Health in Ethiopia
Encyclopedia
Metrics of health
in Ethiopia
are among the world's worst. According to the U.S. government, Ethiopia's health care system is wholly inadequate, even after recent improvements. The Ethiopian government has launched a campaign to improve the health care system.
Ethiopia experiences a heavy burden of disease mainly attributed to communicable infectious diseases and nutritional deficiencies. 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) [1]. The HEP is designed to deliver health promotion, immunization and other disease prevention measures along with a limited number of high-impact curative interventions.
Throughout the 1990s, the government, as part of its reconstruction program, devoted ever-increasing amounts of funding to the social and health sectors, which brought corresponding improvements in school enrollments, adult literacy
, and infant mortality rates. These expenditures stagnated or declined during the 1998–2000 war with Eritrea
, but in the years since, outlays for health have grown steadily. In 2000–2001, the budget allocation for the health sector was approximately US$144 million; health expenditures per capita were estimated at US$4.50, compared with US$10 on average in sub-Saharan Africa
. In 2000 the country counted one hospital bed per 4,900 population and more than 27,000 people per primary health care facility. The physician
to population ratio was 1:48,000, the nurse to population ratio, 1:12,000. Overall, there were 20 trained health providers per 100,000 inhabitants. These ratios have since shown some improvement. Health care is disproportionately available in urban centers; in rural areas where the vast majority of the population resides, access to health care varies from limited to nonexistent. As of the end of 2003, the United Nations
(UN) reported that 4.4 percent of adults were infected with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS); other estimates of the rate of infection ranged from a low of 7 percent to a high of 18 percent. Whatever the actual rate, the prevalence of HIV/AIDS
has contributed to falling life expectancy since the early 1990s. According to the Ministry of Health, one-third of current young adult deaths are AIDS-related. Malnutrition
is widespread, especially among children, as is food insecurity. Because of growing population pressure on agricultural and pastoral land, soil degradation, and severe droughts that have occurred each decade since the 1970s, per capita food production is declining. According to the UN and the World Bank
, Ethiopia at present suffers from a structural food deficit such that even in the most productive years, at least 5 million Ethiopians require food relief.
In 2002 the government embarked on a poverty reduction program that called for outlays in education, health, sanitation, and water. A polio vaccination
campaign for 14 million children has been carried out, and a program to resettle
some 2 million subsistence farmers is underway. In 2003, the government launched the Health Extension Program which will provide universal primary health care coverage by 2009. This includes placing two government-salaried female Health Extension Workers (HEW) in every kebele
, with the aim of shifting the emphasis of health care to prevention. About 2,700 HEWs completed their training by the end of 2004 at 11 technical and vocational education
centers, while 7,000 HEWs were still in training in 2005, and over 30,000 HEWs were expected to complete their training by 2009. However, these trainees encountered a lack adequate facilities, which included classrooms, libraries, water, and latrines. The selection of trainees was flawed, with most being urban inhabitants and not from the rural villages they would be working in. Reimbursement was haphazard as trainees in some regions did not receive stipends while those in other regions did. In January 2005, the government began distributing antiretroviral drugs, hoping to reach up to 30,000 HIV-infected adults.
According to the head of the World Bank's Global HIV/AIDS Program, Ethiopia has only 1 medical doctor per 100,000 people. However, the World Health Organization
in its 2006 World Health Report gives a figure of 1936 physicians (for 2003), which comes to about 2.6 per 100,000. There are 119 hospitals (12 in Addis Ababa
alone) and 412 health centers in Ethiopia. Globalization is said to affect the country, with many educated professionals leaving Ethiopia for a better economic opportunity in better-developed countries.
Ethiopia's main health problems are said to be communicable diseases caused by poor sanitation
and malnutrition. These problems are exacerbated by the shortage of trained manpower and health facilities. Ethiopia has a relatively low average life expectancy of 45 years.Aids Action (The International News Letter on AIDS Prevention and Care): Issue 46, Health Link World Wide (October-December 1999) Only 20 percent of children nationwide have been immunized against all six vaccine-preventable diseases: tuberculosis
, diphtheria
, whooping cough, tetanus
, polio, and measles
. Rates of immunization are less than 3 percent of children in Afar
and Somali Region
s and less than 20 percent in Amhara
, Benishangul-Gumuz, and Gambela
. In contrast, almost 70 percent of children have received all vaccinations in Addis Ababa and 43 percent in Dire Dawa
; children in urban areas are three times as likely to be fully immunized as children living in rural areas.
released a report on The State of the World's Midwifery. It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries. The 2010 maternal mortality rate per 100,000 births for Ethiopia is 470. This is compared with 589.7 in 2008 and 967.7 in 1990. The under 5 mortality rate, per 1,000 births is 109 and the neonatal mortality as a percentage of under 5's mortality is 34. The aim of this report is to highlight ways in which the Millennium Development Goals
can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death. In Ethiopia the number of midwives per 1,000 live births is 0.4 and 1 in 40 shows us the lifetime risk of death for pregnant women.
Ethiopian healers are more commonly known as traditional medical practitioners. Before the onset of Christian missionaries and Medical Revolution sciences, traditional medicine was the only form of treatment available. Traditional healers extract healing ingredients from wild plants, animals and rare minerals. AIDS, malaria, tuberculosis and dysentery are the leading causes of disease-related death. Largely because of the costs, traditional medicine continues to be the most common form of medicine practiced. Many Ethiopians are unemployed which makes it difficult to pay for most medicinal treatments. Ethiopian medicine is heavily reliant on magical and supernatural beliefs that have little or no relation to the actual disease itself. Many physical ailments are believed to be caused by the spiritual realm which is the reason healers are most likely to integrate spiritual and magical healing techniques. Traditional medicinal practice is strongly related to the rich cultural beliefs of Ethiopia, which explains the emphasis of its use.
In Ethiopian culture there are two main theories of the cause of disease. The first is attributed to God or other supernatural forces, while the other is attributed to external factors such as unclean drinking water and unsanitary food. Most genetic diseases or deaths are viewed as the will of God. Miscarriages are thought to be the result of demonic spirits.
One medical practice that is commonly practiced irrespective of religion or economic status is female genital mutilation. Nearly four out of five Ethiopian women are circumcised. There are three levels of circumcision that involve different degrees of cutting the clitoris and vaginal area. Many of these practices are done with an unsanitary blade with little or no anesthetics. It can result in heavy bleeding, high pain, and sometimes death.
It was not until Christian missionaries traveled to Ethiopia bringing new religious beliefs and education that modern medicine was infused into Ethiopian medicine. Today there are three medical schools in Ethiopia that began training students in 1965 two of which are linked to Addis Ababa University
. There is only one psychiatric treatment facility in the whole country because Ethiopian culture is resistant to psychiatric treatment. Although there have been huge leaps and bounds in medical technology there is still a large problem in the distribution of medicine and doctors in Ethiopia.
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
in Ethiopia
Ethiopia
Ethiopia , officially known as the Federal Democratic Republic of Ethiopia, is a country located in the Horn of Africa. It is the second-most populous nation in Africa, with over 82 million inhabitants, and the tenth-largest by area, occupying 1,100,000 km2...
are among the world's worst. According to the U.S. government, Ethiopia's health care system is wholly inadequate, even after recent improvements. The Ethiopian government has launched a campaign to improve the health care system.
Overview
Ethiopia is the second most populous country in sub-Saharan Africa, with a population of over 90.8 million people. The country introduced a federal government structure in 1994 composed of nine Regional States: Tigray, Afar, Amhara, Oromia, Somali, Benishangul Gumuz, Southern Nations Nationalities and Peoples Region (SNNPR), Gambela and Harrari and two city Administrations (Addis Ababa and Dire Dawa). The Regional States are administratively divided into 78 Zones and 710 Woredas .Ethiopia experiences a heavy burden of disease mainly attributed to communicable infectious diseases and nutritional deficiencies. 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
Health Extension Officer
Health Extension Officers, also known as Health Extension Workers , are a category of health care providers found in some countries including Papua New Guinea and Ethiopia...
(HEP) [1]. The HEP is designed to deliver health promotion, immunization and other disease prevention measures along with a limited number of high-impact curative interventions.
Health and Health related Indicators
| Indicator Description | Value |
|---|---|
| Hospitals | 149 |
| Health centers | 732 |
| Health posts | 11,446 |
| Health stations +NHC | 1,517 |
| Private clinics for profit | 1,788 |
| Private clinics not for profit | 271 |
| Pharmacies | 320 |
| Drug shops | 577 |
| Rural drug vendors | 2,121 |
Throughout the 1990s, the government, as part of its reconstruction program, devoted ever-increasing amounts of funding to the social and health sectors, which brought corresponding improvements in school enrollments, adult literacy
Literacy
Literacy has traditionally been described as the ability to read for knowledge, write coherently and think critically about printed material.Literacy represents the lifelong, intellectual process of gaining meaning from print...
, and infant mortality rates. These expenditures stagnated or declined during the 1998–2000 war with Eritrea
Eritrean-Ethiopian War
The Eritrean–Ethiopian War took place from May 1998 to June 2000 between Ethiopia and Eritrea, forming one of the conflicts in the Horn of Africa...
, but in the years since, outlays for health have grown steadily. In 2000–2001, the budget allocation for the health sector was approximately US$144 million; health expenditures per capita were estimated at US$4.50, compared with US$10 on average in sub-Saharan Africa
Sub-Saharan Africa
Sub-Saharan Africa as a geographical term refers to the area of the African continent which lies south of the Sahara. A political definition of Sub-Saharan Africa, instead, covers all African countries which are fully or partially located south of the Sahara...
. In 2000 the country counted one hospital bed per 4,900 population and more than 27,000 people per primary health care facility. The physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
to population ratio was 1:48,000, the nurse to population ratio, 1:12,000. Overall, there were 20 trained health providers per 100,000 inhabitants. These ratios have since shown some improvement. Health care is disproportionately available in urban centers; in rural areas where the vast majority of the population resides, access to health care varies from limited to nonexistent. As of the end of 2003, the United Nations
United Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...
(UN) reported that 4.4 percent of adults were infected with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS); other estimates of the rate of infection ranged from a low of 7 percent to a high of 18 percent. Whatever the actual rate, the prevalence of HIV/AIDS
HIV/AIDS in Ethiopia
Ethiopia has a large and very vulnerable population, with an estimated 15 percent of the population living below the poverty line. HIV/AIDS is one of the key challenges for the overall development of Ethiopia, as it has led to a seven-year decrease in life expectancy and a greatly reduced...
has contributed to falling life expectancy since the early 1990s. According to the Ministry of Health, one-third of current young adult deaths are AIDS-related. Malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
is widespread, especially among children, as is food insecurity. Because of growing population pressure on agricultural and pastoral land, soil degradation, and severe droughts that have occurred each decade since the 1970s, per capita food production is declining. According to the UN and the World Bank
World Bank
The World Bank is an international financial institution that provides loans to developing countries for capital programmes.The World Bank's official goal is the reduction of poverty...
, Ethiopia at present suffers from a structural food deficit such that even in the most productive years, at least 5 million Ethiopians require food relief.
In 2002 the government embarked on a poverty reduction program that called for outlays in education, health, sanitation, and water. A polio vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
campaign for 14 million children has been carried out, and a program to resettle
Resettlement and villagization in Ethiopia
Resettlement and villagization in Ethiopia has been an issue since the late nineteenth century, due to the overcrowded population of the Ethiopian highlands...
some 2 million subsistence farmers is underway. In 2003, the government launched the Health Extension Program which will provide universal primary health care coverage by 2009. This includes placing two government-salaried female Health Extension Workers (HEW) in every kebele
Kebele
A kebele is the smallest administrative unit of Ethiopia similar to ward, a neighbourhood or a localized and delimited group of people...
, with the aim of shifting the emphasis of health care to prevention. About 2,700 HEWs completed their training by the end of 2004 at 11 technical and vocational education
centers, while 7,000 HEWs were still in training in 2005, and over 30,000 HEWs were expected to complete their training by 2009. However, these trainees encountered a lack adequate facilities, which included classrooms, libraries, water, and latrines. The selection of trainees was flawed, with most being urban inhabitants and not from the rural villages they would be working in. Reimbursement was haphazard as trainees in some regions did not receive stipends while those in other regions did. In January 2005, the government began distributing antiretroviral drugs, hoping to reach up to 30,000 HIV-infected adults.
According to the head of the World Bank's Global HIV/AIDS Program, Ethiopia has only 1 medical doctor per 100,000 people. However, the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
in its 2006 World Health Report gives a figure of 1936 physicians (for 2003), which comes to about 2.6 per 100,000. There are 119 hospitals (12 in Addis Ababa
Addis Ababa
Addis Ababa is the capital city of Ethiopia...
alone) and 412 health centers in Ethiopia. Globalization is said to affect the country, with many educated professionals leaving Ethiopia for a better economic opportunity in better-developed countries.
Ethiopia's main health problems are said to be communicable diseases caused by poor sanitation
Water supply and sanitation in Ethiopia
Access to water supply and sanitation in Ethiopia is amongst the lowest in Sub-Saharan Africa and the entire world. While access has increased substantially with funding from external aid, much still remains to be done to achieve the Millennium Development Goal of halving the share of people...
and malnutrition. These problems are exacerbated by the shortage of trained manpower and health facilities. Ethiopia has a relatively low average life expectancy of 45 years.Aids Action (The International News Letter on AIDS Prevention and Care): Issue 46, Health Link World Wide (October-December 1999) Only 20 percent of children nationwide have been immunized against all six vaccine-preventable diseases: tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, diphtheria
Diphtheria
Diphtheria is an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium. It is characterized by sore throat, low fever, and an adherent membrane on the tonsils, pharynx, and/or nasal cavity...
, whooping cough, tetanus
Tetanus
Tetanus is a medical condition characterized by a prolonged contraction of skeletal muscle fibers. The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, rod-shaped, obligate anaerobic bacterium Clostridium tetani...
, polio, and measles
Measles
Measles, also known as rubeola or morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Morbilliviruses, like other paramyxoviruses, are enveloped, single-stranded, negative-sense RNA viruses...
. Rates of immunization are less than 3 percent of children in Afar
Afar Region
Afar is one of the nine ethnic divisions of Ethiopia, and is the homeland of the Afar people. Formerly known as Region 2, its current capital is Asayita; a new capital named Semera on the paved Awash - Asseb highway is under construction....
and Somali Region
Somali Region
Somali Region ; is the eastern-most of the nine ethnic divisions of Ethiopia. It is often called Somalia, though it is not to be confused with the independent country of the same name. The capital of Somali State is Jijiga...
s and less than 20 percent in Amhara
Amhara Region
Amhara is one of the nine ethnic divisions of Ethiopia, containing the homeland of the Amhara people. Previously known as Region 3, its capital is Bahir Dar....
, Benishangul-Gumuz, and Gambela
Gambela Region
Gambela is one of the nine ethnic divisions of Ethiopia. Previously known as "Region 12", its capital is Gambela. Lying between the Baro and Akobo Rivers, the western part of Gambela includes the Baro salient....
. In contrast, almost 70 percent of children have received all vaccinations in Addis Ababa and 43 percent in Dire Dawa
Dire Dawa
Dire Dawa is one of two chartered cities in Ethiopia . This chartered city is divided administratively into two woredas, the city proper and the non-urban woreda of Gurgura....
; children in urban areas are three times as likely to be fully immunized as children living in rural areas.
Maternal and Child Health Care
In June 2011, the United Nations Population FundUnited Nations Population Fund
The United Nations Population Fund is a UN organization. The work of the UNFPA involves promotion of the right of every woman, man and child to enjoy a life of health and equal opportunity. This is done through major national and demographic surveys and with population censuses...
released a report on The State of the World's Midwifery. It contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries. The 2010 maternal mortality rate per 100,000 births for Ethiopia is 470. This is compared with 589.7 in 2008 and 967.7 in 1990. The under 5 mortality rate, per 1,000 births is 109 and the neonatal mortality as a percentage of under 5's mortality is 34. The aim of this report is to highlight ways in which the Millennium Development Goals
Millennium Development Goals
The Millennium Development Goals are eight international development goals that all 193 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015...
can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death. In Ethiopia the number of midwives per 1,000 live births is 0.4 and 1 in 40 shows us the lifetime risk of death for pregnant women.
Ethiopian traditional medicine
The low availability of health care professionals with modern medical training, together with lack of funds for medical services, leads to the preponderancy of less reliable traditional healers that use home-based therapies to heal common ailments. High rates of unemployment leave many Ethiopian citizens unable to support their families. In Ethiopia an increasing number of "false healers" using home based medicines have grown with the rising population. The differences between real and false healers are almost impossible to distinguish. However, only about ten percent of practicing healers are true Ethiopian healers. Much of the false practice can be attributed to commercialization of medicine and the high demand for healing. Both men and women are known to practice medicine from their homes. It is most commonly the men that dispense herbal medicine similar to an out of home pharmacy.Ethiopian healers are more commonly known as traditional medical practitioners. Before the onset of Christian missionaries and Medical Revolution sciences, traditional medicine was the only form of treatment available. Traditional healers extract healing ingredients from wild plants, animals and rare minerals. AIDS, malaria, tuberculosis and dysentery are the leading causes of disease-related death. Largely because of the costs, traditional medicine continues to be the most common form of medicine practiced. Many Ethiopians are unemployed which makes it difficult to pay for most medicinal treatments. Ethiopian medicine is heavily reliant on magical and supernatural beliefs that have little or no relation to the actual disease itself. Many physical ailments are believed to be caused by the spiritual realm which is the reason healers are most likely to integrate spiritual and magical healing techniques. Traditional medicinal practice is strongly related to the rich cultural beliefs of Ethiopia, which explains the emphasis of its use.
In Ethiopian culture there are two main theories of the cause of disease. The first is attributed to God or other supernatural forces, while the other is attributed to external factors such as unclean drinking water and unsanitary food. Most genetic diseases or deaths are viewed as the will of God. Miscarriages are thought to be the result of demonic spirits.
One medical practice that is commonly practiced irrespective of religion or economic status is female genital mutilation. Nearly four out of five Ethiopian women are circumcised. There are three levels of circumcision that involve different degrees of cutting the clitoris and vaginal area. Many of these practices are done with an unsanitary blade with little or no anesthetics. It can result in heavy bleeding, high pain, and sometimes death.
It was not until Christian missionaries traveled to Ethiopia bringing new religious beliefs and education that modern medicine was infused into Ethiopian medicine. Today there are three medical schools in Ethiopia that began training students in 1965 two of which are linked to Addis Ababa University
Addis Ababa University
Addis Ababa University is a university in Ethiopia. It was originally named "University College of Addis Ababa" at its founding, then renamed for the former Ethiopian emperor Haile Selassie I in 1962, receiving its current name in 1975.Although the university has six of its seven campuses within...
. There is only one psychiatric treatment facility in the whole country because Ethiopian culture is resistant to psychiatric treatment. Although there have been huge leaps and bounds in medical technology there is still a large problem in the distribution of medicine and doctors in Ethiopia.
See also
- List of hospitals in Ethiopia
- HIV/AIDS in EthiopiaHIV/AIDS in EthiopiaEthiopia has a large and very vulnerable population, with an estimated 15 percent of the population living below the poverty line. HIV/AIDS is one of the key challenges for the overall development of Ethiopia, as it has led to a seven-year decrease in life expectancy and a greatly reduced...
- Water supply and sanitation in EthiopiaWater supply and sanitation in EthiopiaAccess to water supply and sanitation in Ethiopia is amongst the lowest in Sub-Saharan Africa and the entire world. While access has increased substantially with funding from external aid, much still remains to be done to achieve the Millennium Development Goal of halving the share of people...
- Famines in EthiopiaFamines in EthiopiaTraditionally the Economy of Ethiopia was based on subsistence agriculture, with an aristocracy that consumed the surplus. Due to a number of causes, the peasants lacked incentives to either improve production or to store their excess harvest; as a result, they lived from harvest to harvest.Despite...
External Links
The State of the World's Midwifery - Ethiopia Country ProfileFurther reading
- Richard Pankhurst, An Introduction to the Medical History of Ethiopia. Trenton: Red Sea Press, 1990. ISBN 0-932415-45-8