Health Systems Strengthening Programs/Approaches

Experience from Ethiopia

Eshete Yilma, USAID/Ethiopia

Global Health Council Satellite SessionJune 13, 2011

Understanding HSS on the Ground

• No clear and common understanding of what HSS is• Sub-system-focused approach/strategy (health

financing, etc.)• For many development partners, HSS is disease /

program-based • For host government, HSS is mainly construction of

facilities• Initiatives/programs camouflaging and distorting HSS• No strong networking of HSS groups

Health System Building Blocks: Experience In Ethiopia

1. Health financing

2. Health workforce

3. Health information

4. Supply management system

5. Governance

6. Service delivery

Financing Mechanism for HSS

MCHGAVIGlobal FundPEPFAR wrap-around Bilateral and multilateral development partners GOE at all levels

1. Health Sector Financing

Challenges•Health sector is underfinanced •Misallocation of resources•Large OOP expenditure•Limited participation of private sector •No protection for the poor /vulnerable groups

USAID Response•Advocacy (NPA, NHA…)•Create policy environment•Private sector participation•Fee retention-decentralization•Health insurance

2. Health Taskforce Development

Challenges•High attrition rate•Understaffed in rural areas •Delayed implementation of HRH strategy (incentive, training)

USAID Response•Support public health colleges for a decade•5,000 health officers trained•Support HEW program•Community health workers… task shifting

3. Health Information

Challenges•Poor HMIS •Decisions not evidence based•No comprehensive surveys/vertical surveys•Inconsistency (variability) of data for same indicator

USAID Response•Create center of excellence in focus regions•Initiated and supported HMIS reform •DHS

4. Supply Management System

Challenges•Shortage of essential commodities at the last mile•Weak supply chain •Focus on vertical programs

USAID Response•Supported improvement of the supply system•Supporting the design and implementation of Logistic Master Plan as a key partner

Recommendations

1. Focus on big picture

2. Work on comprehensive HSS

3. Establish global/regional networking

4. Discourage camouflaging of initiatives to distort the HSS concept

5. Promote harmonization of the concept of HSS (WHO HSS Building Blocks) in terms of sustainability