At the High-Level Dialogue on Value for Money, Sustainability and Accountability in the Health Sector on July 4-5 in Tunis Tunisia, over 50 Ministers of Finance and Health and or their representatives sought for examples of best practice in health system reform as they laid out their priorities in the post MDG health agenda. One case presented and discussed was that of Ethiopia’s dramatic achievements witnessed over the last two decades.
In the 1990s and 2000s, Ethiopia had serious weaknesses in their health system, reflected by high morbitity and mortality rates aggravated by poor geographic access to health services and a shortage and maldistribution of health workers.
HHA Partner Support for Ethiopia
Costing Tool: institutionalizing and building on-the-ground capacity to use the Marginal Budgeting for Bottlenecks tool. USAID (through Health Systems 20/20) ,WB, UNICEF
Research activity to compare the effectiveness of performance-linked health worker incentives to increase HCT among TB patients at private facilities.USAID (HS 20/20)
National Health Accounts estimation, which included subaccounts on HIV/AIDS, TB, reproductive health, child health, malaria, and health information systems USAID (HS 20/20)
Access to Basic Services: Budget support for a program that aims to contribute to expand access and improve the quality of decentralised delivery of services health and other services while continuing to deepen local accountability and transparency in basic service delivery. AfDB & other Donors
Government Response
In order to tackle these challenges, the government launched a pro-poor health policy and embarked on a
national health Sector Development Programme (HSDP) in 1998. The HSDP focused on maternal and child health,HIV/AIDS, malaria and tuberculosis and used an evidence-based costing tool that evaluates returns in terms of mortality and morbitity reductions. The program also includes a number of initiatives such as:
The Health Extension Worker (HEW) Program which involves training and sending workers to health posts to deliver a set of 16 packages of health interventions. So far, around 40,000 HEWs have been trained and deployed covering all villages.
The accelerated expansion of health infrastructure which includes expanding the number of health facilities and the training and deployment of key health workers in order to close the geographic barrier and inequitable distribution of health infrastructure.
The Harmonization and Alignment of Aid towards sustainable Financing, whereby multiple sources of funding were harmonized through a flexible multi-donor financing scheme. This one-plan, one-buget one-result framework works within the context of the IHP+ compacts and within the operational frameworld of HHA.
A turnaround in health outcomes
Over the past two decades, Ethiopia has made significant progress in key health indicators. Since 2005, more than 40 million Insecticide Treated Nets (ITNs) have been distributed covering households in malarious areas while close to 10 million people have been tested for HIV/AIDS. Ethiopia's comprehensive approach in the implementation of its successful malaria control program—in which Ethiopia reduced the malaria prevalence to a level low enough to make it possible to eliminate malaria in 2020—has become a flagship program in Africa. Child mortality has been cut in half according to government figures, meaning that together with the drop in under-five mortality rates, Ethiopia is on track to meet 5 MDGs (1,2,4,6 and 8) and is likely to meet the other 3 MDGs (3,5 and 7).
HHA partner support for Ethiopia
Ethiopia’s innovative approach to financing for its health interventions led to close harmonization of partner support. Jointly developed by UNICEF, the World Bank and the African Development Bank, the Marginal Budgeting for Bottlenecks (MBB) is a results-based planning and budgeting tool used in Ethiopia that utilizes evidence about the impact of interventions on child and maternal mortality, identifies implementation constraints, and estimates the marginal costs of overcoming these constraints.
The African Development Bank has supported the government through the Promoting Access to Basic Services Budget Support programme (PBS) which aims to expand access and improve the quality of decentralised delivery of services, including health. This has led to substantial progress in access to basic services and significant gains in social indicators. PBS is also supported by a large number of donors and is anchored on aid effectiveness principles, which include alignment with country systems and harmonisation to ensure programme effectiveness and reduced transaction costs.
