Building frameworks to improve health.
During the past fifteen years, the Federal Ministry of Health has developed a framework for improving the health for all, including maternal and neonatal health. Ethiopia has made particular progress in increasing the number of health care facilities and decentralization of the health system.
Cognizant of the challenges of health care financing, the Health Care and Financing Reform Strategy was launched with the primary goals of:
- Identify and obtain resources
- Increase efficiency in the use of available resources
- Promote sustainability
- Improve the quality and coverage of health services
The following guiding principles also inform the strategy: services will be offered on the basis of cost sharing between the receiver of services (patient) and provider of services (government), and user fees will be retained and used by the health facilities to improve the quality and quantity of services. In addition, any fee waivers shall be granted to reduce financial barriers for the poor, and exemptions shall be given to encourage consumption of particular kinds of preventive or public health services. The cost of fee waivers shall be covered by an appropriate third party.
Accordingly, the financial arrangement of the healthcare service has three layers namely exempted services, essential health service package (EHSP) with cost sharing and high cost services on cost recovery. The EHSP is the sum of exempted services and the essential health service package with cost sharing.
Health insurance is among the interventions proposed in the health care financing reform. Consequently, two types of insurance schemes namely Social Health Insurance (SHI) and Community Based Health Insurance (CBHI) will be implemented to cover a considerable size of the population. SHI will covers employees in the formal sector which is mainly payroll-based while CBHI will cover the rural population and the informal sector in urban areas. Scaling up of CBHI to 161 woredas (districts) is under way after piloting in thirteen Woredas in the four pilot regions. Preparation for implementing SHI is at its final stage.
FMOH has built a framework for health for all over the past 15 years, which has included a wide range of strategies such as Making Pregnancy Safer (2000), Reproductive Health Strategy (2006), Adolescent and Youth Reproductive Health Strategy (2006) and the Revised Abortion Law (2005). There are also strategies on free service for key maternal and child health services (Health Care Financing Strategy), the training and deployment of new workforce of female Health Extension Workers (HEWs) for institutionalising community health care with clean and safe delivery at Health Post (HP) level, and deployment of Health Officers (HOs) with MSc training in Integrated Emergency Obstetric and Surgery (IEOS) skills.