1. SPECIAL SESSION COUNTDOWN TO 2015 IN ETHIOPIA SIX BUILDING BLOCKS OF THE HEALTH SYSTEM: PROGRESS TOWARDS THE INTEGRATION IN ETHIOPIA Dereje Mamo Tsegaye Director, Policy and Planning Directorate Federal Ministry of Health Addis Ababa, 24 April 2012

2. Outline of the presentation Overview of the building blocks of health systems Six building blocks – Experience in Ethiopia in integrating building blocks: Service delivery; Health workforce; Information; Medical products, vaccines and technologies; Financing; and Leadership and governance Conclusions 2

3. Building blocks

4. – Health systems are highly context specific – No single model for improved performance – Key challenge: cost-effective and high-impact interventions available – But…they require a functioning health system to have an effect at the population scale – Question: how to get drugs, vaccines, and other forms of prevention, care and treatment – on time, reliably, in sufficient quantity and at reasonable cost – to those in need? – Need for learning from country’s experience on integration of building blocks

5. Building blocks – Integration of building blocks Leadership/ stewardship Human Resources Pharmaceuticals Planning and M&E Health Care Financing Health Services

6. Service delivery – “Service delivery” building block – In HSDP IV: integration of programmes at the point of service delivery Integrated packages of services (i.e., FP/HIV, HIV/TB etc.); Definition of roles of primary and other levels of care in delivering the packages; Development of referral system Establishment of service standards; Continuity of care; Integration of disease control activities.

7. Service delivery – Backbone of the health service delivery system: Health Extension Workers (HEW) provide integrated promotive, preventive and basic curative services at community level – Health Extension Package include prevention of HIV/AIDS, STIs and TB; malaria prevention and control; first aid emergency measures; maternal, newborn and child health; family planning; immunization; nutrition; adolescent reproductive health; excreta disposal; solid and liquid waste disposal; water supply; food hygiene and safety measures; healthy home environment; control of insects and rodents; personal hygiene; health education and communication.

8. Health workforce – “Health workforce” building block – In HSDP IV: Production of key categories of health workers (HW) in short supply; Intersectoral collaboration; Public-private partnership; Quality assurance in training; Geographic distribution of HWs; Regulatory system; and Cost-effectiveness in staff retention and mechanisms.

9. Health workforce – Strengthening health workforce in Ethiopia Production: over 6,000 medical students on training, over 1,600 nurse midwives on training etc.; Skill mix and task shifting: production of new integrated cadres, i.e., 252 integrated emergency surgery officers on training to address the needs for emergency, Comprehensive Emergency Obstetrical and Neonatal Care and Basic Emergency Obstetrical and Neonatal Care; Women’s empowerment: Over 38,000 Health Extension Workers trained and in place (in rural and urban areas) to provide integrated preventive and basic curative services at community level; Retention and motivation: i.e., upgrading program for HEWs etc.

10. Information – “Information” building block – Building Health Information System (HIS) with integration of different data sources for evidence-based decision making

11. Information – Purpose of the information system: to improve the health of the population

12. Information – Ongoing HMIS reform based on four principles integration of data collection and reporting (single channel); standardization of indicators, data collection instruments and analysis procedures; and simplification to decrease data burden and focus on use of information institutionalization

13. Information – Community-based information system based on an integrated Family Folder (FF) FF designed as an integrated and comprehensive data collection and documentation tool to be used by Health Extension Workers; To meet the information needs in order to manage family-centered services at community level; Including Health Cards and Integrated Maternal and Child Care Card

14. Information – Integrated reporting system and information dissemination for performance monitoring and accountability purposes, including: Reports on performance of the health sector; Quarterly Health Bulletins “Policy and Practice”; Statistical Reports

15. Medical products, vaccines and technologies – “Medical products, vaccines and technologies” building block – In HSDP IV: Integration of pharmaceutical supply and services; Local production of pharmaceutical supply and services; Increased efficiency with lower prices for clients; Decentralization with revolving drug fund and cost- recovery system; Drug and therapeutic committees in facilities; Integrated pharmaceutical logistic system

16. Financing “Financing” building block In HSDP IV: – Health care financing reform in Ethiopia Revenue retention and utilization Facility governance – Health insurance Social health insurance Community-based health insurance – Financial/expenditure management and control Integrated Financial Management Information System

17. Leadership and governance “Leadership and governance” building block – Integration according to the principles of harmonization: “One Plan-One-Budget-One Report” HSDP as a single strategic plan framework for coordinating health sector action (“One Plan”); District-based annual plan with horizontal integration (across programs) and vertical integration (from district to national levels); MDG Fund as a pooled funding mechanism to finance priorities under HSDP(“One Budget”); HMIS as Integrated and harmonized reporting system (“One Report”).

18. Conclusions Progress are made towards the integration of building blocks There are still challenges towards the integration of building blocks to meet MDGs (and beyond 2015) Critical issue: address the three delays to reduce maternal mortality

19. Thank you