Table 1 progress in key health indicators, ethiopia, 2005 and 2011 health outcomeoutput 2005 2011 change underfive mortality rate 123 88 28% infant mortality rate 77 59 23% stunting in underfive children 51 44 14% prevalence of anemia among women 27 17 37% total fertility rate 5. Implications on access to essential medicines eskinder eshetu ali, bpharm, msc department of pharmaceutics and social pharmacy, school of pharmacy, college of health sciences, addis ababa university, addis ababa, ethiopia abstract background. The health system in ethiopia has to be revaluated because of an upcoming shift in disease patterns in the epidemiological transition. A firstofitskind course gave unicefs ethiopia office health programme staff a crucial insight into the increasingly important role of health care financing in ethiopia and its implications for the countrys children. This 16 page evaluation showcases the final results of the groundbreaking program designed and implemented by care ethiopia and. A lowincome country, ethiopia has made impressive progress in improving health outcomes. In the united states, health care is technologically advanced but expensive. Financing alliance for health fah, and dalberg advisors. Chapter 12 financing health systems in the 21st century george schieber, cristian baeza, daniel kress, and margaret maier. Pdf on jun 14, 2014, yibeltal assefa and others published improving health care financing in ethiopia, find, read and cite all the research you need on researchgate. The implementation of these reform initiatives was. The prioritized initiatives are mobilizing adequate resources mainly from domestic sources, reducing outofpocket spending at the point of service use, enhancing. Thus, there is a clear need for wellorganized research on the issue.
The capacity development resource guides highlight the key technical areas of expertise needed to effectively influence health policy design, implementation, and monitoring and evaluation. National reproductive health strategy phe ethiopia. Cii and fah would like to thank the community health and financing experts who generously provided input and perspectives into this report see annex for a full list of experts consulted. Important barriers to improved health care financing include. With a history of over 3000 years, ethiopia is the only african country that was never.
Hospitals and health centers in the three big regions started to retain revenue in 20052006, and now it is being rolled out to all regions as a national program. The ethiopian health care system is under tremendous reform. Reducing financial barriers to reproductive health care. The existing low government expenditure in the health sector is better manifested when the budget allocated to the sector is seen in. Ethiopia is located in eastern africa, just west of somalia. Health care financing in ethiopia implications on access. About ethiopia ethiopia s total population is 88,0,491, making it the worlds 14th most populous country. During this period, our country has made huge strides in improving access to health services and improvements in health outcomes. In order to tackle these challenges, the government launched a propoor health policy and embarked on health care financing reform in 1998. Health economics and financing course ethiopia 2016. Ethiopia endorsed a health care financing strategy in 1998 that envisioned a wide range of reform initiatives.
In an effort to protect citizens from catastrophic effects of the clearly high share of. Ethiopia health sector transformation plan 201516201920. The authors would like to thank the ministries of health in ethiopia and zambia, in particular, for. It envisions reaching universal health coverage by 2035. The term primary health care phc is the name given to the essential healthcare that is universally accessible to individuals and is acceptable to them at a cost that the country and community can afford.
H42,h51,i18 abstract this paper examines the efficiency and equity implications of alternative health care system financing strategies. This means that, due to economic development, the burden of disease shifts away from communicable diseases like. Pdf improving health care financing in ethiopia, researchgate. Only major cities have hospitals with fulltime physicians, and most of the hospitals are in addis ababa. Nha shows ethiopia s health care financing reforms have yielded tremendous achievements. Overview of health care financing fundamentals merck. A central feature of the sector is the priority given to the health extension programme, which delivers costeffective basic services that enhance equity and provide. A well performing system ensures the production, analysis, dissemination and use of timely and reliable information. The infant mortality rate is almost twice that of the world. Decentralizing health care 201 7 financing health in lowincome countries 209.
User fee retention, waivers, exemptions and public subsidies for income forgone. Ethiopia universal health coverage for inclusive and sustainable development. Introduction to ethiopias health care financing reforms an overview ethiopias health financing strategy, the financing situation, and ethiopias approach to achieving universal health coverage. A step on the road to universal health coverage 3 for example, interviews with users revealed that. In the early 1990s, ethiopia was recovering from a prolonged civil war. Health care financing in ethiopia implications on access to. Public disclosure authorized program in ethiopia the. Health care financing, efficiency, and equity sherry a. Sep 05, 2014 institute for health metrics and evaluation ihme 4,617 views 1.
This financing takes place via contributions to medical schemes, direct outofpocket expenditure and to a limited extent to other forms of private insurance. Health in ethiopia has improved markedly since the early 2000s, with government leadership playing a key role in mobilizing resources and ensuring that they are used effectively. Health care economics and organizationsunited states. Ethiopia s health care system includes primary health centres, clinics, and hospitals. A good health financing system raises adequate funds for health. Public disclosure authorized program in ethiopia the health. Ethiopian health system health care in ethiopia health. Private health care plans, while significant and popular among the affluent, cover only about 16% of south africas population, even though the. Significant analytical work, training, and capacity building are supporting the governments implementation of its new health financing strategy for universal health coverage. Lia tadesse a woman committed to improving health care delivery system duration.
Using data across the oecd, i find that almost all financing choices are compatible with. One of the issues high on the agenda is health care. Between 1986 and 1996, government financing grew from 23% to 43% of total health care financing in ethiopia. Poor health care financing is one of the major challenges for the health system of ethiopia fmoh 2010. Nha shows ethiopias health care financing reforms have yielded tremendous achievements. Ethiopia universal health coverage for inclusive and. Health financing revisited t his publication, health financing revisited. In the healthcare facility, for every 100 clients that experienced poor services, about 70 patients would be unlikely to patronize the same health facility. Access to modern health care is very limited, and in many rural areas it is virtually nonexistent. This article aims to highlight the components of the ethiopian health care financing. Further promotion of health insurance schemes including the provision of formal health care insurance can be considered as a way of reducing the high levels of personal oop health care charges. Another participant expressed that the insurance coverage in africa has reached about 44% on average, however in ethiopia.
Executive summary improving health care financing in ethiopia. This could be because health care financing reforms, especially health insurance, are a new phenomenon for the countrys health care system. Health financing functions health financing involves the basic functions of revenue collection, pooling of resources, and purchase of interventions. Although the health financing in ethiopia comes from a variety of sources, direct outofpocket spending accounts for a significant portion of health sector spending in the country. Health financing functions revenue contribution and collection.
The main targets sets to measure the progress toward this goal are reaching contraceptive coverage rate of 60% by 2010, ensuring awareness. As a result, ethiopia has done remarkably well in meeting most of the mdg targets. Generally, there is no clear evidence on the effect of health care financing reforms on access to essential medicines in ethiopia. In terms of health care financing strategies, ethiopia is moving away from a largely unoperationalized free care policy toward social and communitybased health insurance, which may include rh exemptions. Institute for health metrics and evaluation ihme 4,617 views 1. The current ethiopia health care financing strategy focus on financing of primary health care services in a sustainable manner.
The implementation of these reform initiatives was legalized through regional legislations and operationalized in line with prototype implementation frameworks that were modified and aligned within specific regional contexts. In an effort to protect citizens from catastrophic effects of the clearly high share of outofpocket expenditure, the government is currently working to introduce health insurance. The gff is supporting a diverse and ambitious health financing portfolio in ethiopia. Unicefs ethiopia health staff attended a tailormade course on how health care financing can improve health care coverage for children in ethiopia in line with the country aspiring to be a middleincome country within a decade. Level of patient satisfaction with health care provider interactions at. Ethiopia s health sector is heavily dependent on donor financing. National reproductive health strategy viii 20062015 lization of quality fp services and to delegate the service delivery to the lowest level possible without compromising safety or quality of care. Little is known about physicians role in financial protection of patients and families at the bedside in lowincome settings and how they perceive their roles and duties when treating patients in a health care system requiring high out. Ministers approved a comprehensive health care financing strategy fmoh 1998 in june 1998 to. A village economic and savings association discusses finance, borrowing and saving in ethiopia. Ethiopia health sector transformation plan 2015162019. The reforms the health care financing reform strategy, recognizing that health care should be financed through. We also support the development of much needed human resources and health financing schemes. Implications on access to essential medicines background the ethiopian health care system is under.
In the past two decades, the government of ethiopia has invested heavily in health system strengthening guided by its propoor policies and strategies resulting in significant gains in improving the health status of ethiopians. Global analysis of health insurance in subsaharan africa. One of the issues high on the agenda is health care financing. We have supported the government of ethiopia to train and deploy more than 38,000 health extension workers and 4,000 health officers, and is helping the government develop and deploy midwives, nurses, and anesthesiologists. It is a landlocked country with a central mountain range divided by the great rift valley. Background outofpocket health expenditures can pose major financial risks, create accessbarriers and drive patients and families into poverty. The second largest source of health finance is household spending. Health care financing, efficiency, and equity nber working. Health care financing reform has allowed health facilities to retain and use their revenue for health service quality improvements. Ethiopias health sector is heavily dependent on donor financing. The health workforce in ethiopia public disclosure authorized. Government also provides a tax benefit those who purchase private health care cover through medical schemes. A central feature of the sector is the priority given to the health extension programme, which delivers costeffective basic services that enhance equity and provide care to millions of women, men and.
The graphic above depicts the threetier structure of the ethiopian health system. It envisaged clients receive good customer care by health facilities given much focus so far as patients expectation is concerned. Pdf on jun 14, 2014, yibeltal assefa and others published improving health care financing in ethiopia, find, read and cite all the research. Strengthening primary health care through community health. Mar 01, 2012 ethiopia endorsed a health care financing strategy in 1998 that envisioned a wide range of reform initiatives. Health care is paid for by government programs such as medicare and medicaid, private health insurance plans usually through employers, and the persons own funds outofpocket. In addition, health service delivery was inefficient and inequitable, and quality of health care was generally poor. The secondary and tertiary levels are comprised of general and specialized hospitals, and the coverage of each extends to larger portions of the population. Foreword by the minister of health ethiopia has implemented successive health sector development plans hsdps since 1997 in four phases. The management, coordination, and distribution of technical support in each and every level is the responsibility of. This twohour session 50 expected participants will discuss the health care financing reforms hcfr undertaken by the government of ethiopia with the support.
Implications on access to essential medicines background the ethiopian health care system is under tremendous reform. A model projecting resource mobilization and costs executive summary executive summary this paper presents the results of modeling to project ethiopias future resources to finance primary health care and compare them with the likely costs of providing primary care according to current government plans. A model projecting resource mobilization and costs executive summary executive summary this paper presents the results of modeling to project ethiopia s future resources to finance primary health care and compare them with the likely costs of providing primary care according to current government plans. Procurement and supply programs need to ensure equitable access, assured quality and costeffective use. Table 1 progress in key health indicators, ethiopia, 2005 and 2011 health outcomeoutput 2005 2011 change underfive mortality rate 123 88 28% infant mortality rate 77 59 23% stunting in underfive children 51 44 14% prevalence of anemia among women 27 17.
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