon's President Omar Bongo, Africa's longest serving leader and widely viewed as one of the world's richest rulers, has blamed the poor health services on corrupt officials, in what his critics say is an attempt to deflect public anger.
"I refuse to believe that the lack of medicines in our health centers, despite the large budgets allocated to them every year, is not due to embezzlement," he said in speech in December to commemorate his 40th anniversary in power.
But foreign aid workers have questioned the government's strategy. They say plush hospitals, like the state-of-the-art new military clinic in Libreville where Bongo has a private suite, are no substitute for local healthcare.
"They've neglected the basics, so now we are trying to convince the government to invest in health posts at a village and community level," said the WHO's Ndikuyeze.
The five-day inoculation campaign in Gabon, funded by the United Nations Foundation, aimed to provide some 300,000 children under five with a measles vaccination, vitamin A and de-worming tablets, and a mosquito net to prevent malaria.
Worldwide more than 750,000 children under five die each year from malaria, most of them in Africa where it is the main cause of infant mortality. Only 3 percent of African infants sleep under long-lasting, insecticide-treated nets, the United Nations says.
The vaccination campaign faced huge challenges: materials were late reaching vaccination stations as officials complained they lacked vehicles. Some centers were not well signposted, and many staff appeared poorly trained.
Some aid workers expressed frustration Gabon did not provide more support for the program. It relied on a $1 million donation from the U.N. Foundation, while using a $200 million windfall from record oil prices to cancel foreign debt.
Government officials said the IMF-backed debt repayment should free up future budgetary resources for social spending, and would brace Gabon for a gradual decline in its oil revenues.
Despite a slow start, U.N. officials said the campaign had reached the vast majority of Gabonese children, particularly in rural areas. Some voiced optimism that central Africa could make great inroads against disease if the political will was there.
"We should see a huge reduction soon in the number of children dying from malaria in Gabon," said Andrea Gay, U.N. Foundation director of child health, adding that more effort would be needed to eliminate diseases such as measles.
"That takes political leadership ... The countries here that have the highest income like Gabon and Equatorial Guinea ought to be doing more," she said.
Demonstrating the importance of political leadership, she noted that that a backlash against polio immunization by traditional Muslim leaders in northern Nigeria in 2003 suspended vaccinations for more than a year and allowed the disease to spread to 10 countries across the Sahel.
The discovery of oil in Gabon in the late 1960s, during the first decade of independence from France, brought the country billions of dollars in revenue, but it still has one of the most unequal income distributions in the world.
In Libreville, a flood of migrants from the countryside and neighboring countries live in the ramshackle slums a stone's throw from the city's glitzy oceanfront hotels and offices.
It is a familiar story in much of central Africa.
Equatorial Guinea, with a population of just 500,000, has earned billions of dollars from oil in the past decade but remains in the bottom third of the U.N. development index.
President Teodoro Obiang's government says it has increased health spending, but IMF officials note the budget for the presidency exceeds all expenditure on healthcare and education. The former Spanish colony completely ran out of vaccines for several months last year, aid workers say.
In conflict-torn Chad corruption drained resources from a recent program, meaning only a fraction of the planned vaccination teams were deployed.
"In Chad, we were throwing our money down the drain," said one foreign health worker, who asked not to be identified.
President Idriss Deby's government in Chad, ranked as the most corrupt country in the world in 2005 by Berlin-based Transparency International, has created a special ministry to fight graft in the landlocked oil-producing state.
For proof of the role politics can play, some point to the late Thomas Sankara, Africa's "Che Guevara." His four-year government in impoverished Burkina Faso aimed for "a clinic in every village" and practically eliminated polio, meningitis and hepatitis in the 1980s, earning the praise of the WHO.
In Lybe, a village near Gabon's border with mainland Equatorial Guinea, Marie Eyeang says she must travel 25 km (16 miles) to reach a clinic if her baby daughter falls ill.
"I know if a mosquito bites her she can fall sick," she said, cradling her child as she shows off her new mosquito net hanging over the bed. "So this is to avoid sickness."
Editing by Pascal Fletcher and Philippa Fletcher