Ethiopia on the path towards UHC

Transcription

1 Ethiopia on the path towards UHC May 3, 2016 Addis Tamire Woldemariam, MD, MPH, Former Chief-of-Staff, Ministry of Health, Ethiopia

2 Country Background Total Pop. = 100+million Total land mass=1.1 million km² Rural Population = 84% 9 regional states and 2 city councils Pop. Under 15 = 45% Diversity: Urban, Pastoralist, Agrarian

3 Country Health Statistics Indicator Rate PHS coverage (potential) 100% Hospitals (Public) 280 HC 3,335 HP 16,251 MMR U5MR HIV Prevalence/Incidence 353/100,000 LBs 64/1000 LBs 1.1%/o.o3% PLWHA on ART 360,000 Average LE Health Workforce density 64 Yrs 1.3/1000 pop

4 A Three-Tier Health Service Delivery Arrangement Specialized hospital (3.5-5mil )People) General Hospital (1-1.5 mil. People) Tertiary level Health Care Secondary level Health Care Primary Hospital (60, ,000 people) Health Center Rural=15,000-25,000 People Urban= 40,000 people Health Post=3,000-5,000 People Primary level Health care Source: MoH

5 Ethiopia: Past, Present and Future 1990 MMR=1400 U<5=204 HIV/TB/Malaria ALE=45 Yrs MMR=350 U<5=64 HIV/TB/Malaria ALE=64 Yrs MMR=199 U<5=30 NMR=10 HIV/TB Eliminate malaria from 50 districts ALE=69 Yrs. Eliminate Obstetric Fistula 2030 SDG 2035: Vision 2035 UHC: MMR=45 U<5=16 NMR=8 HIV/TB=Zero new/death Malaria Pre-eliminated ALE=76 Pro-poor policies and strategies Community ownership-health Extension Program/Health Development Army Development Assistance Expansion of health facilities and health work force HSTP-Transformation Agenda, Quality and equity in health care Information Revolution Woreda Transformation CRC Empower the community to play a significant role in the health sector; Strengthen primary health care units (PHCU) within the larger health sector context; Ensure a robust Human Resources Development system that commensurate with socio economic development of the country as LMIC by 2025 and middle-middle IC by 2035; Enhance role of non-state actors in support of the MOH s vision; Develop sustainable financing mechanisms; Develop capacity in the health sector to be responsive to changing economic, social, environmental, technical, and epidemiologic context.

6 Health Sector Transformation Plan, HSTP Vision: To see healthy, productive and prosperous Ethiopians Mission: To promote health and wellbeing of Ethiopians through providing and regulating a comprehensive package of promotive, preventive, curative and rehabilitative health services of the highest possible quality in an equitable manner 6

7 Key words & transformation agenda of HSTP Key Words Transformation Agenda Quality and Equity UHC Transformation Equity and quality of health care Information Revolution Woreda Transformation CRC Health Workforce Health Sector Transformation Plan, 2015/

8 Health Extension Program, HEP It is the main strategy adopted with a view of achieving universal coverage of primary health care to the rural population It s a defined package of basic and essential promotive, preventive and basic curative health services targeting households Its philosophy: "If the right knowledge and skill is transferred to households, they can take their responsibility for producing and maintaining their own health

9 The Packages of HEP Disease Prevention & control (3) Hygiene & ES (7) 16 Health Extension Packages Family Health (5) Health Education

10 Definition of UHC in Ethiopian context: Guaranteeing access to all essential services, as will be defined in each health sector strategic plans, for everyone while providing protection against financial risk Two key issues: essential healthcare and financing mechanisms

11 Federal Ministry of Health August 2005

12 Essential Healthcare Package (EHCP): The concept refers to a set of cost-effective, affordable and acceptable interventions for addressing conditions, diseases, and associated factors that are responsible for the greater part of the disease burden. It comprises the core set of interventions that are agreed to be necessary and which people can expect to receive through the various health delivery mechanisms and points with in their reach, which for practical purposes is within a district.

13 Components and guiding principles of EHCP for Ethiopia: Family Health Services Communicable Disease Prevention and Control Services Hygiene and Environmental Health Services Health Education and Communication Services Basic Curative Care and Treatment of Major Chronic Conditions Cost effectiveness Affordability Equity Necessity Capacity Accessibility

14 EHCP financing: The three layers represent the total health services that could be provided by a health facility EHCP is the sum of the base and the middle layers. High Cost services: On Cost Recovery Essential Health Service Package: On Cost Sharing Exempted Services: Free of Charge like EPI, TB, HIV, FP Figure 1: Financing of the health services including the EHCP

15 Revision of the EHCP: The existing package needs updating to reflect actual changes and transitions: demography and epidemiology including the aging of the population and the rise of NCDs and injuries, technological advances, economic growth and increased public expectations, in various regions of the country e.g. rural vs. urban areas

16 Criteria for revision: DCP-Ethiopia guidance Equity and quality will guide all choices in the revision process. The proposed criteria for revising the content are: cost-effectiveness (efficiency), priority to the worse off (equity), and financial risk protection. Of particular importance is that effective and equitable services rely on high quality of services. Since improving health is a primary purpose of the health system, one useful strategy is to start with cost-effectiveness data to roughly sort services into priority classes and then make adjustments based on the two additional criteria-equity and financial risk protection

17 Essen al health care package Specification of the EHCP: Priority 1 Exempted services (Free of charge) 1A: Current list of exempted services 1B: Very cost-effec ve services that serve the worse off and provide high financial risk protec on Priority 2 Cost sharing 2A: Cost-effec ve services that serve the worse off and provide high financial risk protec on 2B: Other cost-effec ve services Priority 3 Cost recovery 3A: Not in group 1 & 2 3B: Non-essen al services (cosme c surgery, etc.) Figure 2: Classification of health care services

18 Revised Healthcare Financing Strategy to achieve UHC 1.Mobilization of adequate, innovative and sustainable financing 2. Reducing out of pocket spending at the point of use 3. Enhancing fairness and Equity 4. Enhancing efficiency and effectiveness 5. Strengthening public private partnership 6. Capacity development for improved health care financing

19 THANK YOU!