RECAP – Health Policy and the Government: What’s at Stake?

AWiB President Kemer Temam welcomed the crowd introducing AWiB and highlighting upcoming events.  She encouraged those who are not members to join.  Kemer asked how many of the attendants check the AWiB website, then asked who the Spotlight is on, what the Pinnacle section highlights, and what research piece is in Focus for this month.  Those who answered correctly were gifted prizes sponsored by Waryt Furniture, one of the monthly event’s sponsors.  Kemer acknowledged LonAdd Consultancy, another company that made the month’s networking platform and program possible.  Kemer invited Tihitina Legesse, CEO of Waryt, to the stage to share information about the company then gave the platform to a couple members to introduce their companies.

The discussion aimed to wake us up and analyse the current health system, deliberate our struggles and seek resolutions to deliver affordable, quality healthcare service to the general population, and touched on the need for universal or community health coverage in Ethiopia.

Panelists: Dr. Daniel Burssa, Senior Advisor to the Minister at the Ministry of Health of Ethiopia; Dr. Tewabech Bishaw, a passionate public health specialist who has spent over 40 years in the sector; Ms. Yasmin Wohabrebbi, a state minister at Ethiopia’s Ministry of Finance with a portfolio of international economy cooperation leading the national experiment resource mobilization allocation and management; Dr. Tinsa’e Alemayehu, a pediatric infectious diseases specialist


Kemer asked the first question to Dr. Daniel stating in some instances, Ethiopia has shown progress regarding the health sector.  There have been reductions in the rates of child and maternal deaths.  To keep this progress going, what is the government doing?  And there’s a gap health service between the urban and rural parts of Ethiopia; what is being done to fill this gap?

Dr. Daniel responded saying that the health system has shown great progress.  Health centers give priority to mothers and children, so up to 76% of the ministry’s total budget is for them.  He said there are about 4,000 health centers, 410 hospitals and about 17 health posts open.  A 10-year road map and a five-year health transformation plan have been designed.  These are successes, he said.  The challenges include attaining quality service.   Another challenge Dr. Daniel mentioned is people suffering to get cancer, heart and kidney treatment.  There are many who can’t afford to get treated abroad.  To solve this issue, the health minister has taken action in a few ways.  The first is a 10-year speciality and sub-speciality roadmap where the government directly invests in and widens the use of insurance.  The second factor is for the private sector to work with the government, giving quality service to the community.  The third factor is to understand and stray away from the dependency on outside help.

Participation of women in the health sector is high, Dr. Daniel said.  The government’s next focus will be bringing more women to the management level.  Two state ministers in the health ministry are women.  What must be worked on is bringing more women in hospitals and health centres to the management level.

Kemer raised the next question to Ms. Yasmin.  What has the government planned regarding the health budget and finance in the 10-year roadmap?

Ms. Yasmin said 240 billion ETB was planned for 2012 E.C.  From that, 12.8 billion is for the health sector.  In 2013 E.C., of 290 billion ETB about 19 to 20 billion ETB is for the health sector. Because of COVID-19, an additional resource is being processed.  From funds gained by way of partners, the greatest amount goes to the health sector, she said.  But 60% of the heath budget comes from the sub-cities.  Three years ago, there was a research called Value Formal which shows the budget from the WOREDA level is increasing by 10%.  This is reflected in the salary of health professionals and the expenditures for health services, a sign that the health service is showing progress.  There is also a flow of resources coming from NGOs that is not accurately captured.

Ethiopia has achieved targets when evaluating plans reached at the end of the year and was recognized internationally.  But we can’t say the budget that comes from our partners and the government is enough as it is always limited.  For this issue our solution can be public-private partnership and mandatory health insurance.

The Ethiopian agency has established a social insurance and is working towards it; Ms. Yasmin leads the board.  This particular system works only for those who can’t afford to get health treatment, and its main focus is farmers.  The team has reached up to 800 WOREDAS meaning six million household or 33 million people have social insurance.  Ms. Yasmin asked how many in the audience know about this service in Addis Ababa and encouraged attendees to spread the information, and get people to register and use the service.  The contribution is 600 ETB per month.

Kemer directed the next question to Dr. Tinsa’e.  “How are private health centres contributing to an affordable health system?”

Dr. Tinsa’e stated in 2018 in Ethiopia there were 290 hospitals and only 41 of them were private hospitals.  If you visit public hospitals they are always crowded and noisy as there are a lot of patients, he said.  People with drastically different income levels get service.  Therefore, having more private hospitals would help those who have middle and high income get treatment and help us reach our grand aim.

Dr. Tinsa’e said involving the Diaspora is possible to improve health services.  They can contribute to the social insurance at the level their budgets allow.  Fifteen years ago there was a research in the U.S. asking Ethiopians living there if they were willing to contribute $25 per month for their families in Ethiopia; more than 81% were willing to contribute for the social health insurance.  Dr. Tinsa’e said we can also implement experiences from other countries and resolve issues in healthcare.

Kemer asked our last speaker, Dr. Tewabech, what the public health specialist—one who has worked for numerous years in the health sector—considers as major challenges we have faced and will be facing in the coming years.

Dr. Tewabech mentioned the ideas raised were very good and a lot is getting done to improve healthcare, but we need to measure how we are contributing to giving healthcare service to the general population.  How many health professionals does Ethiopia have compared to the population?  If we really observe this matter, we cannot say we have done enough; we are only starting.

To reach Sustainable Development Goals every country has to improve the physician to population ratio.  Ethiopia must answer the question of countless unemployed doctors.Our aim should be reaching goals set internationally.  Health is not just about the body.  Health is about being mentally, emotionally, and physically healthy.  It is about our society being healthy.

Health professionals cannot be the only ones responsible for improving healthcare.  The agriculture, education, water, housing and transport sectors, for instance, should contribute to the health sector.  Our concern should be how we make the various sectors contribute to the health sector.  This shows us our concern should be on the leadership, management, governance and financing.  Therefore, the health sector needs to push all those other area to take responsibility and contribute to healthcare for all citizens.  We can’t really talk about development if we don’t have a strong health system because we need a healthy and productive population.  The problem is health is being considered as expenditure instead of development and a productive sector.  The other issue is when one arrives at a managerial position, instead of focusing on the person’s leadership skills we concentrate on their background to verify a match with the sector they are heading.

Ethiopia follows a decentralized federalism said Dr. Tewabech, but this system has a break when it comes to the health center.

Dr. Tewabech concluded saying health is politics, it should reach the entire community, and it’s a responsibility of all people; there should be a policy and strategy for it.

Kemer thanked the speakers and opened the floor for audience Q&A.

Questions were raised regarding land for health centers and hospitals.  How many working in private health centers can give discounts to patients and survive?An inquiry directed to Dr. Daniel was what kind of services are health centers giving?   If they are truly doing their jobs correctly why would we go abroad to get treated?  A question raised to Dr. Tinsa’e was what his day-to-day biggest challenges are as a clinician.  The last question asked was how the public sectors are getting support.

Ms. Yasmin answered the question regarding the budget, mentioning the Ministry of Finance gets its resources from the domestic resource (tax) and from their partners.  The ministry is currently working directly with the private sector and bringing resources.  When it comes to the health centers from the cost expenditure, 31% is covered by the government, 36% is covered by partners and 33% is out-of-pocket (patients’ responsibility).

Loans and resources received from overseas will reduce in the future, so the government is planning how to diversify resources.  Making health insurance 100% mandatory is considered, but the challenge is the schemes are very weak and there is a financial deficit.

Dr. Daniel followed noting the health sector faces many challenges; that’s how they approach the analysis to develop the strategic plan.  They are translating the 5 years strategic plan and all documents related to health in Amharic.  Regarding the service health centers give, Dr. Daniel agrees there is a lack of quality service by the health professionals.

Dr. Daniel covered a few points on the COVID – 19.  Highlighting the importance of health is the biggest lesson the pandemic gave us.  When COVID – 19 was first discovered in Ethiopia it was difficult to test people, so it was done in South Africa.  Testing machines are here now.  Travellers arriving in Ethiopia are also screened.  Before COVID we had 197 ventilator machines.  Now the number has doubled.  These machines are expensive but we have invested in them, said Dr. Daniel.

COVID brought fear.  People used to avoid going to health centers and because of insulin shortage they were dying in their homes.  The health centers were empty.  The health sector requires a larger budget and different challenges are hindrances to improvement along with the financial.

Dr. Tinsa’e identified major challenges of providing the necessary health care including not having enough options of diagnostics and medications.  What he suggested as a solution is the government supporting private health centers with their obstacles on importing more medication.  A private pharmacy and a diagnostic center can provide those medications.

Responding to another question, Dr. Tinsa’e said a health professional might make mistakes and more training in medical school should be provided.  There needs to be continuous education on how these mistakes should not happen and how they could be avoided.  But just as the government has a policy to punish professionals, there also needs to be a policy to punish the media because they contribute a lot of false information.  Mistakes made by health professionals have disproportionate reporting.

Kemer gave each of our speakers three minutes to conclude the discussion.

Dr. Tewabech concluded mentioning our health centers should become stronger when it comes to their overall capacity.  Participation of other sectors in this area should be institutionalized.  Parties in the upcoming election should include healthcare as a critical topic in their programs as a commitment.  Our health sector must evaluate itself critically and come up with an impactful solution.  We also need to create awareness in our society about health, making it part of our culture and habit.  Dr. Tinsa’e appreciated the opportunity given to him as a panellist and said he learned a lot.  Dr. Daniel thanked everyone who organized the event and said everyone should be responsible for their own health.  He said we should protect ourselves from COVID – 19.  Let us eat healthy, exercise and have a healthy lifestyle.  Ms. Yasmin departed before the end of the program.

Gifts were presented to panellists, and some in the audience of 80 departed inquiring about a second gathering on health as this is a critical topic.

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