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Community Ownership: The secret of Ethiopia's health
sector achievement Muna Jamal
03-25-16 The provision of health services have changed
dramatically in the past two decades. Among several areas where remarkable
changes have been registered from 1991 to 2014; the decline of maternal
mortality ratio declined from 1,400 per 100 000 live births to 420 is notable.
In 1990, 204 children of each 1,000 died before the age of five and only six
countries had a higher rate. However, the latest data shows that by 2012 the
rate had dropped to 68, a massive 67% fall in the under-five mortality rate. Similarly, the proportion of population without
access to improved drinking-water sources declined from 13% to 42%; and the proportion
of population without access to improved sanitation rose from 2 to 29% and the
figure of underweight children below the age of 5 five decreased from 43.3% to
20.2%. The list of areas with remarkable changes is long
and impressive. It includes the life expectancy of Ethiopians. Indeed, the life
expectancy of Ethiopians rose from 45 to 64 in the past 23 years, adult
mortality rate - that is, the probability of dying between 15 and 60 years of
age per 1000 population - have declined from 478 to 212. The World Health Organization (WHO) report entitled
"World Health Statistics 2014" stated that: "At the
national level, 24 countries gained more than 10 years in life expectancy (both
sexes combined) between 1990 and 2012. Of these countries, 12 were in the WHO
African Region and five in the WHO South-East Asia Region, along with
Afghanistan, Cambodia, the Islamic Republic of Iran, the Lao People’s
Democratic Republic, Lebanon, South Sudan and Turkey. The top six
individual gains recorded were in Liberia (19.7 years) followed by Ethiopia,
Maldives, Cambodia, Timor-Leste and Rwanda. Among high-income countries, the
average gain was 5.1 years, ranging from 0.2 years in the Russian Federation to
9.2 years in the Republic of Korea."All these in the last 23 years!!! Indeed, this is an outcome of prudent pro-poor
policies and strategies, sustained efforts to reorient health services towards
health promotion, disease prevention, and curative services. The
scientific health policy and strategies put in place since 1992 have been based
on critical examination of the nature, magnitude, and root causes of the
dominant and emerging health problems. Indeed, appropriate emphases have been
given to the under-privileged sections of the population especially to the
rural people. In
order to achieve the goals of the health policy, a twenty-year health sector
development strategy has been formulated, which is being implemented through a
series of five-year plans. The implementation of the first health sector
development program (HSDP) was launched in 1997, and now the second HSDP is
under way. From
the beginning, the government acknowledged the decisive role of popular
participation. Priority was given to the realization of access to a basic
package of quality primary health care services. The
health sector development program introduced a four-tier health service system
which contains: a primary health care unit - that is, a network of a health
center and five health posts. A
single health post is currently manned by two health extension workers. These
new health crews are trained through a one-year training that put emphasis on
disease prevention measures. On
the other hand, a health center, which is at the highest level of a primary
health care unit, includes services such as in-patient and out-patient services
as well as surgery, and with laboratory services. A health station, on the
other hand, is a bit different. It is used to give the services that a health
center does at a smaller scale. However, health Station is now being phased
out. Based
on the new health sector development program, a primary health care unit
comprises of five health posts and a health center serving as a referral point.
Therefore, when the HSDP is fully implemented, a health center will serve
25,000 people. The
key aspect is that the health management responsibilities are delegated to the
community. The decentralization process has reached woreda level currently. The
principal responsibility for service delivery and management have been devolved
from regional health bureaus to woreda health offices, as a result empowering
them with the management and coordination health care provision in the their own
areas. Throughout
these processes, the key model has been community ownership. Indeed, Ethiopia's health extension
programme provides cost effective basic services to all citizens, essentially to
women and children. It is underpinned by the central belief of community
ownership which empowers communities to handle health problems specific to
their own areas, thus enabling them to produce their own health This
has been achieved by bring together inhabitants voluntarily into local development
armies. Indeed, the health development army mobilized families, mainly women,
to ensure broader community participation and also with the objective of
facilitating community ownership. According
to the government's annual report, a total of 450,000 health development army
groups with 2.3 million one-to-five networks have been formed. Indeed,
it has been testified that: Although, the
mechanism of reaching every household and community through the Health
Development Army is a relatively recent initiative, evidence shows that in
areas with advanced HDA networks, the coverage of key health interventions has
improved significantly including institutional delivery. However, appropriate organization
and capacity building of HDA remains a challenge in some parts of the country. Indeed,
the accomplishments demonstrate the farsightedness of the policies applied in
the health sector in general and the significance of community ownership in
particular. |