Health care is a key social development agenda aiming for the realization and maintenance of a decent standard of living for a society. Public health issues have an inevitable knock-on effect reverberating throughout the economic activities and social life of a nation. It is therefore imperative to achieve universal health coverage across the nation whereby the society could have access to affordable and quality health care services.
Cognizant of this fact, Ethiopian authorities have prioritized the health sector in their ‘roadmap’ for achieving national prosperity. The government is continuously exerting well-researched measures to widening the health coverage as well as upgrading the quality of the health services being provided to the populace. Despite the existing challenging overall situations that affect the government’s capacity to focus on economic and social infrastructure development, the country’s health care budget is continuing to show impressive growth.
As a growth-promoting public investment area, the health sector is said to be receiving a budget allocation, which is rising by 1 percent each year aiming to reach up to 15 percent of the total annual budget of the government. [the Abuja Declaration target]. Reports show that in two decades, the total per capita spending on health increased by eight folds. This fiscal year, the health care system is the fourth largest budget item, at Birr 18.7 billion, which is a significant 46 percent increase from last year. The health budget is only outweighed by that of road, education, and debt servicing.
Looking from a different perspective, the federal government budget expenditure on health is up by 73 percent from Birr 10.8 Billion to 18.7b Billion over the last two years. This makes health care, the sector that saw the second-largest rise in budget allocation only next to water resources and energy. All these figures are pointing to the shift in the equilibrium of government policy priority in favor of the health care sector.
With primary health care at its core and having a prevention-focused strategy, the county’s health system has exhibited commendable performance. The mushrooming of hundreds of state-owned health care facilities and the upgrading of the existing ones in both rural and urban parts of the country, within a year, is a living testimony to the fruitful efforts of the authorities towards upgrading the accessibility of health care services. The benefits these public health investments brought to society are well evidenced by the tangible outcomes indicated in the figures of key markers of the society’s overall health.
Despite being under-resourced in essential inputs as well as the lack of adequate infrastructure and public utilities, the Ethiopian health system has registered appreciable results in reducing maternal mortality rates, as well as child and infant mortality rates. Ethiopia’s success in this regard has been recognized by international agencies. It is to be recalled that The Inter-agency Group for Child Mortality Estimation reported that Ethiopia has achieved Millennium Development Goal (MDG) 4, three years ahead of target, with under-5 mortality at 68 per 1,000 live births in 2012. Furthermore, appreciable results have been registered in combating the spread and reducing fatalities of major communicable diseases like HIV and TB.
With regard to non-communicable diseases, which are on the alarming rise over recent years, health authorities have made policy and strategy reforms to provide an appropriate response to the pressing issue. The vaccination campaign for cervical cancer prevention, the promulgation of alcohol and tobacco control proclamations, increasing the distribution of primary and specialized health centers providing advanced treatment to non-communicable diseases, are some of the specific actions taken in this regard.
Health authorities have made great strides in building a resilient and robust health care system that could withstand the pressure and the unexpected load of national health emergency and pandemic situations as in the case of COVID 19. It is undeniable fact that the country’s health system, despite being under-resourced, has shown internationally acclaimed performance in providing a well-coordinated response to the Coronavirus pandemic by focusing on prevention and control approaches.
Other major areas of activities the Health Ministry bent on to upgrade health services include: the improvement in the accessibility of ambulance services, fair and efficient purchase and distribution of medical supplies [over six billion Birr worth of medical equipment have been purchased and distributed to public health facilities during the last three years], as well as increasing capacity for local production of medical supplies including drugs.
In addition, since 2004 the Health Ministry has been running a Community Health Extension Programs package, which brought the intended change in the thinking and practices of rural people [the majority of the population] regarding disease prevention, family health, hygiene and environmental sanitation.
In 2019, the Ethiopian government launched a revised Essential Health Services Package, (EHSP), explicitly identifying interventions to address the population’s health needs adequately. EHSP was built on the national health policy’s goals, which target expanding the availability and accessibility of a comprehensive set of quality health services to the whole population equitably, without geographical and financial barriers. The package is tailored to achieve Universal Health Coverage across the nation
The Health Ministry is continuously working in collaboration with all stakeholders both local and international to achieve its goal of widening its overall health coverage and upgrading the quality of health services per the needs and demands of the society. In reference to the Sixth National Quality Summit held recently, the Health Minister commented: “ We are building on the remarkable progress Ethiopia has made in improving access to health services and improving the health outcomes in the past two decades.”
However challenges are facing the tasks of upgrading health service quality, and one of these is inadequate health financing. To tackle this problem the government has devised various resource mobilization schemes including the introduction of Community Based Health Insurance (CBHI), initiative that gathers payments made by members into a fund, which covers basic health care costs; thus, members have enabled access to appropriate services at local health care centers whenever they need to. The government has also decided to direct the excise tax levied on items that are hazardous to health to be used to finance health care services.
Nevertheless, considering the current situation of limited economic capacity, and high prevalence of various diseases in the country, government alone may not be able to generate the required amount of fund for the health service without the enhanced participation of the private sector, civic societies, and international agencies, at least in the short term.
A recent study reveals that there is a gap between resource needs and available resources for the implementation of the EHSP. Furthermore, external aid, economic growth, and the government’s continued commitment to prioritize health are important determinates of the funding to upgrade health care service quality in Ethiopia.
Promoting the private sector’s engagement in the health sector could substantially increase available resources for health via domestic and foreign direct investment. Furthermore, incentivizing the private sector to be attracted to health care can also facilitate technology transfer, improve service quality, and redirect resources from other sectors.
The building of hi-tech specialized health centers by the private investors would mean that the country would save a lot of foreign currency paid by citizens to get medical services abroad, and even the country would have a new channel of foreign currency revenue from medical tourists looking for specialized medical services.
More NGOs dedicated to works on resource mobilization and providing support for the provision of quality health care to society are in demand. All in all, the government, together with all stakeholders, must devise reliable mechanisms to further upgrade quality, improve efficiency in using health budgets and reduce costs.
BY SOLOMON WASSIHUN
The Ethiopian Herald 30 May 2021
