Health Service Organization of Ethiopia.pptx

health

1. 1 Health Delivery System in Ethiopia Ayinengida A.(BSC, MPH) Department of Health Economics and Management Bahirdar University

2. Contents Historical development of health services in Ethiopia National health policy and drug policy Organization of Ministry of health National health plan Specific programs within the health service

3. Objectives 3 At the end of this unit, students are expected to: Describe how the Ethiopian Health System developed over time Be introduced to policy priorities and major strategies in the Ethiopian health policy Explain the current structure of the Ethiopian health care delivery system Discuss the Ethiopian HSDP and HSTP

4. Entry Questions When do you think that modern medical practice was started in Ethiopia?

5. Health Services Delivery System In Ethiopia Introduction Modern health care as organized by the government began to be practiced in Ethiopia only at the beginning of the 20 th century. However, introduction of modern medicine and its use in fragmented manner dates back to the 16 th century. Modern health care delivery movement in Ethiopia has come a long way from its traditional medicine base to the current Sector Wide Approach program (SWAP). 5

6. Historical development of health services in Ethiopia Period of introduction (1500-1900) Period of Ethiopianization (1900-35) Italian occupation (1935 -1941) Restoration and Basic Health Services period (1941- 1974) The primary health care period (1974 – 1991) The Sector Wide Approach Period (1991 onwards) 6

7. 1. Laying the ground for ‘Modern Medicine’ (Before 1936) The introduction of Western type health care in Ethiopia backs to the 15th Century 1520 – 1526 Joao Bermudes – the 1st documented modern medical practitioner in Ethiopia a member of Portuguese diplomatic mission to Atse Lebnedengel (1508 – 1540) 7

8. Before 1936 cont … Progress during the reign of Menelik II (1889 to 1913) Mass Vaccination for small pox Before the war of Adwa (1896), Italian doctors used to visit Ethiopia introducing lots of modern medical practices After the victory of Adwa, the Russians Red Cross mission put significant contribution in the history of modern medicine in Ethiopia Health facilities were constructed in different places The use of piped water started 8

9. 2. The Italian Interlude (1936 to 1941) The drive by Emperor Halileselassie I was interrupted during the brief ‘occupation’ of Ethiopia by the Italians. The existing health care facilities for Ethiopians were destroyed by Italian troops while making preparation to fulfill the medical needs for about 500,000 white soldiers. The Italians prepared base and moveable outreach hospitals with a total of 2,484 doctors, 188 pharmacy officers and 384 nurses for their troops 9

10. 3. The reconstruction period (1941 to 1953) Soon after the end of the Italo -Ethiopian war in 1941, The health care was overtaken and restored by the Ethiopian Government A unit called “Public Health Directorate” was established under the then powerful Ministry of Interior (MOI) . However, autonomous development of health care did not happen until the formal establishment of the Ministry of Public Health (MOPH) in 1948 With responsibility of providing adequate medical care and health services to all sectors of the Ethiopian population. 10

11. The reconstruction period cont … During the period 1941 to 1950, a number of enactments happened to issue a number of proclamations: Medical registration proclamation Pharmacists and Druggists proclamation Proclamation to systemize and regulate medical missionary activities Public health proclamation (1947) Medical practitioners registration proclamation 11

12. The reconstruction period cont… In 1951, Ethiopia had 38 hospitals with about 80 physicians Shortage of trained human resource was one of the major problems during this period. 1949 to 1951 Ethiopia became a member of WHO Three nursing schools were opened 12

13. 4. The Basic Health Services period (1953 to 1974) According to WHO, the aim of BHS was to organize a health delivery system that is able to meet the most urgent health care needs of the major section of population in member countries. 13

14. The BHS period cont… The period of BHS can be seen as two phased: The initial training phase – health center team training The implementation phase – deployment of graduates and provision of health care in rural health centers 14

15. The BHS period cont… The training was supported by US-AID, WHO, UNICEF 1954 – Gondar public health college started to train Health Officers, Nurses and Sanitarians then dressers in 1956 Implementation Through networks of health facilities Two categories of health centers (Major and minor) Clinics/Health Stations 1960 – Health tax introduced to finance expansion and improvement of health care. It was part of the land tax (roughly 30%) 1960 to 64 – school of pharmacy and medicine established 15

16. Establishment of special/vertical projects . Some of the major diseases targeted at were; Venereal Diseases Control Project Tuberculosis Control Project Leprosy control project Malaria Eradication Services Ethiopian nutrition institute Smallpox eradication program 16 The BHS period cont…

17. Starting from 1957 three consecutive five year plans were implemented. The fourth plan that was drafted to be implemented from1974 to 1979 was not well implemented because of the Revolution. The PHC period cont…

18. 18 5. The Primary Health Care period (1974 to 1991) Change in Government from Imperial rule to Military rule This was followed by subsequent political orientation into socialist ideology. This transition brought with it radical changes in the health policy of Ethiopia which in some ways provided the foundation for further development in health care delivery.

19. 19 The PHC period cont… MoH adopted a policy in 1976 that reflected Emphasis on disease prevention and control Priority to rural health services and their expansion Promotion to self-reliance and community involvement in health activities This approach was further strengthened by the adoption of PHC with the purpose of achieving health for all by the year 2000 . Ethiopia was one of the signatories of PHC and started implementing it in short period after ALMA ATA declaration.

20. 20 The PHC period cont… The ten years perspective plan( 1974 & 1984) was the major instrument to implement PHC activities. Health delivery system was changed to six tiers. The inclusion of community-based service delivery using new short-term trained cadres (CHAs and TTBAs) at the time was aimed at extending the point of service delivery to kebele level.

21. The six tier health care delivery system 21

22. 22 The PHC period cont… The major interventions included were: Health education School health Control and prevention of communicable diseases Maternal and child health care Environmental health services Food and nutrition Traditional drugs and medical practices Medical services Pharmaceuticals, medical equipments and supplies Others (health service delivery system, maintenance, HRD, …)

23. 6.The Sector Wide Approach Period (1991 onwards) The current health policy was endorsed during this period(1993). It mainly focuses on: decentralization of the health system; Development of the preventive and promotive the health service. Accessibility of health care to all population; Inter- sectoral collaboration, involvement of NGOs and the private sector; and Promoting and enhancing national self- reliance in health development by mobilizing and efficiently utilizing internal and external resources. 23

24. SWAps are seen as ways of delivering agreed upon health policies and manage domestic as well as aid resources. The HSDP was launched in 1998 in response to the prevailing and newly emerging health problems in Ethiopia and in recognition of weaknesses observed in the existing health delivery system. The initial Health Sector Development Program which was drafted in 1993/94 was designed for a period of 20 years, with a rolling five-year program period. 24 The Sector Wide Approach period…

25. The Sector Wide Approach period… The eight components of HSDP are: Health service delivery & quality of care Facility rehabilitation & expansion Human resource development Strengthening pharmac eutical services IEC HMIS Health care financing Monitoring and Evaluation 25

26. Major changes in HSDP Conversion of the health system to 4 tiers(HSDP I)and then three tiers(HSDP IV) Instillation and expansion of Health Extension Program- HSDP II Implementation of Millennium Development goal The Sector Wide Approach period…

27. Four tier system Specialized/Teaching hospital (1:5,000,000) Beds: 250, Technical Staff: 120, Non-technical Staff: 50 Regional hospital (1:1,000,000) Beds: 100, Technical Staff: 60, Non-technical Staff: 35 District Hospital (1:250,000) GP & other staffs, Beds: 50, Technical Staff: 33 Non-technical Staff: 35 Primary health Care unit (PHCU) HO & other staffs At the HC no. of Beds: 10, Technical Staff: 13-15 & Non-technical Staff: 12 27

28. The three tier system 28

29. Currently the program implemented in the health system is Health Sector Transformation Plan(HSTP) Currently running 20 year strategic plan(2015-2035) Is designed inline with GTP-II Is based SDG The Sector Wide Approach period…

30. HSTP Developed as part of the second Growth and Transformation Plan (GTP II). Based of the lessons learnt from implementation of former plans( HSDP) Even though visible achievements are made still there are triple health problems- CD,CNCD, and Injuries Considering the current socio-economic landscape It is the first phase of the 20 year health sector strategy called as ‘Envisioning Ethiopia’s Path to Universal Health Care through strengthening of Primary Health Care’. 30

31. The health sector transformation plan (HSTP) has three key features: quality and Equity universal health coverage and transformation. 31 HSTP

32. Four Pillars of Excellence Excellence in health service delivery Excellence in quality improvement and assurance Excellence in leadership and governance Excellence in health system capacity 32 Strategic Themes of HSTP

33. The four pillars of excellence are further decomposed to fifteen strategic objectives categorized Under two driver perspectives – Business process and learning & growth AND And two result orientations - community perspective and financial stewardship 33 Strategic Objectives of HSTP

34. The four transformation agendas Transformation in equity and quality of health care Information revolution Woreda transformation The Caring, Respectful and Compassionate health work force 34 Transformation Agendas

35. Governance of the Health System The MOH is only responsible for major policies and guidelines. Moreover, the MOH is expected to give policy and technical guidance and coordinate donor support. Its relationship with RHB in the decentralization process is still evolving. The Regional Health Bureaus (RHBs) are under the Regional Administration which emanates from the Regional Council. Regional policies and plans are decided by the Regional Councils which also decide on the budget allocated to the regional health activities. 35

36. Zonal Health Departments (ZHDs) Are essentially administrative branches of RHB. In most cases the decentralization to the woreda level has led to major downsizing of ZHD with most becoming small desks with very few (5-7) staff. WrHOs Responsible to the Woreda Administration which emanates from the Woreda Council, an elected body. WrHOs have only technical link with the RHB and/or ZHD. It is expected to oversea the PHCUs in the woreda and is responsible for the planning, implementation and evaluation of all district health activities . 36 Governance of the Health System

37. Structure of the current Health Delivery System(MOH) 37 Regional Administration Zonal Administration Office Woreda Administrative Council RHB ZHD WrHO K ebele PHCUs(Dist Hospitals, HCs & HPs) General Hospitals FMOH Federal Government Specialized Hospitals

38. 38 Structure of the Ethiopian Health System

39. Thank you!!! 39