ETHIOPIA | Summary

Bill Gates highlights Ethiopia's health infrastructure, which has added 35,000 new health workers all over the country and has been helping with overall health outcomes, sanitation, maternal health, and infectious diseases.⁹ Ethiopia’s health service is structured into a three-tier system: primary, secondary and tertiary levels of care. The primary level of care includes primary hospitals, health centres and health posts.⁵ The lowest level of the primary health care are the health posts staffed with two women each to take care of their communities. They have around 15,000 health posts and about 30,000 women trained to run them. These women know their communities well and have a registry of their people to know when mothers are pregnant and approximately when they are due to give birth. Although they are focused on maternal and child health, these posts also provide other services to their community.⁹ Gates states that the health center is the next level up and here they have the ability to do some surgeries, provide more drugs and some have physicians. Health centers manage 5 health posts.⁹ According to Ethiopia's Ministry of Health, maternal and child health are two of the most serious issues in Ethiopia.¹⁰ Women are socially pressured to become mothers without the proper infrastructure and care to support her through pregnancy, birth and then the infant's health. The Ministry of Health goes on to say that mothers must rely on their communities to transport them to health posts and health centers that are understaffed, under resourced, and cannot support the mother properly. Many infants and children do not make it past the age of five due to diarrheal disease, acute respiratory infection and lack of proper vaccination.¹⁰

 

The secondary level of care consists of general hospitals that serve 1 to 1.5 million people.⁵ The tertiary level of health care specialized hospitals and serves 3.5 to 5.0 million people.⁵ However, according to Encyclopedia Britannica, only major cities have hospitals with full-time physicians, most of which are in Addis Ababa.⁸ Access to modern healthcare is very limited, and in many rural areas it is virtually nonexistent.⁸ Most facilities are government owned and medical schools in the country continue to graduate general practitioners and a few specialists, but it’s not meeting the rising demand of health services.⁸ Health care is also faced with shortages of equipment and drugs are persistent problems in the country.⁸ Traditional healing, including such specialized occupations as bone setting, midwifery, and minor surgery, continue to be useful.⁸

 

The Community Ownership movement is a grassroots approach that works towards providing health solutions that can be done in the household.¹⁰ They established health extension workers which are a family-oriented, community-based service dedicated to providing preventative and health promotion services. These are determined locals within the community that check up on residents with intentions to improve health. The Ministry of Health also enforced laws against child marriage and other traditions harmful to health. Family planning programs introduced contraceptives, giving women a choice over their sexual and reproductive health. Initiatives like this lowered the total fertility rate from 7 to 4 births per woman.¹⁰ Infrastructure is being built to provide better transportation to health centers which will greatly increase access to health services. The government has public health as a national priority and they have implemented initiatives such as distributing mosquito nets, HIV education, and nutrition for programs. Ethiopia has also seen an increase in non-communicable diseases and are working towards feasible solutions to address these emerging diseases.¹⁰

 

According to the World Health Organization, Ethiopia’s healthcare sector is financed by multiple sources including loans and donations from all over the world (46.8%), the Ethiopian Government (16.5%), out-of-pocket payments (35.8%), and others (0.9%).⁵ The country allocated $1.6 billion to health care in 2015 and of total health expenditure, approximately 15% goes to primary health care.⁵ The Ethiopian Government has been developing a Community-Based Health Insurance (CBHI) for the informal population since 2010 and has been trying to establish Social Health Insurance (SHI) for the formal sector as a way to achieve universal health coverage.¹¹ CBHI covers 11 million people, which makes it one of the largest health schemes in Africa.¹¹ Although there is no mandate to have health insurance, the government does promote CBHI expansion. Members pay a 240 birr ($8.40) annual premium per household, with additional payment for adult children.¹¹ The premium has a 25% subsidy from the federal government. Regional and district governments cover premiums for a small portion of households who are unable to pay.¹¹

 

Social Health Insurance (SHI) was planned to be fully implemented by 2014, however, the implementation has been postponed multiple times mostly due to strong resistance from public servants.¹² Enrollment in SHI is compulsory and the proposed contribution is 3% of their salary.¹² According to Cost Effectiveness and Resource Allocation journal, the insurance benefit package includes outpatient care, inpatient care, delivery services, surgical service, diagnostic tests and generic drugs.¹² CBHI and SHI provide free-to-access care in public health facilities, reimbursed through a fee-for-service system. CBHI and SHI cover primary, secondary and tertiary care for patients following a referral system.¹¹