Health in Ethiopia has improved markedly in the last decade, with government leadership playing a key role in mobilizing resources and ensuring that they are used effectively. Birth rate has risen because of this. A central feature of the sector is the priority given to the Health Extension Program, which delivers cost-effective basic services that enhance equity and provide care to millions of women, men and children. Ethiopia has demonstrated that low-income countries can achieve improvements in health and access to services if policies, programmes and strategies are underpinned by ingenuity, innovativeness, political will and sustained commitment at all levels. An example is the development and rapid implementation of the Ethiopian Health Extension Programme.
Ethiopia is the second most populous country in sub-Saharan Africa, with a population of over 94.1 million people the population of goes to 104 million (CSA projection). The country introduced a federal government structure in 1994 composed of nine Regional States: Afar, Amhara, Oromia, Somali, Benishangul Gumuz, Southern Nations Nationalities and Peoples Region (SNNPR), Gambela, Tigray and Harrari and two city Administrations (Addis Ababa and Dire Dawa). The Regional States are administratively divided into 78 Zones and 710 800 Woredas.
Ethiopia experiences a triple burden of disease mainly attributed to communicable infectious diseases and nutritional deficiencies, NCD and traffic accident. Shortage and high turnover of human resource and inadequacy of essential drugs and supplies have also contributed to the burden. However, there has been encouraging improvements in the coverage and utilization of the health service over the periods of implementation of Health Sector Development Plan (HSDP).
HSDP constitutes the health chapter of the national poverty reduction strategy and aims to increase immunization coverage and decrease under-five mortality at large. The health service currently reaches about 72% of the population and The Federal Ministry of Health aims to reach 85% of the population by 2009 through the Health Extension Program (HEP) . The HEP is designed to deliver health promotion, immunization and other disease prevention measures along with a limited number of high-impact curative interventions.
TB and Leprosy Control Program (TLCP)
History of Tuberculosis and Leprosy control Program in Ethiopia
Tuberculosis has been identified as one of the major public health problems in Ethiopia for the past five decades. The effort to control tuberculosis began in the early 60s with the establishment of TB centers and sanatoria in three major urban areas in the country. The Central Office (CO) of the National Tuberculosis Control Program (NTCP) was established in 1976. From the very beginning the CO had serious problems in securing sufficient budget and skilled human resource. In 1992, a well-organized TB program incorporating standardized directly observed short course treatment (DOTS) was implemented in a few pilot areas of the country.
An organized leprosy control program was established within the Ministry of Health in 1956, with a detailed policy in 1969. In the following decades, leprosy control was strongly supported by the All African Leprosy and Rehabilitation Training Institute (ALERT) and the German Leprosy Relief Association (GLRA). This vertical program was well funded and has scored notable achievements in reducing the prevalence of leprosy, especially after the introduction of Multiple Drug Therapy (MDT) in 1983. This has encouraged Ethiopia to consider integration of the vertical leprosy control program with in the general health services. The two programs were merged to being the National Tuberculosis and Leprosy Control program (NTLCP), and coordinated under the technical leadership of the CO from 1994.
TB prevalence, incidence and mortality rates in Ethiopia
The most recent WHO global report classifies Ethiopia as one of the 30’s high burden countries for TB, TB/HIV and MDR-TB. The TB prevalence estimates in Ethiopia shows a steady decline since 1995 with an average rate of 4% per year, which is accentuated in the last five years (annual decline of 5.4%). Likewise, the estimates for TB incidence reached a peak value of 431/100,000 population in 1997, and has been declining at an average rate of 3.9% per year since 1998, with annual decline of 6% within the last five years. The incidence estimate for all forms of TB in 2015 is 192/100,000 population. TB mortality rate has also been declining steadily since 1990 and reached 26/100,000 population in 2015. The decline in prevalence rate for all forms of TB has declined from 426/100,100 in 1990 to 200/100,000 population in 2014 (53% reduction). Similarly, the TB incidence rate has dropped from 369 in 1990 to 192/100,000 population in 2015 (48% reduction), after a peak of 421/100,000 in 2000. Furthermore, TB related mortality rate has been declining steadily over the last decade from 89/100,000 in 1990 to 26/100,000 in 2015 (70% reduction from 1990 level).
In 2011, the first population based national survey shows a prevalence rate of 108/100,000 population smear positive TB among adults, and 277/100,000 population bacteriologically confirmed TB cases. The prevalence of TB for all groups in Ethiopia was 240/100,000 populations in the same year. This finding indicates that the actual TB prevalence and incidence rates in Ethiopia are lower than the WHO estimates. Additionally, the survey showed a higher prevalence rates for smear positive and bacteriologically confirmed TB in pastoralist communities. However, pertaining to its methodology, the survey did not produce further disaggregated sub-national estimates.
Maternal and child health care
The 2013 maternal mortality rate per 100,000 births for Ethiopia is 420. This is compared with 589.7 in 2008 and 1400 in 1990. The under 5 mortality rate, per 1,000 births is 64 in 2013 compared with 205 in 1990. In Ethiopia the number of midwives per 1,000 live births is 0.4 and the lifetime risk of death for pregnant women 1 in 40.