Health Services

Management

Ethiopian Health services organization

Zeleke Hailemariam (Assis prof)

zelehyle@gmail.com
Wachemo University
May, 2025
Objectives of the session
At the end of the session students are
expected to:
 Define Health Care &Health Services
 Explain a Health Care System
 Identify the elements needed for

functioning Health System

 List Main institutions involved in the

delivery of health services in Ethiopia

 Describe the history of the Health Care

System in Ethiopia:

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Objectives…
 Explain health Care Expansion in
Ethiopia:
 The Basic Health Care Services
(BHS) period (1953-1974).
 The Primary Health Care (PHC)
period (1978-1991)
 Health Care System under
Transitional Government of
Ethiopia (TGE) and later under
the Federal Democratic Republic
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What do we mean by Health
Care & Health Services?
 Health care
 Is the total societal effort, undertaken in
the private and public sectors, focused on
pursuing health.
 Health services
 are specific activities undertaken to
maintain or improve health or to prevent
decrement of health.
 Can be preventive, promotive, curative or
rehabilitative in nature.

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 What is a Health Service Organization & a
Health Care System?
 Health service organization (HSO)
o Organizational structure within which the

health services is directly delivered to

consumers.
o Structure that facilitates the coordination and

implementation of health activities.

 Health (care) systems

 Are formally linked HSOs, possibly including

financial arrangements, joined together to

provide more coordinated & comprehensive
health services
 A health system consists of all the organizations,

institutions, resources and people whose

primary purpose is toHSM
08/13/2025 improve health. 5
Frameworks for monitoring
health systems
performance…

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 Main categories of activities for a
functioning Health System
According to Green (1999), there are four
main categories of activities that are
needed for the functioning of a health
system:
Policy formation
Financing
Service provision, and
Regulation
Within these, the state may have
different forms and levels of roles.
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Organizations involved in the provision
of health care services
Organizations involved in the
provision of health care are
classified into 4 groups.
1. State/Government
2.Non-government organizations
(NGOs)
3.The private-for-profit sector
4.Traditional practitioners

(Green, 1999)
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 Organizations involved…

For many countries, especially in the

developing countries, it is very likely
that the state remains the largest single
provider of health care giving an
impression of dominating health care
provision.

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 Institutions involved in the delivery of
health care in Ethiopia: TM
Traditional medicine(TM), the oldest
means of coping with illness has a
long history in Ethiopia as elsewhere
in many developing countries.

Despite the relatively rapid

expansion of modern medicine, TM is
still the predominant health care
resource in Ethiopia.

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 Traditional medicine…

WHO estimated that 80% of the

population in developing countries and
as much as 90% of the Ethiopians use
TM for their illnesses.

Formal recognition to TM in Ethiopia was

given in 1942 (Proc. 27) where
legitimacy of the practice was
acknowledged as long as it does not
have negative consequence on health.
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Traditional medicine…

However, despite such recognition, the

policy issue of TM in Ethiopia is not clear.
Traditional Medicine shall be given
appropriate attention by:-
Identifying and encouraging utilization
of its beneficial aspects
Co-ordination and encouraging
research including its linkage with
modern medicine.
Developing appropriate regulation and
registration for its practice.
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 The start of modern medicine in
Ethiopia
Modern health care delivery movement in
Ethiopia has come a long way from its
traditional medicine base to the current
Sector Wide Approach program (SWAp).

The historical development of modern

medicine in Ethiopia is predominantly public
or state-based.

To date public provision of health care

accounts for 80% whilst the remaining 20% is
shared between the private-for-profit and
NGO sectors.
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The start of modern medicine…
 The advent of western type/modern medicine
in Ethiopia dates back as far as the 16th
century.
 During this time, the practice had been
introduced by
 Diplomats
 Religious missionaries
 Explorers
 Merchants
 But served the ruling class

 Entered a new and a far important phase

with the reign of Emperor Menelik II (1889-
1913).
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The advent of modern medicine…
 Reign of Emperor Menelik II
 1st Ethiopian Sponsored

hospital built in 1901 in Addis

 The foundation for formalized

health service in Ethiopia goes

back to 1908 GC (when office
dealing with health was
created in Ministry of interior)

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 Health care expansion under the time of
Emperor Hailesellasie I (1917-1974)

1941 “Public Health Directorate” was

established under the Ministry of Interior.

Public health proclamation which charged

the government will be responsible for the
health of the people (1947)

However, the major step in the

autonomous development of health care
didn’t happen until the formal
establishment of the Ministry of Public
Health (MOPH) in 1948.
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Emperor Hailesellasie I (1917-
1974)…
 1st medical legislation to regulate the
work of medical practitioners and
pharmacists (1930)
 Interrupted during the brief Italian
occupation of Ethiopia.

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 Emperor Hailesellasie I…

 Member of WHO 1949

 1952 – 38 hospitals and 80 physicians all

foreigners

 1954 – Gondar public health college (HO,

Nurse and Sanitarian)

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 The Basic Health Services Period-
1953-1974
According to WHO, the aim of BHS
was to organize a health delivery
system that is able to meet the most
urgent health care needs of the
major section of population in
member countries.

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The BHS period- 1953-1974…

For Ethiopia (following the WHO

recommendation), BHS was seen as
a long term strategy for
 providing adequate and essential
health care by
 making available a HC for a population
of 50,000 and a Clinic for a population
of 5,000.

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 Health Care Expansion in Ethiopia: The
PHC period (1978-1991)
The political orientation was
socialist ideology after 1974,
brought with it radical changes in
the health policy of Ethiopia
In some ways provided the
foundation for further
development of health care
delivery.

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The PHC period (1978-1991)
 PHC approach was introduced into
Ethiopia after
 The 1978, International Conference

on Primary Health Care held in

Alma Ata, USSR (Kazakhstan)
sponsored by WHO and UNICEF
 To attain a level of health for all

citizens that will permit them to

lead a socially and economically
productive life
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The PHC period (1978-1991)
…
 The key factors for the
implementation
 Equity

 Real political commitment

 Community involvement
 Intra and intersectorial

collaboration
 Decentralization
 Appropriate technology

 Emphasis on health promotion and

prevention
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The PHC period (1978-1991)
…
 This approach was articulated in the
ten-year comprehensive perspective
plan for the years 1984-1994.
 The health system was organized into
six-levels of health care delivery
network
 all levels of health facilities were to provide
both preventive and curative services
irrespective of their level or size.

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 A pyramidal arrangement of the health
care structure during the Derg Rule

Central
Ref. Hosp

Regional Hosp 1.6 -3 mil.

Rural/Medium Hosp 50-100,000

Health centre (HC) per 50,000 pop.

Health Stations (HS) per10,000 pop.

Community Health service (CHS) per 1,000 pop.

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 The PHC period (1978-1991)
…
The inclusion of community-based
service delivery
 new short-term trained cadres of
CHAs and TBAs
 aimed at extending the point of
health service delivery to kebele
level

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 Drawbacks of the six tier
HS indicated that:
 It is very centralized, no decision
making ability below regional level
 Participation of the community is
minimal.
 Undesirable impacts on efficiency and

resource allocation are inherent.

 Health service institutions clustered

around immediate points of

supervision resulting in overlapping
services around a minor segment of
the population. HSM
08/13/2025 27
 SWAP-Based HSDP, 1991-
 The basis for SWAP-based
Health Sector Development
Program (HSDP)
 The 20 –year health
development plan produced
by the TGE to be
implemented in four phases
of five years each.

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 A Reasonable definition of SWAps
has the following five elements
1. All significant funding agencies
support a shared, sector wide
policy and strategy
2. A medium term expenditure
framework or budget which
supports this policy
3. Government leadership in a
sustained partnership

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Definition of SWAps
4. Shared processes and approaches
for implementing and managing the
sector strategy and work program
5. Commitment to move to greater
reliance on Government financial
management and accountability
systems.

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Health Care system since 1998 : The
Sector Wide Approach period
 The health system organization
introduced as part of the
development of HSDP I was a revised
version from six-tiered system to a
four tiered system which was as
follows:

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 Four tier system of
health care delivery,
1998

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 S p e c i a li ze d H o s p it a ls
#
P e rs o n s C o v e re d : 5 , 0 0 0 , 0 0 0
Bed s: 250
T e c h n i c a l S t a ff : 1 2 0
N o n -t e c h n ic a l S t a ff : 5 0

Z o n a l H o s p it a ls
#
P e rs o n s C o v e re d : 1 , 0 0 0 , 0 0 0
B ed s: 1 00
T e c h n ic a l S t a ff : 6 0
N o n -te c h n ic a l S t a ff : 3 5

D is t ric t H o s p it a ls
#
P e rs o n s C o v e re d : 2 5 0 , 0 0 0
Bed s: 50
T e c h n ic a l S ta ff : 3 3
N o n -te ch n ic a l S t a ff : 3 5

P r im a r y H e a lt h C a re U n it s ( P H C U )
#
P e rs o n s C o v e re d : 2 5 ,0 0 0
Bed s: 10
T e c h n ic a l S ta ff : 1 3 - 1 5
N o n -te ch n ic a l S t a ff : 1 2

C o m m u n it y H e a lt h C l in ic s ( C H C ) or H e a lt h P o st s
#
P e rs o n s C o v e re d : 5 , 0 0 0
Bed s: 0
T e c h n ic a l S ta ff : ?
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c h n ic a l S t a ff : ?
33
The three tier system during
HSDP-IV

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 The Sector Wide Approach period…
 SWAP-based health care delivery
system
 is owned by the state

 implementation is firmly based

on strong partnership between

 the Central Government,

 the Regional Government,

 the Health Development

Partners,
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
 The Sector Wide Approach period…
 The focus of health delivery system
is expansion and improvement in the
quality of care and is guided by the
eight components of HSDP at all
levels.

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 The Sector Wide Approach period…

The eight components of HSDP

are:
Health service delivery & quality
of care
Facility rehabilitation &
expansion
Human resource development
Strengthening pharmaceutical
services
IEC
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HMIS HSM 37
 Health Extension Package Program
Hygiene and environmental sanitation
 Proper and safe excreta disposal system
 Proper solid and liquid waste disposal

system
 Water supply safety measures

 Food hygiene and safety measures

Disease prevention and control

 HIV/AIDS prevention and control

 TB prevention and control

 Malaria prevention and control

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 First Aid
Health Extension Package Program…

Family health service

Maternal and Child Health


 Family planning

 Immunization

 Adolescent Reproductive Health

 Nutrition

Health education and

communication

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Reading assignment

Ethiopian Health Policy

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 Thank you.

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