1. Fikru Tessema
Director, Health Sector Reform
May, 2011
Addis Ababa
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2. Outlines
 Why we really need this exercise
 What to achieve: health outcomes
 How to achieve: redesigned health system
building block
 What achievements of the reform: key
results
 Conclusions
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3. Background
 The major health problems of the country largely
preventable communicable diseases and
nutritional disorders.
 Ethiopia’s population face a high rate of morbidity
and mortality.
 Consequently the health status remains relatively
poor.
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4.  Lack of comprehensiveness and access to services
 Poor quality of health services
 Lack of appropriate public health emergencies
management
 Poor Health and Health Related Services and
Product Regulation
Why these?
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5.  Inadequate harmonization and alignment of
strategic and operational plans at all levels
 Inability to link resource allocation with
performance
 Lack of research projects that were not always
based on priority problems of public health
importance with poor project implementation
capacity and planning
Why … cont’d
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6. Consequently,
 DHS 2005 shows a life expectancy of 54 years (53.4
years for male and 55.4 for female), and an IMR of
77/1000.
 Under-five mortality rate 101/1000 in 2010.
 The major causes of maternal death are
obstructed/prolonged labor (13%), ruptured
uterus (12%), and malaria (9%).
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7. Why reforms?
Business as usual is less efficient and
effective:
 Task oriented or functional centered
organization
The question was we need institutional
transformation that enables to be more
efficient and effective.
Where to transform was the next step:
 Seamless or process centered organization
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8. In responses,
The Federal Ministry of Health:
 embarked on health sector reform in order
to ensure the paradigm shift of the health
system.
 so as to bring its services that
commensurate with customers need.
 So, the tool we employed was:
 Business Process Re-engineering (BPR)
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9. Key Steps to the Success of
Reforms
 Top to down approach: Political leadership
 Planned: Nothing is spontaneous
 Change agents: Innovators with high level competency
 Institutionalize: a team accountable top level
management
 Technical back up: trainings
 Regular communication: at all level
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10. Origins of Health Sector Reforms
First, top level decision is needed:
 Realization by the national government that the service
delivery was NOT at its optimum and potential .
 NOT just because it has now become a world wide fashion
‘‘To Reform’’
 NOT because of donor pressure;
 But because of the obvious need (driving forces):
 to have a health system that is more responsive to the
needs of the people and
 to achieve better outcomes and value for money.
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11. Health Sector Outcomes
Consensus on common agendas for all:
1. Community, who produced its health, served with
quality preventive, curative & rehabilitative health
services and protected from Emergency Health
hazards.
2. Community accessing standardized Health Facilities.
3. Research finding that solve health problems and
ensured technology transfer
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12. Outcomes …..cont
4. Quality and affordable Pharmaceuticals supplied in a
sustainable manner.
5. Sustainable and accessible health Insurance for
equitable health service
6. Community protected from Sub-standard and Risky
Health & Health Related Services and Products.
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13. Building Blocks (BB) of the
Health System
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14. Building Blocks of the Health System
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Health System
Health care delivery
Public health emergency
management
Research and technology
transfer
Pharmaceutical supply Health care financing
Health regulation
Policy, planning and M&E
Health workforces
Health infrastructure

15. Basis for Reforms on the BB
What was lacking: 4 parameters for
redesigning
1. Speed
2. Quality
3. Cost and
4. Customer satisfaction
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16. Health system framework
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Services Provider
Services Purchaser Services Regulatory

17. Health System Build Block from
Service Provider Side
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Health care delivery
Public health emergency
management
Research and technology
transfer
Pharmaceutical supply
Resource mobilizationPolicy, planning and M&E
Health workforces

18. Health System Build Block from
Service Purchaser Side
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Social Health Insurance Community Health Insurance
Health Insurance

19. Health System Build Block from
Service Regulatory side
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Health Related Services and
Products Regulation
Health Services and
Products Regulation
Health Regulation

20. Implementation
 Strategy
 Institutionalize
 Communicate, communicate and communicate:
Your staff
Stakeholders
Community
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21. Some key achievements of 2 years
implementation of reforms
 Patient flow: service utilization rate from 0.77 to 1.3
times
 Pre-admission waiting time from 6 months to 2
weeks
 Emergency cases attained within 5 minutes of their
arrival at health faculties
 Food safety and sanitation monitoring of premises
from 25% reached 50%
 Duration for market authorization decreased from
310 days to 30 days
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22. Some key achievements … cont’d
 Procurement lead time reduced from 390 days to 118
days
 No drug stock out : bi-monthly supply schedule
 In most HFs essential and tracer drugs are available
 100% detection of out breaks in 48 hours and
notification of threat or epidemics and initiation of
response operation in 2 to 3 hours
 Zero maternal death related to pregnancy/delivery at
health facilities
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23. Conclusions
All these require:
 Time and commitment,
 Teamwork, Patience, Ownership at all levels,
 High level coordination,
 Additional resources and
 Above all, needs critical monitoring and follow
up, i.e. change management
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