Health Financing Profile of Ethiopia
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Transcript of Health Financing Profile of Ethiopia
Health Financing Profile of Ethiopia
BackgroundTotal Population *
74 mln , 84% rural
GDP PC ** USD 160Main source of Income**
Agriculture 44% to GDPCoffee, oilseeds, hides and skin, pulses, meat
Political System
Federalist, 9 regional govt and 2 city administrations
Population in absolute poverty
44%
Sources: *CSA, 2009 **NBE, 2007/08
Health Service Organization
Regional Hospital
Regional HPTI**
Referral Hospital Federal
HPTI*
ZHD
RHB
FMOH
WorHO
District Hospital
PHCUHC
5 satellite HPs
Health Sector Indictors 2007/08 (1)IMR* 77U5MR* 123MMR 673Life expectancy 53.4 (Male), 55.4 (female)TFR 5.4HIV prev 2.1ANC coverage 59%Attended delivery 20%PNC coverage 25%Pentavalent 3 81%Fully immunized 63%
Source: FMOH, 2007/08 * DHS, 2005
Health Sector Indictors 2007/08 (2)PHS Coverage (?) 90% Per capita service utilization 0.24 visits/yearHospitals 149HC 732Nucleus HC 1517Health Posts 11466Physician to population ratio 1: 37,996HO to population ratio 1: 63785Nurse to population ratio 1: 4725HEW to population ratio 1: 3224
Source: FMOH, 2007/08
Health Expenditure NHA 2004/05
Total Health expenditure USD 522 mlnPer capita THE USD 7.1Total public health expenditure USD 2Health as % of total public spending 10 %Health as % of GDP 4%
Sources of Finance
1995/96 1999/00 2004/050%
20%
40%
60%
80%
100%
40% 33% 31%
53%
36%31%
7%
9%2%
1%
22%37%
Government OOP private fund donors
Source: FMOH, NHA various years
Health Care Functions
1995/96 1999/00 2004/050%
10%20%30%40%50%60%70%80%90%
100%
20.7% 14.8% 16.6%
33%30% 18%
16%
13%19%
4%
6%6%
3% 6% 6%
8% 12%
Curative Care Pharmaceuticals Prevention and public health
Health administration Capital formation Other health related services
Health Financing System• Predominantly user fee based (since 2005
retention)– Fee waiver (means tested)– Exemption
• Government line item budget to HFs• Donor support• private health insurance < 1% • SHI – under design• CBHI – under pilot
Challenges (1)• User fees–Regressive–Weakness in
targeting systems–Limited revenue
• Govt budget–Limited
• Donor resource–HIV–Still issue with aid
effectiveness
• Private health insurance–Unaffordable–culture
Challenges (2)• SHI– Limited formal sector (<10%)–HF availability (rural/remote)– Inequity
• CBHI–Unaffordable to most–Other barriers– Service availability (rural)
• Overall– Effective access (HR, supplies,….)–Quality–HR crisis
Way Forward• CBHI – under pilot with voluntary and
mandatory options–Huge subsidy–Networking/risk pooling
• SHI – to start with civil servant and family with expansion to all public sector– Explore options for non-public sector
• Longer term donor commitments
References• CSA. (2006). Demographic and health Survey 2005. Addis Ababa.• FMOH. (2007). Scaling Up For Better Health in Ethiopia: IHP+ Road
map for harmonization and alignment of government and partner programmes and financing towards attaining the health related MDGs. Addis Ababa, November.
• FMOH. (2008). Health and Health Related Indicators. Addis Ababa.• FMOH. (2008). Human Resource for Health Strategy: Presentation
during the annual review meeting of the HSDP. Mekelle, October.• FMOH, National Health Accounts Studies (various years)• NBE. (2009). National Bank Annual Report 2007 – 2008. Addis
Ababa, August.
Thank you