Chapter four

Health Systems and Health Policy

Ayele G(MPH)

CHMS, HU

November 2015
Session Objectives

Current and emerging health care issues

Health System Strengthening

Health Policy, Strategies and Reforms in Ethiopia

District Health Systems in Ethiopia

 Existing vs. Emerging Issues
• Emerging health issues are health problems occurred
since the last ten years

• Existing health issues have been around since before

• Some existing issues have new emerging

components  re-emerging
• Emerging health problems
–Ebola
–SARS
–Hantavirus
–NCD (developing nations)

• Re-emerging health problems

– MDR-TB
– Drug resistant strain of malaria
 Major current pandemics include:
• Non-communicable

• HIV/AIDS and Tuberculosis

• Malaria and Malnutrition

• Avian influenza (or other influenza)

• Severe Acute Respiratory Syndrome (SARS)

• Ebola
 Health System Strengthening
What is Health system?
Health system is the sum of the
organizations, institutions, and resources
whose shared primary purpose is to improve
health status.
Fully functional health system
When management subsystems are integrated
together to provide the best possible health
services to all beneficiaries

Health system has six building blocks

 Health System Building blocks
1. Service delivery

2. Health workforce

3. Information

4. Medical products, vaccines & technologies

5. Financing

6. Leadership and governance

 Health Policy of Ethiopia
• A health policy is a set of clear statements and
decisions defining priorities and main
directions of improving health and health care
in a country.

• Health policies have to be dynamic and should

change in time to adapt to new national and
global circumstances and challenges.
 National Health Policy of Ethiopia

• Established in 1993
• Envisioned the HSDP for the next twenty years.
• Reorganized health services delivery to contribute
to the socio-economic development.
• It principally focuses on fiscal (financial) and
political decentralization, expanding the PHC
services
 General theme of the policy
1. Democratization and decentralization of the
health service system.
2. Development of the preventive and promotive
components of health care.
3. Development of an equitable and acceptable
standard of health service system
4. Promoting and strengthening of inter-sectoral
activities.
5. Promotion of attitudes and practices conducive to
the strengthening of national self-reliance
 General theme of the policy
6. Assurance of accessibility of health care for all
segment of the population
7. Working closely with neighboring countries, regional
and international organizations
8. Development of appropriate capacity building based
on assessed needs
9. Provision of health care for the population on a
scheme of payment
10. Promotion of the participation of the private sector
and governmental organizations in health care
Health Sector strategies and reforms
in Ethiopia
 The National Health Strategy
▬As a means of achieving the goals of the health
policy, the government has formulated a twenty-year
health sector development strategy (HSDP).

▬It is being implemented through a series of five-

year plans.
▬The implementation of the first HSDP was launched in
1997,
▬Now the fourth HSDP is under way.
The main goals of HSDP

▬Building basic infrastructure

▬Provide standard facilities and supplies

▬Develop and deploy appropriate health personnel

 HSDP I (1997/98–2001/02)

▬Covered the first five years

▬Prioritized disease prevention
▬Introduced four-tier health service delivery
system

▬Characterized by PHCU, district hospital, zonal

hospital and specialized hospital

▬Development of three in one’s & harmonization

P

Central/Referral Hospital

Regional Hospital- 1:1.6-3 million populations

Rural Hospital- 1:50,000-100,000 population

Health Center- 1:25,000-50,000 population

Health Station- 1:10,000 population

•
• Community Health Service-1: 1000 population
18
 The

Central/Referral Hospital = 1:5, 000,000 population

Regional Hospital- 1:1,000,000 population

District Hospital 1:250,000 population

PHCU- 25,000 population (1 PHCU=1HC

with 5CHP) 5 CHP)
19
 HSDP-II (2002/03–2004/05)

▬Introduced the Health Service Extension Program

▬Innovative health service delivery system
▬It is a community based health care delivery system
provided at kebele and household levels

▬Focus on sustained preventive health actions

and increased health awareness.
 HSDPIII (2005/6-2009/10)

▬Directly aligned with the health-related MDGs

▬ Focuses on high-impact interventions needed to
accelerate scale-up and increase coverage of key

health services for HIV,TB, malaria, as well as

maternal and child health.
 HSDP IV (2010 –2015)

1. Developed as part of the National GTP

2. The expression of the renewed commitment to the

achievement of MDGs

3. Gives priority to maternal and child health,

nutrition, prevention and control of major
communicable diseases
 HSDP IV (2010 –2015) (2)

4. Emphasizes the strengthening of HSEP to improve

the quality of PHC, human resource
development and health infrastructure

5. Developed the three tier health delivery system

6. Community empowerment/ownership

7. Developed two approaches: BSC &MBB

 Ethiopian Health Tier System
Specialized
Hospital Tertiary level health care
3.5 – 5.0
Million
General hospital Secondary level health care
(,1000,000-1,500,000) people
Primary hospital
60,000-100,000
Health Health center
center Primary level
15,000-25,000
40,000 Health post
health care
3,000-5,000
Urban Rural
The priorities and targets of the HSDP IV

Maternal and newborn health

Child health

TB and HIV/AIDS

Malaria and nutrition

Health Sector Transformation Plan (HSTP)
• HSTP is prepared using BSC which is a strategic
planning and management system

• The BSC Strategic Planning starts with the

organizational Mission, Vision, and Core
Values
Structure of HSTP

Mission, Vision, and Core Values

Strategic Themes (Pillars of Excellence)

Strategic Objectives

Strategic persipective

Strategic Initiatives
 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
 Core Values
1. Community first
2. Integrity, loyalty, honesty
3. Transparency, accountability, confidentiality
4. Impartiality
5. Respecting the law
6. Be a role model
7. Collaboration
8. Professionalism
9. Change/Innovation
10.Compassion
Strategy of HSTP
• Defining customer value proposition

• Strategic themes

• Strategic results

• Perspectives.
Strategic themes “Pillars of Excellence are:
1. Excellence in health service delivery
2. Excellence in quality improvement and
assurance
3. Excellence in leadership and governance
4. Excellence in health system capacity
• Strategic Theme 1
Comprehensiveness

Accessibility

Coverage

Continuity

Responsiveness

Coordination
Strategic Theme 2:
• Effective
• Efficient
• Acceptable/patient-centered
• Equitable
• Safe
• Timely
Strategic Theme 3
• Equitable and effective resource allocation

• Leadership development

• Community empowerment

• Woreda transformation

• Partnership and coordination

Strategic Theme 4
• Health workforce
• Construction of new facilities and rehabilitation
• Health care financing
• Supply chain management
• Technology
• Effective medical equipment management
• Information
Strategic Perspectives

• Community- Ownership” “Empowerment”

• Financial/Stewardship-efficiency

• Internal process-Quality

• Capacity building- capacity

The Health Sector Strategic
Management House
Transformation agendas
1. Transformation in equity and quality

2. Information revolution

3. Woreda transformation

4. Caring, Respectful and Compassionate health

workforce
 Health sector reform…
Business Process Reengineering (BPR)
BPR is the fundamental rethinking and radical
redesign of business processes to achieve
dramatic improvement in critical, contemporary
measures of performance such as cost, quality,
service and speed.
The Key words in the definition are:

 Fundamental: It means starting from clean

slate. Ignore what is and concentrate on what should be.

Radical: getting to the root of things, not

improving existing procedures.
Dramatic: it is not about improvements, it is
about bringing complete changes.

Processes: Reengineering focuses on processes

instead of people, functions and structures.
 Health sector reform…
▬Business Process Reengineering leading to a
set of new approaches like:
Benchmarking best practices

Designing new processes

Revising organizational structures

Selection of key processes.

 Health sector reform…

▬Balanced Score Card (BSC)

▬Decentralization
▬Woreda Based Planning
▬Joint Governance and Coordination
▬Health Care Financing
▬Health Facility Governance
Thank you