Health Systems Strengthening Programs/Approaches: Experience from Ethiopia

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Health Systems Strengthening Programs/Approaches: Experience from Ethiopia

  1. 1. Health Systems Strengthening Programs/Approaches Experience from Ethiopia Eshete Yilma, USAID/Ethiopia Global Health Council Satellite Session June 13, 2011
  2. 2. Understanding HSS on the Ground <ul><li>No clear and common understanding of what HSS is </li></ul><ul><li>Sub-system-focused approach/strategy (health financing, etc.) </li></ul><ul><li>For many development partners, HSS is disease / program-based </li></ul><ul><li>For host government, HSS is mainly construction of facilities </li></ul><ul><li>Initiatives/programs camouflaging and distorting HSS </li></ul><ul><li>No strong networking of HSS groups </li></ul>
  3. 3. Health System Building Blocks: Experience In Ethiopia <ul><li>Health financing </li></ul><ul><li>Health workforce </li></ul><ul><li>Health information </li></ul><ul><li>Supply management system </li></ul><ul><li>Governance </li></ul><ul><li>Service delivery </li></ul>
  4. 4. Financing Mechanism for HSS <ul><li>MCH </li></ul><ul><li>GAVI </li></ul><ul><li>Global Fund </li></ul><ul><li>PEPFAR wrap-around </li></ul><ul><li>Bilateral and multilateral development partners </li></ul><ul><li>GOE at all levels </li></ul>
  5. 5. 1. Health Sector Financing <ul><li>Challenges </li></ul><ul><li>Health sector is underfinanced </li></ul><ul><li>Misallocation of resources </li></ul><ul><li>Large OOP expenditure </li></ul><ul><li>Limited participation of private sector </li></ul><ul><li>No protection for the poor /vulnerable groups </li></ul><ul><li>USAID Response </li></ul><ul><li>Advocacy (NPA, NHA…) </li></ul><ul><li>Create policy environment </li></ul><ul><li>Private sector participation </li></ul><ul><li>Fee retention-decentralization </li></ul><ul><li>Health insurance </li></ul>
  6. 6. 2. Health Taskforce Development <ul><li>Challenges </li></ul><ul><li>High attrition rate </li></ul><ul><li>Understaffed in rural areas </li></ul><ul><li>Delayed implementation of HRH strategy (incentive, training) </li></ul><ul><li>USAID Response </li></ul><ul><li>Support public health colleges for a decade </li></ul><ul><li>5,000 health officers trained </li></ul><ul><li>Support HEW program </li></ul><ul><li>Community health workers… task shifting </li></ul>
  7. 7. 3. Health Information <ul><li>Challenges </li></ul><ul><li>Poor HMIS </li></ul><ul><li>Decisions not evidence based </li></ul><ul><li>No comprehensive surveys/vertical surveys </li></ul><ul><li>Inconsistency (variability) of data for same indicator </li></ul><ul><li>USAID Response </li></ul><ul><li>Create center of excellence in focus regions </li></ul><ul><li>Initiated and supported HMIS reform </li></ul><ul><li>DHS </li></ul>
  8. 8. 4. Supply Management System <ul><li>Challenges </li></ul><ul><li>Shortage of essential commodities at the last mile </li></ul><ul><li>Weak supply chain </li></ul><ul><li>Focus on vertical programs </li></ul><ul><li>USAID Response </li></ul><ul><li>Supported improvement of the supply system </li></ul><ul><li>Supporting the design and implementation of Logistic Master Plan as a key partner </li></ul>
  9. 9. Recommendations <ul><li>Focus on big picture </li></ul><ul><li>Work on comprehensive HSS </li></ul><ul><li>Establish global/regional networking </li></ul><ul><li>Discourage camouflaging of initiatives to distort the HSS concept </li></ul><ul><li>Promote harmonization of the concept of HSS (WHO HSS Building Blocks) in terms of sustainability </li></ul>

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