Ethiopia Extends Health to Its People

Bulletin of the World Health Organization, July 2009 | Go to article overview

Ethiopia Extends Health to Its People


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Dr Tedros Adhanom Ghebreyesus was appointed health minister of Ethiopia in 2005, having worked at the ministry of health since 1986. As a malaria researcher, he has published articles in leading scientific journals, including a prize-winning study of malaria incidence among children living near dams in northern Ethiopia in the BMJ in 1999. He is chair of the UNAIDS board and was chair of the Roll Back Malaria Partnership from 2007 until May this year. He earned a Doctor of Philosophy in community health from the University of Nottingham in 2000, and a Master of Science in the immunology of infectious diseases from the University of London in 1992. He completed his undergraduate studies in biology at the University of Asmara in 1986.

At a time when aid effectiveness is under scrutiny, Ethiopia is embracing a new approach to make health aid work--not least with an innovative programme to train and deploy thousands of 'health extension workers' in communities across the country.

Q: What was the greatest challenge when you became health minister?

A: Significantly improving and strengthening our health system--building and expanding our health infrastructure, rapidly scaling up our health workforce and revamping our information systems. We want to achieve universal access to primary health services of an acceptable standard to all Ethiopians. We are working to meet these challenges, first, through social mobilization at the grassroots level, led by our community-based health extension workers. Second, by accelerating expansion of our infrastructure through a major government-led effort that aims to have in place 3200 health centres by 2010--including 2500 new ones over half of which are under construction. By December 2008, 11 446 health posts had also been constructed against our target of 15 000 to bring primary health care to all communities.

Q: In 2005, Ethiopia's total health expenditure per capita was about US$ 6, much lower than the average US$ 24 for sub-Saharan countries. Has this increased?

A: Government health expenditure increased to 11% from 7% of the total budget three years ago. External resources and partners' contributions have also increased. The issue of long-term sustainability is well recognized by our government and that is why we have been prudent in choosing where to target our investments. We are investing in high

impact low-cost interventions aimed at addressing the most pressing health problems. Hence, the priority we have given to primary health care delivery. By the end of 2008, we had trained and deployed 30 190 health extension workers. By engaging health extension workers as full-time salaried civil servants, we have moved away from volunteerism and this has been a key success factor.

Q: Ethiopia seems to be far from meeting the Millennium Development Goals (MDGs) on child and maternal health.

A: We are progressing well on child health. Overall, under-five child mortality has been declining considerably-from 200 per 1000 live births in 1990 to 123 in 2005. Also, as of June, 2007, infant immunization coverage had reached 81%, measles immunization coverage 71%, and full immunization had exceeded 80%. We are confident that these levels have increased since then. MDG 5--reducing maternal mortality--remains our greatest challenge. We aim to further reduce the current maternal mortality ratio of 671 per 100 000 (compared to 1040 in 1990) live births down to 267. Our strategy includes ensuring that at least one-third of the 3200 health centres are appropriately staffed and equipped to provide comprehensive maternal care. Also, the 16 blood banks being built around the country will help ensure an adequate supply of blood for dealing with post-partum haemorrhage--the leading cause of maternal deaths in Ethiopia. Our Health Extension Programme of community health workers is also already having a significant impact by providing services directly to women and developing an effective referral system. …

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