UNIT 5: EDUCATION, HEALTH AND LAND TRANSPORT

Contents
5.0 Aims and Objectives
5.1 Introduction
5.2 Education
5.3 Education Expansion and Achievement
5.4 Different Levels of Expansion is Higher Education
5.5 Scarcity of Graduates is Highly Demanded Fields of Study
5.6 Summary
5.7 Health
5.8 Health System Organization
5.9 An Overall Review of HSDP Implementation
5.10 Prevention and Control of Communicable Diseases
5.11 Health Care Financing
5.12 Conclusion and Recommendation
5.13 Land Transport
5.14 Review Policy Measures in the Transport Sector
5.15 Road Transport Service
5.16 Rail Way Transport
5.17 Summary
5.18 Answers to Check Your Progress Exercises

5.0 AIMS AND OBJECTIVES

The aim of this unit is to acquaint students with the knowledge of the performance of the
major sub-sectors of the service sector-namely, education, health care service and Land-
transport.

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After completing this unit students will be able to know about the performance of:
 the education sub-sector,
 the health sub-sector, and
 the land transport-sub sector

5.1 INTRODUCTION

The service sector is comprised of many sub-sectors like education, health care service,
transport and communication. Each of these sub-sectors includes many systems. For
exmaple, the transport sub-sector includes land, water and air transport systems. The
study of the detail study of the service sector might be too much for a one-semester
course. Therefore, this unit is devoted for three of them only: education, health care, and
land transport.

Education, health and transport services are both consumption and investment goods.
Therefore, their performance and access to these services determine current standard of
living as well as the prospect for future development.

As it is the case with the agriculture and industry, the performance of Ethiopian economy
these aspects is not satisfactory.

Despite the fact that a lot has done to improve the status of education, still many
Ethiopian children do go to school, there is high rate of dropout, many do not complete
high-school; gender disparity is high in rural Ethiopia.

The situation in the public health-care is not nay better. Despite all the efforts, prevalence
of diseases seems to increase rapidly.

The situation with land transport, specifically with road transport, has been improving,
although much is left to be done.

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5.2 EDUCATION

5.2.1 The Current Status of Education in Ethiopia

Basic Education
A century has passed since modern education began in Ethiopia. The world has
witnessed, during this period, dramatic progress in knowledge accumulation supported by
revolutionary technological changes that led to significant improvements in livelihoods
and lifestyles. Many of the current developing countries achieved their independence
during this period and those who achieved their independence early seem to have also
gained the momentum for fast development earlier. Almost all African countries below
the Sahara gained their independence during the second half of the century. Although
these countries including Ethiopia have witnessed tremendous progress in their
livelihoods and lifestyles in the past fifty years, the changes have been gradual and
incremental in sharp contrast to the spectacular changes witnessed in other parts of the
world.

In many respects, Ethiopia, in fact, seems to have lagged behind the performance of most
SSA countries and seems to have lost in the process its glamour and image, even if it has
never been colonized save for the five year occupation by Italy. Since 1980, developing
countries have invested substantial amounts of public resources in education services. In
the 1990s, more than three-quarters of school-age children in developing countries were
enrolled in schools, up from less than half in the 1960s. Illiteracy rates dropped from 39
to 30 percent between 1985 and 1995 (World Bank 1999a). However, after a century,
half of the Ethiopian children still do not have access to primary education. Given the key
role played by education in economic growth, there is no doubt about the fact that the
majority of Ethiopians remaining uneducated partly explains the poor development
performance of the country over a prolonged period. Ethiopia’s low achievement in
education becomes significant when compared to progress made in other parts of the
world.

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Trends in Gross Primary Enrollments, 1970-1996
1970 1982 1993 1996
Region
104 102 103 103
Developing 79 95 107 108
Countries
East Asia and 88 111 118 118
Pacific
Latin America 99 105 109 114
and Caribbean
Middle east and 68 91 95 94
North Africa
South Asia 67 77 97 101
Sub-Saharan 50 74 68 74
Africa
Ethiopia 16 36 26 36
Source: Based on UNDP Human Development Reports

Ethiopia has started implementing a multi-year Educational Sector Development program

(ESDP) that started in 1997/98. Under ESDP Ι, coverage of primary education as
measured by enrollment in grades 1-8 have shown a rapid expansion. The Enrollment in
primary grades increased from 4,468,294 in 1996/97 to 7,401,473 in 2000/01. This
constitutes an annual rate of growth of 13.4%. In spite of this rapid achievement in recent
years, Ethiopia’s educational achievement in terms of getting children into schools is
comparable to the stage reached by Sub-Saharan Africa thirty years ago. This is indeed
worrisome.

Survey results also show that the majority of Ethiopians have still little or no education
with females much less educated than males. According to the CSA 2000 DHS survey,
62 percent of males and 77 percent of females have no education, and 27 percent of
males 17 percent of females have only some primary education. Less than 3 percent of
males and 1 percent of females have completed primary education only, and 6 percent of
males and 4 percent of females have attended, but not completed, secondary school. Only
3 percent of males and 1 percent of females have completed secondary school or higher.
Among women and men aged 15-49 only 10.7 and 20.5 percent respectively have

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completed primary education (CSA, 2000: DHS survey). Among girls and boys aged 6-
12, only 23.5 and 28.0 percent are attending school. 71.5 percent of women aged 15-49 in
Ethiopia are also illiterate.

The net attendance ratio (NAR)- the percentage of school-age children that is attending
school – is 30.2 percent for elementary school level and 11.5 percent for secondary
school level. In Ethiopia, only 19 percent of women and 40 percent of men are literate
(CSA, 2000:DHS survey)

Moreover, the gap between the educational attainment of the rich and of the poor and
among different regions is expected to be enormous. In rural areas where more than 80
percent of Ethiopia’s population lives, educational attainment is substantially lower, with
84 percent of women and 58 percent of men having never attended school. Ethiopia’s
unacceptable low human condition could be traced, therefore, among others, to the
inadequacy of the education service delivery system.

Although gross enrollment rate at primary level has doubled during the past five years
(see section B below for details) there are serious issues concerning the quality of
education and the high degree of inequality in performance the different regions in the
country. Gross enrollment rate has actually declined, for example, in the Somali region
and more or less remained the same in Afar region during the last five years. Whereas the
relatively well developed regions have managed to more than double the enrollment rate
indicating a widening gap in education attainment between the regions.

Check Your Progress

1. How much is the level of literacy in Ethiopia?

…………………………………………………………………………………………
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2. How much is the net attendance ratio?
…………………………………………………………………………………………
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Secondary (+Vocational/Technical) Education
Secondary schools in Ethiopia serve as institutions that prepare young students for
tertiary level education and/or training the youth for the world of work using academic
and vocational/technical programs respectively. In 1995/96, there were 1304 junior
secondary schools, 346 senior secondary schools and 17 vocational/technical schools in
the country (MoE, 1997).

According to the Ministry of Education, enrolment at this level of education has been
growing at an average of 9.2 per cent since 1995/96. In 1999/2000 academic year, the
total enrolment has passed the half a million mark of which 40.8% were female. The
share of female students has in fact fallen from a high of 43.2 in 1995/96 to 40.8 in
1999/2000.

Table VΙ.2: Total secondary school enrolment (9-12)

Year no. Of students % of female
1999/00 571,719 40.8 2.1
1998/99 521,728 40.6 2.1
1997/99 467,669 40.9 2.1
1996/97 426,495 41.5 2.3
1995/96 402,753 43.2 2.4
Source: Compiled from MoE sources (August, 2000).

Another interesting fact is that of the total students, 97.9 per cent were registered in
public schools. That means, despite the conductive policy environment the government
claims to have created, the contribution of private schools in education provision remains
extremely low and declining.

In 1999/2000, there were 410 secondary schools in Ethiopia of which 44 (10.7%) were
registered as private (includes non-government, mission, religious and foreign
community schools). This also indicates that private schools have a long way to go before
they make any significant contribution to the provision of education as indicated, for
example, by average class size in these schools.

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In 1999/2000 the national average school size for private schools was about 270 students
per school (340 for Addis Ababa) as opposed t 1562 students per public secondary
school. The class size is 76 in public schools and 47 in private schools.

Regional distribution shows that Tigray, Amhara, Oromiya, SNNPR, Addis Ababa and
Dire Dawa are host to private secondary schools. Private schools contribute 4.3 to 5.8 per
cent of total enrolment in Addis Ababa. Out of the 44 private secondary schools,
25(56.8%) were in Addis Ababa.

Whereas the current capacity at secondary school level is poor and is faced, as discussed
in subsequent chapters, with wide ranging quality problems, the implementation of the
new education structure on top of these problems has raised widespread concern.
According to the new education structure, general education ends at grade 10. In June this
year, about 110 thousand students sat for the national general education completion
certification exam. Results of the exam did not come out on time, which affected the
smooth transition to implementation of the new policy. Moreover, technical/vocational
schools are believed to be ill prepared, particularly in terms of acquiring qualified
teachers and support facilities, to receive the mass of students who are supposed to
continue technical/vocational education according to the new policy.

Check Your Progress

3. How much was the availability of infrastructure for secondary level education in
1997?
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………
Higher Education
The world economy is changing as knowledge supplants physical capital as the source of
present and future wealth. Technology is driving much of this process, with information
technology, biotechnology, and other innovations leading to remarkable changes in the
way we live and work. As knowledge becomes more important, so does higher education
(WB, 2000: Higher education in LDCs: Peril and Promise)

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There has been also modest expansion in students’ intake capacity of higher education
institutions during the past decade. This mainly has come about due to the opening of
new regional universities and to some extent upgrading of existing institutions. The
number of students enrolled in degree programs increased, for example, from 8,971 in
1992/93 to 21,014 in 1999/2000. Similarly, the number of diploma students enrolled in
higher education institutions increased from 6,185 to 7,838 during the same period.

Currently, there are 19 public higher education institutions in Ethiopia. These include six
universities (Addis Ababa, Alemaya, Debub, Jimma, Bahir Dar and Mekele); and thirteen
colleges of medicine, agricultural, commerce, technical, engineering, forestry and teacher
education.

There are also many private colleges registered and accredited to offer diploma and
degree level education.

The overall contribution of private colleges to higher education enrollment seems to be

far better than their contribution to secondary education. For example, in 1999/2000 there
were 14,961 students registered for diploma in all institutions of higher education. Of
these, 5,472 (36.6%) were registered with the above four private colleges. There are a
number of other colleges not appearing on the Ministry of Education list perhaps because
they are awaiting accreditation.

Most of these institutions provide three modes of education, namely regular, evening and
summer (kiremt) programs. In the 1999/2000 academic year there were 37,195 students
in regular, 25,595 in evening and 4892 in summer (kiremt) programs, which brings the
total students in higher education to 67,682.

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Year Regular Evening (Summer) All programs
Kiremt
Total female% Total % female Total female % Total female%
1995/96 17,378 10.7 16,464 29.0 1,185 3.4 35,027 19.1
1996/97 21,128 14.1 18,838 28.4 3,351 5.3 43,317 19.7
1997/99 23,603 14.3 19,810 25.8 2,141 9.4 45,554 19.1
1998/99 27,345 14.8 20,585 25.6 4,376 7.9 52,306 18.7
1999/2000 37,195 19.8 25,595 26.9 4,892 8.6 67,682 21.6
Source: computed from Ministry of Education (August, 2000).

But enrollment has always been low considering the size of the population in general and
the number of secondary school graduates in particular. Space limitations at the colleges
and universities caused the government to raise admission standards. The emergence and
growth of private tertiary level institutions and their phenomenal growth in enrollment
are due to lack of space to accommodate a good proportion of those completing 12 th
grade in public institutions. As stated in our first annual report (EEA, 1999/2000), “the
majority of the students, tens of thousands annually, discontinue their education and join
the ranks of the unemployed not because they don’t have the academic capability to
admit them”.

There are also indications, as discussed in subsequent chapters that quality of education at
tertiary level has been declining in recent years. This particularly has been grave for
Addis Ababa University, which also suffered from declining relative importance since the
new universities reduced its monopoly of providing tertiary level education. The number
of degree program graduates also increased from 1,724 in 1992/93 to 3,796 in 1999/2000.
Out of these graduates, 1,217 and 1,312 were from Addis Ababa University during the
respective periods. The proportion of graduates from A.A.U out of the total graduates in
the country declined therefore from about 71 percent in 1992/93 to 35 percent in
1999/2000. That is a decline by half in a matter of seven years period. This shows a
significant decline in the importance of Addis Ababa University as a national university.

In 1992/93 the number and qualifications of teachers in A.A.U were as follows: 293 PhD,
233 M.A. and 101 B.A degree holders. By 1999/2000 the number of teachers with PhD
declined to 234, with M.A. degree slightly increasing to 247 whereas those with B.A

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degrees declined to 99. In fact, the number of teaching staff holding PhDs in all higher
education institutions declined from 464 in 1992/93 to 447 in 1999/2000. The current
state of higher education in Ethiopia and the problems it faces are discussed in detail in
subsequent sections of this report.

5.3 EDUCATION EXPANSION AND ACHIEVEMENTS

Based on enrollment trends, it is possible to conclude that total enrolment in general and
primary enrolment in particular has shown significant growth in the country in absolute
terms. The 7 million targeted size of enrolment in primary schools for the years 2001/02
in the Education sector Development program (DSDP) 4 has already been achieved and
even surpassed before the winding up of the program.

However in light of the size of the relevant school age population and the level reached
on average in SSA as depicted by gross enrollment ratios (GER) and net enrollment ratios
(NER) 5 the current enrollment level is still very low. Moreover, the recent achievement
in expanding access to school was made in most cased at a huge cost of quality and
equity as discussed in separate sections of this report. In the following section the
outstanding issues in the sector regarding enrollment are presented.

Growing But Still Low Coverage

The enrollment trend at the national level shows that undoubtedly there has been growth
over the past few decades. From half a million in 1968 it doubled to 1 million in 1975
and rose to 3.3 million in the last year of the Dergue6. It has now reached well above 8
million. However compared to other countries in East Africa and the sub Saharan Africa
(SSA) regional average, the Gross Enrollment Ratio (GER) and Net Enrollment Ratio
(NER) in Ethiopia are still among the lowest.

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The Table below shows comparison on GER and NER at primary and secondary school
levels for selected East African countries and the Sub Saharan Africa regional average in
the year 1997 for which comparative data was available. The table shows that while the
SSA average gross primary enrolment ratio was 78, it was 43 for Ethiopia. Whilst
Kenya’s achievement was almost twice that of Ethiopia, both Uganda and Tanzania have
by far higher ratios than Ethiopia. Even when it comes to net enrolment ratios, the
Ethiopian scenario is still very low compared to both Kenya and Tanzania. With regards
to secondary education, we notice that GER of Kenya and SSA average are twice as high
as the Ethiopian figure.

Table VI.5: Country comparisons of primary and secondary implement Ratios (1997)
ETHIOPEA KENYA UGANDA TANZANIA SSA
GER NER GER NER GER NER GER NER GER NER
PRIMARY 43 35 85 65 74 - 67 48 78 -
SECONDARY 12 25 24 61 12 - - - 27 -
Source WDI (2000)

High Regional Inequality

The regional profile is presented in three forms of comparison both in terms of the
absolute size of enrollment and GER. First percentage change comparison between1995
(starting from which we have regional data) and 2001 is made. This kind of percentage
comparison is useful in that it presents a rough picture of the changes under gone in the
given period. However it has also limitations in that it does not tell us the level of access
created for the people. It is possible that due to poor initial conditions the percentage
might have grown but what has been achieved by the end of the day is not much in
terms of the level of access provided to the people. Hence a second measure is provided
which shows the status reached at the national and regional levels. Thirdly the average
compound annual growth rates are presented to show average regional preference over
the years.

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Using the information gained from these method of comparison one can conclude that
there has been an unbalanced growth enrolment among the regions in the country (tables
v1.5 below). If we take the case of Somali, GER in 2001 is lower than what it used to be
in 1995 showing a fall by 9 percent, while there is a 198percent increase between 1995
and 2001; the regions with the highest achievements are Amhara. (198%), Oromya
(170%), Benishangul (150%) and SNNP (122%),which have more than doubled their
GER in the given period. Other than Somalia, Afar (69%) and Addis Ababa (39%) are
the regions with the lowest performance. The case Addis could be explained by its
highest position both in 1995 (84.9%) and in 2001(105.3%). How ever the situations in
afar (11.5%) and Somali (11.6%) is an area of concern in that the 57%GER at the
national level can in no way represent these regions as it is more than five times their
actual level while there are regions that have gone far beyond the national average.

The ESDP equity target was to raise the primary gross enrolment ratio in two most
underserved areas in the country to 25% by the year 2001/02. But what has actually been
achieved so far is far is far below this, which would make the target of achieving it
implausible. With regards to secondary education the current achievement in GER
(year2001) indicates that the highest performances are recorded for Addis Ababa (60.7%)
and Harari (50.2%) followed by Tigiray (23.0%). On the contrary not even 1 per cent of
secondary school age children go to school in Somali region and only around 3 per cent
do so in the Afar region. Tigray has growth rate of enrollment of three times higher than
the national average followed by Benishangul (27.8%) and Gambella (23.0%).

With regards to absolute size of enrollments one can say that between the years 1995 and
2001 almost all regions exhibited changes in enrolment levels albeit at different rates.
Among the better-served regions there has been an appreciable positive change in
primary enrolment. The change was higher in Oromiya and Amhara followed by SNNP.
Addis Ababa showed somewhat a stagnant. In fact in some years there was decline.

In the case of the under served regions of Afar and Somalia, changes started to be visible
only in 2000 or 2001, while in the rest of the regions there was a change that could be
described as relatively dynamic. Eve if it was not as sharp an increase as that of
Benishangul, Gambella, Harari and Dire Dawa also showed an increasing trend in

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enrolment. If we compare these two groups of regions (the bigger and the smaller ones)
we notice that there is a highly pronounced gap. While most of the bigger regions except
Addis Ababa showed sharp increase in primary enrolment, the smaller regions (saving
Benishangul Gumuz) did not.

If one compares average growth rates achieved by each by each region between the years
1995-2001, the highest average growth rates were that of Amhara, (21.0%), Oromiya
(18.7%), Benishangul (17.2%) and SNNP (14%). On the other hand Somali (5.6%) and
Afar (11.1%) are still among those regions with lower annual growth rates of enrollment
without considering the other regions like Addis which have low rate of growth but had
already attained fairly higher levels.

In the case of secondary education, the disparity among regions in each group is narrower
compared to primary education. But still the bigger regions except Addis Ababa show a
fast increasing trend, with Oromiya, Amhara SNNP taking the lead. Among the smaller
regions Benishangul and Gambella showed a consistently increasing trend, while the rest
of the regions lack that kind of consistency. In the same way as in the case of primary
enrolment, Somali and Afar regions were highly disadvantaged. Comparing annual
growth rates of enrolment at secondary level, Tigray had the highest annual growth rate
(36.6%) followed by Afar (25.5%) and Benishangul (24.9%). Addis Ababa and Harari
have the lower average annual growth of enrolment because of their historically high
levels of achievement.

As in the case of primary education, comparison is made based on percentage change in

secondary enrolments achieved in 2001 over the initial condition of 1995. Accordingly,
Tigray (452%) and Gambella (401%) exhibited well above four-fold growth followed by
Benishangul (209%) that raised its enrollment by two fold. It is in the presence of such
drastic growth that we still have regions like Afar (38%) that have lagged far behind.
Hence here also what we can say is that the problem of balanced growth or the issue of
regional equality is at stake both at primary and secondary education levels. When we
look at the latest achievement figures (i.e. primary GER of 2001) we notice that there is a
huge gap in gross enrolment ratios among regions. In 2001 the highest was that of Addis

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Ababa (118.3)%) while the lowest was Somali (10.6%). The next highest and lowest
regions were Harari (105.3%) respectively.

According to the ESDP the equity target set was to raise the primary gross enrolment
ratio in the two most underserved areas from their initial position of 16.2% to 25% in the
year 2001/02. But actually what has been achieved so far is too far below not only the
target but also the initial level as well (i.e. 10%) that would make the target obviously
unachievable. The GER of these regions could be easily misrepresented by the commonly
quoted national average (like 57.4% for the year 2001), which obviously masks regional
inequities. Another point to note here is that while net enrolment ratios (NER) are more
useful indicators of access (as they are calculated net of under aged and over aged
children), due to problems of data availability they are not usually reported for regions.
However, as indicated earlier, the latest achievement in GER (for the year2001) clearly
establishes the existing regional inequity. As has been discussed in the part on size and
growth rates of enrolment at secondary level, Tigray has three times higher than the
national average growth rate of enrollment followed by Benishangul (27.8%) and
Gambella (23.0%).

In the preceding we saw the regional dimension of education by looking at the size and
growth of enrollments in absolute terms and in terms of annual growth rates and
cumulative percentage changes observed between the date of the inception of the sector
development program and the achievement reached to date. All these measures of
looking at the regional profile lead us to a similar conclusion. Despite the government’s
high priority of narrowing disparity in level of education among regions, the fact on the
group indicates that there is still a lot to be done in terms of ensuring regional equity. The
possibility of achieving a nation wide universal access to primary education will be far
from a reality unless a drastic measure is taken to reverse the status of the regions that
have lagged far behind the trace. Effort has to be made in the identifying the causes of
these inequalities and addressing them accordingly. Possible causes for such inequalities
include issues related with the level of of priority ascribed to the sector by the respective
regional bodies; inefficiencies of resource allocations or capacity constraints to utilize
allocated founds; social and economical factors at the individual hose hold and

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community levels that affect decisions to send child to school as well the existence of
politically and socially conductive environment. This latter factor is the most probable
cause for the low level of penetration in the Somali regional state.

Degree of Emphases: primary vs. _secondary education levels significantly differs

across regions
In education policy documents of the government it has been clearly stated that priority
should be accorded to primary education. To realize this objective the sectors
development program stated 60%of the total resources allocated for education to primary
education. However and even the fact the provision of education to the responsibility of
regional government, there is no mechanism to guarantee that such kind of priority would
be in forced in each region. Partly as a manifestation of this problem we notice regional
variation in the level of change in enrollment between primary and secondary levels. For
instance Tigray registered above four-fold change in enrollment by raising its gross
secondary enrolment ratio from 4.4 percent in 1995 to 23.3%in 2001 twice as high as the
national average. However, Tigray ranks 8th in terns of achievements in primary
education. In contrasting to its 400% change in secondary schooling the region registered
only 69 percent change in primary schooling. Amhara and Oromya have the highest
achievements in primary education measured in terms of gross enrollment ratios. Interims
of percentage changes made between 1995 and 2001 their performances are 198 percent
for secondary enrollment and 173 percent for primary and 83 percent and 93 percent for
secondary. This relative changes in achievement could be taken as one indicator off the
difference in the relative weights given by regions in there priorities with respect to the
Deferent levels of educations. If the national targets are to be met there has to be a
mechanism by which they could be realized in all regions.

5.4 DIFFERENT LEVELS OF EXPANSION IN HIGHER EDUCATION

There is very little attention rendered to higher education in Ethiopia due to the emphasis
of the sector development program on the expansion of primary education. However, the
federal government seems to have reconsidered its position, as a result of which a
significant increase in enrolment of a territory level has occurred in recent years.

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If we look at the trend in total enrolments at tertiary level over the past two decades we
can see that there has been expansion over the last decade. Further looks at the
distribution of resources reveal that the undergraduate degree and diploma programs
account for larger proportions. On the other hand postgraduate programs did not show an
equally remarkable expansion in the same period. This is an area of concern in that the
expanding program areas could only be backed properly if there is an equally growing
post graduate programs to meet the newly opening programs as well as enabling the
society take advantage of the globally exploding knowledge and technologies.

Although the magnitude of its dominance has been declining over the years due to the
emergence of the new universities, the historic Addis Ababa University is still the one
with the highest in take of students.

Looking the distribution of graduates at the degree and diploma levels, a clearly
observable fact that the gap between the number of diploma and degree graduate has been
growing wider and wider at the current regime. Between 1991 and 2000 the total
graduate grew by 172% while the number of under graduate and postgraduates grew by
125% and 63% only. This would endanger the countries potential for producing high-
level professionals. On the other hand the importance of having a good number of
postgraduate programs that would produce professionals in a variety field cannot be over
emphasized in the presence of newly opening universities and colleges for it is usually
graduates from this programs that would back up the faculty of the same as well as
producing capacity to tap the over growing global knowledge. However the growth of
graduates from these programs does not seem proportional. This would further worsen
the initial low level of postgraduates training in the country.

5.5 SCARCITY OF GRADUATES IN HIGHLY DEMANDED FIELD OF

STUDIES

As we look at enrolment trend at tertiary level under the broad classification of fields of
study (UNESCO: 1998), we notice that expansion of basic education was the major
explanatory factor for the total increase in enrolments. This should not come as a surprise

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given the demand-pull pressure exerted from below resulting from the primary schools
expansion associated with the ESDP. Between 1993-1996 growth of enrolment in the
broad classification of education, humanities, social sciences, natural sciences and
medicine was 103 %,6%, 28%, 38% and 50% respectively. Again the highest growth in
the field of education is in line with the emphasis rendered to the education sector.
However an equivalent rate of growth has not been observed in the expansion of medical
education consistent with and supportive of the highly ambitious health sector plans.
Figure VI.3: trend in the number of Tertiary Students by Broad Fields of Study (1980-
1996)

The table below presents the total number of graduates all over the country in the fields
of Business and Economics, Technology, Medicine, Law and Computer Science. The
selection of these fields of study is based on their significance in the current development
context. According to the table the highest share of graduates in the given fields are those
of business and economics followed by technology. On the other hand the fact that the
number of graduates in medicine, and computer science is too low is a strong signal of
the country’s position regarding the availability of qualified manpower to meet demands
in information technology and medicine.

Graduates from Selected Regular Undergraduate Programs 2000.

FIELD OF STUDY DIPLOMA DEGREE TOTAL
Business & Economics 551 378 929
Economics 189 189
Management 22 84 106
Banking & finance 157 0 157
Public Administration 16 16
Marketing Management 93 93
Accounting 279 278 557
Technology, of which 105 229 334
Architecture & Urban Planning 25 25
Building Technology 62 62
Chemical Engineering 25 25

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 Civil Engineering 83 83
Electrical Engineering 54 54
Mechanical Engineering 42 42
Municipal Engineering 43 43
Medicine 42 42
Law 261 261
Computer science 19 19

While the low level of graduates in the fields of studies that are essential to locate the
country on the trajectory of knowledge and technology driven poverty-reducing growth is
lamentable, the insufficiency is further exacerbated by the possible migration of these
professionals out of the country. This is likely to induce the government to chart ways
and means of keeping them at home while expanding capacity to train more people in this
essential track of technological development.

5.6 SUMMARY AND CONCLUSION

In general enrolment size in Ethiopia for the last few decades has been on an increasing
trend. This especially trues of the current government whose deliberate move to expand
primary education in the country has dramatically increased the pace. Despite these
laudable accomplishments, the country lags far behind how much needs to be done to
expand coverage to afford respectable proportion of the relevant age cohort an
opportunity as well as close the huge gap that exists between itself and that of other
countries in Africa. The Ethiopian enrolment ratios are by far lower than SSA average.

As assessment on the current expansion across regions indicates, the current achievement
has not been evenly distributed. Despite the government’s repeated assertion of effort to
narrow the gap between the relatively developed and the relatively undeveloped regions
the disparity on the growth rates of the size and ration of enrolments has been growing
over the years. However the disparity level and magnitude depend on which level we are
considering, primary or secondary. Between 1994-2001 regions like Amhara and
Oromiya have had the highest growth of primary enrolments while Gambella and Tigray

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have had the highest growth of enrolments at secondary level. This would cast doubt
weather the nationally set priority to primary education has been adhered to equally at
every region all over the country. It was also learnt that regions like Somali and Afar are
still at severely low enrolment level in both primary and secondary education.

When it comes to tertiary level enrolments, again the trend is one of an increase
throughout the years, with the current government having the sharpest increase of ever.
As we unpack the total tertiary level into levels and specialization areas we learn that the
highest rate of increase is enrolment size of diploma students followed by undergraduate
and postgraduate degrees respectively. If the new universities and colleges are to be well
staffed then postgraduate programs must grow in tandem. On the other hand it is also
imperative to keep in mind that the growth of the economy largely depends on the
existence of competent manpower both in the civil service and the private sector. This in
turn depends on the capacity of the education system in the country to produce
professionals with the desired level and type of training. For instance it is a very sad
situation to see a handful of IT professional in the country in an age of incredibly fast
growing information technology.

Once again, one cannot fail to understand and appreciate the critical importance of
education to economic and social development. To this end, it is incumbent on the
government to not only invest on education but it should do so in ways that would
produce graduates at all level who are capable of addressing not only current needs but
also take advantage of future prospects both from within as well as and most importantly
from outside.

Check Your Progress

4. How much is the share of private institutions in higher education?
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………

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5.7 HEALTH

Ethiopia has extremely poor health status compared to other low-income countries. This
is largely attributed to prevalence of preventable infectious diseases, nutritional
deficiencies and a high rate of population growth. Moreover, widespread poverty along
with general low income levels of the vast majority of the population, low education
levels (especially among women), inadequate access to clean water and sanitation
facilities, and poor access to health services have also contributed to the overall burden.
Furthermore, the under financing of the health sector has limited the government's ability
to meet the demand for health care services. As a result of the lack of resources, the
government's spending on health has also been very low.

Since the introduction of formal health services in the country some 50 years ago,
responsibility for providing health care delivery system has steadily deteriorated over the
past years and, at best, reaches only less than half of the country's population. Health and
demographic indictors demonstrate that there are major maternal and child health
problems and a high burden of disease in the country.

Cognizant of these problems, the Transitional as well as the Federal Governments of

Ethiopia have attempted to reform the Health Sector Development Program (HSDP) with
assistance of donor organizations and other financiers (including the World Bank). The
implementation period for the HSDP I was planned for 1996/97 to 2001/02.

A review of some secondary sources, notably the HSDPII was not, by and large, able to
bring about the promised changes in the health sector. A number of reasons explain why
the program implementation was not successful as originally planned. One of such reason
is that for much of its financial resource requirements, the HSDPI was dependent up on
external assistance and grants. However, the required funding could not be generated as
the launching of the program was soon followed by the outbreak of the war between
Ethiopia and Eritrea in the years 1998 to 2000. Consequently, the government could not
generate enough financial resources to fund the health sector in as much as other sectors
were under financed. The government has now adopted the second phase of the program,
which is HISDPII. It is planned for implementation during 2002/03 to 2004/05 (i.e.1995

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to 1997 EC). As was the case with HSDPI, the second phase of the program depends up
on external assistances to finance the program implementation.

5.7.1 The Current Health Situation

Ethiopia has very poor health status relative to other developing countries, including
those in Sub-Sahara Africa. Services are poorly allocated, inequitably staffed,
underutilized and under-funded.

5.7.2 Health Status

According to the screen Ethiopian Demographic and Health Survey, national level of
mortality estimates indicate slight improvement, as shown in table below.

Major indicators, 1998 and 2000

1998 20
0
Infant Mortality 105 97
Under five Morality 172 166
Maternal Mortality 500-700 871
Sources: HSDP II, MOH 2002

Poor nutritional status, infections and a high fertility rate, together with low levels of
access to reproductive health and emergency obstetric services, continue to be one of the
highest maternal mortality rates in the country. World population Data sheet (2001)
suggests that average life expectancy at birth is revelry low at 54 (53.4 for male and 55.4
for female). The Federal Ministry of Health (2000) expects that this figure is to decline to
46.5 years if present HIV infection rates are maintained.

The finding of the Demographic and health survey (2000) indicates that nutritional
disorders rank among the top problems affecting the population in general and children
and mothers in particular. In this regard, 52% of children under the age of five years were
stunted while26.3% were severely student; 11% were wasted and 1% severely wasted;
and 47% were underweight, and 16% severely under weight. In additions, 44% of
children under-five years suffer from sub-clinical vitamin A deficiency and 22% are
iodine deficient. In 1996, nutritional deficiencies in Ethiopia were estimated to directly
account for 7.8% of all deaths and 9.3% of discounted life years lost. However, the

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World Bank (1997) states that taking in to account the interaction of nutritional
deficiencies and other diseases, the total direct and indirect contributions to mortality was
29%.

Infectious and communicable diseases account for about 60-80% of the health problems
in the country. The ten top leading causes of outpatient visits in 1993 EC are shown in the
next table.
Leading causes of outpatient visits, 1993EC
Diagnosis %
Malaria, all types 10.4
Helminthiasis 6.7
Acute upper respiratory infections 6.5
Bronco-pneumonia 5.5
Infections of skin and subcutaneous tissue 4.6
Gastritis and duodenitis 4.4
Dysentery 3.5
Tuberculosis of the respiratory system 2.2
Sexually Transmitted Infections 2.2
Bronchitis, chronic and unqualified 1.9
Top Ten causes 47.9%
Total cases seen 3,167,514
Source: Health and Health Related Indicators 1993, MOH

The total burden of disease, as measured by premature death from all causes, is
approximately 350 DLYs (Discounted Life Years) lost per 1,000 populations. Ethiopia's
burden of diseases is significantly higher than in neighboring Kenya (estimated at 170
DLYs lost per 1,000 population).

According to PHRD (1998), Ethiopia's burden of disease is dominated by peri-natal and

material conditions and AIDS. Indeed, the top ten causes of mortality account for 74% of
all deaths and 81% of DLYs lost. Diseases that affect children under the age of 5 years
(ARI, diarrhea, nutritional deficiencies and meals) account for33% of deaths and 40% of
DLYs lost. When peri-natal and maternal conditions are added, the health problems of
mothers and children combined account for 50% of all deaths and 56% lost..

5.8 HEALTH SYSTEM ORGANIZATION

Service Delivery

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The health care delivery system of the country has recently introduced a four-tier system
for provision of health services. This is characterized by primary health care unit
(PHCU), comprising one health center and five satirized by a primary health posts, and
then the district hospital and a zonal hospital. In terms of catchment's population a PHCU
has been planned to serve 25,000 people, while a district and a zonal hospital are each
expected to serve 25,000 and 1,000,000 people respectively.

The number of health facilities and hospital beds in 1993EC, together with the health
facility to population ratio for each type is indicated in table 3 (see next page)These
figures include government institutions, non-government organizations (NGOs) and the
private sector, and the population figure is based on the projections of the central
Statistics Authority (CSA ) for the year 1993 EC, which is estimated at 65,334,000.

Health Facility to population ratio, 1993EC

Type of Health Numbe Ratio
facility r
Hospitals 110 1:594,036
Health Centers 382 1:171,057
Clinics 3,463 1:18,869
Health posts 1,023 1:63,875
Hospital Beds 10,736 1:6,086
Sources: FMOH (1993) Health and Health Related Indictors

The facility to population ratio clearly shows that health facilities are limited in number.
In addition, their distribution among regions and between urban and rural settings is
uneven.

The growing size and scope of the private health sector, both for profit and not-for profit,
offers an opportunity to enhance health service coverage. It is important for the
government to encourage their participations. According to the HSDPRe, an increasing
number of local and international NGO s are currently involved in various aspects of
service delivery, and there are an estimated 1,170 private clinics and 17 private and NGO
owned hospitals in the country. In addition, of the 311 pharmacies, 249 drug shops and
1,917 rural drug vendors which are estimated to exist, some 95% are privately owned.

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5.8.1 Management and Support
Heath services are managed in accordance with the decentralized structure of the country
as a whole. Overall responsibility for health policy and regulation is the responsibility for
management of health service delivery falls to the respective Regional Heath Bureaus
(RHB). As a result, management of health facilities, personnel, and health training
institutions within the regions is undertaken by the RHBs. They are supported in this
function by zonal health departments in some places, and increasingly through the
establishment and staffing of wereda health offices. Supervision takes place at all levels,
from the FMOH departments through to zones. Responsibility for logistical support is
again shared between the FMAOH and the RHB. A Health Management Information
system(HMIS) has been established for routine reporting of activates and health
utilization, and structures are in place fro periodic monitoring and evaluation of the health
system as a whole.

Check your progress

1. List the ten top causes of outpatient visits.
…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………

5.8.2 Health Care Utilization and Coverage

The Ministry of Health measures coverage using what it calls "potential health service
coverage", and is defined as percentage of the population within 10Km of a health
station. Accordingly, it is estimated at 51. 2% in 1993EC. However, this varies largely
around the country, according to topographic and demographic and demographic
characteristics. Largely around the country, according to topographic and demographic
characteristics. One important case is that of pastoralist communities, who represent
about 10% of the population and who are Mobil and seasonally change their residence.
Special attentions are required to ensure access to health services for such communities.

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Utilization of formal health services has traditionally been, and remains, low at about
27% per capita per year. In part this is due to coverage figures, with geographic distance
to a health facility still presenting a barrier for almost half the population.

Estimated health service coverage and utilization by origin 1993EC

Region Populatio Potential health Out patient
n Service coverage visits
% Per capita
Tigray 3,797,000 66.24 0.80
Afar 1,247,000 52.70 0.23
Amhara 16,748,000 43.50 0.15
Oromia 23,023,000 46.91 0.28
Somali 3,797,000 30.55 0.04
Benshangul-Gumuz 551,000 86.21 0.76
SNNPR 12,903,000 55.06 0.20
Gambella 216,000 87.96 0.80
Harari 166,000 114.46 0.79
Addis Ababa 1,570,000 93.39 0.55
Dire Dawa 330,000 51.52 0.28
National 65,334,000 51.24 0.27
Source: MOH (1993) Health and health-Related Indicators

Coverage in terms of health workers remains poor. In 1993Ec, there were 1,366
physicians, 296 health Officers, 7,723 Nurses, 7,386 Health Assistants, 85 pharmacists,
1,050 Laboratory Technicians, 190 x-ray Technicians, 513 pharmacy Technicians, 920
Environmental Health workers, and 4,379 front Line Health workers (FLHW). The
FLHW comprises community health agents, traditional birth attendants and primary
health workers. The health worker/population ratio for 1993 EC is shown in Table 5
below.

Health Workers/population Ratio, 1993 EC

Health Workers Numbe Ratio
r
Doctors 1,366 1:47,836
Nurses of all types 7,723 1:8,461
Health Assistants 7,386 1:8,847
Technicians of all types 1,753 1:37,276
Pharmacists 85 1:768,753
Sanitarians 920 1:71,026

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 Source: FMOH 1993) Health-Related Indictors

As can be noted from the table, the physician to population and nurse to population and
nurse to population are much lower than the WHO minimum standard of one physician
for 10,000 and nurse for 5,000 people. There are also serious imbalances in the
distribution of health workers especially in the following categories such as general
surgeons and obstetricians /gynecologists.

5.8.3 Health Financing

Health service in Ethiopia is financed by four main sources. These are government (both
federal and regional), bilateral and multilateral donors (both grants and loans), non-
government organizations, private contributions, both from out of pocket payments and
through private sector investment in the health sector.

According to a comprehensive report of the Ministry of Health, there are no updated

figures available for the break down by source of total health expenditure in the country.
The most recent is the one from the National health Accounts exercise for the financial
year 1995/96.

Since the aforementioned source is relatively old to show trends in health sector
financing, I have used another sources to show the extent of health financing in Ethiopia.
This sources is Economic Analysis: Health sector Development program Ethiopia 1997-
2002 by Matthew Jowett of the University of York, which is an appraisal mission report
financed by the Irish Aid and conducted 18th May 1998. Table 06 below shows Health
sector Financing, comparing the state of affairs in 1990/1 to those prevailed in 1997/98.

Table 06: health Sector Financing

Average for
least
1990/ developed
INDICTOR 1 1997/9 countries
8 1995
Government health expenditure as % GDP 1.3% 1.7% 1.9%
Government health expenditure per capital (US$) 2.4% 1 5.9
Government health spending as % of total 3.5% 6.6% 7.4%

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government expenditure
Private expenditure as % of total health spending 63% 39% 59%
(1986 and 1996)
Government health expenditure on health as % of 2.7% 7.9% -
total capital
Government recurrent Expenditure on health as % 3.5% 5.5% -
total recurrent

As can be noted from table 05, government health expenditure in Ethiopia by then stood
at US$ 1 per person per annum, considerably below the least developed countries (LDCs)
average of $5.9 and the lowest of any country reporting. It should be noted that LCDs
include those countries with GNP per capita equal to or less than US$400. Total
government health expenditure has however increased from 1.3% GDP prior to 1991, to
1.7 GDP in 1997, similar to other LCDs.

As a share of total government expenditure the health sector received around 6.6% in 197
compared with an average of 3.5% through the 1980s, reflecting increase in health sector
funding. This trend is also reflected in the government’s share of total health expenditure,
which has increased from 35% in 1985/6 to 61% in 1995/6.

Both recurrent and capital government health expenditures have increased substantially
since 1991, with capital expenditures rising more rapidly. This pattern is a result not only
of central government health spending per capita varied widely in 1996/97, with
Gambella Region spending 8.4 times the national average, and Amhara only 0.6 of the
average. This pattern reflects both regional preferences for allocating resources to heath
services, and the health infrastructure each region inherited when formed in 1991.

Average regional per capita recurrent expenditures increased 6% in real terms over the
last four years. National recurrent spending increased 60% in nominal terms in 1993/4
(over 1992/3), falling to 14% in 1994/5, 5% in 1995/6 and 0.5% in 1996/7. At US$0.68
per capita in 1996/7 government recurrent spending is lower than in almost any other
country.

Government allocations of recurrent funding to PHCU increased over the period 1987-
1993 to around 40% of the total government recurrent spending, but fell since 1994 to

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37.4%. This turndown resulted partly form-increased allocation of capital expenditure to
hospital facilities since 1994, in turn creating greater demands for recurrent funding to
this level. Without adequate recurrent funding to the primary level, an expanded
infrastructure will achieve little in terms of improving the health of the population.

Recurrent spending on salary compared to non-salary (operating) reflects technical

improvement, and indicates the priority given to funding those supplies and services (e.g.
drugs, maintenance and repairs) necessary to ensure the delivery of quality health
services. Since 1991 operating expenditures have increased form 32.7% of total spending.
However, the low level of salaries contributes to poor quality of care, and anecdotal
evidences suggest that workers are increasing resorting to private practice out pf-hours,
using public health facilities and supplies.

As government health spending has increased as a share of total spending, private

payments have correspondingly declined to 39% (this includes payments to private
providers, 31% of health spending and to public provider, 8%). User fees existed since
1950s and constituted almost 20% of total recurrent spending up to 1992, declining to 9%
in 1997. This trend is a result of several factors including increase in total recurrent
spending without increase in fees, increasing exemption coverage, and a fall in the
previously strong effort at fee collections. As a percentage of total household expenditure
recent estimates put health spending at a low 0.7%

Donor financing has declined rapidly as a proportion of total capital expenditure in

Ethiopia, form 57% in 1994/5 to 27% in 197/8. Total envelopment assistance (ODA) and
technical co-operation to Ethiopia has fallen in each year since 1992 by annual average of
6%.

5.9 AN OVERALL REVIEW OF HSDPI IMPLEMENTATION

The HSDP I was launched in 1997/98 to partly resolve the prevailing and newly
emerging health problems in Ethiopia as well as the weaknesses in the existing health
delivery systems. The proceedings of the last review meeting of donor organizations
compiled by the World Bank have been used as a source for this part of the paper.

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According to the document, the specific objective of the first phase of the HSDP was the
development of a health system, which would:
 Improve the coverage of and quality of health services
 Be primarily implemented and managed by regional, zonal and wereda level
health officials; and
 Be financially sustainable.

For budgeting and implementation purposes, the HSDP was made up of eight
components. This section of the paper will provide a summary impression of the
achievements, problems and challenges faced during the last four years in the
implementation of the HSDPI.

Check your progress

6. How much is gov. health spending as % of the total gov. spindly?

…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………

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5.9.1 Health Service Delivery and Quality of Care

Medical Services
During the period of implementation, the old six-tier health delivery system was
transformed into four-tier system, led by establishment of PHCUs (see section 2.2.1 for
details on four-tier system). The only achievement on a record is mentioned as follows:
“A complete set of national standards for health posts, health centers and district
hospitals which have been prepared, approved, published and distributed to regions”.
These contain specifications for the building design, equipment and furniture lists, the
scope of services, detailed information on the cadres of staff required, and drug lists for
each level. he Ethiopian government claims that expansion of the number of health posts
as part of the transformation has contributed to “the modest increase in the utilization rate
from 0.25 to 0.27 visits per person per year.

Family Health Services

There has been some progress in the delivery of antenatal care, with an increase in the
percentage of the target population (women of child bearing age) receiving services form
health facilities from 30.4% in 1989EC to 34.7 in 1993EC. However, it is important to
note that there are great variations between regions.

According to Health and Health-Related Indicators (1993), there has been a slight decline
in the total fertility rate in the country, from an estimated 6.7% reported in the Program
Action Plant, to 5.9% reported in the Demographic and Health Survey (2000). The
Indicators document argues that this is supported by the substantial increase in the use of
family planning services in the country, with the contraceptive prevalence rate increasing
form 9.8% in 1989EC to 18.7% in 1993EC, with some regions such as Harari, Dire
Dawa, Tigray, Addis Ababa, and Gambella showing substantial improvement. Amhara
and Benishangul-Gumuz have reached over 21%, in Tigray 35%.

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5.10 PREVENTION AND CONTROL OF COMMUNICABLE DISEASES

Malaria
Malaria is still one of the leading causes of morbidity and mortality. About three-quarter
of the total area of Ethiopia is estimated to be malarious with around two-thirds of the
population being at risk of infection. In the past as a vertical program, malaria control
activities were divorced from basic health services and the achievements gained in the
control of the disease remained illusory and non-sustainable. Little has been done by way
of prevention and control of malaria during the HSDPI as malaria continues to be killing
disease in the country. The only achievement worth mentioning is related to the number
of studies on aspects of malaria were initiated during the HSDP period. These include
studies on: malaria in pregnancy, retrospective analysis of malaria data, malaria drug
resistance, resulting in a change of first line treatment; a baseline study for RBM; and an
insecticide resistance study.

TB/Leprosy Control Program

TB services are currently provided only in health facilities. However, the number of
zones in which Directly Observed Treatment- Short Course (DOTS) has been introduced
has increased from 31 in 1999GC to over 56 zones, including Harari Region and Dire
Dawa Administrative Council. However, there are no report on the extent to which TB
prevalence was reduced as a result of HSDPI during the last four to five years. With
respect to Leprosy, coverage for multi-drug therapy is higher than for DOTS, reaching
health facilities in almost half of the country (46%)

HIV/AIDS Prevention and Control

The HIV/AIDS epidemic started almost 17 years ago in Ethiopia, and there is consensus
that the virus has now infected a substantial proportion of the Ethiopian population, with
estimated prevalence of 7.3% in 2002. Not much work has been done during the life of
the HSDPI, however. The government’s attention was geared to establishment of
committees and councils whose performance remain to be seen. At the end of the

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HSDPII, the prevalence rate is expected to be contained at 7.3%. Yet, this can only be
done if the government continues to undertake information and education in the coming
years to bring about desired behavioral changes by raising the level of awareness of the
population in general and the youth in particular.

Blindness Prevention and Control

During HDSP I, a taskforce was established to coordinate and promote coordination and
expansion of essential eye care services. At present there are about 46 primary, 18
secondary and two tertiary level eye care unit in the country. The number of
ophthalmologists and ophthalmic nurses has increases by 23% and 180% respectively,
training of post basic ophthalmic nurses was started in ALET in 1999 GC, and in-service
training has also taken place. Yet, it is not clear in the document if such increase in the
number of eye health workers was the result of the HSDPI as this increase was not made
in relation to certain targets.

Hygiene and Environmental Health Services

According to the document, during HSDPI access to safe water and sanitation faculties
has improved at national level, with 23.1% in 1990 to 28% in 1992EC; while access to
sanitation increased from 12.5% to 17% during same period. The achievements in the
environmental health services are however mixed. For instance, the management of solid
waste is institutionalized in Addis Ababa and Dire Dawa, but not yet elsewhere.

Despite the achievements mentioned earlier for the sub component of Health Service
Delivery and Quality of care, there still remain some problems and challenges for the
whole component in general. For instance, the definition of an essential or minimum
health care package, to include community-based services and emergency obstetric care,
and a clearly defined referral system, has not yet been undertaken. This has contributed to
a continuation of the fragmented approach, with plans reflecting a number of individual
programs rather than developing overall systems for service delivery at each level,
including district hospital level.

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Little progress has also been made in terms of making the NGO and private sector full-
fledged partner in the HSDP implementation. In spite of this clear priority setting and
policy orientation, the activities undertaken during the HSDPI in general still remain
inadequate in terms of the required emphasis on prevention services in practice.

5.11 HEALTH FACILITIES CONSTRUCTION & REHABILITATION

The expansion of health infrastructure is a necessary, but not sufficient condition, for
improving access to health service. The number of hospitals has increased from 87 in
1989EC to 110 193. The number of health centers increased from 257 to 382, while a
total of 1023 health posts were constructed during the same period. Thus, the increase of
23 additional hospitals by 1993EC surpassed the target for phase I HSDP. Furthermore,
considerable rehabilitation of health facilities, and building and furnishing of support
facilities, has been undertaken. The extent of the rehabilitation and the number of
facilities that benefited from this has been mentioned, however. Although this being the
case with expansion of the infrastructure, the there are still concerns about the imbalance
between new constriction using capital budget, and mismatch in human resources and
recurrent funding to adequately staff and equip the new facilities.

Human Resources Development

The assessment made on the achievements of the HSDPI in human resources
development area revealed that 14,062 health workers of different categories were trained
between 19990EC and 1993Ec while the aggregated target set for HSDPI period was
9,579. This was greater by 47% over the planned target for HSDPI. In addition to this, a
total of 345 health workers graduated from post-basic and postgraduate programs.
Training institutions increased from 15 to over 30 and graduates number per year from
7000 to 4,500. However, there is still a problem with the distribution and management of
available human resources.

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Strengthening Pharmaceutical Services
Improvements in drug availability has been observed in the public and private sectors,
partly through licensing of a large number of drug outlets of various levels to sell drugs
(estimated at 311 pharmacies, 249 drug shops and 1917 rural drug vendors), and the
establishment of several domestic manufactures of drugs and medical supplies within the
country. Some 62 items are currently being manufactured, and have assumed about 30%
market share. Moreover, a number of major legislative, regulatory and organizational
reforms have been undertaken during the HSDPI: Proclamation to Provide for Drug
Administration and Establishment of Drug Administration and Control Department,
National Drug List, and other guidelines.

Nevertheless, weaknesses in the area of strengthening capacity, efficacy, potency and

quality of drug have been noted during the last four to five years. Moreover, there are
critical shortages of trained pharmaceutical staff at regional and zonal level (and will also
be the case at wereda level), partly due to the limited capacity of existing training
institutions, but also to rapid growth in private sector drug outlets.

Health Care Financing

In terms of overall financing the sector, budgetary allocations to the health sector
increased steadily over HSDPI, despite a shift with in the total budget allocation in that
period towards defense as a result of the conflict with Eritrea.

Health care financing (HCF) activities were implemented in the context of the Health
Care and Financing Strategy (HCFS), with a better understanding and articulation of
reform measures having been achieved during HSDPI. Reform areas considered include:
(i) revision of user fees; (ii) retention of facility revenue piloted through revolving drug
funds; (iii) promotion of various forms of risk pooling mechanisms and social financing;
(iv) encouragement of private sector/NGO participation in health service delivery.

However, resources outside government budget remained limited. Cost-sharing revenues

(revenues collected at health facilities) still do not represent an addition source of funding

144
for health care delivery as almost all revenues generated by health facilities are
transferred to the Government treasury.

Other issues
Gender
Although gender issues were given prominence in HSDP I, it has not yet been well
mainstreamed into HSDP implementation, partly due to a failure to understand the
meaning or importance of gender in the sector. Regions do not often report indicators
disaggregated by sex, and number of women trained as a % of the total remains low for
all cadres

Pastoralists
Pastoralists account for some 10% of the Ethiopian population, yet to date there is no
clearly defined systems for ensuring that they have access to health care.

Nutrition
Nutrition is considered in the HSDP as crosscutting issue, due to the contribution of
various sectors in ensuring adequate nutritional status. However, the importance of
adequate nutrition for good health, and conversely the implications of poor nutritional
status for susceptibility to and severity of other common diseases, suggests that it should
be mainstreamed in the child and family health sub-component of health service delivery.

5.12 CONCLUSIONS AND RECOMMENDATION

Although relative to what was 15 years ago the current status of health is slightly
improved as explained earlier, the health status of the country is still the poorest even
compared to low-income countries. Increased financing for the health sector is required
in terms of increasing the share of the health budget and ensuring access of the
population to basic and primary health care. The last consultative and review meeting of
all stake holders including the World Bank has forwarded series of recommendations for
improving the performance of the health sector in the second and third phases of the
HSDP. These are summarized below:

145
A balanced approach to health service expansion
Capital versus recurrent expenditures
Investment was guided by availability of a capital budget with insufficient analysis of the
future resources requirements implied by the investment. This problem is compounded by
the fact that requests for health facility budgets are based on simple increments and
allocation on resource availability without a proper calculation of the requirements of
each health facility.

One of the major concerns under HSDP I has been the imbalance between expansion of
physical infrastructure through construction of new facilities, and the capacity both in
terms of recurrent budget and staff to effectively render such new facilities functional.
Specifically, the need to ensure balance in the following areas has been identified:
investment in new health facilities in order to improve coverage
investment in human resources development to meet the growing demand for health
professional with increase in coverage; and,
ensuing funding for recurrent expenditures in new facilities as well as improving quality
in existing facilities to maintain a minimum standard of service delivery

Facility versus community-based service delivery

In light of the above concerns regarding the balance between components, and continued
limited access to facility-based health services, innovative strategies are required in order
to enhance essential health services, innovative strategies are required in order to enhance
essential health service coverage for the population. In this regard, avoiding fragmented
approaches, and developing a more structured and comprehensive approach to
strengthening community-based health services is recommended.

Harmonizing Planning and monitoring cycles

A further weakness of existing systems has been the failure to integrate HSDP into
general government planning and monitoring processes. Regional Health Bureaus
currently prepare two separate plans-one as part of the regional development plan, and
one as their contribution to the HSDP, each of which is required both on annual and a
periodic basis. Budget codes, reporting formats and processes differ, doubling the
administrative burden on management entities at regional level. This has contributed to

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lack of ownership of the HSDP at the implementation level, together with limited
familiarity with and understanding of the HSDP at lower levels of the health system.

Strengthening the partnership and its process

Challenges exist regarding the partnership between government and donors, and HSDP
II, the second phase, should ensure that consultations, communications and commitment
are the guiding principles of the document. Leaving aside the obvious challenges
presented by the Ethio-Eritrea conflict during the period of HSDPI, there is some felling
that the partnership had been weakened during that period by a divergence in
expectations between the different partners. In specific terms, it was felt the Government
expected higher level of harmonization/integration of procedures from donors over the
HSPD I period, while donors expected more frequent and joint consolation on technical
and strategic issues.

5.13 LAND TRANSPORT

In the history of modern transport in the country, road transport services take the
forefront which accounted for more than 95 percent of the total volume of ton km and
passenger km being transported while the remaining 5 percent is accounted for by other
forms of transportation. In the domestic freight traffic flow, scantier amount is conveyed
by air and inland water transport.

Following the rooting-out of Italian aggressors from the face of Ethiopia, the transport
sector was in disarray for a long period of time. The need to put the sector into shape was
so invoking that Proclamation No. 16/1943 was promulgated portraying for the first time
rules and procedures to be adhered by investors in the sector.

In the course of time, it was increasingly asserted that revenue accruing to transport
operators ought to commensurate to the services rendered by them. Thus, by 1960 a
proclamation came into force by fixing transport tariff. After successive improvements, a
government organization named “Road Transport Administration” was instituted
bestowed with the responsibility of overseeing the safety and quality of passenger and
freight transport services, issuing license, regulating area of operation and trip schedule.

147
In 1969, the mandate of yearly inspection of vehicles, and issuing of driving licenses was
transferred from the municipality to the authority and this continued till 1976. The
Imperial Regime had taken such important steps which shaped the transport sector.

After the take-over of power by the Derg, the cropping up of private transport operators
was stifled and road transport operations came under state regulation and control
following the state proclamation of 1976 which helped establishes two state agencies
under the Ministry of transport and Communications namely the Road Transport
Authority (RTA) and the National Road Transport Corporation (NATRACOR). The
proclamation charged RTA with the responsibilities of determining vehicle size and
weight, registration and inspection of vehicles, issuing licenses, setting road transport
tariff as well as enforcing safety and load regulations. The NATRACOR on the other
hand was given he power to provide road transport services using state owned trucks and
buses, and control the private commercial fleet owned by road transport companies and
individual operators as associates.

As the need to partition the NATRACOR into small and manageable units become
apparent, two government parastatals namely Freight Transport Corporation (FTC) and
Public Transport Corporation (PTC) were brought into existence as a result. To centralize
the management of transport operations, the country was divided into six freight and
seven passenger transport zones (“Ketenas”) complying with the 1976 provision. These
two government organizations were preoccupied with route, cargo and passenger
assignment to operators.

The Ethio-Djibouti (CED) railway is a single track with 781 km. length having one meter
gage jointly owned by the governments of Ethiopia and Djibouti. Construction of the
railway commenced in 1897 within the demarcation of Djibouti which later on reached
Dire Dawa in 1902. The railways were not extended to Addis Ababa until 1917. The
railway was originally built by the French who were involved with its management for
many years. The 1981 treaty between the government of Ethiopia and Djibouti replaced
the previously existing organization, the “Compagnie du Chemin de Fer Franco-
Ethiopien de Djibouti a Addis Ababa” with the present bi-national organization the
Chemin de Fer Djibouti – Ethiopien (CDE).”

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The Ethiopian Airlines (EAL) was established in 1945 with paid up capital of 2.5 million
birr. It started operation with five DC-3 air crafts from the U.S.A. World War II surplus.
The first scheduled flights were domestic ones connecting Addis Ababa with major towns
of Dire Dawa, Asmara and Gondar. A few months later, however, the service was
extended to neighboring cities of Cairo, Djibouti and Aden. The total workforce at that
time was only 159. The airline by joining the jet age shuttles and higher capacity air
crafts is currently entertaining scheduled and chartered services loan even wider part of
the world.

The Ethiopian Shipping Lines (ESL) was set up in the year 1964 and began operation in
1966 by deploying three newly built vessels (two cargos and one oil tanker) in the Red
Sea and North Europe trading routes. The start up capital was contributed by the
Ethiopian government amounting 49 percent and the rest by foreign companies. This
mode of ownership was annulled after two years of service by scrutinizing the services of
the organization which are highly attached to the benefits of the country. Thus, ownership
become within the full grip of the government. Since then, much alteration have been
made on its organization and vessels type to met the growing domestic demand for
shipping services and to cope with international competition.

Before the advent of the Derg, there were many national and foreign private transistors
alongside three government owned organizations namely Marine & Transit Service under
the Ethiopian shipping Lines, ship Transit Enterprise under Ministry of Foreign Trade
and, Transit Service organization under Ministry of Transport. All these were merged
together in 1978 and formed one giant Marine and Transit Service Corporation which
monopolized the market without any potential competitor. Following the fall of the Derg,
private transistors and forwarders have been allowed to participate in the market.

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5.14 REVIEW OF POLICY MEASURES IN THE TRANSPORT SECTOR

The commercial road transport industry in Ethiopia – was so unique, having

characteristics which differ markedly from such industries elsewhere. These unusual
characteristics were partly the result of deliberate policies introduced under the Derg
regime which placed the entire commercial truck and passenger transport sector under
effective control of the state, and partly the consequence of the major food relief
programs which have been necessary since the early 1980’s. Food relief has become one
of the major freight flows in Ethiopia accounting for 20-25 percent of ton kms
transported and generated a relief transport sector which used to operate more or less
independently of the commercial sector.

The very monumental policy change in the sector occurred during 8 May 1992 heralding
the deregulation of freight transport industry with the statement issued by the Ministry of
Tran port and Communications. This statement annulled proclamation No. 107/1976 that
put the sector under close state regulation and control. The main content of this new
policy included:
 Zonal transport offices (ketenas) established according to the proclamation No.
107/1976 to control & regulate commercial road transport operations were closed
down;
 Freight rates were no longer to be fixed by government authorities;
 Private operators were no longer required to report to government agencies for
their route and cargo assignment;

Regarding passenger transport, modest deregulation was effected prior to the change in
the political regime whereby tariff-fixing for mini buses was terminated. The process
continued and extended to midi-buses by the issuance of directives from the Ministry of
Transport and communications in September 1994.

The tariff and operation of intercity buses are still regulated in the sense that they operate
according to trip schedules prepared on a monthly basis by RTA and association
representatives with fixed tariff for the routes. Middle and Maxi buses are still operating

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in one of the seven passenger transport zones. These practices are a continuation of the
pre-deregulation period, but the retention of this practice is strongly desired by the private
operators mainly because of the fear of cut-throat competition among themselves.

Major liberalization of the transport industry begun with the government’s Proclamation
No. 14/1992. The proclamation emphasizes the promotion of efficiency and equitable
distribution, and regular services provision for passenger and cargo transport. It permits
individuals to operate either as associates of government enterprises as they used to be or
establish their own companies, or organize themselves into independent associations.

Following the 1992 proclamation, many of the private commercial freight and passenger
transport operators left the corporations and formed their own independent associations.
Some, however, continued as associates of government enterprises. At the moment, entry
into the exiting association is free. Any group of individuals can obtain licenses to form
associations provided the minimum requirements are met. These include:
 Having a minimum of 50 members in the case of freight transport and 30 in the
case of maxi-buses, and should not exceed the maximum fleet size set by RTA;
 Submitting the list of members to RTA;
 Ensuring that they have office facilities with relevant staff, managers and
accountants;
 Having printed freight orders, tickets, mobile cards and other forms.

The procedure to obtain licenses for private and share companies is more or less the same
except that no limit is set concerning the number of trucks and buses they are supposed to
have. In a nut shell, deregulation of the industry and domestic market liberalization has in
effect substantially diminished state monopoly in the road transport industry.

The mammoth capital outlay needed to take part in the rail transport services is a
handicap to the private sector. The cost of power units like locomotives and auto rails,
conventional trains, passenger coaches, wagons and the physical infrastructure like he
construction of rails, sleepers and other sidetracks are well beyond the reach of the
private sector. As a result, proclamation No. 37/1996 vividly presented that rail transport
services are reserved for the government.

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Besides, any domestic potential investor is welcome to join the air transport industry
using aircraft with a capacity of up to 20 passengers or with cargo capacity of up to 2700
kg as plainly st6ated in the investment (amended) Proclamation No. 116/1998. In this
regard, 4 domestic investors are license to operate in the commercial air transport
services while Midroc Ethiopia takes license for own use (non commercial one).

The revised investment proclamation as well relaxed areas of investment that were
formerly the protected right of the government. For instance, investors are by now
allowed to invest in telecommunication services in partnership with the government
which was an entirely impossible area before the amendment. No investor has yet
appeared to acquire investment license up until 11 June 1998, the date in which the
proclamation come into force.

The Ministry of Transport and Communications as per the Proclamation No. 4/1995 is
bestowed upon the responsibility of expanding and supervising air, rail and sea transport
services as well as postal and telecommunications services; regulate maritime and transit
services as well as road transport services that link regions. Thus, those organizations
which are being engaged in the system are accountable to the Ministry. These includes
freight and passenger transport enterprises or government parastatals, and the private
sector, the Road Transport Authority, the Ethio-Djibouti Railway Enterprise, the
Ethiopian shipping Lines, the Marine and Transit Service Enterprise and private clearing
and forwarding agents, the Civil Aviation Authority, the Ethiopian Air Lines, Postal
Enterprises, and the Telecommunication Corporation.

Check your progress

7. List major types of transportation

…………………………………………………………………………………………
…………………………………………………………………………………………
…………………………………………………………………………………………

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5.15 ROAD TRANSPORT SERVICE

Refereeing to the pre-reform structure, all commercial road transport operators were
organized into regional “ketenas” which were then managed either by the Ethiopian
Freight Transport Corporation (EFTC) or the Passenger Transports Corporation (PTC).
These parastatals not only operated large fleets of truck and bus themselves but also
managed the rest of the sector. In the case of trucking, EFTC acted as the commercial
trucking organization. In addition to its own fleet, EFTC controlled all the private sector
operators as its sub-contractors. EFTC would thus obtain the business, allocate leads to
individual truckers, organize payments and others. An individual truck owner was
effectively responsible only for operating and maintaining his/her vehicle. For these
commercial services, the private operator paid a 5 percent commission.

Following the deregulation, EFTC was re-organized into three dry cargo trucking
enterprises namely Comet, Bekelcah, and Shebele, and a bulk oil transport enterprise
named Woira in which each of the parastatals still retain a number of associates as sub-
contractors. The enterprises’ fleet size range between 150-200 vehicles comprising the
newest of the ex-EFTC vehicles.

In addition to these parastatals, four haulier companies have been established to provide
employment and income for workers retrenched from different governmental
organization. These are Tarik Public and Freight Transport Share Company with 23
freight vehicles, Nib, Noah, and Abyssinia Transport Share Companies having 80, 179,
and 118 freight vehicles which altogether constitute 400 freight vehicles. These
companies were established through the social safety-net program.

Besides government policy has clearly indicted that road transport will be primarily a
private sector activity and there is almost universal experience that a vigorous and
competitive private sector produces efficient low cost transport services. Following the
deregulation as of 14 august 1992, there have been 38 private freight transport
associations with a total fleet size of 5373, 41 freight transport companies having 1250
freight vehicles and 162 independent freight transport operators with 302 trucks giving
rise to a total fleet size of 6,925.

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By the same token, deregulation of the inter city passenger transport sector ended the
dominant role of the PTC and the ketena system, transferring responsibility for regulating
the sector to the RTA. Subsequently many of RTA’s operational powers and
responsibility were devolved to RTBs. After a period of continued control, the
government also withdrew from its fare schedule setting roles for the mini and midi bus
sectors, retaining control only over inter-urban bus enterprise namely Walia, and the
Addis Ababa urban bus enterprise called Anbessa. Walia currently owns 88 operational
maxi buses which are assigned across 130 routes of long’ medium. Short and round
distances all over the country.

Urban transport has still remained regulated. Conventional urban bus transport in
confined to Addis Ababa and to a limited extent in Jimma which remains the effective
monopoly of the parastatal enterprise Anbassa. Service is being provided by deploying
326 buses of ages ranging from 2-17 years with a daily availability of 87 percent. The
city of Addis Ababa is divided into 5 zones namely Yeka, Merkato, Piyassa, Aratkillo
and Legehar surroundings so as to coordinate the provision of the service.

As of 14 august 1998, private bus operators are organized into 26 public transport
associations with 3883 buses, 6 passenger transport companies managing 89 buses and 3
independent passenger transport operators owning 5 buses constituting a total fleet size of
3977. The private operators still stick to areas previously defined by the “ketena” system.
Most associations continue the system of rotating routes among their members every 15
days. This rotating pattern of operations was initially required when passenger fares were
fixed by government and did not differentiate between routes of varying profitability. The
system has been maintained now in an attempt to protect the weakest bus owners with the
oldest and least efficient vehicles. The schedules are determined by the association and
then registered by the relevant RTB Offices.

Review of Fleet Size

The total volume of registered fleet size has been increasing during the post reform
period with an average annual growth rate of about 8 percent. In absolute terms, fleet size
for road transport increased from 60576 in 1990/91 to 96502 in 1996/97. The total fleet

154
size is dominated by private cars which account for about 42 percent of total fleet size on
average during the period 1990/91 to 1997/98. The next dominant type of vehicles in
Ethiopia are trucks (with varying capacity of up to 180 quintals) whose share in total fleet
size was about 23 percent. Over the period 1990/91 to 1996/97, the number of trucks
have been growing faster than any other vehicle with average growth rate of 15 percent
per annum; their share in total fleet size likewise increased from 19 percent in 1990/91 to
24 percent in 1996/97. Private cars, though dominant in number have been growing by 5
percent per annum with the share in total fleet size declining from 46 percent to 35
percent between 1990/91 and 1996/97.

Registered Vehicles by Type and Size

N Type of Vehicles 1991/92 1992/93 1993/94 1994/95 1995/96 1996/97
o.
1 Private cars 26717 28423 30902 35686 35219 37906
2 Station wagons 10421 5636 6094 6101 7847 8090
3 Taxi less than 5 seats 1004 2070 1705 1850 1935 2057
4 Taxi 5-12 seats 3267 3163 3164 4455 5060 4465
5 Buses less than 30 seats 2853 1491 5453 6994 7567 9635
6 Buses above 30 seats 807 551 889 1699 2387 2625
7 Truck up to 70 quintals 6813 10630 10347 11069 11492 12286
8 Trucks 71-180 Quintals 5019 5590 5866 8504 10713 10996
9 Trailers 1185 1903 1761 2505 3227 3698
10 Truck-tractors 497 737 515 480 1286 1108
11 Semi-trailers 323 271 478 360 971 190
12 Tanker 542 908 760 1191 994 1085
13 Tanker Trailers 250 600 276 877 900 856
14 Semi-tanker-Trailers 54 28 44 7 7 36
15 Motors, machinery & special 1017 1087 1465 1501 2252 1469
equipment
16 Unspecified vehicles - 1432 - - - -
Total 60769 64520 69719 83279 91857 96502
Source: Ministry of Transport and Communication (Statistical Bulletin)

The third largest stock of vehicles belongs to the group of buses with seats above and
below 30 persons. Except for a decline in the first two years of the reform period, their
fleet size has been increasing steadily accounting for about 10 percent of total fleet size
since 1993/94. However, more than 75 percent of buses are mini-buses with less than 30
seats. Station wagons which are largely under the services of government institutions and
non-governmental organizations account for about 8 percent of total fleet size since
1992/93; their share has been more than 15 percent in the preceding years. Taxis closely
follow station wagons with 7 percent share and their number has been increasing at 8.5

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 per annum during the post reform period. Unlike buses, the total stock of registered taxis
sis dominated by those with seats for 5-12 persons (about 70 percent).

The total number of vehicles including the major ones described on Table 14.1 above has
been growing fast during the period under review with a serious implication on the need
for additional roads and, maintenance and upgrading of the exiting ones . Lack of a
commensurate increase in the road stock inadvertently affects the efficient utilization of
vehicles, increases the maintenance and operational cost of vehicles and lead to
widespread traffic accidents.

Freight Rates of Road Transport

Following the deregulation of road transport in May 1992, freight transport has been
operated on competitive basis among all freight operators, public an d private. Public
enterprises like the private ones were allowed to set their own freight rates based on the
prevailing market situation. Accordingly, the Ministry of Transport and Communications
compiles data on freights rates of both public and private enterprise (represented by
selected freight transport associations) for some major routes on monthly basis. However,
for the purpose of this report, data have been summarized on annual basis for broader
comparison of trends in freight rates fro major routes and among private and public
freight operators.

Freight Rates of private and public Enterprises by Major Routes (cents/quintal/Km}

Private Operators Public Enterprises
Type of 91/92 93/94 94/95 95/95 96/97 97/98 91/92 93/94 94/95 95/96 96/97 97/98
Routes
fleet
Addis Ababa – T/Trailer 3.433 1.724 1.842 2.010 1.823 1.870 3.483 2.017 1.846 1.372 1.516 1.493
Assab
Assab – " 3.052 3.183 2.849 3.033 3.079 3.166 2.880 2.838
Addis Ababa
Addis Ababa – Truck 3.433 3.381 3.85 3.517 3.548 3.517 3.483 3.662 3.762 3.913 3.537 3.389
Jimma
Jimma – “ 3.483 3.483 3.515 3.483 3.731 3.599 3.413
Addis Ababa
Addis Ababa – Truck 3.483 3.870 4.551 3.895 4.118 3.817 3.483 4.037 4.254 4.283 4.004 3.585
Dire Dawa
Dire Dawa - “ 2.913 2.596 2.318 2.585 3.259 2.571 3.070
Addis Ababa

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Addis Ababa – Truck 3.483 3.614 3.817 3.714 3.950 3.474 3.483 3.993 4.420 3.834 3.369 3.627
Mekele
Mekele - “ 3.586 3.585 3.534 3.597 3.784 3.590 3.420
Addis Ababa
Addis Ababa – “ 3.483 3.384 3.535 3.491 3.491 3.429 3.483 3.662 4.510 4.632 3.511 3.737
Nekempt
Nekempt - “ 3.483 3.529 3.515 3.483 3.550 5.430 3.683 3.532
Addis Ababa
Addis Ababa – “ 3.585 3.716 3.585 3.740 3.667 3.875
D.Markos
D.Markos - “ 3.585 3.569 3.585 3.695 3.590 3.536
Addis Ababa
Aggregate “ 3.483 3.195 3.437 3.334 3.329 3.248 3.483 3.408 3.679 3.625 3.295 3.309
Average
Source: Road Transport Authority
. – Average of July-March, for the 1997/98 F.Y.s

Immediately before the deregulation of the sector, i.e., in s1991/92, a uniform tariff rate
was set both for public and private freight operators irrespective of the route (condition of
road) and seasonal variation in cargo availability. This rate was 3,483 cents per quintal
for each kilometer traveled. Once prices were set free to be determined through
negotiation by freight operators and their customers, wide variations occurred among
routes and type of enterprises.

The Addis – Assab route was the first to experience a sharp decline in tariff both by
public and private operators after the deregulation of the sector. It declined to and
remained stable around 1.8 Cents/Qtl/Km for private operators and well below that for
public enterprises until 1997/98. the Addis-Dire Dawa and Mekele routes, noted for their
terrible road conditions, faced on the other hand, an immediate increase in tariff both by
public and private operators after the deregulation of the sector. Relatively marginal
post-deregulation tariff increments were made on outgoing operations to Nekempt and
Jimma. See Table 14.2 for details.

Despite the ups and downs of freight rates in various routes, the expected post
deregulation surge in freight rates has not materialized which could be attributed to
significant increase in the number of imported trucks for which government gave
incentives in the form of duty free importation. Freight rates were more or less stable

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after the deregulation with that of the private sector on the whole showing a sign of
decline (albeit marginal). It was also observed that private sector freight rates have
mostly been below and sometimes equal to their public counterparts almost in all routes
showing that private freight operators are more competitive than public enterprises.

Performance of Freight Transport

With regard to road freight transport, annual performance was measured based on fleet
size and estimated number of working days per year and average distance traveled per
day. It is revealed from Table 14.3 below that volume of dry cargo transported on roads
increased steadily from 11,874.22 thousand tons in 1991/92 to 23,866.5 thousand tons in
1996/97. This is tantamount to an average growth rate of about 15.5 percent per annum.
Dry Cargo in ton-km also grew at the same rate and stood at 5,873.32 million ton-Km in
1996/97 up from 2,906.56 million in 1991/92. the increase in agricultural and industrial
output coupled with growing volume of imports is the major reason behind this strong
performance.

Trends in Road Transport Services

Annual
Item 1991/92 1992/93 1993/94 1994/95 1995/96 1996/97 Average
Growth
Rate
( percent
)
1. Passenger Transport
1.1. No. of Passengers 6356.64 6221.0 6511.7 6783.0 7538.8 8701.6 8.9
(‘000)
1.2. Passenger – km 6285.9 6039.3 5826.9 6148.2 8384.5 8981.0 8.0
(million)
2. Dry Cargo
2.1. Ton (‘000) 11874.22 13091.77 15330.7 17984.6 23414.66 23866.5 15.4
2.2. Ton-km (million) 2906.56 3198.62 3750.2 4408.6 5761.52 5873.32 15.5
3. Liquid Cargo
3.1. Ton-km (million) 826.2 824.2 871.3 905.0 956.2 961.3 3.5
Source :- National Team, MEDaC .

Measurement of annual liquid cargo transport was even more difficult than passenger and
dry cargo transport. Apart from the absence of actual data on private sector performance,

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the existence of a variety of liquid cargo, i.e., different types of petroleum products with
varying density makes it difficult to estimate the volume of dry cargo transported each
year. With all the short comings, the total liquid cargo transported has been estimated to
increase from 826.2 million cubic-meter-kilometers in 1991/92 to 961.3 million in
1996/97 with an average growth rate of 3.5 percent per annum.

Estimates of the Road Transport Authority indicated that the share of public freight
transport enterprises in total dry cargo transport stood at about 32 percent during the
years 1994/95 to 1996/97. In terms of ton-kilometers their share is close to 15 percent
during the same period. This shows that the bulk of domestic freight transport is being
undertaken by the private sector in recent years. It also asserts that a systematic way of
gathering data on private transport activities needs to be in place to provide a reliable and
fair measurement of the performance of the sub-sector.

Annual transport of liquid cargo (petroleum products) also declined in the post reform
period (to 773 tons per annum on average) by about 23 percent from the average annual
performance in the pre-reform period. The associated increase in liquid cargo transported
by the Ethio-Djibouti railway company during the same period is believed to have
reduced the volume of petroleum transported by road.

Performance of Passenger Transport (Inter-urban)

The table above also depicts the performance of road transport sub-sector with respect to
interurban passenger transport. The number of passengers transported and passenger
kilometers covered were computed using the average seat capacities of different buses
(60, 40, and 20) and the estimated average number of days and average kilometers each
group of vehicles would work/cover in one year. This is done for the reported number of
registered vehicles so as to establish these performance indicators. Based on this
approach, the number of passengers transported among urban centers (interurban)
showed marginal decline during the years 1991/92 to 1993/94 and began to grow
thereafter successively. The average growth rate of passenger transport during the period
1991/92 to 1996/97 therefore stood at 8.9 percent per annum. Likewise, the total distance
passengers traveled during the years (passenger-km) increased by 8 percent per annum.

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It has to be noted, however, that the actual performance of passengers transport could
vary widely from what is depicted in Table 13.4 though it fairly indicates the average rate
of growth and the increasing tendency during the period under review. The major
problem in this regard is the absence of performance reports from private passenger
transport enterprises since the deregulation of the transport sector in 1991/92.

As explained earlier tariff rates in the public transport sector are in some cases regulated
and market determined in other cases. Fares for cross-country buses are government
controlled while those of small sear capacity (less than 45 seats) transport services are
deregulated. Although no data are available, observed tariff in the deregulated public
transport sector has not risen dramatically as expected. This is presumably due to the
comparatively large number of buses in this category which allow for strong competition
in the public sector.

5.16 RAILWAY TRANSPORT

Background
The close rival to the road, mode of transport is trail transport which accounts for about 5
percent of the total freight movement in the country. This rate is expected to increase
since May 1998 for the port of Djibouti is getting importance over the port of Assab
following the Ethio-Eritrean border conflict.

The Ethio-Djibouti railway company is one of the oldest rail lines in the continent which
has operated for 100 years having a single track line of 781 km of which 681 km
stretches in Ethiopia and the remaining 100 km in Djibouti. There are a total of 34
stations along this route among which 28 are found in Ethiopia and the remaining in
Djibouti.

The rolling stock of the CDE consists of 17 road locomotives, 5 auto rails, 4 shunting
locomotives, 22 passenger coaches, 403 freight wagons and 87 fuel tankers. Passenger
and freight services are split at Dire Dawa. This means that one train is formed at
Djibouti to run to Dire Dawa and another is formed at Dire Dawa to run to Addis Ababa.
Likewise trains formed at Addis Ababa terminate at Dire Dawa.

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The only railway line in the country which links the port of Djibouti to Addis Ababa
started around 1916/17. Its construction took about 19 years. The railway line which is
781 km in length and equally owned by the two governments is characterized by aging
track and rolling stock and is of one meter gauge standard.

A study financed by European Union is being conducted to rationalize its management

system and improve the age old track and rolling stock. The study includes alternative
investment schemes on roads and privatizing the various activities and services that are
currently under the railway system. If timely considered and appropriate decisions made
the life long problems of the railway might be mitigated (if not completely resolved) and
the systems future would clearly be defined.

5.16.1 Performance of the Ethio-Djibouti Railway

Except for the year 1994/95, performance of the railway transport sector has generally
been poor during the post reform period. The number of passengers transported by rail
domestically has been declining until 1994/95 with a moderate recovery thereafter.
International passengers on the other hand, declined in number from 1993/94 onwards
from a relative stable size in the preceding years. Total number of international
passengers in 1996/97 was 73,700 down from 150,400 in 1993/94. Likewise the total
distance traveled by international passengers who used the railway (expressed in
passenger-kilometers) decline from 42 million in 1993/94 to 21 million in 1996/97 as
depicted on Table 14.4 below.

Performance of the Ethio-Djibouti Railway Organization

Type of Service Fiscal Years

1. Passenger in ‘000
1.1. Domestic 840 570 5786 515.0 378 645.4 687.9
Passenger KM in Million 240 164 191.8 144.4 111.9 133 135.7
1.2. International 165 130 132.2 150.4 135.8 120.7 73.7
Passenger KM in Million 45 36 37.8 42.1 38.8 33 21.2
2. Freight in ton
2.1. Domestic 90000 50000 60965 46520 47716 62340 58001
Ton KM in ‘000 30000 16000 22053 15802 84628 21872 20047
2.2. International

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 2.2.1. Import (Ton) 130000 110000 100323 94690 84628 108561 98252
Ton KM in ‘000 60000 50000 52487 51403 41440 50725 52852
2.2.2. Export (Ton) 95000 70000 72665 69363 72280 67747 75801
Ton KM in ‘000 48000 34000 37099 35098 35360 31379 33142
3. Total
3.1. Passenger in ‘000 1005 700 710.8 665.4 514 766 761.6
3.1.2. Passenger KM in Million 285 200 229.6 188.5 150.7 1666 156.9
3.2. freight in ton 315000 230000 233953 210572 204629 238649 232053
3.2.1. ton KM in ‘000 138000 10000 111639 102303 93025 103976 106039
Source: Ministry of Transport and Communication

With regard to domestic freight transport, performance of the railway company exhibited
ups and downs but it was relatively stable as compared to the declining trend in passenger
transport. About 47 to 62 thousand tons of cargo have been transported each year by the
railway company domestically during the period 1991/92 to 1996/97. Domestic cargo
transported during the pre-reform period averaged within the range of 70 to 90 thousand
tons per annum indicating to reduced level of performance in the post reform period.

The international freight transport service by the Ethio-Djibouti railway is split into
import and export. Unlike a relatively stable domestic cargo transport, import cargo
carried by the railway company declined steadily during the period 1990/91 through
1995/96 at the rate of 10 percent per annum on average. After a moderate recovery in
1995/96, volume of import through this line declined again in 1996/97. although volume
of import through this line declined again in 1996/97. Although volume of import
through the railway company began to decline since 1985/86, about 164 thousand tons of
import used to be transported annually until 1990/91. the annual average volume of
import for the post reform period is only around 104 thousand tons.

Export, however, has not been declining sharply as that of import. Sharp decline was
observed only in 1991/92 (probably because of security problems) by about 26 percent./
marginal declines in volume of export was observed in 1993/94 and 1995/96. Export to
Djibouti via the railway strongly recovered in 1996/97 showing a 12 percent growth over
the preceding year. Nearly 70 to 75 thousand tones of export was carried by the Ethio-
Djibouti railway company during the post reform period which is but below the pre-
reform average of 75 to 100 tons of export especially in the second half of the 1980’s.

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Ethiopia’s export carried by the railway company is dominated by fruits and vegetable
destined mainly to Djibouti and near by Arab sates, followed by export of sugar and
molasses. On the import side, fuel and lubricants have been the major items of import
carried by the railways company during the post reform period (grain &flour have been
dominant in the pre reform period) followed by metal and metal products.

Number of Locomotives, Passenger Coaches and Freight Wagons

Type of Equipment 1988/89 1989/90 1990/91 1991/92 1992/93 1993/94 1994/95 1995/96 1996/97
1. Auto-rail 6 6 6 6 6 6 4 5 5
2. Passenger coaches 36 36 36 31 31 31 31 31 31
3. Line Locomotive 20 17 17 22 22 22 18 17 13
4. Freight Wagons
4.1. Dry Cargo 470 465 581 570 435 435 460 460 460
4.2. Tankers 128 125 157 155 155 155 130 130 130
Source: Ministry of Transport and Communication

The decline in overall performance of the railway company is the result of poor status of
the infrastructure (due to lack of maintenance) and aging of the transport equipment
affecting its capacity and smooth operations. Not only are the transport equipment old,
they have also declined in number in recent years further eroding its capacity. By
1996/97 there were only 5 rail cars for passengers and 13 line-locomotives for cargo
which were 6 and more than 20, respectively until 1993/94. Passenger coaches and
freight wagons have also declined in number. Some of the exiting facilities are said to be
on the verge of being written-off and they are intermittently in and out of duty. See Table
14.5 for the capacity of the liner.

Operating Income and Expenses

Traditionally the Ethio-Djibouti railway company had as problem of covering operating
expenses out of operating income and hence mostly been unprofitable. This situation has
not changed in the post reform period; only in 1992/93 was operating income higher than
operating expense. The gap between revenue and expense as could be observed from
table 14.6 seems to be widening since 1994/95.

1989/90 1990/91 1992/93 1993/94 1993/84 1995/96 1996/97

Operating Income 30140 30805 22690 43960 44830 54000 52850
Operating Expanses 32279 32750 28440 42030 50841 59200 57490
Source: Ministry of Transport and Communication

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Both operating revenue and expenditure of the company were expanding during the post
reform period with an average growth rate of about 9 and 9.8 percent per annum,
respectively. Investment in the company has also been low during the post reform period.
Only in 1995/96 and 1996/97 F.Ys wer relatively large volume of capital expenditure ( to
the tune of Birr 14.8 and 11.9 million) effected in the company, respectively. Investment
expenditures as high as Birr 10.7, 42.2 and 20.9 million were made in the years 1982/83,
1983/84 and 1987/88, implying that much needs to be done in this regard to upgrade the
capacity, service quality and profitability of the company.

The increase in the operating expense of the company is attributed mainly to aging of its
locomotives, rail cars, passenger coaches and freight wagons which in the one hand
reduce its capacity to transport cargo and increases the current expense for a unit of
operation (service) on the other. The company’s passenger transport service is also said
to be more of a social obligation than a profitable activity. More than 75 percent of the
company’s revenue comes from freight transport which compensates the losses incurred
by passenger transport. Moreover, the size of the company’s personnel is said to be large
relative to its present level of service capacity further worsening the expenditure revenue
gap.

Development Plan for the Future

The Ethio-Djibouti railway company celebrated its 100 years anniversary in 1997/98.
Though the company is respected for long years of service and socio-economic
development of the two countries along its route, it was revealed that its capacity and
service quality has deteriorated severely along the course of its history especially in the
past two decades. Ironically, the demand for rail transport has increased following the
Ethio-Eritrean boarder conflict which shifted the importance of the Assab Port to that of
Djibouti.

To overcome the problems of poor capacity and to meet the recent increase in demand for
railway transport; the Government of Ethiopia and Djibouti have undertaken studies
which are already completed. These studies envisage a grant agreement with the
European community for about 35 million European Community for about 35 million

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European Currency Unity (ECU) which includes purchase of passenger and cargo
locomotives (rail cars), rehabilitation of the railway and maintenance of bridges and
communication equipment and supply of spare parts. In the short-run a grant from the
Government of France was secured and four new locomotives have been purchased
which began operation in January 1998. The purchase of these locomotives and repair of
the railway has helped improve performance in recent months.

It is apparent that the existing level of technology in the Ethio-Djibouti railway company
is too old and there is a pressing need to introduce modern transport facilities in this sub-
sector in the medium to long run. The company’s hope for the future relies heavily on
the realization of these medium to long term plans from which resources need to be
mobilized from the two countries and external sources. Studies indicated that a minimum
of 102 million ECU will be need to finance expenditure on different components of the
project. This would enable the age old company to level-up to financial health and
competitiveness it used to enjoy during the commencing of its services.
5.17 SUMMARY

The Ethiopian education system is entangled with the complex problem of accessibility,
equity, quality and relevance. We are far from achieving universal primary education
gender disparity is still wide specially in rural areas, the quality and relevance of
education, especially that of higher education is questionable.

The health status of the Ethiopian population is extremely low. There are too few health
facilities and professionals, compared to the population. Malaria, Tuberculosis and Aids
are major health challenges.

The transport sub-sector has been improving rapidly, however, still roads are of poor
quality and the public and freight transport systems are not well developed.

5.18 ANSWERS TO CHECK YOUR PROGRESS EXERCISES

1. 19% of women and 40% of men

2. 30.2% for elementary level and 11.5% for secondary school level.

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 3. 130x Junior secondary schools, 346 senior secondary schools and 17
vocational/technical schools.
4. It is now about 37% is growing rapidly
5. Malaria, Helminthiasis, Acute upper respiratory infections, Bronco-Pneumonia,
infections of skin and subcutaneous tissues, Gastritis and duodenitis, Dysentery,
Tuberculosis of the respiratory system, sexually transmitted infections, and
Bronchitis, Chronic and Lengualified.
6. Less than 7%
7. Road transportation, railway transportation, water transportation, Air
transportation.

5.19 REFERENCES

 Annual report on the Ethiopian Economy

 Second Annual Report on the Ethiopian Economy

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