In the past two decades, the Government of Ethiopia has invested heavily in health system strengthening guided by its pro-poor policies and strategies resulting in significant gains in improving the health status of Ethiopians. As a result, Ethiopia has done remarkably well in meeting most of the MDG targets. Among the notable achievements include achievement of MDG-4 with a 67 percent drop in under-five mortality from the 1990 estimate, that contributed to an increase in average life expectancy at birth from 45 in 1990 to 64 in 2014. A 69 percent decrease in maternal mortality from a high estimated base of 1400 per 100,000 live births. An improvement in contraceptive prevalence rate from 3% to 42% has led to a drop in total fertility rate from 7.7 in the 1990s to 4.1 in 2014.
Mortality and morbidity due to HIV/AIDS, Tuberculosis and malaria has reduced markedly. Death due to malaria has declined with a significant decrease in admissions and deaths of under-five children by 81% and 73% respectively. Generalized malaria outbreak has not been witnessed for the last decade. HIV new infection has dropped by 90% and mortality cut by more than 50% among adults. Besides, Ethiopia is one of the few sub-Saharan African countries with “rapid decline” of mother-to-child transmission of HIV,with a reduction by 50% of new HIV infections among children between 2009 and 2012. Similarly the country has achieved the targets set for tuberculosis prevention and control. Mortality and prevalence due to Tuberculosis has declined by more than 50% and incidence rate is falling significantly. The decline in mortality was profound from 2005 onwards partly due to TB/HIV collaborative activities, including the initiation and scaling up of free ART services.
The significant gains made are as a result of the political commitment and strong leadership at all levels of government, community engagement and ownership of health programs, and the unprecedented support from development partners. The country’s flagship Health Extension Programme has been the principal vehicle in expanding access to essential health services packages to all Ethiopians, with specific focus on women and children. It has also been the primary vehicles to drive improvements in hygiene and sanitation. More than 38,000 HEWs have been trained and deployed all over the country, availing two HEWs in every Kebele (a cluster of villages). Health extension workers are tasked to transfer knowledge and skills to families they serve so that households have better control over their own health. This philosophy of training and graduating model families, who have demonstrated behaviour change and improved uptake of high-impact health interventions, have been scaled up to reach close 3 million families across the country. A health development army that mobilizes these model families to enhance community engagement and solidarity movements has been established during HSDPIV. Despite the varying degree of success in different localities, the HDA has proved to be a successful strategy to engage community, identify locally salient bottlenecks that hinder uptake of services, and scaling up best practices.
Over the last 20 years, the country has successfuly implemented its strategy of expanding and rehabilitating primary health care facilities. To this effect, 16,440 health posts, 3,547 health centers and 311 hospitals have been constructed. In parallel to the construction of health facilities, investment in human resource development and management has been scaled up; reformed supply chain and logistics management to ensure continuous availability of health commodities at an affordable price in a sustainable manner; and strengthen coordination and partnership.
Though good trends are observed, the country is still facing a triple burden of diseases consisting of communicable diseases, non-communicable diseases and injuries. This burden coupled with the ever increasing demand urges the Government to be increasingly focused on addressing equity in access to health care, quality in health services provision and in strengthening community engagement and ownership in health decision-making and management.
Building on the lessons learned in implementing the earlier plans and to be highly responsive to the current socioeconomic landscape, the Government of Ethiopia has developed Health Sector Transformation Plan (HSTP), which is part of the second Growth and Transformation Plan(GTP II). HSTP is also the first 13 Health Sector Transformation Plan phase of the 20-year health sector strategy called ‘Envisioning Ethiopia’s Path to Universal Health Care through strengthening of Primary Health Care’.