University of Gondar

College of Medicine and Health Science

Institute of Public Health
Department of Health Systems and Policy

HEALTH POLICIES IN ETHIOPIA

Wubshet Debebe (BSc, MPH)

September,2022

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 HEALTH POLICIES IN ETHIOPIA

• A health system, also known as health care system

or healthcare system, is the organization of
• People
• Institutions
• Resources that deliver health care services to
meet the health needs of target population

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 Health Policy of FDRE
General policy
1. Democratization/ Decentralization
2. Comprehensive health care (Prev., Prom. & Curative)
3. Equitable/Acceptable health service for all
4. Inter-sectoral collaboration
5. National self reliance in health development
6. Accessibility
7. Work closely with neighboring, regional and international organizations
8. Capacity building (need based)
9. Pay/Free service
10.Private sector & NGO participation

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 TWENTY-YEAR HSDP (1996-2015 GC)
Launched in 1998
The focus was on preventive and promotive
aspects of care with
Phases of HSDP
. HSDP I -1997/8-2002
•HSDP II -2002/3-2005
•HSDPIII –July 2005-June 2010
•HSDP IV –June 2010-2015

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TWENTY-YEAR HSDP (1996-2015 GC)…
HSDP I (1997/98–2001/02)
Prioritized disease prevention
• Introduced a four-tier system for health service
delivery
• Characterized by a primary health care unit (PHCU),
comprising one health center and five satellite health
posts; the district hospital, regional hospital and
specialized hospital.

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TWENTY-YEAR HSDP (1996-2015 GC)…
HSDP-II (2002/03–2005) 
• Introduced the Health Service Extension Program
(HSEP).
• Innovative health service delivery system
• It is a community based health care delivery system

HSDPIII (2005/6-2010)
• Directly aligned with the health-related MDGs

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HSDP IV (2010 –2015)

• Developed as part of the National Growth and Transformation Plan (GTP)

• Renewed commitment to the achievement of MDGs as a top global Policy

• Gives priority to maternal and child health, nutrition, as well as the

prevention and control of major communicable diseases, such as HIV/AIDS.

• Emphasizes the strengthening of HSEP to improve the quality of PHC,

human resource development and health infrastructure.

• Developed the three tier health delivery system

• Community empowerment/ownership

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Current Ethiopian Health Tier System

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 Health sector transformation plan
HSTP-I (July 2015–June 2020) achieved significant achievements despite ongoing
challenges, such as internal conflicts leading to population displacement and the
COVID-19 pandemic.
Four transformation agendas were implemented during HSTP-I:
1) Woreda Transformation
2) Information Revolution
3) Transformation in Quality & Equity, and
4) Compassionate, Respectful, and Caring Health Workers.

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 HSTP II
2020/21-2024/25
• Five priority issues were identified as part of the
transformation agenda for HSTP-II
• Key interventions will be implemented to
address these priority issues
• The transformation agenda are:

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 HSTP II
1. Quality and Equity
2. Information revolution
3. Motivated, competent, and compassionate
health workforce
4. Health financing
5. Leadership

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 PRIMARY HEALTH CARE

Learning objectives
Historical development
Definition of PHC
Principles of PHC
Components of PHC

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PHC HISTORICAL DEVELOPMENT
 The World Health Organization, WHO, established in
1948.
 Major objective: The attainment by all people of
the highest possible level of health.
Health definition: “A state of complete physical,
mental and social well being and not merely the
absence of disease or infirmity”.
Due to political and socio economic factors the
various health care approaches implemented in
different countries between 1948 and 1978 did not
enable WHO to meet the stated objectives.

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PHC Definition cont…
 Strategies used by WHO
- In the 1950s the vertical health service strategy which included
mass campaigns and specialized disease control programs for
selected communicable diseases, such as control of malaria,
tuberculosis and venereal diseases. But it was found to be
expensive and unsuccessful.

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PHC HISTORICAL DEVELOPMENT
cont…
- In the mid 1950s the concept/strategy of Basic
Health Service came to being. This approach gave
more attention to rural areas through construction
of health centers and health stations providing
both preventive and curative care.
- In the early 1970s integration of the specialized
disease control programs with the basic health
services was emphasized.

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PHC HISTORICAL DEVELOPMENT
cont…
All these approaches were disease oriented based on high cost health
institutions requiring advanced technology to solve the health
needs of the people, and thus ultimately failed to reach the desired
goal.
The evaluation of these strategies during 1950s and 1970s showed
the following:
- the health status of millions of people in the world unacceptable,
- the health status of the majority of people in disadvantaged areas
of most countries of the world remained low,

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PHC HISTORICAL DEVELOPMENT
cont…
The magnitude of health problems and inadequate
distribution of health resources called for a new approach
and the Concept of PHC was born.
 In 1977 the WHO set a goal of providing “Health for All
by the year 2000” which aims at achieving a level of health
that enables every citizen of the world to lead a socially
and economically productive life. The strategy to meet this
goal was later defined in the 1978 WHO/UNICEF joints
meeting at Alma-Ata USSR. In this meeting it was declared
that the PHC strategy is the key to meet the goal of
“Health for all by the Year 2000”.

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 PRIMARY HEALTH CARE
DEFINITION
The International Conference on PHC held at Alma-
Ata in 1978 defines as:
PHC defined as essential health care on
practical, scientifically sound, and socially
acceptable methods, and technology made
universally accessible to individual and families
in the community through their full
participation and at a cost that the community
and country can afford to maintain at every stage
of their development in the spirit of self-reliance
and self-determination.
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PHC PRINCIPLES

A. INTERSECTORAL COLLABORATION- means a joint concern and

responsibility

B. COMMUNITY PARTICIPATION - Individuals and families develop the

 capacity to contribute to their health and the community’s
development. the communities should be actively involved:
 In the assessment of the situation
 Problem identification
 Priority settings and making decisions
 Sharing responsibilities in the planning
 implementing, monitoring, and evaluation.

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 PHC PRINCIPLES cont…
C. APPROPRIATE TECHNOLOGY
Criteria for appropriateness:
1. Effective: must work and fulfill its purpose
2. Culturally acceptable and valuable.
3. Affordable, i.e. cost-effective.
4. Locally sustainable.
5.Environmentally accountable:
harmless or at least minimally harmful.
6. Measurable: need proper and continuing
evaluation if it is to be widely recommended
7. Politically responsible.

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 PHC PRINCIPLES cont…
D. EQUITY
- This is to close the gap between the ‘have’s’ and the ‘have not’s’.
- To achieve more equitable distribution of health resources.
E.FOCUS ON PREVENTION AND PROMOTION
F. DECENTRALIZATION
- Bringing decision making closer to the communities served and to field level
providers of services.

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 PHC COMPONENTS cont…
8 essential elements:
1. Health Education
2. Provision of Essential Drugs
3. Immunization
4. MCH/FP (Family Health)
5. Treatment of common diseases & injuries
6. Adequate supply of safe water & basic sanitations
7. Communicable diseases control
8. Food supply and proper nutrition

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 PHC COMPONENTS cont…
 additional elements incorporated in the Ethiopian context;
1. Oral health
2. Mental health
3. The use of Traditional Medicine
4. Occupational health
5. HIV/AIDS
6. ARI
7. AYRH

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 end

THANK YOU

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