18 December 2016

Ethiopia's Great Health Reform


Edna lives in a village on the outskirts of Berhale, roughly 900 kilometres from Addis Ababa. Every day, she travels through the desert to deliver essential health services to families' doorsteps. As a front -line health worker, Edna is part of a historic movement that has extended primary health care to the poorest and most marginalised communities and saved millions of lives.

At the turn of the Millennium, for every 1,000 children born in Ethiopia, 166 would not make it to their fifth birthday. With the closest health clinic often located hours away, pregnancy was a matter of life and death for children and their mothers.

To turn things around and expand coverage of essential health services, the Ethiopian government launched the Health Extension Programme in 2003. Since then 38,000 community health workers have gone through a year-long training program that prepares them to treat acute illnesses as well as provide family planning and immunisation services.

As of today, more than a decade after its inception, the programme has saved millions of lives by delivering essential health services to previously unreachable districts. Ethiopia was one of a handful of countries in Africa to reach the Millennium Development Goal targets for dramatically cutting child and maternal mortality. Ethiopia's investment in front line health workers, more clinics and increased access to health diagnostics and medicines accelerated progress but more has to be done to ensure universal access to quality primary health care services.

Primary healthcare is the foundation of universal health coverage and meets 90 per cent of people's health needs, providing a range of services that people can access in one place at one time. Strong primary health care systems are especially beneficial for the poorest and most marginalised communities, many of whom are geographically isolated and lack convenient access to hospitals or other formal health facilities.

Yet, people in low- and middle-income countries currently spend more money from their own pockets on primary healthcare than governments and donors spend combined. This must change. When poor families spend their limited savings on health services, they're often forced to forego other essentials like food or education. Many put off seeking help, which leads to symptoms worsening, co-infections and ultimately the cost of treatment exponentially rising in cost and time out of work.

To save lives, reduce poverty and protect countries from possible shocks, it's imperative for governments and donors to invest in primary healthcare. Millions of people still suffer from infectious diseases like HIV, malaria and tuberculosis, and as lifestyles change globally, non-communicable diseases like cancer and heart diseases are spiking. Strong primary healthcare guards against both types of threats. And when it works well, a mother can have her child vaccinated, obtain reproductive health services and receive nutrition guidance, all in the same visit.

Primary healthcare is the closest thing we have to a silver bullet to prevent and treat a range of diseases simultaneously. In today's world where national and international security are increasingly compromised by global health threats, building resilience through strong primary healthcare systems is more important than ever.

Health systems built on primary healthcare are more resilient and better prepared to withstand shocks, necessities in today's warming world where disease outbreaks are increasingly common. The recent Ebola epidemic that shook West Africa revealed how weak health systems can collapse and lead to the further spread of diseases across country borders. A robust primary healthcare system capable of preventing, monitoring and treating disease is the best first defence.

By making smart investments in primary healthcare, governments and donors are in a position to save millions of lives and avert countless cases of illness and poverty. For a long time, we lacked concrete information and guidance on how to improve primary healthcare systems. Now, countries are starting to gather data that can help us optimism investments in primary healthcare. By continuing to collect and use this data, we can ensure that our health systems meet people's needs.

For Edna and the tens of thousands of front line health workers across Ethiopia, nothing is more important than ensuring that vulnerable children and their mothers can access essential health services. It's critical that governments around the world learn from Ethiopia's example and ensure that everyone, everywhere, has access to primary health care.


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