1. Health Financing Profile of Ethiopia

2. Background Total Population * 74 mln, 84% rural GDP PC **USD 160 Main source of Income** Agriculture 44% to GDP Coffee, oilseeds, hides and skin, pulses, meat Political System Federalist, 9 regional govt and 2 city administrations Population in absolute poverty 44% Sources: *CSA, 2009 **NBE, 2007/08

3. Health Service Organization Regional Hospital Regional HPTI** Referral Hospital Federal HPTI* ZHD RHB FMOH WorHO District Hospital PHCU HC 5 satellite HPs

4. Health Sector Indictors 2007/08 (1) IMR*77 U5MR*123 MMR673 Life expectancy53.4 (Male), 55.4 (female) TFR5.4 HIV prev2.1 ANC coverage59% Attended delivery20% PNC coverage25% Pentavalent 381% Fully immunized63% Source: FMOH, 2007/08 * DHS, 2005

5. Health Sector Indictors 2007/08 (2) PHS Coverage (?)90% Per capita service utilization0.24 visits/year Hospitals149 HC732 Nucleus HC1517 Health Posts11466 Physician to population ratio1: 37,996 HO to population ratio1: 63785 Nurse to population ratio1: 4725 HEW to population ratio1: 3224 Source: FMOH, 2007/08

6. Health Expenditure NHA 2004/05 Total Health expenditureUSD 522 mln Per capita THEUSD 7.1 Total public health expenditureUSD 2 Health as % of total public spending10 % Health as % of GDP4%

7. Sources of Finance Source: FMOH, NHA various years

8. Health Care Functions

9. Health Financing System Predominantly user fee based (since 2005 retention) – Fee waiver (means tested) – Exemption Government line item budget to HFs Donor support private health insurance < 1% SHI – under design CBHI – under pilot

10. Challenges (1) User fees – Regressive – Weakness in targeting systems – Limited revenue Govt budget – Limited Donor resource – HIV – Still issue with aid effectiveness Private health insurance – Unaffordable – culture

11. Challenges (2) SHI – Limited formal sector (<10%) – HF availability (rural/remote) – Inequity CBHI – Unaffordable to most – Other barriers – Service availability (rural) Overall – Effective access (HR, supplies,….) – Quality – HR crisis

12. Way Forward CBHI – under pilot with voluntary and mandatory options – Huge subsidy – Networking/risk pooling SHI – to start with civil servant and family with expansion to all public sector – Explore options for non-public sector Longer term donor commitments

13. References CSA. (2006). Demographic and health Survey 2005. Addis Ababa. FMOH. (2007). Scaling Up For Better Health in Ethiopia: IHP+ Road map for harmonization and alignment of government and partner programmes and financing towards attaining the health related MDGs. Addis Ababa, November. FMOH. (2008). Health and Health Related Indicators. Addis Ababa. FMOH. (2008). Human Resource for Health Strategy: Presentation during the annual review meeting of the HSDP. Mekelle, October. FMOH, National Health Accounts Studies (various years) NBE. (2009). National Bank Annual Report 2007 – 2008. Addis Ababa, August.

14. Thank you