Ethiopia Aid effectiveness in the health sector - Action for Global ...

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Ethiopia – Aid Effectiveness in the health sector 1. Country Overview Ethiopia is currently the second largest country in Africa by population and has one of the highest growth rates in the world at 3.21%. 1 Every year, the population increases by more than 2 million people. Over 84% of Ethiopians live in rural areas, 2 something which, in a big country with little infrastructure and an extremely difficult topography, makes the task of delivering essential services very difficult and heavily dependent on infrastructure and investment. Ethiopia is among the poorest countries in the world. Despite robust economic growth over the last five years (over 11% annually), 3 the country still features 169th out of 179 countries on the Human Development Index (HDI) ranking. 4 The share of population living below the national poverty line has decreased over the last few years, but still stands at 35%. At the same time, Gross Domestic Product (GDP) per capita in 2007 was US$780, or just over US$2 a day, which means a significant share of the population still lives below the World Bank’s moderate poverty line (the latest figure available is 78%). 5 In the last few years, Ethiopia has gained significance as an aid-recipient country. In 2001, Ethiopia received US$1 billion, two-thirds of which was provided by multilateral agencies and with a strong emergency component. In 2007, the figure had risen to US$2.4 billion and slightly over half was provided by Organisation for Economic Cooperation and Development-Development Assistance Committee (OECD-DAC) donors. 6 However, at present, the biggest Development Partners (DPs), both in general terms and in the health sector, are PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria (see page 9). While the arrival of these two donors has boosted resources in the health sector, it has also unbalanced the distribution of funds. Accordingly, one of the main challenges for AE in Ethiopia is to increase the harmonisation of vertical donors. Progress in the health sector Ethiopia is also making progress in the health sector. Maternal mortality rates have decreased from 871 deaths per 100,000 births in the 1990s to 673 per 100,000 in 2005/2006. Similarly, the national under-five mortality rates also went down from 180 in 1992/1993 to 123 in 2004/2005. 7 In spite of the improvements, Ethiopia still has a long way to go. Both maternal and under-five mortality rates will have to decrease by half in order to meet MDGs 4 and 5 by 2015. We have seen that most people in Ethiopia live in rural areas. As a consequence, one of the main challenges for aid and the health sector in Ethiopia is bringing health services to the population. This requires long-term programmes, sustained aid and good coordination among DPs, the Governments and Non-Governmental Organisations (NGOs) working in the 8
Ethiopia – Aid Effectiveness in the health sector health sector. The Government, with the support of DPs, has put in place innovative programmes to bring health to rural areas. So far, results are encouraging and progress on the health MDGs could speed up over the next few years. Aid programmes in the health sector Parallel to the National Development Plan, the Government of Ethiopia is currently implementing three-five year rolling plans for the health sector known as the Health Sector Development Plan (HSDP). The programme includes different components aimed at addressing Ethiopia’s main health problems. These include reducing maternal and child mortality, decreasing the fertility rate and fighting HIV/AIDS, TB and malaria. The HSDP also places strong emphasis on expanding basic health coverage through an innovative programme called the Health Extension Plan (HEP). The HEP must be seen not only as a component of the HSDP but also as the tool by which the Government plans to achieve all the other targets. The implementation of the HEP started in 2003, during HSDP Stage II, with the objective of improving equitable access to preventive essential health through community-based health services, with a strong focus on sustained preventive health actions and increased health awareness. 8 The HEP aims at deploying two female Health Extension Workers (HEW) in each village (more specifically, in each of the 15,000 Kebeles – the smallest administrative unit in Ethiopia). The reason for selecting women for this role is that they can have access to a greater share of the population, especially when it comes to reproductive health. HEWs are high-school graduates, who attend a one-year course at technical and vocational training and education centres. During the training, HEWs learn about basic healthcare; their main tasks are preventive and educational. They are also responsible for referring patients to health centres for basic health care) or district hospitals for more advanced services. 9 The initiative is now close to its midterm completion point. By the end of 2007, more than 24,000 HEWs had been trained and the target of 30,000 HEWs by 2008 has probably been reached. i The construction of health posts is also progressing at a good pace: by the end of 2007, more than 4,000 posts were to be built; but the target of 15,000 posts by the end of 2008 has probably not been met. Construction is lagging behind mainly in the regions of Benishangul Gumuz, Gambella, Oromiya and the pastoralist areas in Ethiopia’s Southern Nations, Nationalities and People’s Region (SNNPR). 10 i Official statistics and progress reports are released with significant delays in Ethiopia, hence the gap. 9
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