The document summarizes the historical development of Ethiopia's health care system from the 1500s to present day. It outlines the system's organization into 6 tiers during the socialist period of 1974-1991 and its restructuring into a 4-tier system in 1991 under the current federal democratic republic. The national health plans from the 1950s to present are also summarized, highlighting priorities around expanding access and decentralizing services. Key policies of the transitional government emphasize decentralization, preventative care, accessibility, and intersectoral collaboration.
The document summarizes the historical development of Ethiopia's health care system from the 1500s to present day. It outlines the system's organization into 6 tiers during the socialist period of 1974-1991 and its restructuring into a 4-tier system in 1991 under the current federal democratic republic. The national health plans from the 1950s to present are also summarized, highlighting priorities around expanding access and decentralizing services. Key policies of the transitional government emphasize decentralization, preventative care, accessibility, and intersectoral collaboration.
The document summarizes the historical development of Ethiopia's health care system from the 1500s to present day. It outlines the system's organization into 6 tiers during the socialist period of 1974-1991 and its restructuring into a 4-tier system in 1991 under the current federal democratic republic. The national health plans from the 1950s to present are also summarized, highlighting priorities around expanding access and decentralizing services. Key policies of the transitional government emphasize decentralization, preventative care, accessibility, and intersectoral collaboration.
The document summarizes the historical development of Ethiopia's health care system from the 1500s to present day. It outlines the system's organization into 6 tiers during the socialist period of 1974-1991 and its restructuring into a 4-tier system in 1991 under the current federal democratic republic. The national health plans from the 1950s to present are also summarized, highlighting priorities around expanding access and decentralizing services. Key policies of the transitional government emphasize decentralization, preventative care, accessibility, and intersectoral collaboration.
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UNIT 5
Organization of the Ethiopian health
.
care delivery system
HSMMRB-2011 1 Learning objectives
At the end of this unit, the learner is expected to understand
• The historical development of the Ethiopian health are delivery system • The Ethiopian health policy and strategy
• The components of HSDP
• Structures of the Ethiopian health system
• Functions of the different levels of the health care system
• The concept of decentralization
2 ORGANIZATION OF HEALTH SERVICES IN ETHIOPIA
Historical Development
• The concept of Traditional Medicine
• Modern health service coverage 90%(2001E.C). • Based on physical accessibility, not the quality of service. • Introduction of modern medicine to Ethiopia =16 th century. • Since then, its development is arbitrarily divided in to 6 periods as follows
3 Historical Development . . . . . . .
1. Period I = Period of introduction =1500-1900
2. Period II = Period of Ethiopianization =1900-1935
3. Period III = Period of Italian occupation =1935-1941
4. Period IV = Period of overtaking responsibility of health
service by the government =1941-1974
5. Period V = Period of socialist economy = 1974-1991 ` 6. Period VI = Period of market economy, Democratization, Decentralization, and Privatization = 1991- to date 4 Period I/ Introduction/ 1500-1900
• Modern medicine introduced by diplomats, religious,
explorers, and merchants First :- Joao Bermudez, Portuguese surgeon 1520-1526 = During Atse Libnedingl Second:- Emperor Yohannes ,( traditionalist,) But it only entered a new phase with the regimen of Emperor Menelik II (1889-1913). By Russian medical mission • But served mainly the ruling class (royal families). 5 Period II /Ethiopianization/ 1900-1935 =time of Menelik II
• Most significant period in the expansion of modern
medicine: • 1930-1st medical legislation
Period III /Italian Occupation/ 1935-1941
• Brought numerous doctors to Ethiopia • There was expansion of hospitals and launched massive small pox vaccination. • Generally – This period was a set-back to the Ethiopian health development (i.e.-no benefit to Ethiopians). 6 Period IV 1941-1974 Restoration and overtaking of the health care by Ethiopian government • Ethiopian government took back the responsibility, • 1947 public health proclamation was set • Then a separate ministry of Public health was established in 1948. • 1949 - Ethiopia became member of WHO
7 Period V /Socialism/ 1974-1991
= Total change of social system
• Completely taken over by the Government –no private
sub- sectors • The broad objective was ‘promoting equity in health care, aimed at abolishing the existing inequalities in health care provision • 10 years perspective health plan was developed. • The health care delivery was structured into a 6-tier system. 8 Pyramidal arrangement of the health care structure during the Derg rule
Central/Referral Hospital
Regional Hospital- 1:1.6-3 million populations
Rural Hospital- 1:50,000-100,000 population
Health Center- 1:50,000-100,000 population
Health Station- 1:10,000 population
• • Community Health Service-1: 1000 population 9 Limitations of the 6-tire system
• Centralized management and lack of
professionalism • Poor community & private sector participation
• Redundancy /overlapping of service around towns
• Inefficient resource utilization.
10 Limitations of the 6-tire system . . . . ..
Government measures/responses: • Under took annual campaign by high school and university students in rural areas, between 1970-1976 E.C. aimed at overcoming urgent problems • Construction of communal latrines (from 650 to 1950) • Number of health stations tripled. • Number of health centers increased from 93 to 145.
11 Period VI 1991- to date EPRDF, FDRE
• Complete change of socio – political policy
• Market Economy, Privatization, Decentralization, and Democratization • The modern health care system was restructured into a 4-tier system.
12 The 4- tire system of FDRE
Central/Referral Hospital = 1:5, 000,000 population
Zonal/Regional Hospital- 1:1,000,000 population
District Hospital 1:250,000 population
PHCU- 25,000 population (1 PHCU=1HC
with 5CHP) 5 CHP)
13 National Health plans - the past and the present
1. The first 5-years development plan of Ethiopia 1950 -1954 E.C
• It didn’t include public health.
• Priority was given for economic growth through developing
infrastructure. 2. The second 5-years development Plan 1955-1959 E.C • Strategy for national health services was formulated for the first time • It gave emphasis for both preventive and curative health services
• Focused on health centers and health stations construction.
14 National Health plans - the past and the present
Limitations of the 2nd five year development plan were:
• Shortage of resources • Inefficient management and supervision of the activities • Mismatch between the plan and implementation
Only 11 % of the planned health centers & health
stations were constructed.
15 National Health plans . . . . .
3. The third 5-years development Plan 1960-1965 E.C
• High priority was given to agriculture.
• Major health goals focused were:
A. Malaria eradication program B/c of its greatest
economic impact. B. Improvement of health services by:
• Expansion of health services
• Decentralization of services
• Better training of health professionals.
16 National Health plans . . . . .
4. The fourth 5-years development Plan 1966-1971 E.C
• Re-emphasized the importance of public health services. • Planned to increase health services coverage from 15 to 30%. • It failed completely because of 1966 E.C social & political turmoil/chaos.
17 Health policy in TGE
Definition • Policy is a broad statement of intent • Polices are networks of interrelated decisions • Policies are expressed in whole series of practices, statements, regulations and even laws,
18 General 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 & acceptable standard of health service system that will reach all segments of the population within the limits of resources.
19 General policy . .. . . .
4. Promoting and strengthening of inter sectoral activities.
5. Promotion of attitudes and practices conducive to the strengthening of national self-reliance 6. Assurance of accessibility of health care for all segments of the population. 7. Working closely with neighbouring countries, regional and international organizations to share information.
20 General policy . . . . .
8. Development of appropriate capacity building based on
assessed needs. 9. Provision of health care for the population on a scheme of payment according to ability 10.Promotion of participation of the private sector and non-governmental organizations in health care.
21 Priorities of the policy
1. Information, Education & Communication (I.E.C)
2. Emphasis shall be given to: The control of : Communicable diseases, Epidemics Malnutrition and poor living conditions, Promotion of occupational health and safety Development of environmental health, Rehabilitation of the health infrastructure and Development of an appropriate health service Mgt. system.
22 The ten-years health sector plan 1977-1986 E.C.
• Was part of the global movement to achieve health for all by
the year 2000
Objective of the plan:
• Apply the principles of PHC
• Control all major communicable disease
• Expand EPI services
• Extend medical service to 80% of the population
• Ensure the provision of comprehensive health services
e.g. Mothers and children 23 The ten-years . . . . . .
Target of the ten years plan were:
• Reduction of IMR form 155/1000 to 95/1000
• Reduction of CMR from 247/1000 to 95/1000
• Improve life expectancy at birth from 42 to 55 years
• Increase health service coverage from 43% to 80%
• Clean water supply to 80% of the rural population
• Provide health service to 80% of the population
Objective
• To give an acceptable standard of comprehensive &
24 Twenty Year HSDP of (FDRE)1984-2005 E.C
Focus was on – • Preventive and promotive aspects of care with Health education, Reproductive health care, Immunization. Nutrition, Environmental health and sanitation Change the six tier health delivery system into 4-tier Implementation of Decentralized, Democratized and participatory administration 25 HSDP . . . . . .
HSDP • Is a vehicle by which the national health policy is implemented • Is a 20 yrs. health sector strategy, of 5 year rolling plan in four phases – HSDP-I: 1997/8 - 2001/02
– HSDP-II: 2002/3 - 04/05
– HSDP-III: 2005/06 - 2009/10
– HSDP-IV:2011-2015 26 The eight Components of HSDP
1. Health services delivery and quality of care
2. Health facility rehabilitation and expansion 3. Human resource development 4. Strengthening pharmaceutical services 5. Information education and communication 6. Health management and information system 7. Health care financing 8. Monitoring and evaluation 27 What is Health Extension Program (HEP) ?
• It is a community based program introduced in 2003
• To make essential health services available at grass root level
• Strongly focused on sustained preventive actions and increased
health awareness.
• It is a package of promotive, preventive & basic curative services
• It is a mechanism of shifting health care resources to rural people
for achieving MDGs
28 Objectives of HEP
The objective was to:
• To increase awareness, among community members • To Promote healthy life style • To improve access to basic health care services • To promote equity in health care delivery • To improve quality of health care • To promote women empowerment
29 Principles of HEP
• Preventive & promotive interventions are more cost-
effective • Communities identify & prioritize their own health needs and problem • Community involvement, ownership, empowerment and self-reliance need to be promoted to ensure sustainability • Women involvement in all decision-making process is central • Learning/teaching by doing 30 HEP Components
16 extension package divided in to 4 main categories and
one cross cutting issue I. Hygiene & Environmental health component II. Family Health service III. Disease Prevention & Control IV. Health Education & Communication/BCC
31 HEP Implementation Strategy Strengthening decentralization of the health services
Expansion & strengthening health infrastructures at all levels
