TABLE CONTENT

Introduction.... .......................................... .. 1

Definition of health . .............................. ..........1

Primary level of care...... ..... ..........................2

secondary level of care........ ..................2

The tertiary level of health care..................... 2

HEALTH SECTOR TRANSFORMATION......... 6

Family planning service Family.....7

Prevention and control of tuberculosis...... 7

Malaria prevention and control ........ 7

Prevention and control of non-communicable diseases.. ... 8

Prevention and response to the COVID -19 pandemic...... ... 8

Conclusion................ ..............8

Reference .........................8

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Ethiopia Primary health care and health care system tranisformation
2014__2015
Introduction

The health sector with various stakeholders prepared the five years health sector transformation plan II
(HSTP II) and finalized the implementation of the second-year plan period and prepared a third -year
core plan document. Efforts are being made for the sector to achieve better results by setting major
strategic initiatives and core activities to implement the strategic directions indicated in the HSTP II. The
EFY 2015 plan was prepared by taking into account the targets set in the third year of the health sector
transformation plan II and the performance of EFY 2014. Initially, the indicative plan for EFY 2015
prepared at national level and enriched its content by respective levels and shared to all level of the
health sector.This helps to address priorities of the health sector to properly address at all level of the
health system. The Woreda health offices and health facilities were also tried to prepare their annual
plan based on the indicative planand by taking into consideration their situation. The annual plan
document has been prepared by the health facilities and Woredahealth offices. The Woreda Plan
aggregated, refined and summarized by zonal, regional and national level. Plan reconciliation was
conducted at national level, produced draft core plan and then shared to all Federal Ministry of Health
(FMOH) Directorates and Agencies to enrich the draft core plan. All relevant comments from
directorates and Agencies incorporated in the draft document and got approval by higher officials. This
core plan includes the objectives of the health sector, the strategic directions, the baseline and targets
for major indicators intended to measure the achievement, as well as the priority areas, strategic
initiatives and main activities to be performed during the fiscal year. To implement the annual core plan
activities, it shall be cascaded down to the subsequent lower and individual level. Plan alignment
conducted among FMOH Directorates, partners and Agencies. The health sector agencies, health
facilities, non-governmental organization, stakeholders and communities are expected to align and
integrate their effort to implement the plan and strive the achievement of the plan accordingly.

Definition of primary Health care

According to the WHO, PHC is a whole-of-society approach to health that aims at ensuring the highest
possible level of health and well-being and their equitable distribution by focusing on people’s needs
and as early as possible along the continuum from health promotion and disease prevention to
treatment, rehabilitation, and palliative care, and as close as feasible to people’s everyday environment .

Ethiopia’s health service is structured into a three-tier system:

primary, secondary and tertiary levels of care

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The primary level of care

it includes primary hospitals, health centres and health posts.The lowest level of the primary health
care are the health posts staffed with two women each to take care of their communities. They have
around 15,000 health posts and about 30,000 women trained to run them. These women know their
communities well and have a registry of their people to know when mothers are pregnant and
approximately when they are due to give birth. Although they are focused on maternal and child health,
these posts also provide other services to their community.Gates states that the health center is the
next level up and here they have the ability to do some surgeries, provide more drugs and some have
physicians. Health centers manage 5 health posts.According to Ethiopia's Ministry of Health, maternal
and child health are two of the most serious issues in Ethiopia.10 Women are socially pressured to
become mothers without the proper infrastructure and care to support her through pregnancy, birth
and then the infant's health. The Ministry of Health goes on to say that mothers must rely on their

communities to transport them to health posts and health centers that are understaffed, under
resourced, and cannot support the mother properly. Many infants and children do not make it past the
age of five due to diarrheal disease, acute respiratory infection and lack of proper vaccination.

The secondary level of heath care

It consists of general hospitals that serve 1 to 1.5 million people.

The tertiary level of health care

It is specialized hospitals and serves 3.5 to 5.0 million people.

However, according to Encyclopedia Britannica, only major cities have hospitals with full-time
physicians, most of which are in Addis Ababa.Access to modern healthcare is very limited, and in many
rural areas it is virtually nonexistent.Most facilities are government owned and medical schools in the
country continue to graduate general practitioners and

few specialists, but it’s not meeting the rising demand of health services.Health care is also faced with
shortages of equipment and drugs are persistent problems in the country.Traditional healing, including
such specialized occupations as bone setting, midwifery, and minor surgery, continue to be useful

Ethiopian has been implementing the primary health-care approach since the mid-1970s, with primary
health care at the core of the health system since 1993. Nevertheless, comprehensive and systemic
evidence on the practice and role of primary health care towards UHC is lacking in Ethiopia. We made a
document review of publicly available qualitative and quantitative data. Using the framework of the
Primary Health Care Performance Initiative we describe and analyse the practice of primary health care
and identify successes and challenges. Implementation of the primary health-care approach in Ethiopia
has been possible through policies, strategies and programmes that are aligned with country priorities.
There has been a diagonal approach to disease control programmes along with health-systems

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strengthening, community empowerment and multisectoral action. These strategies have enabled the
country to increase 8health services coverage and improve the population’s health status. However, key
challenges remain to be addressed, including inadequate coverage of services, inequity of access, slow
health-systems transition to provide services for noncommunicable diseases, inadequate quality of care,
and high out-of-pocket expenditure. To resolve gaps in the health system and beyond, the country
needs to improve its domestic financing for health and target disadvantaged locations and populations
through a precision public health approach. These challenges need to be addressed through the whole
sustainable development agenda.

Ethiopia has been implementing the primary health-care approach since the mid-1970s when it
developed its health policy that emphasized disease prevention and control, gave priority to rural areas
and advocated for community involvement Since 1993 primary health care has been the core of the
country’s health system.The structure and composition of the system has evolved over time and
currently consists of primary hospitals, health centres and health posts. Primary hospitals provide
promotive, preventive, curative and rehabilitative outpatient care, basic emergency surgical procedures,
and comprehensive emergency obstetric care, with a minimum capacity of 35 beds. Health centres
provide promotive, preventive, curative and rehabilitative outpatient care, and inpatient care with the
capacity of 10 beds for emergency and delivery services. Health posts provide essential promotive and
preventive services and limited curative services.

Despite consistent implementation of this approach in Ethiopia over the past three decades,
comprehensive and systemic evidence on the practice and role of primary health care towards UHC is
lacking in the country.We carried out a policy evaluation to identify the successes and challenges
towards achieving UHC in Ethiopia

New Project to Improve Primary Health Care in Ethiopia

November 4th, 2022 | NEWS

On October 21, JSI, in partnership with Amref Health Africa and the Bill & Melinda Gates Foundation,
launched a project in Ethiopia to expand high-quality primary healthcare services that will ultimately
lead to improved reproductive, maternal, newborn, child, adolescent health, and nutrition outcomes.

The five-year Improve Primary Health Care Service Delivery (IPHCSD) project will strengthen the health
system by enhancing service quality, access, surveillance, and accountability. During implementation,
the project will focus on identifying and rectifying gender disparities in primary health care service
delivery.

Over 100 people attended the launch including Minister of Health Her Excellency Dr. Lia Tadesse, and
representatives from implementing partners and regional bureau heads. In a gesture of camaraderie,
attendees joined hands to cut cake.

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In her statement, Dr. Tadesse , said “the IPHCSD project will help in the operationalization of the
Ministry’s 15-year Health Extension Program roadmap,” and that “the evidence…will inform the national
primary health care implementation plan and MOH [will] provide the necessary support to realize the
project goal.

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HEALTH SECTOR TRANSFORMATION

The health sector with various stakeholders prepared the five years health sector transformation plan II
(HSTP II) and finalized the implementation of the second-year plan period and prepared a third -year
core plan document. Efforts are being made for the sector to achieve better results by setting major
strategic initiatives and core activities to implement the strategic directions indicated in the HSTP II. The
EFY 2015 plan was prepared by taking into account the targets set in the third year of the health sector
transformation plan II and the performance of EFY 2014. Initially, the indicative plan for EFY 2015
prepared at national level and enriched its content by respective levels and shared to all level of the
health sector.

Brief summary performance of main activities in EFY 2014

. Family planning service Family

planning service is one of the main activities planned in EFY 2014 fiscal year in order to improve the
quality and accessibility of maternal health. Accordingly, the service was delivered to 13,597,787(68%)
women of reproductive age group. In addition, It is 202,273 mothers were given a postnatal family
planning service.

Maternal health service In the last fiscal year, 3,352,750 (97%) pregnant mothers received ante-natal
care at least once, and 2,288,351 (69%) of mothers received ANC 4 service. In addition to this,
2,274,755(68%) of mothers were received skilled delivery service and 2,858,525 (86%) of mothers were
able to get a service of postnatal care.

Child Health and Immunization Services In the fiscal year, 3,136,463 (100%)of children under the age of
one year were able to get the third dose of penta-valent vaccine and2,872,306 (93%) of the children
were also received fully immunization services. Besides to this, the first round dose of measles vaccine
was provided to 2,983,788 (96%)of children.

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Youth and adolescence health services At the national level, to create enabling environment and to
convenience for service seekers, 118 new service provision facilities were prepared to expand the health
services for young and adolescence age group people.

Nutrition Based on the food and nutrition policy, a food and nutrition strategy and the activities of all
sectors have been prepared and shared to the federal and regional sectors for its

 Disease Prevention and Control

 HIV prevention and control

Prevention and control of tuberculosisIn

order to achieve the first 95 % target to test and identify HIV positive individual, 7,257,031peopletested
for HIV and provided counseling services. Within the fiscal year 49,687 undetected people with HIV were
planned to be tested and identified their status. About 36,893people were detected. 2 Prevention and
control of tuberculosis The detection rate for all types of TB was 82% and the performance of TB cure
also reached 96%. The coverage of drug-resistance TB and detection of leprosy are 59% and 89%,
respectivelyabout3778 people with HIV were detected TB case and have got their treatment with ant-TB
drugs. .

Malaria prevention and control

The procurement of 55,924 kilograms of chemicals required for the spraying of 933,613 unit structure
has been on process and the procurement is currently in progress

Prevention and control of non-communicable diseases

Regarding the services provided by health facilities, 352,757women have been provided cervical cancer
screening services. During the fiscal year, the total number of people who screened to identify high
blood pressure was 7,996,494and started treatment to 245,784 cases with higher blood pressure.

Prevention and response to the COVID -19 pandemic

The Ethiopian government has implemented various prevention and control measures against COVID-
19; In order to coordinate this, an effective and coordinated response is being given by structuring and
organizing Public Health Emergency Coordination Centers (PHEOC) at the national and regional levels,
and also establishing a National COVID-19 Task Force (CTF). I

Conclusion

Overall, Ethiopia has undertaken significant health financing reforms over the past decade, which have
improved budget performance and efficiency and expanded prospects for new resource mobilization.

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There is an opportunity to leverage Ethiopia’s strong and sustained economic growth to increase
domestic financing for and ownership of Ethiopia’s health sector, particularly priority health programs
including HIV, TB, and malaria. The pervasive perception within higher levels of government that health
programs are well-financed with donor support has resulted in hesitance to allocate additional
domestically generated resources to the sector.

. Advocacy efforts toward MOFEC and other key decision-makers must be strengthened and should
focus on three areas:

•Sensitizing MOFEC, cabinet members, and parliament to external financing levels, program
implications, and impact of reduced financing on health outcomes;

• Demonstrating clearly where additional funds will be used and that they will used effectively, based
on tailored historical evidence and clear plans for improved efficiency; and

• Justifying these investments based on outcomes, not only on reduced morbidity and mortality, but
also on long-term health sector savings and contribution toward cross-sectoral development goals

These advocacy and negotiation efforts must be cognizant of the country’s macro-fiscal and economic
context, with it’s strong positive trends in economic and revenue growth and persistent challenges
related to monetary policy and foreign exchange weakness and restrictions. Reasonably positioning
financing requests in this context will help to clearly demonstrate available fiscal space and from where
new funding can be mobilized.

Reference

https://www.legit.ng/ask-legit/top/1154143-13-components-primary-health-care/

https://www.publichealth.columbia.edu/research/comparative-health-policy-library/ethiopia-
summary

https://www.jsi.com › improve-primary-health-care-ethi...