History of Modern Health Care in Ethiopia Abebaw

History of Modern Health Care in Ethiopia Abebaw Derso Assistant Director, Medical Services Directorate, FMOH

Outline Modern medicine Health during Italian interlude Formal Health care system: 1941 -1953 Basic health care services (1953 – 1974) Primary health care (1974 – 1991) Current health care system (1991 – 2010)

Modern Medicine in Ethiopia o Modern health care delivery movement in Ethiopia has come a long way from its traditional medicine base to the current Sector Wide Approach program (SWAP). R. Pankhrst, “The Beginning of Modern Medicine in Ethiopia” Young, 1944; Kloos, 1974; Gish, 1983; Slikkerveer, 1990, EPHA, 2005

Modern Medicine … u The historical development of modern medicine in Ethiopia is predominantly public or statebased. u To date public provision of health care account for 80% whilst the remaining 20% is shared between the private-for-profit and NGO sectors.

Modern Medicine … – Started in the 16 th century (Atse Lebnadengel) Joao Bermudes, portuguese barber-surgeon, 1520 -1526 – Emperior Yohannes Vaccination

Modern Medicine … Emperor Menelik II (1889 -1913) ◦ Russian Red Cross mission (1896) ◦ 1900 the first hospital established in Addis Ababa ◦ Modern health care was considered as a privilege to the royal family prior to the establishment of this first hospital ◦ Office dealing with health created in 1908 G. C in the ministry of interior

Modern Medicine … Expansion During Emperor Hailesellasie I ◦ Reforms in economic and social conditions including health service expansion ◦ Twelve hospitals and 35 clinics ◦ This drive was interrupted during the brief occupation of Ethiopia by the Italians. ◦ 1935 – 1941: Italians converted all health service facilities into army medical clinics for use of the military As the result the benefit to the population was insignificant

Modern Medicine … • Soon after the liberation of Ethiopia in 1941, a unit called “Public Health Directorate” was established under the powerful Ministry of Interior (MOI). The 1 st health legislation was established in 1947 G. C which guarantees the creation of separate ministry However, the major step in the autonomous development of health care did not happen until the formal establishment of the Ministry of Public Health (MOPH) in 1948.

Modern Medicine … According to WHO, the aim of BHS was to organize a health delivery system that is able to meet the most urgent health care needs of the major section of population in member countries.

Modern Medicine … • For Ethiopia (following the WHO recommendation), BHS was seen as a long term strategy for providing adequate and essential health care by making available a HC for a population of 50, 000 and a Clinic for a population of 5, 000.

Modern Medicine … First Five Year Plan. ◦ 48 new health centres ◦ 3 new hospitals ◦ 100 government health stations were established

Modern Medicine … The 2 nd 5 year Development plan contained major polices and strategies regarding health sector. Emphasis on preventive measures. Expansion of basic health services. The plan period set long term objectives for health centers and health stations It envisioned : . 1 HC – to serve 50, 000 population and supervise 10 health stations. 1 health station – to serve 5000 pop.

Modern Medicine … The Third Five Year Development Plan focused on : 1. Malaria Eradication service 2. Dev. of BHS was planned partly to complement the malaria program 3. Emphasis was laid on expansion of health services 4. Provincial Health Departments to be developed to ensure close supervision of health activities and enhance preventive function 5. Emphasis to be given to training of health professionals

Modern Medicine … The 4 th 5 YDP. Re-emphasized the importance of public health services. It set a target to raise the health service coverage from 15 – 30% at the end of the plan period The 4 th 5 year plan did not materialize due to social upheaval and change of government

Modern Medicine … • PHC approach was introduced into Ethiopia after the World Health Assembly fully endorsed at Alma. Ata Conference in 1978. • The key factors for the implementation of PHC were real political commitment, active community participation, inter-sectoral collaboration, equitable distribution, focus on prevention, appropriate technology and decentralization.

Modern Medicine … Ten Years Perspective Plan whose objectives were to: Foster full and active community involvement in all health activities; Ensure multi-sectoral collaboration and coordination in health actions among the concerned governmental and mass organizations; Extend health services to where the broad masses live and work; Put under control all major communicable diseases; Expand EPI services to ensure a wide coverage of the population; Ensure the provision of comprehensive health services to special population groups such as mothers and children, students, under-privileged nationalities, workers etc. ; and Create a healthy living, working and recreational environment.

A pyramidal arrangement of health the health care structure during the Derg Rule Central Ref. Hosp Regional Hosp Rural/Medium Hosp Health centre (HC) per 50, 000 pop. Health Stations (HS) per 10, 000 pop. Community Health service (CHS) per 1, 000 pop. 17

Modern Medicine … The basis for SWAP-based Health Sector Development Programme (HSDP) was the relatively articulate 20 –year health development plan produced by the TGE to be implemented in four phases of five years each.

Ethiopian health tier system Specialized Hospital 3. 5 – 5. 0 Million Tertiary level health care General hospital Secondary level health care (1000000 -1500000) people Primary hospital Health center 40000 60000 -100000 Health center 15000 -25000 Health post 3000 -5000 Urban Rural Primary level health care

Modern Medicine … • SWAP-based health care delivery system is owned by the state, but its implementation is firmly based on strong partnership between the Central Government, the Regional Government, the Health Development Partners, the Private and NGO sectors.

Modern Medicine … The focus of health delivery system is expansion and improvement in the quality of care and is guided by the eight components of HSDP at all levels. Health service delivery & quality of care v. Facility rehabilitation & expansion w Human resource development x. Strengthening pharmaceutical services IEC HMIS Health care financing Monitoring and Evaluation

Modern Medicine … The National Health Policy The Government of Ethiopia formulated the National Health Policy in 1993. The policy emanated from commitment to democracy and gives strong emphasis to the fulfilment of the needs of the less privileged rural population that constitutes about 85% of the total population in Ethiopia.

Modern Medicine … The Health Policy mainly focuses on: Democratization and decentralization of the health system; Prevention of disease and Promotion health Ensuring accessibility of health care to all population; Promoting inter-sectoral collaboration Promoting and enhancing national self- reliance in health by mobilizing and efficiently utilizing internal and external resources. The health policy has also identified the priority intervention areas and strategies to be employed to achieve the health policy issues.

Modern Medicine … The formulation of HSDP-III needs to focus on the prevention and control of poverty related diseases through ◦ Health Service Extension Programme (HSEP), Accelerated Expansion of Primary Health Care Facilities and, ◦ Essential Health Service Packages become important to achieve the MDGs.

Modern Medicine … Health Service Extension Programme (HSEP) As clearly stipulated in HSDP-II, HSEP is introduced in recognition of failure of essential services to reach the people at the grassroots level.

Policy context … Health Extension Package- is package of services that include: Provision of immunization, Prevention, control and treatment of malaria, Prevention of HIV/AIDS/STDs, Prevention and control of Tuberculosis, Provision of oral contraceptives, Deliveries, follow up of high risk pregnant mothers, First Aid, Sanitation services including excreta disposal, insect and rodent control, safe water supply, housing construction and overall environmental issues within the rural context.

HSEP… HSEP includes 17 packages in four main areas: 1. Hygiene and environmental sanitation This area shares seven of the seventeen packages. These are: ◦ proper and safe excreta disposal system; ◦ proper and safe solid and liquid waste management; ◦ water supply safety measures; ◦ food hygiene and safety measures; ◦ healthy home environment; ◦ arthropods and rodent control; and ◦ personal hygiene.

Modern Medicine … 2. Disease prevention and control This area shares four of the 17 packages. These are: ◦ HIV/AIDS prevention and control; ◦ TB prevention and control; ◦ Malaria prevention and control; and ◦ first aid 3. Family health services This area shares five of the 17 packages. These are: ◦ maternal and child health; ◦ family planning; ◦ immunization; ◦ adolescent reproductive health; and ◦ nutrition. 4. Health Education and Communication

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