Ethiopia's over performs on child mortality reduction


Ethiopia's over performs on child mortality reduction


(Zenabu Yalew  09/20/13)

Last week had been one of the few occasions when the western media is forced to report Ethiopia's achievement without the usual cynicism and "ifs" and "buts".

Major media outlets reported that Ethiopia has already surpassed the Millennium Development Goal 4 (MDG 4) which is reducing the under-five mortality rate by two thirds between 1990 and 2015.

In 1990, an estimated 204 children in every 1,000 in Ethiopia died before the age of five; just six countries had a higher rate.

The latest data shows that by 2012 the rate had dropped to 68, a massive 67% fall in the under-five mortality rate.

Three years ahead of plan, Ethiopia has already achieved that target.

The news came from  UN IGME - the UN Inter-agency Group for Child Mortality Estimation. Who is UN IGME?

"The UN IGME was formed in 2004 to improve methods for child mortality estimation, report on progress towards the Millennium Development Goals and enhance country capacity to produce timely and properly assessed estimates of child mortality. The UN IGME includes UNICEF, the World Health Organization (WHO), the World Bank and the United Nations Population Division of the Department of Economic and Social Affairs as full members.

The UN IGME’s Technical Advisory Group, comprises leading academic scholars and independent experts in demography and biostatistics, provides guidance on estimation methods, technical issues and strategies for data analysis and data quality assessment."

Last week, the UN IGME released its report, titled "Levels & Trends in Child Mortality Report 2013 Estimates Developed by the UN Inter-agency Group for Child Mortality Estimation Under-five mortality".

The report remarked that:

"The latest estimates of under-five mortality from the UN IGME show that under-five mortality declined 47 percent, from 90 (89, 92) deaths per 1,000 live births in 1990 to 48 (46, 51) in 2012. As a result, the total number of under-five deaths in the world has fallen from 12.6 million in 1990 to 6.6 million in 2012 —thanks to more effective and affordable treatments, innovative ways of delivering critical interventions to the poor and excluded, and sustained political commitment."

The past two decades have witnessed an acceleration of progress in lowering mortality among children under age five, with the global annual rate of reduction increasing to 3.9 percent over 2005–2012 from 1.2 percent in 1990–1995, 2.3 percent in 1995–2000 and 3.7 percent in 2000–2005.

"Many countries have made and are still making tremendous progress in lowering under-five mortality. Of the 61 high-mortality countries with at least 40 deaths per 1,000 live births in 2012, 25 have reduced their under-five mortality rate by at least half between 1990 and 2012.

Of them, Bangladesh (72 percent), Malawi (71 percent), Nepal (71 percent), Liberia (70 percent),Tanzania (68 percent), Timor-Leste (67 percent), and Ethiopia (67 percent) have already reduced the under-five mortality rate by two-thirds."

This by itself is a good news that should excite all Ethiopians and friends of Ethiopia. It is also an undenial evidence that the socio-economic stride is continuing and our "ambitious" plans are not out of reach.

However, the bigger message should not be missed.

This achievement would have been simply a fairy tale, had it not been for a sustained high level political commitment, a strong leadership in the health sector, effective alignment and harmonization of stakeholders and  a sincere and massive community participation.

Indeed, the achievement attests the quality of leadership and policies applied both in the health sector and the nation in general.

The report itself underlines that the link between Ethiopia's achievement and issues of political stability. It noted:

"Evidence shows that violence and political fragility (weakened capacity to sustain core state functions) contribute to higher rates of under-five mortality. Of the 20 countries with the world’s highest under-five mortality rates, 13 are either affected markedly by conflict or violence, or are in fragile situations. Of these 20, 9 are also among the list of top 20 countries with the lowest annual rate of reduction since 1990 (excluding countries with population less than half a million), indicating that there is little progress in the countries where progress is most needed."

The achievement is also a clear indication of the scale of political commitment to the health sector.

Government commitment and resources have contributed to Ethiopia's progress on the issue, as Elissa Jobson is Deputy Editor of The International Briefing (a magazine commissioned by the Commonwealth Secretariat) reported.

Dr Peter Salama, Unicef country representative for Ethiopia, noted that:

"The government has set some very bold and extremely ambitious targets. It has then backed them up with real resources and real commitment sustained over the last 10 years,"

"...the fact that the health extension programme has been government-owned rather than donor-led has contributed to its success, and means the gains made are sustainable in the longer term."

Ethiopia's commitment and achievements had been elaborated by Health Minister Dr. Kesetebirhan Admasu last January as follows:

The key components which enabled to significantly reduce child mortality over the past years is mainly a result of sustained and massive investment in building strong, well-functioning and accessible health delivery systems. And thanks to the steadfast commitment of our government and the support of a wide range of partners we have registered steady progress in strengthening our health system, resulting in improved access and quality of child health services.

Ethiopia is rapidly expanding access to basic health services, both through major government-led efforts to rapidly increase the number of well-equipped health facilities throughout the country and through country-wide Health Extension Program - which has trained and deployed over 34,000 Health Extension Workers in communities across the country.

The Health Extension Workers are locally recruited young women, high school graduates with an additional year of intensive training in the delivery of a package of key health promotion and disease prevention interventions.

As women, they are more accessible to and trusted by local women and especially mothers who are the primary beneficiaries of their services.  They have been actively reaching out to women and their children at the community level, teaching them about family planning, closely following up on pregnant mothers and those with newborns and young children and educating families about healthy living.

Minister Kesetebrhan remarked:

"We have been strengthening our health workforce at every level, focusing in particular on mid-level health professionals and areas where we can save lives – that is, by using task shifting and pragmatic training strategies.

We are also revamping our health information system, establishing an effective health commodities supply and logistics system, and have introduced a sustainable health financing mechanisms through health insurance scheme tailored to our country needs."

Indeed, the facts speak for themselves:

·        Over the last three years alone, the government have trained and deployed more than 4500 midwives. This number is expected to reach more than 13,000 by the end of 2015.

·        The number of public medical schools increased from 3 to 25 over the past five years. The enrollment capacity has grown from 600 to 3200.

·        The construction of 15,000 health posts more than 3000 primary health centers and more than 300 primary hospitals across the country is expected to bring about equitable and quality health services to all segments of the population.

The government's commitment is demonstrated nowhere better than in the  most challenging part of the health sector policy. That is; the  financing aspect. As public treasury data indicate:

"The increased share of government financing is the result of a sustained effort to increase the share of health sector expenditure in the total national budget:

Between 1989 and 1996, health expenditures rose from 2.8 percent to 6.2 percent of the total budget.

Between 1991 and 1996, the Government health budget has increased from about 1 percent of GDP to about 2.7 percent of GDP.

During this period, the real value of the health budget increased by 35 percent."

Since 1992 there have been several major changes in the structure of the government budget to the health sector.

·      First, the proportion of salaries in the recurrent budget has declined to 53 percent in 1996 as a large share of the recent increases in health spending has gone to drugs and other non-salary items.

·      Second, there has been a reallocation of resources away from facilities in Addis Ababa and to primary care facilities. Since 1994, capital expenditure on health centers and health stations has risen from 17 to 40 percent of the capital budget.

·      Third, support for public health services has increased with (in 1994) more than half of total regional recurrent expenditures focused on Primary Health Care-related services.

·      Fourth, control over health expenditure has shifted to the regions, which have, since 1994, controlled between 83 and 88 percent of the health expenditure and which in 1996 controlled 83 percent of the recurrent budget and 95 percent of the capital budget.

However, the latest achievement should not distract us from the challenges ahead and the vision we aspire to accomplish.

As the government recently noted:

For Ethiopia the bottom line is – despite meeting MDG 4, it needs to increase the current pace more than ever to reach a more challenging goal of reducing child mortality below 20 by 2035.

To accomplish this objective Ethiopia needs to move fast in building the capacity of the health system to reach many more millions children with the right care at the right time.

This is no small challenge but it can be achieved, given the strong commitment of the Government and the public.

Let me conclude this article by quoting an insightful and inspiring line from Minister Kesetebrhan's recent speech:

"Our experience in Ethiopia has shown that strong leadership and commitment at the country level are absolutely key to advancing the principles of harmonization and country ownership our public health programs.

I strongly believe that if there is one sure indicator that will tell us if we are on the right track - it will be the health and well-being of our children.

We simply cannot claim to have a strong nation if we do not reach our children with basic health services. We cannot improve child survival without establishing a strong health system. These two objectives cannot be separated.

We are conducting a VISIONING exercise for our district health system based on the experience of some middle income countries.

We analyzed skilled human resources for health posts, health centers and hospitals, health care financing, private sector and civil society involvement.

In 50 years we envision a family physician for every village in our districts through placement in the health posts and health centers."


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