2014年-世界发展银行全球_Universal_Health_Coverage_for_Inclusive_and_Sustainable_Development___Country_Summary_Report_for_Ethiopia_26页_1mb

Summary of Ethiopia's Universal Health Coverage (UHC) Country Summary Report

Core Content

This report provides an overview of Ethiopia's progress and challenges in achieving Universal Health Coverage (UHC), as part of the Japan-World Bank Partnership Program for UHC. Ethiopia, a low-income country, has made significant strides in improving health outcomes, particularly in reducing child and infant mortality. However, challenges remain in maternal mortality and financial protection for the poor.

Main Points

1. Ethiopia's Health System Overview

• Health Outcomes: Ethiopia achieved MDG 4 (reducing child mortality) three years ahead of schedule in 2012, with under-5 mortality at 68 per 1,000 live births. Maternal mortality remains high at 420 per 100,000 live births.
• Health Care Delivery System: A three-tier public health care system has been introduced:
  • Level One (Primary): Primary hospitals and health posts (1 per 3,000–5,000 people).
  • Level Two (Secondary): General hospitals (1 per 1 million–1.5 million people).
  • Level Three (Tertiary): Specialized hospitals (1 per 3.5 million–5 million people).
• Health Extension Program (HEP): A key initiative providing free primary care services at health posts and communities. Two female Health Extension Workers (HEWs) are assigned per health post, which serves a kebele of 3,000–5,000 people.

2. Health Insurance Initiatives

• Social Health Insurance (SHI): Targeting formal sector employees and their families (around 11% of the population). The SHI is in the preparation stage and aims to provide financial protection through risk pooling.
• Community-Based Health Insurance (CBHI): Piloted in 13 woredas across four regions, covering over 1.6 million people. It is scaling up to 161 woredas. CBHI excludes certain services like tooth implantation and eye glasses.
• Fee-Waiver and Exemption System: Services such as family planning, deliveries, and antiretroviral treatment are exempted for the poorest, with certificates issued by communities to access free care.

3. Health Financing

• Sources of Health Financing:
  • Government budget (including on-budget donor support)
  • Off-budget donor assistance
  • Private out-of-pocket expenditures
• Public Expenditure: Comprises 57.7% of total health expenditure (THE) in 2011, with THE at 4.65% of GDP.
• Out-of-Pocket Spending: Accounts for 33.8% of THE, indicating a significant financial burden on households.
• Financing Arrangements:
  • MDG Performance Fund (MDGPF): Supports procurement, construction, and capacity building.
  • Block Grants: Transferred from the Ministry of Finance and Economic Development (MOFED) to regional states based on an equity formula.

4. UHC Implementation and Challenges

• Equity in Coverage: Concentration curves show that although inequity exists, it has decreased for most services. Immunization and skilled birth attendance show less improvement.
• Efficiency of the Health Sector: Ethiopia is more efficient than other low-income SSA countries, achieving better health outcomes with lower health expenditure as a percentage of GDP.
• Resource Constraints: The health sector faces financial limitations, and there is a need for better cost management and value for money.

5. Governance and Policy

• Legal and Policy Framework: The National Health Policy and HSDP IV (Health Sector Development Program) guide UHC implementation. HSDP IV is part of the broader Growth and Transformation Program (GTP).
• Decentralization: Ethiopia has a federal system with powers devolved to regional and woreda levels. The Ministry of Finance and Economic Development (MOFED) provides block grants to regional states based on resource allocation criteria.
• Governance Structure:
  • FMOH: Formulates national health policy and regulates services.
  • Regional Health Bureaus: Implement health programs and manage local health facilities.
  • Woreda Health Offices: Coordinate primary health care units and monitor service delivery.

Key Information

• Population: 84.7 million (2011)
• GDP: $31.71 billion (2011)
• GNI per capita: $370 (2011)
• Total Health Expenditure (THE): 4.65% of GDP (2011)
• Out-of-pocket spending: 33.8% of THE (2011)
• Public health expenditure: 57.7% of THE (2011)
• Life expectancy at birth: 59.2 years (2011)
• Hospital beds per 1,000 population: 6.3 (2011)

Strategic Directions

• HEP Expansion: Aimed at urban and pastoral communities to improve service access and equity.
• CBHI and SHI Development: Pilots and plans to expand these insurance schemes to reduce out-of-pocket payments and improve financial protection.
• Public-Private Partnerships: Encouraged to enhance infrastructure, pharmaceutical production, and service delivery.

Conclusion

Ethiopia has made notable progress in health outcomes and is actively working toward UHC through a combination of public health programs, insurance schemes, and decentralized governance. However, challenges remain in financial sustainability, equity in service access, and efficient resource utilization. Continued efforts in policy alignment, cost management, and strengthening health insurance systems are essential to achieving and sustaining UHC.