Health Financing Profile of Ethiopia

BackgroundTotal Population *

74 mln , 84% rural

GDP PC ** USD 160Main source of Income**

Agriculture 44% to GDPCoffee, 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

Health Service Organization

Regional Hospital

Regional HPTI**

Referral Hospital Federal

HPTI*

ZHD

RHB

FMOH

WorHO

District Hospital

PHCUHC

5 satellite HPs

Health Sector Indictors 2007/08 (1)IMR* 77U5MR* 123MMR 673Life expectancy 53.4 (Male), 55.4 (female)TFR 5.4HIV prev 2.1ANC coverage 59%Attended delivery 20%PNC coverage 25%Pentavalent 3 81%Fully immunized 63%

Source: FMOH, 2007/08 * DHS, 2005

Health Sector Indictors 2007/08 (2)PHS Coverage (?) 90% Per capita service utilization 0.24 visits/yearHospitals 149HC 732Nucleus HC 1517Health Posts 11466Physician to population ratio 1: 37,996HO to population ratio 1: 63785Nurse to population ratio 1: 4725HEW to population ratio 1: 3224

Source: FMOH, 2007/08

Health Expenditure NHA 2004/05

Total Health expenditure USD 522 mlnPer capita THE USD 7.1Total public health expenditure USD 2Health as % of total public spending 10 %Health as % of GDP 4%

Sources of Finance

1995/96 1999/00 2004/050%

20%

40%

60%

80%

100%

40% 33% 31%

53%

36%31%

7%

9%2%

1%

22%37%

Government OOP private fund donors

Source: FMOH, NHA various years

Health Care Functions

1995/96 1999/00 2004/050%

10%20%30%40%50%60%70%80%90%

100%

20.7% 14.8% 16.6%

33%30% 18%

16%

13%19%

4%

6%6%

3% 6% 6%

8% 12%

Curative Care Pharmaceuticals Prevention and public health

Health administration Capital formation Other health related services

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

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

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

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

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.

Thank you