Health policy in Ethiopia 5gggggggv r.pdf

Health policy Management

1. Mizan-Tepi university
College of health science and medicine
School of public health
Department of public health



By Mr. Temesgen G. (BSc, MPH in HSM)
10/19/2023 Temesgen g. (MTU) 1

2. Session objectives
 At the end of this class students will be able to:
•Analyse key health system building blocks and their interactions
•Describe the historical development of the health care system
•Analyse the previous and current tiers of health care system
•Discuss the categories of current health care facilities
•Describe the current health policies, strategies and reforms in
Ethiopia
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3. Health System
•A health system is the sum total of all organizations,
people, resources and all activities whose primary
purpose is to promote health, to restore or maintain
health
=> To protect or improve health
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4. Health systems have three objectives
•Improving the health of the population they serve
•Providing financial protection against the costs of ill-health
(Risk Protection)…sharing risk and providing financial protection
=> Fairness in financial contribution
•Responding to people’s expectations (Responsiveness)…reflects
the importance of respecting people’s dignity, autonomy & the
confidentiality of information

Health System
4

5. Health System
A well-functioning health system responds in a balanced way to a population’s
needs and expectations by:
–Improving the health status of individuals, families and communities
–Defending the population against what threatens its health
–Protecting people against the financial consequences of ill-health
–Providing equitable access to people-centered care
–Making it possible for people to participate in decisions affecting their
health and health system.

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6. Health System Building Blocks
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7. National Health Policy of Ethiopia
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8. National Health Policy of Ethiopia
Historically, the Ethiopian healthcare delivery System has not
been very effective in responding to health needs of the people.
Since 1993, The Federal Ministry of Health of Ethiopia
(FMOH) has formulated a 20 years National Health Sector
Development Program (NHSDP)
 In 2015, the sector successfully concluded the NHSDP (HSDP
I to HSDP IV) and launched the Health Sector Transformation
Plan (HSTP).



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9. National Health Policy of Ethiopia…
• The health policy (HSDP) principally focuses on
–Fiscal and political decentralization,
–Expanding the PHC services to all segments of the
population and
–Encouraging partnerships and the participation of
nongovernmental actors.



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10. General Theme of the 1993 Health Policy
1.Democratization and decentralization of the health service
system.
2.Development of the preventive and promotive components of
health care.
3.Development of an equitable and acceptable standard of health
service system
4.Promoting and strengthening of inter-sectoral activities.
5.Promotion of attitudes and practices conducive to the
strengthening of national self-reliance

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11. General Theme of the 1993 Health Policy
6. Assurance of accessibility of health care for all segment of the
population.
7. Working closely with neighboring countries, regional and
international organizations
8. Development of appropriate capacity building based on assessed
needs.
9. Provision of health care for the population on a scheme of payment
10. Promotion of the participation of the private sector and
governmental organizations in health care.

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12. The Ethiopian Health Policy (1993) places the following
interventions as top priorities
–Information, Education and Communication
–Control of communicable diseases and epidemics
–Promotion of occupational health and safety
–Development of environmental health
–Rehabilitation of health infrastructure
–Development of an appropriate health service management
system.
(Source: Transitional Government of Ethiopia, 1993)

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13. –Supporting curative and rehabilitative services,
–Developing the beneficial aspects of traditional
medicine and
–Provision of essential medicines, medical supplies and
equipment.
(Source: Transitional Government of Ethiopia, 1993)

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14. •In addition, the policy gives special attention to the
•Development of human resources for health (HRH),
•Applied health research, addressing the major health
problems, and
•The needs of women and children and those hitherto most
neglected.
(Source: Transitional Government of Ethiopia, 1993)
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15. •Having the national health policy as an umbrella for the
development of HSDP IV, other health and health related
policies and strategies have been considered.
•These include:
–Policy and strategy for prevention and control of
HIV/AIDS
–The National Drug Policy.
–The National Population Policy
–The National Policy on Women
–Child Survival Strategy.

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16. Historical development of health systems &
policies in Ethiopia
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17. Health service approach and period
Approach Period
Traditional Medicine Immemorial
Period of introduction

1500 - 1900
Period of Ethiopianization 1900 - 1936
The Italian interlude 1936-1941
Period Restoration 1941 – 1974
PHC period 1974-1991
HSDP 1996-2015
HSTP 2015-2035
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18. Historical development
1. Period I- Period of introduction (1500-1900)
Joas Bermudes Portuguese diplomatic mission to Lebne dengel in
1520 – 1526 was the 1
st
documented one.
During this time, the medical practice had been introduced by
• Diplomatic visits
• Religious visits
• Explorers
•Merchants
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19. 2. Period II: period of Ethiopianization (1900-35)
 The reign of Minelik
 Vaccine of small pox was given
 The 1
st
hospital was established (by Russian Red Cross in Addis Abeba)
following the 1
st
Ethio-Italian war (1897 – 1906)
 Ras Mekonnen Hospital – 1
st
Ethiopian Sponsored hospital built in 1901
in Harar – run by French Missionaries.
 1909- 1
st
Gov’t hospital in Addis Abeba (Minelik hospital) was
established.
 1910- More private hospital, clinic, pharmacies etc. were established.
 1930- 1
st
medical legislation to regulate the work of medical practitioners
and pharmacies was prepared.
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20. 3. Period III: Italian occupation (1935 -1941)
 2000 physicians for their troops
 Expansion of hospitals and massive small pox
vaccination
 No benefit to Ethiopians
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21. 4. Period IV: Period Restoration (1941 – 1974)
 Restoration and overtaking of the health care by Ethiopian gov’t
 Ministry of health was established in 1948.
1949 – Ethiopia became member of WHO
 1
st
nursing school was opened in Addis Ababa by the Red Cross
Society at the Haile-Selassie I Hospital (currently Yekatit 12
Hospital).
1952 – 38 hospitals and 80 physicians all foreigners
1954 – Gondar public health college (HO, Nurse and Sanitarian)
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22. 5. Period V: PHC period (1974 – 1994)
 Total change of social system
 Control taken – over by the gov’t
 No private sectors
 Health policy emphasizes on
•Prevention
•Rural areas PHC
•Appropriate technology
•Community participation



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23. Cont…
 The government developed 10 years perspective plan
 When health condition was assessed;
• 6,474 health personnel of all categories
• 650 health stations and 93 health centers
• 84 hospitals with 8,624 beds
 Adoption of the Alma – Ata declaration
 6 tier health care delivery system
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24. The 6 tier health care delivery system

Central hospital

Regional hospital
1: 1.6-3 million
Rural hospital
1: 100,000-500,000 people

Health center (HC)
1: 50 -100,000 people
Health Station (HS)
1: 10,000 people
Com. health services
1: 1000 people
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25. 6. Twenty-year HSDP period (1996-2015 GC)

Launched in 1998
The focus was on preventive and promotive aspects of
care with:
•Health Education
•Reproductive Health Care
•Immunization
•Better Nutrition
•Environmental Health and Sanitation.

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26. Components of HSDP
1.Service Delivery and Quality of Care
2.Health Facility Rehabilitation and Expansion
3.Human Resource Development
4.Pharmaceutical Services
5.Information, Education & Communication (IEC)
6.Health Sector Management & MIS
7.Monitoring and Evaluation
8.Health Care Financing
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27. Phases of HSDP
HSDP I -1997/8-2002
HSDP II -2002/3-2005
HSDPIII –July 2005-June 2010
HSDP IV –June 2010-2015
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28. HSDP I (1997/98–2001/02)



Covered the first five years (1997/98–2001/02)
Priority focus was disease prevention
Introduced a four-tier system for health service delivery
characterized by;
•Primary health care unit (PHCU),
comprising one HC and five satellite HPs
•District hospital,
•Regional hospital
•Specialized hospital
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29. HSDP-II (2002/03–2004/05)
 Introduced the Health Service Extension Program
(HSEP)
Innovative health service delivery system
It is a community based health care delivery
system

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30. HSDP III (2005/6-2009/10)



Directly aligned with the health-related MDGs
Focuses on scale-up and increasing coverage of key health
services for HIV, TB, malaria, as well as maternal and child
health.

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31. HSDP IV (2010 –2015)

Developed as part of the national Growth and Transformation Plan
(GTP)
Gives priority to maternal and child health, nutrition and major
communicable diseases, such as HIV/AIDS.
Emphasizes the strengthening of HSEP
Developed the three tier health delivery system
Community empowerment/ownership

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32. Recent Health System Structural Changes
 Ethiopia recently introduced a three-tier health care
delivery system.
Level (Tier ) One - Primary Level
Level (Tier) Two - Secondary Level
Level (Tier) Three - Tertiary Level

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33. Current Ethiopian Health Tier System
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34. Level (Tier) One - Primary Level
The woreda (district) includes:
•A primary hospital (with population coverage of 60,000-
100,000 ),
•Health centres (15-25,000 people for rural, and 40,000 people
for urban) , and
•Satellite health posts (3-5,000 people)
•Connected to each other by a referral system.
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35. Level (Tier) Two - Secondary Level
A general hospital with population coverage of 1-1.5 million
people.
Level (Tier) Three - Tertiary Level
A specialized hospital that covers a population of 3.5- 5
million.

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36. Types of health care facilities
۞Hospitals
۞Health center,
۞Health post
۞Specialty Centers
۞Specialty clinic
۞Stand alone Medical Laboratories
۞Medium clinic
۞Primary clinic
۞Nursing Home
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37. Type and Category of private HF
 Primary clinic
 Medium clinic
 Specialty clinic(19)
•Pediatric specialty clinic
•Eye/ ophthalmology,
•Dental,
•Ear-Nose-Throat (ENT),
•Dermatology,
•Psychiatry,
•Obstetrics & Gynecology,
•Internal Medicine,
•surgery,

•Gastroenterology,
•Neurology,
•Cardiovascular,
•Orthopedic,
•Nephrology,
•Rheumatology,
•Chest & Physiotherapy

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38. health care facilities . . .
Specialty Center(10)
•MCH specialty centre
•Pediatrics specialty Centre
•Internal Medicine
•Oncology
•Gastroenterology
•Surgery
•Orthopedic
•Cardiac
•Neurology
•Renal


Hospital(3)
•Primary hospital
•General hospital
•Comprehensive specialized hospital

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39. 7. Health Sector Transformation plan 1 (HSTP 1) in Ethiopia

It was the five-year national health sector
strategic plan.
It covers July 2015 – June 2020.
Its long-term roadmap “envisioning
Ethiopia’s path towards UHC through
Strengthening PHC.”

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40. Strategic objectives
Perspectives Strategic objectives
Community Improve health status
Enhance community ownership
Financial stewardship Improve efficiency and effectiveness
Internal process Improve equitable access to quality health services
Improve health emergency risk management
Enhance good governance
Improve regulatory system
Improve supply chain and logistic management
Improve community participation and engagement
Improve resource mobilization
Improve research and evidence for decision-making
Learning and growth Enhance use of technology and innovation
Improve development and management of HRH
Improve of health infrastructure
Enhance policy and procedures
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41. Health sector transformation agendas
To achieve the targets set during HSTP 1, we have four
transformation agendas. These are:
1. Transformation in equity and quality of health care
2. Information revolution
3. Woreda transformation
4. The Caring, Respectful and Compassionate (CRC) health
workforce

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42. 1. Quality and Equity in Health Care
•Equity in health care is ensuring availability of the best care to
all.
•The quality of care does not differ by any personal characteristics
such as age, gender, socioeconomic status or place of residence
•Quality health care refers to a care which is safe, reliable,
patient-centered, efficient and provided to all in need in an
equitable and timely manner.
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43. 2. Information Revolution:
It entails a radical shift from traditional way of data
utilization to a systematic information management
approach powered by technology/digitalization .
It is also about bringing fundamental cultural and
attitudinal change regarding perceived value and practical
use of information.
Advancing the data collection, aggregation, reporting and
analysis practice
Promoting the culture of information use

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44. 3. Woreda transformation:
The woreda transformation agenda has three simple and
interrelated goals.
Developing high-performing primary health care units (PHCU),
Graduation of model Kebeles and
Financial risk protection through CBHI

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45. 4. Caring, Respectful and Compassionate (CRC):

CRC health professionals have four essential characteristics:
1. Consider patients as human beings with complex psychological, social and
economic needs and provide patient-centered care with empathy
2. Effective communication with health care teams, interactions with patients
and other health professionals
3. Respect for and facilitation of patients’ and families’ participation in
decisions and care
4. Take pride in the health profession they are in and get satisfaction by serving
the people and the country.

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46. 8. Health Sector Transformation plan 2 (HSTP 2) in Ethiopia
•The second Health Sector Transformation Plan (HSTP-II)
covering the period between July 2020–June 2025.
•The overarching objective of HSTP-II is to improve the
health status of the population by realizing these four
objectives:
1. Accelerate progress towards universal health coverage
2. Protect people from health emergencies
3. Woreda transformation
4. Improve health system responsiveness
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47. Health sector transformation agendas
•Five priority issues were identified as part of the transformation agenda for HSTP-II.
1.Quality and Equity:
•Ensuring equity in delivery of quality health services by creating high-performing primary
health care units, ensuring active engagement of the community in service delivery, and
continually improving clinical care outcomes
2.Information revolution:
•Significantly improving methods and practices for collecting, analyzing, presenting, using, and
disseminating information that can influence decisions.
•HSTP-II, efforts will focus on three pillars of the information revolution:
•Transforming a culture of high-quality data use;
•Digitization of the health information system (HIS); and
•Improving HIS governance.
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48. Health sector transformation agendas cont….
3. Motivated, competent, and compassionate health workforce:
•Ensuring equitable distribution and availability of an adequate number and skill
mix of health workers who are motivated, competent, and compassionate to
provide quality health services.
4. Health financing:
•Reforming public financial management and health financing to improve
efficiency and accountability, while pursuing the agenda of sustainable domestic
resource mobilization for health.
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49. Health sector transformation agendas cont….
5. Leadership:
•Enhancing leadership and governance mechanisms at all levels
of the health system to drive attainment of the national strategic
objectives through activities to ensure alignment and
harmonization, thereby creating an enabling environment for
the translation of plans into results.
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50. Thank you!!


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