2. Outlines
Why we really need this exercise
What to achieve: health outcomes
How to achieve: redesigned health system
building block
What achievements of the reform: key
results
Conclusions
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3. Background
The major health problems of the country largely
preventable communicable diseases and
nutritional disorders.
Ethiopia’s population face a high rate of morbidity
and mortality.
Consequently the health status remains relatively
poor.
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4. Lack of comprehensiveness and access to services
Poor quality of health services
Lack of appropriate public health emergencies
management
Poor Health and Health Related Services and
Product Regulation
Why these?
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5. Inadequate harmonization and alignment of
strategic and operational plans at all levels
Inability to link resource allocation with
performance
Lack of research projects that were not always
based on priority problems of public health
importance with poor project implementation
capacity and planning
Why … cont’d
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6. Consequently,
DHS 2005 shows a life expectancy of 54 years (53.4
years for male and 55.4 for female), and an IMR of
77/1000.
Under-five mortality rate 101/1000 in 2010.
The major causes of maternal death are
obstructed/prolonged labor (13%), ruptured
uterus (12%), and malaria (9%).
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7. Why reforms?
Business as usual is less efficient and
effective:
Task oriented or functional centered
organization
The question was we need institutional
transformation that enables to be more
efficient and effective.
Where to transform was the next step:
Seamless or process centered organization
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8. In responses,
The Federal Ministry of Health:
embarked on health sector reform in order
to ensure the paradigm shift of the health
system.
so as to bring its services that
commensurate with customers need.
So, the tool we employed was:
Business Process Re-engineering (BPR)
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9. Key Steps to the Success of
Reforms
Top to down approach: Political leadership
Planned: Nothing is spontaneous
Change agents: Innovators with high level competency
Institutionalize: a team accountable top level
management
Technical back up: trainings
Regular communication: at all level
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10. Origins of Health Sector Reforms
First, top level decision is needed:
Realization by the national government that the service
delivery was NOT at its optimum and potential .
NOT just because it has now become a world wide fashion
‘‘To Reform’’
NOT because of donor pressure;
But because of the obvious need (driving forces):
to have a health system that is more responsive to the
needs of the people and
to achieve better outcomes and value for money.
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11. Health Sector Outcomes
Consensus on common agendas for all:
1. Community, who produced its health, served with
quality preventive, curative & rehabilitative health
services and protected from Emergency Health
hazards.
2. Community accessing standardized Health Facilities.
3. Research finding that solve health problems and
ensured technology transfer
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12. Outcomes …..cont
4. Quality and affordable Pharmaceuticals supplied in a
sustainable manner.
5. Sustainable and accessible health Insurance for
equitable health service
6. Community protected from Sub-standard and Risky
Health & Health Related Services and Products.
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14. Building Blocks of the Health System
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Health System
Health care delivery
Public health emergency
management
Research and technology
transfer
Pharmaceutical supply Health care financing
Health regulation
Policy, planning and M&E
Health workforces
Health infrastructure
15. Basis for Reforms on the BB
What was lacking: 4 parameters for
redesigning
1. Speed
2. Quality
3. Cost and
4. Customer satisfaction
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17. Health System Build Block from
Service Provider Side
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Health care delivery
Public health emergency
management
Research and technology
transfer
Pharmaceutical supply
Resource mobilizationPolicy, planning and M&E
Health workforces
18. Health System Build Block from
Service Purchaser Side
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Social Health Insurance Community Health Insurance
Health Insurance
19. Health System Build Block from
Service Regulatory side
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Health Related Services and
Products Regulation
Health Services and
Products Regulation
Health Regulation
21. Some key achievements of 2 years
implementation of reforms
Patient flow: service utilization rate from 0.77 to 1.3
times
Pre-admission waiting time from 6 months to 2
weeks
Emergency cases attained within 5 minutes of their
arrival at health faculties
Food safety and sanitation monitoring of premises
from 25% reached 50%
Duration for market authorization decreased from
310 days to 30 days
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22. Some key achievements … cont’d
Procurement lead time reduced from 390 days to 118
days
No drug stock out : bi-monthly supply schedule
In most HFs essential and tracer drugs are available
100% detection of out breaks in 48 hours and
notification of threat or epidemics and initiation of
response operation in 2 to 3 hours
Zero maternal death related to pregnancy/delivery at
health facilities
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23. Conclusions
All these require:
Time and commitment,
Teamwork, Patience, Ownership at all levels,
High level coordination,
Additional resources and
Above all, needs critical monitoring and follow
up, i.e. change management
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