Ethiopia : Improving Health Service Delivery
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World Bank, Washington, DC
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This case study aims to identify how
Ethiopia has adopted and implemented strategies to improve
health services, including the factors that enabled and
inhibited success across a meaningful range of health
services for the period 1996-2006. Particular emphasis has
been given to the impact of utilized strategies on the poor.
This case study reviewed one 'primary strategy',
decentralization in the form of devolution of authority to
the regional level in 1996 and to the district (woreda)
level in 2002, and seven 'corollary strategies' in
the context of decentralization implemented at the
subnational level. The study concludes that decentralization
in the health sector is likely to be more effective when it
is implemented as part of a broader government
decentralization policy across sectors. Sequencing in
implementing Ethiopia's decentralization strategy made
decentralization more manageable, although decentralization
was rolled out prematurely. Moreover, the effectiveness of
implementation was found to be driven largely by the
institutional and management capacity at the subnational
level. At the subnational level, decentralization was found
to be more effective in those regions that increasingly
strengthened their management and institutional capacity and
where regional governments set priorities and adapted the
strategies to local needs. However, decentralization was
often influenced by the 'clientelistic' center,
region power relationship, a problem compounded by the lack
of community voice, making the available resources at risk
of political capture by the local elite. Overall, the key
lesson for implementing improvements in health service
delivery (HSD) is that the lack of any critical inputs
(facilities, health workers, and drugs) inevitably limits
the overall impact of the strategy, and that the
implementation of such key inputs should be carefully
coordinated and properly synchronized.
Palabras clave
ABORTION, ADULT MORTALITY, AIDS RELIEF, ALLOCATIVE EFFICIENCY, ANTENATAL CARE, BASIC HEALTH SERVICES, BEREAVEMENT, BURDEN OF DISEASE, CAESAREAN SECTION, CAPACITY BUILDING, CHILD BIRTH, CHILD HEALTH, CHILD HEALTH SERVICES, CHILD NUTRITION, CHILD SURVIVAL, CITIES, CITIZENS, CLINICS, COMMUNICABLE DISEASES, COMMUNITY HEALTH, COMMUNITY HEALTH SERVICES, CONTRACEPTIVE METHODS, CONTRACEPTIVES, COUNSELING, DEATHS, DEBT, DECENTRALIZATION OF AUTHORITY, DECISION MAKING, DEMOCRACY, DEVELOPING COUNTRIES, DEVELOPMENT POLICY, DIPHTHERIA, DRINKING WATER, EDUCATIONAL ATTAINMENT, EMERGENCY PLAN, EMPLOYMENT, EQUITABLE ACCESS, ESSENTIAL DRUGS, FAMILY PLANNING, FAMILY PLANNING SERVICES, FEMALE CHILDREN, FERTILITY DECLINE, FINANCIAL MANAGEMENT, FINANCIAL NEEDS, GENERAL PRACTITIONERS, GLOBAL HEALTH, GOOD GOVERNANCE, GOVERNMENT POLICIES, GRASS-ROOTS, GROSS DOMESTIC PRODUCT, HEALTH CARE, HEALTH CARE COVERAGE, HEALTH CARE FACILITIES, HEALTH CARE FINANCING, HEALTH CARE SPENDING, HEALTH CARE UTILIZATION, HEALTH CARE WORKERS, HEALTH CENTERS, HEALTH COMMUNICATION, HEALTH EDUCATION, HEALTH EXPENDITURE, HEALTH EXPENDITURES, HEALTH EXTENSION, HEALTH FACILITIES, HEALTH FINANCING, HEALTH INDICATORS, HEALTH INFORMATION, HEALTH INSURANCE, HEALTH MANAGEMENT, HEALTH ORGANIZATION, HEALTH OUTCOMES, HEALTH POLICIES, HEALTH POLICY, HEALTH POSTS, HEALTH PROGRAMS, HEALTH PROVIDERS, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE DELIVERY, HEALTH SERVICE PROVIDERS, HEALTH SERVICES, HEALTH SPECIALIST, HEALTH STATUS, HEALTH SYSTEM, HEALTH SYSTEMS, HEALTH WORKERS, HIGH FERTILITY, HIGH FERTILITY RATE, HIV, HIV INFECTION, HIV/AIDS, HOSPITAL, HOSPITAL ADMISSION, HOSPITAL ADMISSIONS, HOSPITALS, HUMAN DEVELOPMENT, HUMAN RESOURCE DEVELOPMENT, HUMAN RESOURCE MANAGEMENT, HUMAN RESOURCES, HUMAN RESOURCES DEVELOPMENT, HYGIENE, ILLNESS, IMMUNIZATION, INCOME, INFANT, INFANT MORTALITY, INFANT MORTALITY RATE, INFANT MORTALITY RATES, INFORMATION SYSTEM, INFORMATION SYSTEMS, INSTITUTIONAL CAPACITY, INSURANCE SCHEMES, INTERNATIONAL COMPARISONS, INTERNATIONAL ORGANIZATIONS, LABOR FORCE, LACK OF CAPACITY, LAWS, LEGAL STATUS, LIFE EXPECTANCY, LIVE BIRTHS, LOCAL COMMUNITY, LOCAL GOVERNMENTS, LOW -INCOME COUNTRIES, LOW-INCOME COUNTRIES, LOW-INCOME COUNTRY, MALARIA, MALNUTRITION AMONG CHILDREN, MASS MEDIA, MATERNAL MORTALITY, MATERNAL MORTALITY RATIO, MEASLES, MEDICAL DOCTORS, MEDICAL EDUCATION, MEDICAL EQUIPMENT, MEDICAL SUPPLIES, MEDICAL TECHNOLOGY, MEDICINES, MIDWIFE, MIDWIVES, MIGRATION, MILLENNIUM DEVELOPMENT GOALS, MINISTRY OF HEALTH, MORBIDITY, MORTALITY, MOSQUITO NET, MULTILATERAL ORGANIZATIONS, NATIONAL DRUG, NATIONAL GOALS, NATIONAL HEALTH POLICY, NATIONAL LEVEL, NATIONAL POLICY, NATIONAL POPULATION, NATIONAL POPULATION POLICY, NATIONAL STRATEGY, NEONATAL MORTALITY, NUMBER OF CHILDREN, NUMBER OF DEATHS, NURSE, NURSES, NUTRITION, NUTRITIONAL STATUS, PATIENTS, PHARMACIES, PHYSICIAN, PHYSICIANS, POLICY MAKERS, POLIO, POPULATION CENSUS, POPULATION SIZE, POSTNATAL CARE, PREGNANCY, PRIMARY CARE, PRIMARY HEALTH CARE, PRIMARY HEALTH CARE SERVICES, PRIVATE PHARMACIES, PROGRESS, PUBLIC HEALTH, PUBLIC HEALTH EXPENDITURES, PUBLIC HEALTH SERVICES, PUBLIC HEALTH SPENDING, PUBLIC POLICY, PUBLIC SERVICE, PUBLIC SERVICES, PUBLIC SPHERE, QUALITY OF CARE, QUALITY OF HEALTH, RADIO, REHABILITATION, REPRODUCTIVE HEALTH, REPRODUCTIVE HEALTH SERVICES, RESPECT, RULE OF LAW, RURAL AREAS, RURAL DEVELOPMENT, SANITATION, SERVICE UTILIZATION, SEXUALLY TRANSMITTED DISEASES, SKILLED PROFESSIONALS, SKILLED STAFF, SOCIAL SERVICES, SURGERY, SUSTAINABLE DEVELOPMENT, TB CONTROL, TELEVISION, TETANUS, TUBERCULOSIS, UNDER FIVE MORTALITY, UNDER-FIVE MORTALITY, URBAN AREAS, URBAN POPULATION, URBANIZATION, URBANIZED COUNTRIES, USE OF CONTRACEPTION, VACCINATION, WASTE, WOMAN, WORKERS, WORKING CONDITIONS, WORLD HEALTH ORGANIZATION