Healthcare in Ethiopia

Ethiopia is one of the fastest growing countries in Africa with a population just under 115 million. It is also one of the poorest with nearly half of the people living in poverty. Ethiopia has a mostly rural population with poor access to safe water, housing, sanitation, food and health services. The government has made serious investments to the public health sector that have made improvements in health outcomes. However, communicable diseases like HIV/AIDS, TB, malaria, respiratory infection and diarrhea remain a big challenge. High fertility rates and low contraceptive prevalence continue to drive a rapidly increasing population in Ethiopia.  

Since the early 1990s, the government in Ethiopia has been focused on improving the healthcare system of their country. At first little progress was made but in the 2000s new reforms were put in place that started to see some progress. One of them was the Health Extension Program. This included placing two female Health Extension Workers in every kebele (neighborhood) with the goal of shifting the emphasis of health care to prevention. Each team looks after about 500 households. The focus is mainly on family planning, antenatal care and childhood vaccination, but also advising on household hygiene and prevention of HIV, tuberculosis and malaria. Neonatal, infant and maternal death rates have been nearly cut in half since it started but remain high. 

In 2015, Ethiopia started a new program to expand on the HEW, the Health Sector Transformation Plan (HSTP). The goals of the HSTP are; to reduce infant and neonatal mortality rates, decrease HIV contraction, lessen the number of TB deaths and cases, diminish malaria cases and mortality rate. The HSTP puts an emphasis on transforming health services at the woreda (district) level, starting with the health-care units. These units will be subject to performance contracts and citizen scorecards and community members will be invited to join their boards. Community members will also be strongly encouraged to take ownership of their own health. The HSTP extends the concept to the kebele level and is designed to address issues that require social, rather than individual, transformation, such as open defecation. 

Healthcare in Ethiopia is primarily financed from 4 sources: the federal and regional governments; grants and loans from bilateral and multilateral donors; NGOs and private contributions. Healthcare spending is near evenly split between donors, government and households. Out-of-pocket costs for healthcare are extremely high. They can impoverish families and keep families from breaking out of poverty. The significant number of private health centers implies that a substantial number of people would be seeking care from private facilities, incurring significant out-of-pocket costs. The government implemented a fee-waiver system at public health facilities aimed at exempting the poorest from fees. They also developed a health insurance strategy.  

Two types of health insurance programs were created that provided citizens with essential healthcare regardless of economic background. First there is the Social Health Insurance (SHI) is for the formal sector and affordable only for rich people. It only includes about 15% of the population. The second is Community-Based Health Insurance (CBHI) which is for the rural and urban informal sector. A pilot program was created in 2011 in thirteen districts in four big regions. The goal is to reach and cover the very large rural and agricultural sector and small informal sectors in an urban setting. Also, to give equitable and accessible care and increased financial risk protection. Membership to CBHI is voluntary with plans to move to a mandatory system. There’s been great progress to the healthcare system in Ethiopia in the last couple of decades but more improvements are needed. They hope to achieve universal coverage by 2035.