By James Jeffrey
A first-of-its-kind course gave UNICEF’s Ethiopia office Health Programme staff a crucial insight into the increasingly important role of health care financing in Ethiopia and its implications for the country’s children.
Despite undeniable gains Ethiopia has made toward achieving Millennium Development Goal health targets and well defined national strategies for financing health care, troubling figures still abound. About 50 per cent of Ethiopia’s health sector funding still relies on donors. The proportion of households paying from their savings when sick is 34 per cent, with major ramifications for a country in which about 27 per cent still live under the poverty line, according to most estimates.
“A healthy society will be a more productive society,” says Mulat Tegegn working with the Ethiopian Health Insurance Agency, invited by UNICEF to join the course. “The goal is to eventually establish one health insurance scheme in Ethiopia.”
Introducing insurance schemes forms part of the Ethiopian government’s new health care financing strategy. This also includes money from schemes being reinvested to improve health facilities, and increasing taxation resources and the proportion of the government’s budget allocated to healthcare.
Such moves signal big changes for a country in which health care expenditure per capita in 2012 was US$26 compared to US$8,895 in the United States, according to the World Health Organization.
UNICEF staff globally usually congregate in London for health care financing courses developed jointly with the London School of Hygiene & Tropical Medicine. But UNICEF Ethiopia Country Office and The Division of Data, Research and Policy made an exception for this special 12 week on-line and in-situ Workshop in Addis Ababa, the Ethiopian capital.
“When people pay for health care out of pocket it creates a financial aspect to children’s issues,” says Macoura Oulare, chief of health for UNICEF’s Ethiopia office. “So we felt this course was an important opportunity to look at how the team could better advocate for children.”
Technical skills and knowledge from the course will enable participants to better participate in important policy discussions as Ethiopia develops and unrolls its health care financing system.
“UNICEF has broken new ground in seeking to gain skills in health care financing, with about 400 people already trained—that’s quite a commitment,” says London School of Hygiene & Tropical Medicine’s Virginia Wiseman, overseeing the course. “The benefits are undeniable as staff become better users of evidence and data, thereby improving investment decisions and evaluations of programmes.”
There is certainly plenty of data and evidence to analyse while Ethiopia undergoes enormous change as the government strives for it to become a middle-income country by 2025. This undertaking has serious implications for the funding of children, hence UNICEF’s shifting focus toward achieving more support from domestic resources.
“You have to look to the future—if donors were ever to withdraw that would create a big burden for the country,” Oulare says.
The so-called Abuja Declaration agreed upon by African Union countries in 2001 set a target of allocating at least 15 per cent of governmental annual budgets to improve health sectors.
Ethiopia hasn’t got there yet but it appears to be going in the right direction toward making health care more equitable and widespread among its estimated 95 million—and continually increasing—population.
“This is about creating room for more health care funding without compromising the government’s financial commitment to other sectors,” says Fred Matovu from Uganda’s Makerere University, who gave a presentation on achieving universal health care through health care financing.
Getting health care right presents a complex challenge to any country, whether developed or developing. But already the Ethiopian government’s developing community-based health insurance schemes have expanded from the first 13 woredas (districts) where they were piloted in 2006 to around 200 woredas now.
That expansion is only set to continue, while UNICEF’s Ethiopia staff and the governments’ health sector will use their new knowledge to make sure they are actively involved representing children’s interests as effectively as they can.
“You’re the people at the coal face who must disseminate the information,” Wiseman says to the group during a question and answer session after a lecture. “Equity and efficiency don’t have to be in conflict with each other—you can achieve both at the same time.”