Fikru TessemaDirector, Health Sector Reform

May, 2011Addis Ababa

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Outlines Outlines Why we really need this exerciseWhat to achieve: health outcomesHow to achieve: redesigned health

system building blockWhat achievements of the reform:

key resultsConclusions

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BackgroundBackgroundThe major health problems of the country

largely preventable communicable diseases and nutritional disorders.

Ethiopia’s population face a high rate of morbidity and mortality.

Consequently the health status remains relatively poor.

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Lack of comprehensiveness and access to services

Poor quality of health servicesLack of appropriate public health

emergencies managementPoor Health and Health Related Services

and Product Regulation

Why these?Why these?

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Inadequate harmonization and alignment of strategic and operational plans at all levels

Inability to link resource allocation with performance

Lack of research projects that were not always based on priority problems of public health importance with poor project implementation capacity and planning

Why … cont’dWhy … cont’d

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Consequently, Consequently, DHS 2005 shows a life expectancy of 54

years (53.4 years for male and 55.4 for female), and an IMR of 77/1000.

Under-five mortality rate 101/1000 in 2010.

The major causes of maternal death are obstructed/prolonged labor (13%), ruptured uterus (12%), and malaria (9%).

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Why reforms?Why reforms?Business as usual is less efficient and

effective: Task oriented or functional centered

organizationThe question was we need institutional

transformation that enables to be more efficient and effective.

Where to transform was the next step: Seamless or process centered

organization

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In responses,In responses,The Federal Ministry of Health:

embarked on health sector reform in order to ensure the paradigm shift of the health system.

so as to bring its services that commensurate with customers need.

So, the tool we employed was: Business Process Re-engineering

(BPR)

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Key Steps to the Success of Key Steps to the Success of ReformsReforms

Top to down approach: Political leadershipPlanned: Nothing is spontaneous Change agents: Innovators with high level

competencyInstitutionalize: a team accountable top level

managementTechnical back up: trainingsRegular communication: at all level

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Origins of Health Sector ReformsOrigins of Health Sector ReformsFirst, top level decision is needed:

Realization by the national government that the

service delivery was NOT at its optimum and

potential .NOT just because it has now become a world wide

fashion ‘‘To Reform’’NOT because of donor pressure;But because of the obvious need (driving forces):

to have a health system that is more responsive to the needs of the people and

to achieve better outcomes and value for money.

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Health Sector OutcomesHealth Sector OutcomesConsensus on common agendas for all:1. Community, who produced its health, served

with quality preventive, curative & rehabilitative health services and protected from Emergency Health hazards.

2. Community accessing standardized Health Facilities.

3. Research finding that solve health problems and ensured technology transfer

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Outcomes …..contOutcomes …..cont

4. Quality and affordable Pharmaceuticals supplied in a sustainable manner.

5. Sustainable and accessible health Insurance for equitable health service

6. Community protected from Sub-standard and Risky Health & Health Related Services and Products.

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Building Blocks (BB) of the Building Blocks (BB) of the Health SystemHealth System

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Building Blocks of the Health SystemBuilding Blocks of the Health System

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Health System

Health care deliveryPublic health emergency

management

Research and technology transfer

Pharmaceutical supply Health care financing

Health regulation

Policy, planning and M&E

Health workforces

Health infrastructure

Basis for Reforms on the BBBasis for Reforms on the BBWhat was lacking: 4 parameters for redesigning

1.Speed

2.Quality

3.Cost and

4.Customer satisfaction

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Health system frameworkHealth system framework

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Services Services ProviderProvider

Services Services PurchaserPurchaser

Services RegulatoryServices Regulatory

Health System Build Block from Service Provider Side

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Health care delivery

Public health emergency management

Research and technology transfer

Pharmaceutical supply

Resource mobilizationPolicy, planning and M&E

Health workforces

Health System Build Block from Service Purchaser Side

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Social Health InsuranceCommunity Health

Insurance

Health Insurance

Health System Build Block from Service Regulatory side

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Health Related Services and Products Regulation

Health Services and Products Regulation

Health Regulation

Implementation Implementation Strategy Institutionalize Communicate, communicate and

communicate: Your staff Stakeholders Community

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Some key achievements of 2 years Some key achievements of 2 years implementation of reformsimplementation of reforms

Patient flow: service utilization rate from 0.77 to 1.3 times

Pre-admission waiting time from 6 months to 2 weeks

Emergency cases attained within 5 minutes of their arrival at health faculties

Food safety and sanitation monitoring of premises from 25% reached 50%

Duration for market authorization decreased from 310 days to 30 days

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Some key achievements … cont’dSome key achievements … cont’d Procurement lead time reduced from 390 days

to 118 days No drug stock out : bi-monthly supply

schedule In most HFs essential and tracer drugs are

available 100% detection of out breaks in 48 hours and

notification of threat or epidemics and initiation of response operation in 2 to 3 hours

Zero maternal death related to pregnancy/delivery at health facilities

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ConclusionsConclusionsAll these require:

Time and commitment,Teamwork, Patience, Ownership at all

levels,High level coordination,Additional resources and Above all, needs critical monitoring and

follow up, i.e. change management

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