Primary Health Care and Its Challenges in Ethiopia - G5

Primary health care and its challenges in
Ethiopia
Group 5
Group members
• Dr Ermias
• Dr Kalkidan
• Dr Hiwot
• Dr Amanuel
• Dr Abay
• Dr Bontu
• Dr Bezawit
Objectives of this presentation
- Define primary health care

- Components of primary health care
- Background of primary health care in Ethiopia
- Model of Ethiopian primary health care
- Identify challenges of primary health care
Definition
• What is primary health care?
According to the Declaration of Alma Ata,1978 primary health care, is "essential

health care based on practical, scientifically sound and socially acceptable methods
and technology made universally accessible to individuals and families in the
community through their full participation and at a cost that the community and
country can afford to maintain at every stage of their development in the spirit of
self-reliance and self-determination."
Alma-Ata Declaration
1. Health is fundamental human right and its attainment requires action of
other social and economic sectors in addition to health
2. The existing inequality among developing and developed nations is common
concern to all countries
3. Protection of the health of the people is essential to sustained economic and
social development and contributes to a better quality of life and to world
peace.
4. The people have the right and duty to participate individually and collectively
in the planning and implementation of their health care.
5. A main social target of governments, international organizations and the
whole world community in the coming decades should be the attainment by
all peoples of the world by the year 2000 of a level of health that will permit
them to lead a socially and economically productive life
Conti…
6. It is the first level of contact of individuals, the family and community with the
national health system bringing health care as close as possible to where people
live and work, and constitutes the first element of a continuing health care
process.
7. Primary Health Care
• Reflects and evolves from the economic conditions and sociocultural and political characteristics of the
country
• Addresses the main health problems in the community, providing promotive, preventive, curative and
rehabilitative services accordingly
• Includes 8 components
• Involves all related sectors
• Requires and promotes maximum community and individual self-reliance and paticipation
• Should be sustained by integrated, functional and mutually supportive referral systems
• Relies on health workers, including physicians, nurses, midwives, auxiliaries and community workers as
applicable, as well as traditional practitioners as needed, suitably trained.
8. All governments should formulate national policies, strategies and plans of
action to launch and sustain primary health care as part of a
comprehensive national health system
9. All countries should cooperate in a spirit of partnership and service to
ensure primary health care for all people since the attainment of health by
people in any one country directly concerns and benefits every other
country.
10. A genuine policy of independence, peace and disarmament could and
should release additional resources that could well be devoted to peacefull
aims and in particular to the acceleration of social and economic
development of which primary health care, as an essential part.
Components of PHC
• Education on health problems and how to prevent and control them.
• Development of effective food supply and proper nutrition.
• Maternal and child healthcare, including family planning.
• Adequate and safe water supply and basic sanitation.
• Immunization against major infectious diseases.
• Local endemic diseases control.
• Appropriate treatment of common diseases and injuries.
• Provision of essential basic medication.
Background of primary health care in Ethiopia
• Ethiopia is one of the countries in the world which has adopted PHC as a
national strategy since 1976.
• 10 year perspective Health plan (1984/1985-1993/1994)
• The government of that time started to construct Health Posts, train

Traditional Birth Attendants (TBA) and Community Health Agents (CHA),
and assign them to Health Posts.
• Annual campaigns 1978-1985
• Activities by Urban youth and women association
• National Literacy campaign
1984/85 PHC Review (challenges)
1. Lack of clear policy and guideline

2. CHAs and TBAs lacked support from the community and supervisory health institutions
3. Only half of the community health committee were participating in identifying health problems
4. Poor intersectoral collaboration
5. Only one third of the MCH services has clear understanding about factors associated with high risk pregnancy
6. Achieved Immunization coverage 16% ….Target 50%
7. No structural plan and target was in place to diarrheal diseases control programs
8. Fragmentation of services e.g only 42% health centers and 34 % health post provide nutritional screening service
during immunization
9. only 35% of the health centers and 17% of the health stations had job descriptions for their technical personnel,
rendering the implementation of changes in health policy and supervision and training difficult
10. supervision was limited, particularly in the health stations, due to lack of transport and shortages of manpower;
11. only 3% of the health centers and health stations studied submitted complete reports and few facilities used the data
Cont…
• In late 1997, the Federal Ministry of Health in Ethiopia started to
decentralize the health delivery system from Regional
to woreda and kebele level, while still maintaining the vertical
health program approach.
• This approach has not brought the required health outcomes. A
new initiative, the Health Service Extension Program (HSEP),
was therefore launched in 2003 together with the Health Sector
Development Program II (HSDP II)
Model of Ethiopian health care
National expansion of primary health care
services (EPRDF)
• The most well-known component of this was the Health Extension Program (HEP), in which
over 42 000 HEWs were trained to deliver basic primary care.
• Care was largely preventive, with 4 major areas of activity
• Family health
• Disease prevention and control
• Hygiene and environment
• Health education and communication
• Flooding policy
• Mass mobilization and incorporation
• “one-to-five” networks: formation of a network of HDAs and HDTs.
• The HDT leaders, who operate as unpaid volunteers under the supervision of HEWs, carry out a number of tasks,
including helping during immunization campaigns, keeping track of pregnancies and illnesses, and relaying messages
between households and HEWs
• Of the total health expenditure by the government, 26.73% is allocated to primary-level
health care
Strengths
• Expansion of infrastructure have also been carried out successfully over the past 20
years, with 16 440 health posts, 3547 health centres and 311 hospitals constructed
• Implemention of the Integrated Disease Surveillance and Response (IDSR) system

since 1998, and the Health Management Information System (HMIS) since 2005
• Conducive policies and programmes are structured
• Successful ability in attracting donors to back locally developed PHC programmes
Challenges of primary health care
in Ethiopia
• Ideological challenge
• Trend in disease panorama requires profound changes in attitude and practice
• Lack of sustained follow-up support from health offices
• Shortage, growing disatisfaction and lack of motivation of health extension workers
• Increasing criticism towards the health developmental armies being as political
agents
• Inadequacy of human resources to staff the family health team
• Disruption of regular activities during emergencies
• Lack of office space to reorganize outpatient clinics according to the family health
team’s arrangement
• Lack of commitment from Leaders of HDTs and One-to- Five networks
Cont..
• Financial constraints for providing medications

• Transportation problems
• Weak referral network between the health center and hospitals
• Lack of quality of health service
• In equitable distribution of health professionals
• Need for additional Data
• Assessment of community level health contribution
• Limited authority of districts in financial allocation and utilization
References
• Alma-Ata Primary Health care, 1978
• Kevin Croke, The origins of Ethiopia’s primary health care expansion:
The politics of state building and health system strengthening, Oxford
University press, 2020:1318-1327
• Primary health care systems (PRIMASYS): case study from Ethiopia.
Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0
IGO.
• Helmut Kloos, Primary Health Care in Ethiopia under three political
systems: Community participation in a war-torn society, Social Science
& Medicine 1998,Vol 46 :505-522
Thank you

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Primary health care and its challenges in

- Define primary health care

According to the Declaration of Alma Ata,1978 primary health care, is "essential

• The government of that time started to construct Health Posts, train

1. Lack of clear policy and guideline

• Implemention of the Integrated Disease Surveillance and Response (IDSR) system

• Financial constraints for providing medications

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