Metrics of health in Ethiopia are among the world's worst. According to the U.S. government, Ethiopia's health care system is wholly inadequate, even after recent improvements.[1] The Ethiopian government has launched a campaign to improve the health care system.
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Ethiopia is the second most populous country in sub-Saharan Africa, with a population of over 92.9 million people. The country introduced a federal government structure in 1994 composed of nine Regional States: Tigray, Afar, Amhara, Oromia, Somali, Benishangul Gumuz, Southern Nations Nationalities and Peoples Region (SNNPR), Gambela and Harrari and two city Administrations (Addis Ababa and Dire Dawa). The Regional States are administratively divided into 78 Zones and 710 Woredas [2].
Ethiopia experiences a heavy burden of disease mainly attributed to communicable infectious diseases and nutritional deficiencies. Shortage and high turnover of human resource and inadequacy of essential drugs and supplies have also contributed to the burden. However, there has been encouraging improvements in the coverage and utilization of the health service over the periods of implementation of Health Sector Development Plan (HSDP).
HSDP constitutes the health chapter of the national poverty reduction strategy and aims to increase immunization coverage and decrease under-five mortality at large. The health service currently reaches about 72% of the population and The Federal Ministry of Health aims to reach 85% of the population by 2009 through the Health Extension Program (HEP) [1]. The HEP is designed to deliver health promotion, immunization and other disease prevention measures along with a limited number of high-impact curative interventions.[3]
| Indicator Description | Value |
|---|---|
| Hospitals | 149 |
| Health centers | 732 |
| Health posts | 11,446 |
| Health stations +NHC | 1,517 |
| Private clinics for profit | 1,788 |
| Private clinics not for profit | 271 |
| Pharmacies | 320 |
| Drug shops | 577 |
| Rural drug vendors | 2,121 |
Throughout the 1990s, the government, as part of its reconstruction program, devoted ever-increasing amounts of funding to the social and health sectors, which brought corresponding improvements in school enrollments, adult literacy, and infant mortality rates. These expenditures stagnated or declined during the 1998–2000 war with Eritrea, but in the years since, outlays for health have grown steadily. In 2000–2001, the budget allocation for the health sector was approximately US$144 million; health expenditures per capita were estimated at US$4.50, compared with US$10 on average in sub-Saharan Africa. In 2000 the country counted one hospital bed per 4,900 population and more than 27,000 people per primary health care facility. The physician to population ratio was 1:48,000, the nurse to population ratio, 1:12,000. Overall, there were 20 trained health providers per 100,000 inhabitants. These ratios have since shown some improvement. Health care is disproportionately available in urban centers; in rural areas where the vast majority of the population resides, access to health care varies from limited to nonexistent. As of the end of 2003, the United Nations (UN) reported that 4.4 percent of adults were infected with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS); other estimates of the rate of infection ranged from a low of 7 percent to a high of 18 percent. Whatever the actual rate, the prevalence of HIV/AIDS has contributed to falling life expectancy since the early 1990s. According to the Ministry of Health, one-third of current young adult deaths are AIDS-related. Malnutrition is widespread, especially among children, as is food insecurity. Because of growing population pressure on agricultural and pastoral land, soil degradation, and severe droughts that have occurred each decade since the 1970s, per capita food production is declining. According to the UN and the World Bank, Ethiopia at present suffers from a structural food deficit such that even in the most productive years, at least 5 million Ethiopians require food relief.[1]
In 2002 the government embarked on a poverty reduction program that called for outlays in education, health, sanitation, and water. A polio vaccination campaign for 14 million children has been carried out, and a program to resettle some 2 million subsistence farmers is underway.[1] In 2003, the government launched the Health Extension Program which will provide universal primary health care coverage by 2009. This includes placing two government-salaried female Health Extension Workers (HEW) in every kebele, with the aim of shifting the emphasis of health care to prevention. About 2,700 HEWs completed their training by the end of 2004 at 11 technical and vocational education centers, while 7,000 HEWs were still in training in 2005, and over 30,000 HEWs were expected to complete their training by 2009. However, these trainees encountered a lack adequate facilities, which included classrooms, libraries, water, and latrines. The selection of trainees was flawed, with most being urban inhabitants and not from the rural villages they would be working in. Reimbursement was haphazard as trainees in some regions did not receive stipends while those in other regions did.[5] In January 2005, the government began distributing antiretroviral drugs, hoping to reach up to 30,000 HIV-infected adults.[1]
According to the head of the World Bank's Global HIV/AIDS Program, Ethiopia has only 1 medical doctor per 100,000 people.[6] However, the World Health Organization in its 2006 World Health Report gives a figure of 1936 physicians (for 2003),[7] which comes to about 2.6 per 100,000. There are 119 hospitals (12 in Addis Ababa alone) and 412 health centers in Ethiopia.[8] Globalization is said to affect the country, with many educated professionals leaving Ethiopia for a better economic opportunity in better-developed countries.
Ethiopia's main health problems are said to be communicable diseases caused by poor sanitation and malnutrition. These problems are exacerbated by the shortage of trained manpower and health facilities.[9] Ethiopia has a relatively low average life expectancy of 45 years.[10] Only 20 percent of children nationwide have been immunized against all six vaccine-preventable diseases: tuberculosis, diphtheria, whooping cough, tetanus, polio, and measles. Rates of immunization are less than 3 percent of children in Afar and Somali Regions and less than 20 percent in Amhara, Benishangul-Gumuz, and Gambela. In contrast, almost 70 percent of children have received all vaccinations in Addis Ababa and 43 percent in Dire Dawa; children in urban areas are three times as likely to be fully immunized as children living in rural areas.[11]
In June 2011, the United Nations Population Fund released a report on The State of the World's Midwifery. It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries. The 2010 maternal mortality rate per 100,000 births for Ethiopia is 470. This is compared with 589.7 in 2008 and 967.7 in 1990. The under 5 mortality rate, per 1,000 births is 109 and the neonatal mortality as a percentage of under 5's mortality is 34. The aim of this report is to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death. In Ethiopia the number of midwives per 1,000 live births is 0.4 and 1 in 40 shows us the lifetime risk of death for pregnant women. [12]
The low availability of health care professionals with modern medical training, together with lack of funds for medical services, leads to the preponderancy of less reliable traditional healers that use home-based therapies to heal common ailments. High rates of unemployment leave many Ethiopian citizens unable to support their families. In Ethiopia an increasing number of "false healers" using home based medicines have grown with the rising population.[13] The differences between real and false healers are almost impossible to distinguish. However, only about ten percent of practicing healers are true Ethiopian healers. Much of the false practice can be attributed to commercialization of medicine and the high demand for healing. Both men and women are known to practice medicine from their homes. It is most commonly the men that dispense herbal medicine similar to an out of home pharmacy.[14]
Ethiopian healers are more commonly known as traditional medical practitioners. Before the onset of Christian missionaries and Medical Revolution sciences, traditional medicine was the only form of treatment available. Traditional healers extract healing ingredients from wild plants, animals and rare minerals. AIDS, malaria, tuberculosis and dysentery are the leading causes of disease-related death. Largely because of the costs, traditional medicine continues to be the most common form of medicine practiced. Many Ethiopians are unemployed which makes it difficult to pay for most medicinal treatments.[15] Ethiopian medicine is heavily reliant on magical and supernatural beliefs that have little or no relation to the actual disease itself. Many physical ailments are believed to be caused by the spiritual realm which is the reason healers are most likely to integrate spiritual and magical healing techniques. Traditional medicinal practice is strongly related to the rich cultural beliefs of Ethiopia, which explains the emphasis of its use.[16]
In Ethiopian culture there are two main theories of the cause of disease. The first is attributed to God or other supernatural forces, while the other is attributed to external factors such as unclean drinking water and unsanitary food. Most genetic diseases or deaths are viewed as the will of God. Miscarriages are thought to be the result of demonic spirits.[17]
One medical practice that is commonly practiced irrespective of religion or economic status is female genital mutilation. Nearly four out of five Ethiopian women are circumcised. There are three levels of circumcision that involve different degrees of cutting the clitoris and vaginal area. Many of these practices are done with an unsanitary blade with little or no anesthetics. It can result in heavy bleeding, high pain, and sometimes death.[18]
It was not until Christian missionaries traveled to Ethiopia bringing new religious beliefs and education that modern medicine was infused into Ethiopian medicine. Today there are three medical schools in Ethiopia that began training students in 1965 two of which are linked to Addis Ababa University. There is only one psychiatric treatment facility in the whole country because Ethiopian culture is resistant to psychiatric treatment. Although there have been huge leaps and bounds in medical technology there is still a large problem in the distribution of medicine and doctors in Ethiopia.[17]
The State of the World's Midwifery - Ethiopia Country Profile
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