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Part  1


G. Amare 11-25-15


Before anything else, allow me to candidly ask readers to keep the following quotes in mind while reading this writing. “To escape criticism- do nothing, say nothing, be nothing (Elbert Hubbard.” “A man would do nothing if he waited until he could do it so well that no one could find fault (John H. Newman).” “Ring the bells that still can ring; forget your perfect offering; there is a crack in everything; that's how the light gets in (Leonard Cohen).” I also ask readers to read the folktale about “The Boy, the Father and the Donkey” which can be found in a separate chapter in this writing that I consider will benefit anyone of us gauge how challenging and endless criticism may be. With this in mind, this writing presents many wide-ranging, interdependent and intersected topics that impact the provision of quality healthcare service.


Indisputably, guaranteeing a quality healthcare to every citizen without certain degree of marginalization and or discrimination is not a practical matter in any part of the world and in any nation, rich or poor. However, the situation in Ethiopia that has existed for centuries is extremely disturbing and aching. Majority of the Ethiopians have been dismally sufferring from lack of access and equity to healthcare services. They have been living in amiserable and unfairly marginalizedconditions and as of today, they are still struggling for basic healthcare.


Such circumstances have persuaded me wrtite this essaywhich indoctrinates readers on the deprivation of the majority of Ethiopians’ right to basic healthcare, emphasizing their sufferings from unfair and flawed resource allocations and social service provisions age long. For centuries, equity and timely access to basic healthcare to majority of Ethiopians have been unthinkable and worst beyond imagination. To say the least, no focus has been given to recognize the principles of the right to health. This narrative helps readers appreciate the situation and critically think about the roles each and every one of us could play to facilitate the implementation of policies designed to end such unjustifiable and uneven service distribution and provision.


The other urging reason for my writing is the question of quality. There are some individuals who are questioning why the current government is expanding and building new primary healthcare facilities in rural places while the existing ones, mainly located in inner cities and towns, are suffering from poor quality. While acknowledging their concerns, I am curious to learn whether or not it would be fair to deny the majority of their access to basic healthcare until the quality of the urban healthcare system gets improved.


The writing is subsequently structured to provide some reasons why equity and timely access to basic healthcare have been unthinkable and worst beyond imagination; explore and examine the scenario of the past and present day Ethiopia’s basic healthcare services; foretell how the population dynamics and the industrialization process will impact the future day Ethiopia; and discuss quality and factors that practically affect quality in healthcare.


The writing tries to explore the scenario of the past and present day Ethiopia’s basic healthcare services to enable readers obtain a balanced story of the matter and help them learn the extent and depth of the problem and appreciate the conditions where the majority stood then, where they stand now, and where they are heading tomorrow. It provides brief accounts of past day Ethiopia, i.e. prior to the 1991, when a shift in government occurred and new administrative arrangement declared, highlighting the political structure and health policies; pointing out some reasons why the Ethiopian people have depended on archaic remedies and religious beliefs for centuries rather than modern medicine; and subsequently, raising the question, “What went wrong in the past day Ethiopia to let the modern medicine trail far behind the rest of world and remained incapable of providing even a rudimentary healthcare to majority of the Ethiopians for centuries?”


Then, the writing narrates about the present day Ethiopia i.e. post 1991.In this chapter, the present political structure is highlighted; the health policy and its core principles detailed; and the process of policy implementation described; and the pressing conditions behind the inception and formulation of the 1993 health policy paraphrased. In addition, aknowledgement is given to the great wave of changes occuring in the present day Ethiopia to establish Health Posts that have a primary objectve of providing basic healthcare servicesto assuage the difficult times that deprived the majority of their right to basic healthcare, a fundamental part of human rights.


While wowing the values of Health Posts, the author underlines Health Posts not to be the ultimate destiny of the rural Ethiopians when it comes to equity and access to comprehensive healthcare services. The essay stresses that the focus of the future day Ethiopia wave of change to be on how to better serve the majority by not only providing basic healthcare services but also a comprehensive and specialized level of care which is characterzied by efficient, effective and supported by cares provided at reachable places and within a reasonable time and at an affordable cost of care and ultimately, produce outcomes that improve the peoples’ quality of life. The government should show its concerted effort to upgrade HPs to higher-level healthcare facilities, in an incremental manner, that are capable of providing advanced treatment and care. As part of the discussion, the Cuban success story is shared as a model to learn from as far as healthcare service provision is concerned and with the intention to recognize the facts on what it demands to practically implement the motto, “Health for All” without discrimination and marginalization of all citizens.


This writing, in subsequent chapters, also underscores the foreseeable changes that are surfacing in Ethiopia due to environmental changes, population dynamics and the industrialization process. The discussion depicts how such factors will influence the lifestyle of the people; the health of the people; the existing health policy; the current structure of the health service; and the diversity, knowledge, and skill of healthcare professionals. Possible reasons why the future day Ethiopia needs more specialized and skilled healthcare professionals are provided; justification on why the future day Ethiopia needs to focus on formulating a comprehensive health policy is given; and probes the government to contemplate upgrading HPs to high level facilities that are capable of providing specialized and comprehensive health services to all without discrimination and preferential treatment. The author thinks that a second of wave change seems an inevitable project in order to guarantee the majorities’ right to quality healthcare, be it a primary, secondary or a tertiary one.


In another chapter of this writing, the definition of quality from different perspectives is provided; measures of quality are described; the process of creating a successful quality is underlined; factors that affect quality highlighted; and interpretation of the modern day definition of quality in perspective to the U.S. and Ethiopian situations detailed; and an emphasis is made to a meamwork approach as opposed to individual efforts or government stand alone policies to nurture quality in healthcare.


The discussion on quality reflcects the reality that quality is a complex matter to deal with; underlines the fact that quality is not as simple as it is commonly perceived and will not be achieved with a single step but through years of consistent efforts, commitments, and investments to earn a return out of it.


I hope readers will have the same feeling that today’s society is living in an era of greediness characterized by many kinds of immoral and inhuman business acts that commonly affect quality in healthcare. These include but not limited to noncompliance to drug manufacturing norms; proliferation of human immorality and greediness; and counterfeit medicines. A particular emphasis is given to the discussion on immoral and cruel business of counterfeiting, reflecting how it is impacting the quality of healthcare and by reporting the nature, scope, and complexity of the business. It explains that the business of counterfeiting is subjecting consumers to great pains, sufferings, disfigurements and deaths; ruining healthcare service providers’ credibility; challenging regulators’ competency; and negatively affecting genuine industries’ business.


All in all, the narrative on quality will fascinate readers by how the modern day definition of quality could be applied to the Ethiopian situation; will trigger a signal to look back into our expectations as to what quality entails and the way we envisioned quality to be; and will help learn the fact that the definition of quality varies from one country to the other and even from one locality within a country to the other and notably, it is not practical to have a one-size-fits-all definition of quality in practice.


Another chapter presents the philosophical and technological advances in pharmacy practice. Similar to medical practice, the horizon of pharmacy practice has widened overtime and has made evident advancements in history. Today’s pharmacy practice combines product, patient care, and outcome measurement unlike the traditional practice which used to focus only on procurement, storage, compounding, and dispensing of products. This chapter, furthermore, shares the trends in pharmacy practice by taking the situation in the U.S. as an example with the intention to capture readers’ interest in how pharmacy practice impacts the quality of healthcare; learn on what it demands for a pharmacy practice to advance; and define the scope and role of pharmacists as members of the healthcare team.


Finally, the author of this writing acknowledges the fact that positive development is a cumulative sum of every little efforts and contributions made either by a Government, an individual citizen or group of individuals within a community. That is why they say, “Build Big by Building Small.” To fortify this notion, a separate chapter has been included to praise and compliment Governments and individuals who have exerted their full determination and commitment with the vision to change Ethiopia for a better.

With this, I ask readers to stay tuned for  Part 2


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