Ethiopia Presentation

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Information about Ethiopia Presentation

Published on December 3, 2008

Author: aSGuest5086


Health Sector Performance and Constraints: the Case of ETHIOPIA : Health Sector Performance and Constraints: the Case of ETHIOPIA Post-HLF Meeting on Health MDGs 12-13 June 2006 Tunis Outline of the presentation : Outline of the presentation Background Progress in the Health Sector Coordination and Harmonization Next Five Year Plan Main challenges and way forward Background : Background Country Profile : Country Profile 1.1 million 77.3 million population Population growth rate: 2.7% /year Rural population:85% Federal government : 9 Regional States, and 2 City Administration 624 Woredas (districts) 15,000 kebeles (villages) Health Sector Policy and Strategy : Health Sector Policy and Strategy National health policy: 1993 Democratization and decentralization Primary health care approach Preventive, promotive, basic curative and rehabilitative 4 tier health system organization PHCU (health center + 5 health posts) (25,000) District hospital (250,000) Zonal hospital (1 million) Specialized hospital (5 million people) 20 years health sector strategy, 5 year rolling plan HSDP-I: 1997/8 - 2001/02 HSDP-II: 2002/3 - 04/05 HSDP-III: 2005/06 - 2009/10 Health Financing Status : Health Financing Status Low per capita total health expenditure In 2000, US$5.6 in 2000 (US$ 1.8 government, US$ 0.9 donors, OOPS US$2.1, Private/NGO US$0.8 ) In 2004 total health expenditure increased to US$7.8 per capita(3rd NHA) Domestic revenue (23% of GDP) and government expenditures (29 % of GDP) higher than average SSA . But share of public expenditures going to health lower than SSA  margin for increase Progress since HSDP : Progress since HSDP Child Health : Child Health In 2005: Infant mortality 77/1000 from 97 in 2000 Under five mortality 123/1000 from 140 in 2000 DPT 3 coverage 70% from 38% in 2000 Measles coverage 61.3% from 31% in 2000 Immunization : Immunization Maternal Health : Maternal Health In 2005: Maternal mortality 871 (2000) Contraceptive prevalence rate 25% ANC coverage 42% Skilled attendance 12% CPR, ANC, attended delivery and postnatal : CPR, ANC, attended delivery and postnatal HIV/AIDS : HIV/AIDS In 2005: Number of facilities providing VCT 525 from 170 PMTCT providing facilities 72 from 12 Care and support 103,000 Malaria : Malaria 10 million households in malarious area 20 million ITNs required So far, 4.2 million ITNs distributed Gap of around 6 million Health Human Resource : Health Human Resource Health extension workers 9,900 (1/3 of what the about 30,000 required) Physicians (including HOs) =3,229 (Ratio=1:22,621) Health Officers (trained in 5 years)=776 Nurses=18,809 (Ratio=1:3,883) Coordination and harmonization modalities : Coordination and harmonization modalities Harmonization and Alignment : Harmonization and Alignment Ethiopia harmonisation action plan 2004-06 DAG = chaired by Minister of MOFED, heads of development partners, ministers of sectoral ministries PASDEP as overall framework for prioritizing and planning, Annual progress report using the policy matrix and agreed indicators. Attempt at reflecting donor activities in the Public Expenditure Review process – i.e. bringing together all commitments and actual spending in the health sector into one document and review process. Code of conduct was signed in September 2005 between Government and health partners HSDP Governance : HSDP Governance Central Joint Steering Committee: chaired Minister of Health Federal MOH-Health Population Nutrition donors consultative forum: Co-chaired by Minister of Health and head of HPN Joint Core Central Committee: chaired by Planning Programming Department of MOH Joint Review Mission /Annual Review Meeting Mid term and final evaluation of HSDP Next Five Year Plan (HSDP III) : Next Five Year Plan (HSDP III) Policy Framework of HSDP-III : Policy Framework of HSDP-III PASDEP: national framework for development and poverty reduction Represents the health section in PASDEP Zoom at achieving the health MDGs, Builds on: Health Service Extension Programme (HSEP), Accelerated Expansion of Primary Health Care Services Child Survival Strategy, Reproductive Health Strategy Summary of HSDP III Outcomes and Targets : Summary of HSDP III Outcomes and Targets Main Vehicles for HSDP III Implementation : Main Vehicles for HSDP III Implementation Health Service Extension Program (HSEP) GoE flagship program to improve access and equity to preventive essential health interventions 16 packages of promotive, preventive and basic curative services 2 HEWs and a HP in a Kebele Accelerated expansion of PHC facilities 13,635 health posts (existing 4,211) 3,000 health centers (existing (600) Costing and financing of HSDP III : Costing and financing of HSDP III Three scenarios : Three scenarios Scenario 1: US$ 4.8 per capita per year over 5 years Full implementation of the HSEP access to health post 100% (13,635 health post, human resource, essential inputs) access to health center 80% (2,229 health center, human resource, essential inputs, functional B-EOC) Scenario 2: US$7.5 per capita per year over 5 years HSEP plus expansion of first referral clinical Scenario 3: US$13.3 per capita per year over 5 years No resource constraints access to health center 94% (3,153 health center, human resource, essential inputs, functional C-EOC High coverage targets for clinical care e.g. 80% ARV All health MDGs achieved Cost of scaling up health services in Ethiopia : Cost of scaling up health services in Ethiopia Financing Gap : Financing Gap Considering financing for HIV Excluding HIV financing Main challenges : Main challenges Health system is under funded : Health system is under funded Health system National HMIS design with support from UNDP & HMN National logistic master plan design with support from UNICEF Protecting Basic Services (US$64m) to provide essential commodities for HSEP GAVI HSS expected Health infrastructure AfDB Grossly underfinanced Human resource development strategy WB conducting labor market study USAID supporting accelerated training of health officers HRD strategy yet to be developed Donor funds crowd out domestic funding : Donor funds crowd out domestic funding Donor support remains fragmented : Donor support remains fragmented Multiple donor accounts maintained at FMOH Fragmentation Increased transaction cost Increased reporting burden Multiple monitoring and evaluation requirements Their own funding procedures Contribute to the low absorptive capacity MDGs Performance Fund : MDGs Performance Fund Pooling of funds (US$64m) of 5 donors (WB, DFID, Canada, Sweden, Ireland) to procure essential commodities and equipment Key messages : Key messages Ethiopia has a PRSP, costed health strategic plan aligned with MDGs Large funding gap for health systems strengthening-infrastructure and human resources- Large funding gap for maternal and child health, Fragmentation of donor support remains a challenge despite recent efforts (MDGs Performance Fund as part of PBS) =>need to move towards sector budget support: pooled funding => need for more flexible funding that can be tailored to country need, no more earmarked funds ? Our partnership can make a difference : Our partnership can make a difference Thank you : Thank you

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