HSDP of Ethiopia as Foundation to the Implementation of Macroeconomic and Health. Federal Ministry of Health, Ethiopia, Geneva, October, 2003

Transcription

1 HSDP of Ethiopia as Foundation to the Implementation of Macroeconomic and Health Federal Ministry of Health, Ethiopia, Geneva, October, 2003

2 Country Background Federal Government(9 Regional States & 2 City Councils. Decentralization to Regional states and to District level since 2002/03. Budget allocation based on block grant and federal Gov t subsidy using federal council approved formula.

3 Geography, Population, Economy, Health & Education Land Land Area: 1.1 million Sq. Kms. Total Total Population: 70.0 Million (live roughly in 5,000 UDA & 10,000 Rural villages). 85% 85% of the population live in rural areas. Per Per capital Income: USD100(2001/02). Primary education enrollment ratio: 59% Male= Male= 67% Female = 50% (Gross).

4 Health Status, Health delivery System and Available Facilities Infant Mortality Rate : 97/1,000. Maternal Mortality Rate: 871/100,000. Life expectancy : 54 Years. Potential Health coverage: 61% (2002/03). Four-tier health delivery system with PHCU 1 st level, district & Zonal hospitals 2 nd level, & Regional & Central referral hospitals as 3 rd. Facilities: 115 Hosp. 412 HCs, 2452 HSs, 1311 HPs.

5 Health Care Financing (in 2002) Government Health Budget =USD122.1 Million. Health Budget As total Gov t budget = 7.3%. Gov t Health Budget as total GDP = 1.42%. Gov t health expenditure per capita =USD1.56. National Health expenditure per capita based on two rounds of NHA = USD USD4.09 in 1995/96 and USD5.60 in 1999/00. Willingness to pay study (2001) show households on average spend 3% of their income on health. But the lowest income quartile pay 9% and the richest 2%.

6 Health Policy Democratization and decentralization of the health care delivery. Development of the preventive, promotive & curative components of the health care. Assurance of accessibility of health care for all segments of the population. Promoting the participation of the private sector and NGOs in the health care delivery.

7 Health Sector Development Programme (HSDP) The country follows a 20-year plan with a rolling five year programme called HSDP. HSDP HSDP is the major component of SDPRP of the country and linked to macroeconomic framework. main focus is to achieving MDGs. The The 1 st covered 1997/98 to Fully evaluated. The 2 nd was designed to cover 3 years ( ), under implementation.

8 HSDP.. Major Major focus for both are attacking poverty related diseases: HIV/AIDS, Malaria, Tuberculosis, Child Survival and programmes aimed at the reduction of Maternal Mortality. Preparation is progressing for the 3 rd phase to cover All three phases are the product of wider consultation amongst major stakeholders (Govt. Donors..etc).

9 HSDP planning, implementation, monitoring and evaluation Ownership of HSDP rests with the Government. HSDP facilitates bottom-up planning and extensive participation by major stakeholders. It is a SWAP-based, a one planning and a one budget comprehensive planning for the whole sector. It is the base for expanding and strengthening partnership among stakeholders in terms of planning, implementation, reporting, monitoring and evaluation. It ensures greater say and control over regional health resources. Currently extending to district.

10 Partnership of HSDP Three levels of partnership: 1 st, between the Central Government and (FMOH) and the Regional States (RHBs). 2 nd, between the Central Government and health Donor Partners. 3 rd, between the Central/Regional, NGOs and the private sector.

11 Governance of HSDP Existing two levels, and a plan to expand to the third level: At Central level, CJSC (8 members, 2 government seats, 6 seats held by Donor partners on the basis of regional representation). HPN-Government consultative forum as a technical arm of CJSC. RJSC and expected expansion to DJSC. All follow more or less similar formula for representation, but appropriate to local condition.

12 Preparation for the implementation of Macroeconomic and Health MH is a welcome initiative to Ethiopia because it is in line with our development objectives and strategies. We consider MH as a tool for accelerated implementation of HSDP. MH is already enjoying top level Government support including MOFED. A A unit for MH is created under the appropriate Dept. of FMOH. A multi-sectoral steering Committee for MH is in the making.

13 Preparation for the implementation WHO/HQ has introduced the report of CMH in the HSDPI evaluation and ARM2003 forum for 250 participants. FMOH, WHO/AFRO & Columbia University closely worked on the POA, & has been endorsed by FMOH. FMOH FMOH and AFRO closely following the recruitment of a consultant for a wide range of analytical works.

14 Completed analytical works as a foundation for Macroeconomic and health A A National Health Care Financing Reform awaiting legal backing for launching. The HCF Reform constitutes special consideration of the hospital autonomy. Development of a Minimum Health Service Package, 85% already completed. Produced 16 Health Extension Packages for the training and implementation of HEP programme. Piloting of HEP is progressing in five Regional states.

15 Completed analytical works. Two rounds of NHAs. A A study on willingness and ability to pay. Drug revolving Fund initiative with the aim of covering all Government Hospitals and 50% of the Health Centres by A fully-costed project proposal (draft) on accelerated expansion of PHC facilities in rural Ethiopia aimed at achieving universal PHC coverage by 2008 ( ).

16 Together we can make a difference to improve the health status of the poor.