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Health Systems Strengthening Programs/Approaches: Experience from Ethiopia

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

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