SPECIAL SESSION

COUNTDOWN TO 2015 IN ETHIOPIA

SIX BUILDING BLOCKS OF THE HEALTH SYSTEM:

PROGRESS TOWARDS THE INTEGRATION IN ETHIOPIA

Dereje Mamo Tsegaye

Director, Policy and Planning Directorate
Federal Ministry of Health
Addis Ababa, 24 April 2012
 Outline of the presentation

• Overview of the building blocks of health

systems
• Six building blocks
– Experience in Ethiopia in integrating building blocks:
• Service delivery;
• Health workforce;
• Information;
• Medical products, vaccines and technologies;
• Financing; and
• Leadership and governance
• Conclusions
2
Building blocks
 Building blocks
– Health systems are highly context specific
– No single model for improved performance
– Key challenge: cost-effective and high-impact
interventions available
– But…they require a functioning health system to
have an effect at the population scale
– Question: how to get drugs, vaccines, and other
forms of prevention, care and treatment – on time,
reliably, in sufficient quantity and at reasonable cost
– to those in need?
– Need for learning from country’s experience on
integration of building blocks
 Building blocks
– Integration of building blocks

Leadership/
stewardship

Health Human
Services Resources

Health Care
Pharmaceuticals
Financing

Planning
and M&E
 Service delivery
– “Service delivery” building block
– In HSDP IV: integration of programmes at the point of
service delivery
• Integrated packages of services (i.e., FP/HIV, HIV/TB etc.);
• Definition of roles of primary and other levels of care in delivering
the packages;
• Development of referral system
• Establishment of service standards;
• Continuity of care;
• Integration of disease control activities.
 Service delivery
– Backbone of the health service delivery system: Health
Extension Workers (HEW) provide integrated promotive,
preventive and basic curative services at community level
– Health Extension Package include
• prevention of HIV/AIDS, STIs and TB; malaria prevention and control;
• first aid emergency measures;
• maternal, newborn and child health; family planning; immunization;
nutrition;
• adolescent reproductive health;
• excreta disposal; solid and liquid waste disposal; water supply; food
hygiene and safety measures; healthy home environment; control of
insects and rodents; personal hygiene;
• health education and communication.
 Health workforce
– “Health workforce” building block
– In HSDP IV:
• Production of key categories of health workers (HW) in
short supply;
• Intersectoral collaboration;
• Public-private partnership;
• Quality assurance in training;
• Geographic distribution of HWs;
• Regulatory system; and
• Cost-effectiveness in staff retention and mechanisms.
 Health workforce
– Strengthening health workforce in Ethiopia
• Production: over 6,000 medical students on training,
over 1,600 nurse midwives on training etc.;
• Skill mix and task shifting: production of new
integrated cadres, i.e., 252 integrated emergency
surgery officers on training to address the needs for
emergency, Comprehensive Emergency Obstetrical and
Neonatal Care and Basic Emergency Obstetrical and
Neonatal Care;
• Women’s empowerment: Over 38,000 Health
Extension Workers trained and in place (in rural and
urban areas) to provide integrated preventive and
basic curative services at community level;
• Retention and motivation: i.e., upgrading program for
HEWs etc.
 Information
– “Information” building block
– Building Health Information System (HIS) with
integration of different data sources for evidence-based
decision making
 Information
– Purpose of the information system: to improve the
health of the population
 Information

– Ongoing HMIS reform based on four principles

• integration of data collection and reporting (single channel);
• standardization of indicators, data collection instruments and
analysis procedures; and
• simplification to decrease data burden and focus on use of
information
• institutionalization
 Information
– Community-based information system based on an
integrated Family Folder (FF)
• FF designed as an integrated and comprehensive
data collection and documentation tool to be used
by Health Extension Workers;
• To meet the information needs in order to manage
family-centered services at community level;
• Including Health Cards and Integrated Maternal and
Child Care Card
 Information
– Integrated reporting system and information dissemination
for performance monitoring and accountability purposes,
including:
• Reports on performance of the health sector;
• Quarterly Health Bulletins “Policy and Practice”;
• Statistical Reports
 Medical products, vaccines and technologies
– “Medical products, vaccines and technologies”
building block
– In HSDP IV:
• Integration of pharmaceutical supply and services;
• Local production of pharmaceutical supply and services;
• Increased efficiency with lower prices for clients;
• Decentralization with revolving drug fund and cost-
recovery system;
• Drug and therapeutic committees in facilities;
• Integrated pharmaceutical logistic system
 Financing
• “Financing” building block
• In HSDP IV:
– Health care financing reform in Ethiopia
• Revenue retention and utilization
• Facility governance
– Health insurance
• Social health insurance
• Community-based health insurance
– Financial/expenditure management and control
• Integrated Financial Management Information System
 Leadership and governance
• “Leadership and governance” building block
– Integration according to the principles of
harmonization: “One Plan-One-Budget-One
Report”
• HSDP as a single strategic plan framework for
coordinating health sector action (“One Plan”);
• District-based annual plan with horizontal integration
(across programs) and vertical integration (from district
to national levels);
• MDG Fund as a pooled funding mechanism to finance
priorities under HSDP(“One Budget”);
• HMIS as Integrated and harmonized reporting system
(“One Report”).
 Conclusions
• Progress are made towards the integration
of building blocks
• There are still challenges towards the
integration of building blocks to meet
MDGs (and beyond 2015)
• Critical issue: address the three delays to
reduce maternal mortality
Thank you