The Health System
Ethiopia is located in the Horn of Africa and has a total area of about 1.1 million square kilometers. With a population of more thatn 71 million, it is one of the most populous countries in sub-Saharan Africa; more than 85% of the people live in rural areas. The average population density is 52.2 per square km. with great variation among regions. The annual total population growth rate is 2.9% while that of the urban population is 4.1%. The country is one of the least developed countries in the world with an estimated GNP of USD 6.4 billion giving a per capita income of USD 100. Poverty is persistent with 47% of the population estimated to live below the poverty line.
Political and Administrative Structure
The country is a federal state with two parliaments: the House of Representatives and House of Federation. The administrative structure comprises of regions (nine regions namely Tigrai, Afar, Amhara, Oromia, Somali, Benishagul Gumuz; Southern Nations, Nationalities and Peoples; Gambella and Harari), 80 zones, 551 district (woredas) and about 12,000 villages (kebeles). Two city namely Addis Ababa and Dire Dawa, have separate administrations under the federal government.
The country has a worrisome health situation. Most of the health problems are associated with infectious diseases and nutritional deficiencies amenable to preventive measures. Issues such as widespread poverty, low education levels, inadequate access to safe water, sanitation facilities and health services contribute to the ill health situation. Indicators such as infant mortality (97 per 1000); under 5 morality (140.1 per 1000) and maternal mortality (871 per 100,000) speak more on the health and the general socioeconomic situation of the country.
The Health Policy, Plans and Strategies
The government of Ethiopia has issued a health policy in 1993, which emphasizes the importance of achieving access to a basic package of quality primary h ealth care services for all segments of the population using the decentralized state of governance. The health policy stipulates the health service should include preventive, promotive and curative components.
As a means of achieving the goals of the health policy, the government has formulated a twenty-year health sector
development strategy, which is being implemented through a series
of five-year plans. The implementation of the first health sector
development program (HSDP) was launched in 1997, and now the second
HSDP is under way. The main trust of the HSDP implementation is
based on sector-wide approach, encompassing the following eight
• Service delivery and quality of care
• Health facility rehabilitation and expansion
• Human resource development
• Pharmaceutical services
• Information, education and communication
• Health sector management and management of information systems
• Monitoring and evaluation
• Health care financing
The HSDP has introduced a four-tier health service system which comprises: a primary health care unit, (a network of a health center and five health posts), the hospital, regional hospital and specialized referral hospital.
A health post is now being staffed by two health extension workers. These new cadres are trained for one year and their training emphasizes disease prevention measures with focus on the following programs:
The aspect of health management and support within the health system is operated in accordance with the decentralized administrative structures. At present, the decentralization process has expanded to district level and has devolved primary responsibility for service delivery and management from regional health bureaus to district health offices, enabling them to management and coordination primary health care delivey in the their respective areas.
Supportive and educational supervision is undertaken at all levels from the Federal Ministry of Health to district health offices. In addition, responsibility for logistical support is shared among the Federal Ministry of Health, the regional health bureaus, and district health offices.
Health Facilities and Human Resources
Some changes have been observed in regards to access by the population to primary health care services, as expressed in the increased potential health services coverage (64%), EPI coverage (60.8%) antenatal coverage (40.8%). However, a wide range of disparities prevails in the coverage of services and distribution of health facilities between regions as well as urban and rural areas. This situation is further worsened by the inadequate availability of primary health care facilities due to lack of skilled human resource and finance. Thse are the major challenges facing the country in its effort to reach the goal of universal coverage.
Health service in Ethiopia is primarily financed from 4 sources: federal and regional governments; grants and loans from bilateral and multilateral donors; non-governmental organizations; and private contributions.
Currently, there is no updated information available to show the breakdown of health services expenditure in the country. On the other hand, there are information sources indicating that contribution from the private sector is the largest single source of spending on health, while government in collaboration with donors remains the major contributor.