Family Medicine Development in Ethiopia Weyinshet Gossa, MD, MPH Michael Fetters, MD, MPH, MA October 2, 2015

2 Activity Disclaimer We have no relevant financial relationships to disclose.

Objectives To give brief background on Ethiopia To describe Ethiopia’s current health care system To discuss findings from our research assessing key stakeholders’ perspectives on family medicine development in Ethiopia To discuss future steps in the development of family medicine in Ethiopia 3

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Country Profile Population - 99 million people Life expectancy - 61 years Under 5 mortality - 64 / 1,000 live births Maternal mortality / 100, 000 live births Burden of diseases - 74% communicable, 20% non communicable, 6% injuries Health expenditure - 5.1% of GDP 5

Health Care System National Health Policy established in 1991 The Declaration of Alma-Ata of “Primary health care for all” Health Sector Development Plan (HSDP) developed in World Health Report – “Primary health care: Now more than ever” 6

Four-tier Health Care System 7

Health Care Workforce 8

Family Medicine in Ethiopia First family medicine residency program started in 2013 at Addis Ababa University First class of residents graduating in January of 2016 There are currently 21 family medicine residents Two additional programs planned to start at Gondar and Jimma Universities 9

Key Stakeholder’s Perspectives on Development of Family Medicine Mini-ethnography using long interview and field observations At St Paul’s Hospital Millennium Medical College, Addis Ababa University, Federal Ministry of Health and Jimma University Four formal and several informal meetings Data analyzed using SCOT (Strength, Challenges, Opportunities, Threat) framework 10

Strengths Ministry of Health is very supportive of family medicine development and expansion Strong support for family medicine at Addis Ababa University Strong collaborative international partners Successful establishment of first family medicine residency program Support from core specialists Curriculum and objectives revised regularly 11

Challenges Ethiopia’s health care system is under-capacity Family medicine is not well known or understood The roles of family medicine are still evolving Limited numbers of faculty to teach family medicine residents and for mentorship Limited opportunities for leadership training and faculty development Competition for learning from other residents Limited finances, availability of books and online learning resources 12

Opportunities High need for quality comprehensive primary health care Increasing number of medical school graduates Increasing number of postgraduate training programs Waiver of service obligations if joining family medicine New health centers with better training capacity Gap in care provided by GPs, Health Officers, and health extension workers and specialists Opportunity to become health care system leaders 13

Threats Not viewing family medicine as scientific discipline Specialists, GPs and health extension workers may perceive family physicians as competitors Potential for undermining local capacity and ownership Frequent turnover in leadership Extensive responsibilities could lead to burn out and drop out Internal and external brain drain 14

Future Steps Develop common vision for family medicine Establish policy framework with family medicine at the base of the primary health care system Continue dialogue on potential roles of family medicine in the broader health care system Build local capacity and ownership Develop collaborative relationships with other sub-Saharan African countries 15

References 1.African Health Workforce Observatory AHWHO. Human Resources for Health - Country Profile, Ethiopia. 2010; Available from: observatory.afro.who.int/images/Document_Centre/Country_profile_Ethiopia.pdf?ua=. Accessed September 26, CIA. The World Factbook. factbook/geos/et.html. Accessed 9/26/2015.CIA. The World Factbook. factbook/geos/et.html. Accessed 9/26/ Federal Democratic Republic of Ethiopia Ministry of Health. Health Sector Development Plan IV 2010/11 – 2014/ ; Available from: _hsdp_iv_final_draft_2010_-2015.pdf. Accessed June 5, _hsdp_iv_final_draft_2010_-2015.pdf 4.Philpott J, Cornelson B, Derbew M, et al. The dawn of family medicine in Ethiopia. Fam Med. Oct 2014;46(9): WHO. Global Health Observatory (GHO) Data. Ethiopia: country profiles. Accessed 9/26/ World Atlas. Ethiopia Large Color Map. Accessed 9/26/2015.World Atlas. Ethiopia Large Color Map. 16