Federal Democratic Republic of Ethiopia
Ministry of Health
Health Sector Transformation Plan
HSTP
(2015/16 up to 2019/20)
Draft_V1
1
[HSTP ZERO DRAFT_V2] 10th May, 2014
Contents
Chapter 1: Introduction ............................................................................................................................... 3
Chapter 2: Overview of the performance of HSDP I, II, III & IV .................................................................. 3
HSDP I, II, and III ....................................................................................................................................... 3
HSDP IV: Performance Assessment Report (Situation Analysis for HSTP Development) ........................ 3
SO.C1: Access to health services ................................................................................................... 3
SO.C2: Enhancing Community empowerment, engagement and participation .......................... 20
S.O.F1: Maximize resource mobilization and utilization ............................................................ 23
SO. P1: Improve Quality of Service Delivery ............................................................................. 26
S.O. P2: Public Health Emergency Management (PHEM) ......................................................... 26
S.O. P3: Improve Pharmaceutical supply and services (P3) ........................................................ 26
S.O. P4: Improve Regulatory systems (P4) ................................................................................. 27
SO. P5: Improve harmonization and alignment: evidence based decision-making: ................... 27
SO. CB1: Improve Health Infrastructure and access to services (CB1) ...................................... 28
SO. CB2: Improve Human Capital (CB2) ................................................................................... 28
Chapter 3: Health Sector Development Program V ................................................................................... 30
3.1. The Planning Process and Methodology ......................................................................................... 30
3.2. Health Sector Strategic Assessment ............................................................................................... 30
Mission Statement of MOH ......................................................................................................... 30
Vision:........................................................................................................................................... 30
SWOT Analysis:............................................................................................................................. 30
Stakeholder Analysis: ................................................................................................................... 37
3.3. Strategy ........................................................................................................................................... 38
Customer Value Proposition ........................................................................................................ 38
Strategic Themes and Strategic Results ....................................................................................... 38
Perspectives: ................................................................................................................................ 42
3.4. Strategic Objectives (SO)................................................................................................................. 42
Objective commentary................................................................................................................. 43
3.5. Strategy Map ................................................................................................................................... 52
3.6. Performance Measures ................................................................................................................... 53
Summary of the visioning exercise: Ethiopia’s Path to UHC through strengthening the PHC ... 53
Performance Measures and Targets for HSTP............................................................................. 55
3.7. Strategic Initiatives: ........................................................................................................................ 65
Scope and deliverables of the strategic initiatives: ...................................................................... 69
Chapter 4: Costing and Financing (Cost estimate, Resource mapping, Financial gap, etc) ................. 107
Chapter 5: Programme Management Arrangement ........................................................................... 112
Risk Mitigation .......................................................................................................................... 112
Chapter 6: Monitoring and Evaluation (M&E) framework .................................................................. 112
Annex 1: Major Activities: .................................................................................................................... 113
2
[HSTP ZERO DRAFT_V2] 10th May, 2014
Chapter 1: Introduction
Chapter 2: Overview of the performance of HSDP I, II, III & IV
HSDP I, II, and III
HSDP IV: Performance Assessment Report (Situation Analysis for HSTP
Development)
SO.C1: Access to health services
Access to health service is critical to low income countries like Ethiopia. Access to health services
denotes whether services are provided in specific geographic area that refers physical accessibility
which can be measured by availability of health facilities and other inputs compared to the population.
However, physical availability of health facilities might not guarantee utilization of health services as
several factors such as transportation, perception of community towards health services, cost, waiting
time, and poor service etc. may deter people for not using the health facilities that are physically
available.
Remarkable progress has been made in improving access to primary health care units ( particularly
health centres and health posts) and health human resources deployment in the last one and half
decade (table). Notable strides have also been made in increasing the number of primary hospitals in
recent years particularly during HSDP IV. Even though the physical access for primary health care
facilities has improved significantly, some of the health facilities are not providing the services that are
expected to be provided at their level due to various reasons.
Per capita measures of outpatient visits and hospital admission reports indicated low service utilization
compared to expansion of physical access of health facilities. Indeed it is not easy to collect adequate
data on the barriers of utilization. Nevertheless, factors such as what services are offered at what
location, direct and indirect cost of health care (e.g service fee for health care services and transport
cost to get to health facilities) , cultural issues, providers’ attitude and competencies, patent/client
preference and health seeking behaviour of community are believed to influence the health service
utilization.
The fourth health sector development program (HSDP IV) delineates improved access to quality health
care at all levels and at all times as one of the strategic results. This strategic result is ensured through
supporting community to practice and produce good health and protected from emergency health
hazards. The main concepts are promotion of good health (environmental and personal hygiene,
nutrition, and exercise), prevention of disease, providing curative and rehabilitative services, and timely
management of public health emergencies. To improve access to health service, the health service
delivery is organized at household/family, community and health facility level.
These concepts aim to improve the following strategic objectives:
 community empowerment, ownership and positive health practice,
 improve maternal, neonatal, child, adolescent and youth health, nutrition,
 hygiene and environmental sanitation (WASH) and
 to reduce/combat HIV/AIDS, TB and Malaria and other communicable and non-communicable
diseases.
To attain these strategic objectives:
3
[HSTP ZERO DRAFT_V2] 10th May, 2014
1) the health development army (HDA) and the health extension program serve at the base ( household
and community) level for health promotion, disease prevention and selective curative services through
implementation of health packages and integrated community case management of diarrhoea,
pneumonia, malaria, and sever acute malnutrition.
2) The health centres provide support for promotion of health, prevention of diseases and basic
curative services. Health centres are supposed to provide Basic Emergency Obstetric and neonatal care
(BEmONC), treatment of TB, HIV/AIDS including PMTCT. HCs serve as the first referral points for the
health posts.
3) Primary and general hospitals are mainly providing curative services and also supposed to provide
comprehensive emergency obstetric and neonatal care (CEmONC).
4) referral and specialise hospitals mainly handling more complicated and specialized health care
including treatment of non- communicable diseases.
Table 1 Levels and trends of health and socio-economic indicators in Ethiopia, 2000-2011
Unit
Survey Years
Indicators
2000
2005
2013UNIGME
(HMIS)
2011
Health indicators
Potential health service coverage
%
51
72
92
Proportion of children stunted
%
52
47
44
Proportion of children wasted
%
11
11
10
Proportion of children underweight
%
47
38
29
Previous birth interval (median no of months
months)
Proportion of women 15-49 using
%
Contraception (any method)
Antenatal care coverage (1 visit)
%
34
34
34
8
15
29
6
29
43
97
Antenatal care coverage (4 visits)
%
10
12
19
No data
Protection against tetanus
%
17
32
48
Delivery at health institution
%
6
5
10
Skilled delivery
%
5
6
10
Early initiation of breastfeeding
%
52
69
52
%
4
49
52
%
22
32
37
88
Measles vaccination
%
22
35
56
83
Fully Immunized children
%
14
20
24
78
Vitamin A supplementation
%
56
46
53
Seeking care for pneumonia
%
16
19
27
Seeking care for fever
%
19
18
24
ORS during diarrhoea
%
13
20
26
Received antibiotics for pneumonia
%
6
5
7
Received anti-malaria’s for fever
%
3
3
4
Exclusive breastfeeding
months
DPT3 vaccination
until
six
23
4
[HSTP ZERO DRAFT_V2] 10th May, 2014
Socio-economic indicators
Households with Access to safe
drinking waterwith access to toilet
Households
facilities
Women 15-49 Primary education
attainment
Women 15-49 Secondary education
%
25
34
54
%
18
38
62
%
18
26
41
%
5
6
4
attainment of women in union
Proportion
%
64
65
62
1
1
2
19
19
19
Proportion of women with access to
%
mass
media
Women’s
median age at first birth
Years
Source: CSA, Ethiopian Demographic and Health Surveys and MoH (2000, 2005, 2011)
Reproductive health and family planning
Family planning
According to EDHS, the total fertility rate for Ethiopian women reduced from 5.4 to 4.8 children in the
five years between 2005 and 2011. The contraceptive prevalence rate has almost doubled from 15% to
29% in the same period. Albeit the total fertility is still considerably higher among rural women than
urban, 5.5 and 2.6 respectively, the decline in total fertility and an increase in CPR were mainly among
rural women. EDHS 2011 also shows that there are significant disparities among the regions, (with Addis
Ababa highest 63% and below 10% in Afar and Somali regions), between Urban and rural (53% and
23%), by income levels (13% for lowest versus 52% for highest quintiles) and educational status (22% for
the uneducated versus 58% for those with higher than secondary education). While the urban-rural gap
showed a narrowing trend, widening is observed in CPR for economic and educational status.
Moreover, despite the significant increase in the CPR, the unmet need remains to be high at 25%, again
with regional variations, showing the program is not in par with the demand that is created. The
program fares even lower in reaching adolescents, with an unmet need of 33% for the age group of 15
to 19 years old.
70
60
50
40
30
20
CPR
10
Unmet need for FP
0
Fig: Regional variations in contraceptive use and unmet need for FP, EDHS 2011
While geographic and sociocultural factors account for much of the regional variations, the assumptive
attitude of providers, both at health facilities and filed workers, was documented in DHS 2011. The
percentage of nonusers who were visited by a fieldworker and who discussed family planning varies
5
[HSTP ZERO DRAFT_V2] 10th May, 2014
notably by region. The highest percentage is in Tigray (28 percent) and the lowest percentages are
observed in Somali (7 percent), Affar (8 percent), and Gambela (9 percent). Afar is one good example of
gaps in awareness and sociocultural barriers. Despite having a very low level of contraceptive use, its
unmet need for FP is not among the highest.
The HMIS data measures contraceptive acceptance rate (CAR) which is the proportion of women of
reproductive age (15-49 years) who are not pregnant who are accepting a modern contraceptive
method (new and repeat acceptors) in the year. The national contraceptive acceptance rate in EFY
2005 is about 60% ranging from 86% in Amhara to 8% in Somali region. Even though the findings of DHS
and HMIS noticeably differ, both confirm family planning use is markedly increasing in general and wide
variation exists among regions. Among women who do use contraception, although the use of
injectable contraceptives account for much of the increase in CPR over the past decade (from 3% in
2000 to 21% in 2011) the uptake of long acting contraceptive methods, particularly implants, has shown
a very remarkable increase recently (from 0.2% in 2005 to 3.4% in 2011) coupled with a significant drop
in pill users. The increase in modern family planning use, including in implant uptake, is attributed to
increase in access to family planning service and education particularly through health extension
program. Availability of contraceptive commodities at health facilities, particularly the short acting ones
is almost universal, with less access to long acting and permanent methods. Supply side challenges,
including lack of skill, equipment/commodities and responsiveness, plus the socio cultural barriers to
demand require further work. Basing on the documented success, addressing disparities and ensuring
full access and full choice for all segments of the community are vital to benefit fully from meeting the
FP needs of the society.
Abortion care
About 500,000 pregnancies are estimated to end in abortion (both spontaneous and induced) each year
in Ethiopia. Comprehensive abortion care includes safe abortion care, post abortion care, and medical
abortion. Abortion care has been given for 138,303 clients in EFY 2005. However, it is not clear whether
this data includes the service provided by NGO and private clinics. Safe abortion is provided as the law
permits following the 2005 revised family law in relation to abortion and issuance of safe abortion
technical guideline in 2006. Safe abortion care has been introduced in hospitals and health centers in
the last few years. Now days, the service is readily available in some public, private and NGO run
facilities. However, most public health centers are not currently providing comprehensive abortion care
which needs to be expanded. The challenges to fully exploit the legal environment to the wellbeing of
mothers include low awareness on the existing law among community members and health workers,
provider attitude, skill gaps, shortage of supplies and poor follow up and monitoring within the health
sector. Improved follow up by regional and woreda officers, including allocation of human and local
financial resources, can help in realizing the benefits of quality abortion care services.
Adolescent and youth friendly reproductive health
Adolescents and young people aged from 10 to 24 years account about 30% of the total population.
Recognizing the fact that these group are extremely vulnerable to STD/HIV/AIDS, unwanted pregnancy
and abortion, the MoH developed national strategy (2006-2015), minimum service package and
monitoring tool for scaling up of adolescent and youth reproductive health services. The target for
HSDP IV for adolescent and youth reproductive health was to reduce adolescent fertility rate from 17%
to 5% and to expand youth and adolescent friendly reproductive health services to all hospitals and
health centers. According to EDHS 2011, the adolescent fertility rate is at 12% and there is a
disproportionately high unmet need for contraceptives in the younger age groups.
HMIS data does not capture whether health centers provide adolescent and youth friendly health
service. It is known that, some health centers particularly in urban areas provide AYFRHS. Lack of
adolescent and youth friendly health service in most of the public health facilities is recognized
including in the HSDP IV midterm review. The effort by the regional health bureau, woredas or health
6
[HSTP ZERO DRAFT_V2] 10th May, 2014
facilities to expand adolescent and youth friendly health services is suboptimal. Although there is
increasing demand for service from young population including in rural areas, these group is yet
hesitant to use the service in public facilities. Provider bias was also indicated in DHS 2011. An
interesting age pattern is observed for women who were visited by a fieldworker who discussed family
planning, as well as for those women who visited a health facility in the past12 months and discussed
family planning. For both groups of women, the percentage that discussed family planning is lowest in
the youngest age cohort, age 15-19, but steadily increases and peaks in the 35-39 age cohorts before
declining in the oldest age groups. For example, only 10 percent of women age 15-19 reported being
visited by a fieldworker who discussed family planning, compared with 22 percent of those aged 35-39.
In fact, while there is no debate the program should reach this group with a focused approach,
questions have been raised if having a AYFRHS corners in the health centers is the best approach to
achieve it. Expanding the service availability in other outlets that are more accessible to the youth may
need to be given more attention. Therefore, designing and implementing multiple, innovative and
coordinated approaches to reach adolescents in union, in school and coming to public health facilities
and those that are not in union, not in school and not coming to public health facilities is quite crucial.
Improve Maternal and Newborn Health
The HSDP IV target for improving maternal health was to reduce maternal mortality ratio (MMR) from
676 per 1000,000 live births in 2010 to 267 per 100,000 in 2015. Service coverage targets included
increasing ANC at least first and fourth visit from 68% to 90%, and 31% to 86% respectively, increasing
deliveries attended by skilled birth attendants from 10% to 62 %, conducting maternal death
surveillance, increase postnatal care from 34% to 78% and increase coverage of ARVs for prevention of
mother to child transmission of HIV from 8.3% to 77%.
Antenatal care
EDHS 2011 reported the ANC follow up with at least one visit and four plus visit as 43% and 19%
respectively. Whereas, according to HMIS data, in EFY 2005 proportion of pregnant women received
ANC (at least one visit) was 97% with 41.6% in Somali to 100% in Tegray, Oromia, SNNPR, Dire Dawa,
and Harari regions. The 100% coverage might be attributed to double counting in different health
facilities, particularly between a health center and its health posts. HMIS does not yet capture ANC four
visits.
Looking in to key service packages delivered using the ANC forum, tetanus toxoid vaccination was
received in 65% of pregnant women among those who were reached by the 2012 EPI survey and LLINs
utilization by pregnant women was reported at 42% in 2011 malaria indicator survey. Screening and
treatment of syphilis for pregnant women is yet very low. Use of magnesium sulphate for prevention
and treatment of eclampsia is at rudimentary level.
While there is no doubt that access to ANC services has markedly improved, the quality of the ANC
services is yet to be ascertained in order to meaningfully contribute to the health of mothers and their
newborns. This need to be combined with routine monitoring of essential ANC components like
micronutrient supplementation and screening and treatment for syphilis
PMTCT
With regard to prevention of mother to child transmission (PMTCT), the number of health facilities
providing the service increased from 1352 in EFY 2002 to 2150 in EFY 2005. However the PMTCT
coverage remains still low. Proportion of pregnant women counselled and tested for PMTCT reached
55% in EFY 2005. Among estimated HIV positive pregnant women, only 43% received prophylaxis or
antiretroviral therapy. The low level of facility delivery, poor referral linkage in some areas, low
community awareness and ever-changing modality contributed for low coverage of PMTCT. Recent
efforts, guided by the National Road Map for maternal and new-born health and the accelerated plan
for PMTCT, are very encouraging with rapid increase in prophylaxis coverage from less than 20% in EFY
2003 to more than 40% in 2005. Further efforts that focus on delivering PMTCT services as an integral
7
[HSTP ZERO DRAFT_V2] 10th May, 2014
component of MNCH care packages and focusing on areas with high unmet needs is to be undertaken
to achieve the goals of eliminating MTCT of HIV, as stated in the strategy document.
Clean and safe delivery by HEWs
As stated in EDHS 2011, about 90% of births took place at home without skilled attendants. As per
HSDP-IV , HEWs were to assist about one third of deliveries with six cleans (clean hands for the birth
attendant, clean birth surface, clean perineum, clean implement to cut the umbilical cord, clean cord tie, and a
clean cloth for drying ) and do early identification and referal in case of complications. According to HMIS
reports, trend in clean delivery decreased in the last couple of years in Tigray, Amhara, Oromia, SNNPR,
Gambela and Dire Dawa while increasing in Afar, Somali, Benshangul Gumez and Harari. The push
towards encouraging all women to deliver at health facilities (with the general motto of having “home
delivery free kebeles”) is one primary reason for recent declines in women who were attended by HEWs
and is very likely to continue in the coming years as well, limiting the role of HEWs primarily to the
promotional activities in ANC, including supporting the mother for birth preparedness and referral and
the post-delivery follow ups. However, it may be too early to totally disregard the value of clean and
safe delivery practices and community level distribution of oxytocic agents by HEWs and require to be
given a carefully weighed position in the continuum of care.
Institutional delivery and emergency obstetric care
All pregnant women are encouraged to deliver at health facilities with skilled attendance. The HSDP IV
target for skilled birth attendance was 62%. However, the proportion of skilled birth in EFY 2005 is 23%.
Although there are wide variations across regions, tremendous improvement in skilled birth attendance
has been reported in some of the regions recently. Remarkable increase in skilled delivery was reported
from Tigray region and some zones of Oromia, Amhara and SNNPR in EFY 2006 first six months. Given
the speed of change that is being observed, HSDP-IV targets for institutional delivery, however far it
looks at the moment, may not be well off-reach. The recent increase in skilled birth attendance is
ascribed to high level political commitment, movement of HDA and HEWs with resultant demand for
services, and provision of ambulances on top of expansion of health facilities and deployment of
midwives.
The number of health centres and hospitals providing basic and comprehensive emergency obstetric
and new-born care are increased compared to 2008 national baseline assessment. According to HMIS,
the number of HCs that are ready to provide BEmONC service has increased to 1813 (%) and 105
hospitals can provide CEmONC. However, the rate of caesarean section, an important indicator of
access to emergency obstetric care, is 1.6% of all the estimated pregnancies in the 2005 EFY, compared
to the national target of 7%.
Equally important is the need to aggressively work on improving the unacceptably low level of quality of
care in MNCH. Improving the availability of skilled health workers, including in emergency obstetric
care, provision of supplies, institutionalizing standard practices and continuous quality improvement
mechanisms are on-going efforts to increase quality of care. These need to be combined with alleviating
the basic infrastructure gaps of the health facilities, particularly in water and electricity supplies,
currently lacking in more than half of the health centres. Performance based incentives for health
facilities and/or health workers and motivating and positively changing the attitude of health workers is
one area that can be explored for better quality of care.
As one tool of improving the quality of maternal health care and particularly care during pregnancy,
child birth and the post-partum period, the MoH launched national maternal death surveillance and
response (MDSR) system in May 2013 that was rolled out in phases for nationwide
implementation. Initial reports are encouraging in terms of reporting and particularly locally
responding to address avoidable cause of deaths. This system, once institutionalized, can also be
8
[HSTP ZERO DRAFT_V2] 10th May, 2014
used for tracking maternal deaths with the aim of counting each one of them and helping to
achieve a more accurate estimate.
Postnatal Care
In EFY 2005 it was reported that about half of delivered mother had postnatal check-up by any health
worker within 42 days of delivery, again, with variations across regions. Comprehensive postnatal care
by trained health worker within two days after delivery is recommended for the health of the mother
and new-born. Although this is not captured by HMIS, EDHS 2011 reported coverage of 7% for PNC
within the recommended two days period. One important intervention that needs to be given added
emphasis during the immediate post natal care is promotion of early and exclusive breast feeding.
While breast feeding is a universal practice in Ethiopia, both in rural and urban population, early
initiation and exclusive breast feeding remain to be limited (both at 52% as per DHS 2011). It is believed
that increase in skilled delivery and introduction of community based new born care will significantly
increase the postnatal care coverage in the coming years.
Essential new-born care interventions
The neonatal period is critical period for the survival of new-born. EDHS 2011 reported the Neonatal
Mortality Rate (NMR) as 37/1000 live births, which has not shown significant declines from the earlier
report.
Table Trends in child mortality rate
category
EDHS 2000
EDHS 2005
EDHS2011
2012 UN IGCME
U5
165
123
88
68
child
76
50
31
infant
97
77
59
post neonatal
48
38
22
Neonatal
49
39
37
47
29
Close to 80% of neonatal deaths are attributable to infection (37%), asphyxia (25%) and prematurity
(17%). Hence service coverage targets for reduction of neonatal mortality were to increase proportion
of resuscitation of asphyxiated children from 7% to 75% and increase treatment of sepsis from 22% to
74%. Although coverage of maternal and newborn health interventions across continuum of care has
increased, utilization of key high impact service are still lagging compared to HSDP IV targets.
HMIS does not capture newborn care services yet; other limited scope surveys (COMBINE data, L10K
survey 2011) show there is not much of a change from the base line in addressing these problems.
A number of initiatives are ongoing to tackle the challenge including availing newborn corners at health
centers, establishing neonatal intensive care units in referral hospitals and more recently, community
based newborn care by HEWs. The results of all these concerted efforts are yet to be seen.
Child Health interventions
9
[HSTP ZERO DRAFT_V2] 10th May, 2014
Ethiopia is among the few countries in the world that are recognized to achieve MDG 4 targets three
years ahead of the due date. This by large is attributable to large scale implementation of promotive,
preventive and curative primary health care interventions coupled with socioeconomic changes. Among
the important interventions that have been successfully implemented and contributed to the
achievement are IMNCI (currently being provided in 71% health facilities) and ICCM (with a national
coverage of 79%), prevention and management of malaria (with 65% of under 5 children sleeping under
ITN with IRS reaching 47% of houses in endemic areas in 2011), and community based nutrition
programs. However, the coverage of some other essential interventions like proper case management
of ARI and diarrhoea is still low.
EPI, another important intervention, is not performing to the
expectation in recent years. Immunization program in many areas is now suffering from high dropout
rates, supply shortage, vaccine stock out and poor follow up.
Routine EPI coverage and Surveys (Penta 3 and Measles) 2003 to 2013
Source: FMOH 2005, 2008, 2011/2012, vaccine coverage survey 2012
Sustaining the momentum and further reducing child morbidities and mortalities with the aim of
preventing all avoidable child hood deaths is an important task at hand and requires continuing
community engagement, further scale up of services with improved quality across the continuum of
care.
Nutrition
Nutrition is a crosscutting issue that contributes to achievement or acceleration of progress towards
several MDGs. Ethiopia has the highest rate of malnutrition in Sub-Saharan Africa, and faces the four
major forms of malnutrition: Acute and Chronic Malnutrition, Iron Deficiency Anemia (IDA), Vitamin A
deficiency (VAD) and Iodine Deficiency Disorder (IDD). These are compounded by high incidence of
malaria and other parasitic diseases. A national nutrition strategy and program (NNP) has been
developed and implemented by the Government of Ethiopia (GOE). The HSDP IV has integrated nutrition
into the HEP to improve the nutritional status of mothers and children through the following programs:
Enhanced Outreach Strategy (EOS) – now being transformed into the Community Based Nutrition
program (CBN), Health Facility Nutrition Services, and Micronutrient Interventions and Essential Nutrition
Actions / Integrated Infant and Young Feeding Counseling Services.
The NNP has been revised with a special focus on key actions using the lifecycle approach to (i)
accelerate stunting reduction, (ii) to provide more focus on maternal nutrition, together with (iii) more
emphasis on inter-sectoral actions on nutrition. The revised NNP will serve as an implementation
framework for supporting the scaling-up and monitoring of key nutrition interventions in the country.
10
[HSTP ZERO DRAFT_V2] 10th May, 2014





The prevalence of any anemia has declined from 27% in 2005 to 17% in 2011, a decrease of 37%.
The prevalence of mild and moderate anemia also has declined between the two DHS surveys, from
17% to 13%, and from 8% to 3%, respectively.
There has been almost no progress in wasting, and slightly more progress in stunting and in the
proportion of underweight children but still falling short of HSDP targets. However, with some
additional effort and an absence of emergencies the targets could be achieved.
Breastfeeding is nearly universal in Ethiopia, but a very large proportion of women do not practice
appropriate breastfeeding and complementary feeding behavior for their children. About a third of
babies do not receive breastfeeding within one hour of birth and only 27% of babies receive prelacteal feeds (with 73% of babies receiving pre-lacteal feeds in Somali, DHS 2011). Only one-in three
children age 4-5 months is exclusively breast fed.
In EFY 2004 10,000 Health Facilities were treating SAM – 95% are HPs. In total 3995 metric tons
Ready to Use Food was disseminated. The HMIS report that 322,336 SAM cases were treated last
year with 85.2% cure rate, defaulter rate of 4.1%, and a mortality rate of 0.4%.
Hygiene and environmental Sanitation
Promoting hygiene and environmental sanitation is one major component of the health extension
program. Improving personal, food and household hygiene, promoting improved household latrine
preparation and utilization, improving water quality through proper handling, and safe disposal of liquid
and solid waste are some of the key packages in hygiene and sanitation component. The HSDP IV target
for household latrine utilization was to increase from 20% to 82%, to increase proportion of open
defecation free kebeles from 15% to 80% and households practicing safe water handling and treatment
from 7% to 77% which were ambitious targets.
According to administrative data the latrine coverage is increased to ___with disparity in coverage
across regions. Hygiene and latrine coverage is enhanced through community led total sanitation
(CLTS), HDA, model family initiatives and mobilization through celebration of successes. However,
quality of implementation, scale-up of best practices, monitoring and evaluation of utilization of latrines
and water quality, marketing improved sanitation facilities need to be strengthened.
Prevention and control of major communicable diseasesTuberculosis & leprosy
Ethiopia is among the high burden countries for drug susceptible TB, MDR-TB and TB-HIV co-infections
as well as among countries that contribute for high number of missed cases of tuberculosis1. According
to the current estimate more than 250,000 people are affected by tuberculosis in Ethiopia every year
with more than 16,000 estimated deaths1. Hence, Tuberculosis is still among the major communicable
diseases with huge public health significance. Detecting and curing tuberculosis are among key health
interventions for addressing poverty and inequality.
Promising progresses have been made in the last couple of decades through the Health Sector
Development Programs which were launched since 1997. The earlier strategies (HSDP I & II) were
focused on integrated TB and leprosy control programs (TLCP). HSDP III was mainly focused on
enhancing the case detection rate and completion of treatment. HSDP IV mainly focused on initiatives
that are in line with the global STOP TB Strategy and strengthening early case detection of leprosy.
Four Components of the global stop TB strategies were used as initiatives of the strategic objective of
improving access to health services for prevention and control of tuberculosis.
1
World TB Report, 2013
11
[HSTP ZERO DRAFT_V2] 10th May, 2014
Achievements and challenges against strategic initiatives2
Expansion of Community DOTSAt present, 34% of Health Posts are providing DOTS services (treatment
follow up) as a result, up from only 15% at the beginning of HSDP IV, with a near term target to reach
80% of health posts. The rate limiting factor for expanding community DOTS was the Integrated
Refresher Training (IRT) for HEW’s as the training for Community DOTS has been integrated into IRT.
Hence, the progress with this initiative may be hastened by strengthening program integration to
conduct IRT for HEWs in harmonious and efficient manner.
Strengthening case detection and management The expanding HEW program has facilitated wider
identification of cases (Case Detection) than was previously feasible. Over 2,000 microscopes were
purchased (with Global Fund support) for improving TB diagnosis at Health Centres, expanding the
scope of services being provided. Integrated supportive supervision is being carried out from the
National to Regional levels, improving on the program management.
However, in spite of these efforts, a number of challenges are still noted. Quality of service delivery
challenges abound:
- current case detection achievements and the HSDP IV target of 75% is still below international
standards).
- The internationally accepted norm to establish one TB laboratory per 100,000 population has
not yet been achieved.
- Supply chain disruptions, particularly in TB diagnostic supplies and equipment are affecting
quality of care – partly a result of poor facility capacities for demand driven procurement and
compiling of consumption reports needed for the Integrated Pharmaceutical Logistics System.
This is made worse by the fact that procured commodities, particularly diagnostic reagents, are
too few to satisfy the demand.
Addressing TB/HIV, MDR-TB & Leprosy
TB/HIV collaborative activities are showing improvement as screening rates provision of CPT for HIV
positive TB patients, intensified TB case findings amongst HIV positives, Infection Prevention Control
and INH prophylaxis are increasing.
There has been expansion of MDR-TB diagnosis and treatment sites across the country – 5 regional
laboratories are now providing MDR-TB diagnostic services (up from 1 site at the beginning of HSDP IV),
and 8 treatment sites are now operational (up from 3 at the beginning of HSDP IV). Commodities and
supplies for dealing with MDR-TB are now more available across the country, with 850 patients already
enrolled during HSDP IV.
Intensive training for leprosy management is still carried out in the pockets of the country where the
condition is still prevalent with passive case detection ongoing.
However, we note that there is still inappropriate reporting from facilities of TB/HIV screening, due to
lack of clarity on how to report this from both HIV, and TB clinics. The MDR/TB diagnosis and treatment
sites are still too few, as compared to the increasing burden.
2
HSDP IV MTR
12
[HSTP ZERO DRAFT_V2] 10th May, 2014
. The program is not targeting vulnerable populations as yet, though a childhood TB framework has
been developed to specifically address childhood TB.
The country has reduced investments in leprosy management that has weakened the impact that the
existing capacity could attain. Prevalence of Leprosy has declined from 19.5 per 10,000 people three
decades ago to 0.5 in 2004 E.C. The start of Multi-drug therapy (MDT) has contributed a lot for the
decline by treating about 150,000 people since 1975 E.C. However, the number of new cases reported
in the last decade remains almost the same in a range of 4000 to 5000 patients. The disability rate
(Grade II disability rate) remain 7% in 2004 E.C. despite the target set to reduce it to 1% by end of HSDP
IV from a base line of 7%. Even though the country has able to meet the elimination level of leprosy (< 1
per 10,000 people) at national level, the elimination level is not met in 5 of the regions including Addis
Ababa. Gambella had a rate of 2.4 per 10,000 people. In 2003 E.C., 8.4% of new leprosy cases were
children at national level which is below the global target of 5% indicating poor efforts to interrupt the
transmission of the bacteria. Three regions had high rates of children affected by the disease with a rate
of nearly 20% (SNNP, Benishangul and Gambela).
Engaging all care providers
In the area of engagement of all care providers, Public/Private Mix (PPM) activities are ongoing, with
close to 300 facilities currently involved with the public sector. PPM guidelines were revised in 2011/12,
with the revisions focusing on providing guidance for drug vendors and traditional healers on TB
management, plus MDR-TB management by private hospitals. The country is implementing
International Standards for TB Care. However, collaboration within Government stakeholders is still
quite weak. For example, the PFSA, ENHRI and FMHACA are critical regulatory bodies influencing TB
management that need to coordinate their actions with the FMOH TB program. However, this is not
being done, leading to gaps in quality of service delivery (missing inputs / drugs). There is also
inadequate stewardship at the FMOH across the different case teams that support the program, as
these are not working in a harmonized manner to take advantage of their existing expertise. There is
also inadequate capacity to monitor adherence to ISTC in the country,– such as not holistically
implementing DOTS by HEW’s due to their heavy workloads.
Enabling and promoting research
The TB Research Advisory Committee (TRAC) is in place, with FMOH as its secretariat. An annual
meeting on TB research is held as part of the World TB day celebrations each year where research
findings are shared with stakeholders. The MOH has endorsed a TB operational research road map.
Moreover, there is an ongoing operational research capacity development program being implemented
through AHRI, EHNRI and partners.
One of the long standing challenge of the TB program was the very low case detection rate which was
partly due to the estimate based on WHO’s parameters. The first TB prevalence survey conducted in
2011 has enabled to better estimate the prevalence of the disease. The survey showed a TB prevalence
(all forms) of 240 per 100,000 population, that was lower than the previous model-based estimate (585
per 100,000 population); furthermore, the smear positive TB incidence (less than 80/100,000) was at
least two times lower than the previous estimate.
Progress against HSDP IV targets3
Domain
HSDP IV expectations
Outcomes Increase Tuberculosis Cure Rate
from 67% to 85%.
Reduce mortality from all forms of
3
Status
TB cure rate is still low, at 70.3% (2005 EFY
FMOH report).
TB mortality estimates are at 18/100,000,
HSDP IV MTR
13
[HSTP ZERO DRAFT_V2] 10th May, 2014
Domain
Outputs
HSDP IV expectations
TB from 64/100,000 to 20/100,000.
Reduce proportion of registered TB
patients who are HIV positive 24 to
10%.
Increase TB case detection rate from
36% to 75%.
Increase TB treatment success rate
from 84% to 90%.
Status
showing achievement of the HSDP IV target
Data is not available
Increase proportion of MDR TB cases
treated with second line drugs from
2% to 55%.
Increase proportion of PLHIVs
screened for TB from 15% to 80%.
850 cumulative clients put on MDR
treatment, out of an estimated 2,000 new
clients annually requiring treatment
HMIS data has achievement at 44% (about
half the target), while PEPFAR estimates
target at 86%
TB prevalence Survey (2013) found a CDR of
59% - below the HSDP IV target
Current estimates for treatment success rate
are 91.4%, just above the HSDP IV target
(2005 EFY FMOH report)
Malaria
In past decade, Ethiopia has made significant strides in expanding coverage of key malaria interventions
throughout the country. The commitment of government coupled with support from its partners has
enabled to scale up use of artemisinin-based combination therapy (ACT) as the first line treatment,
expand use of rapid diagnostic tests (RDT) by the Health Extension Workers (HEWs) as well improve the
vector control and prevention through the wide distribution of long-lasting insecticidal nets (LLINs)
supplemented by targeted indoor residual spraying (IRS).
The government of Ethiopia has launched a NATIONAL STRATEGIC PLAN FOR MALARIA PREVENTION
CONTROL AND ELIMINATION IN ETHIOPIA (2011-2015) based on the direction in HSDP IV.
4
In Ethiopia, nationally aggregated data show an increase in admissions, possibly due to an expansion of
health services, with increased hospitals, health centers, and health posts being built since 2005.
However, a review of data from 41 hospitals located at <2000 m altitude (malarias areas) indicated a
>50% decrease in confirmed malaria cases, admissions and deaths in 2011 compared to 2001.
Table: Progress against HSDP IV targets5
Domain
HSPD IV Expectations
Outcomes
Increase proportion of households in
malarious areas who own at least one
LLITN from 65.6% to 90%.
Reduce lab confirmed
4
World malaria report 2013…
5
HSDP IV midterm review
Status
54.8% of HH’s with a LLITN
No evidence in reduction in total
14
[HSTP ZERO DRAFT_V2] 10th May, 2014
Domain
Outputs
HSPD IV Expectations
(RDT/Microscopy) malaria incidence
per year, among under-5 children &
adults to less than 5 per 1000
population per year
Increase proportion of pregnant
women who slept under LLITN the
previous night from 42.5% to 86%.
Increase proportion of U5 children who
slept under LLITN the previous night
from 41.2% to 86%.
No monthly malaria cases report for 24
months from previously malarious
Kebeles of targeted Woredas for
elimination of malaria.
Increase proportion of households in
IRS targeted areas that were sprayed in
last 12 months from 55% to 77%.
100% of suspected malaria cases are
diagnosed using RDTs & or microscopy
within 24 hours of onset of fever.
Reduce lab confirmed
(RDT/Microscopy) malaria case fatality
ratio among under-5 children & adults
to less than 2%
Status
numbers of Malaria cases (through
national fever prevalence has reduced
from 24.0 to 19.7% un I5’s, and from
21.8 to 14.9% in U1’s. mortality has
reduced) Malaria prevalence
(microscopy under 2,000m) at 1.3 per
1,000 (1% Pf, 0.3% Pv), and by RDT’s
at 4.5%
35.3% of pregnant women slept under
a net, the previous night (63.8%
amongst HH’s with at least one net)
38.2% slept under a net the previous
night (64.5 amongst HH’s with at least
one net)
Increase in HH’s covered, from 20% in
2007 to 46% in 2011
Access to care metric improved, from
15% access to care within 24 hours to
51% at present
Mortality has reduced significantly,
due to better drug quality and early
diagnosis
Achievements and challenges against strategic initiatives6
Early diagnosis and treatment of cases
Community and facility capacity for early diagnosis has been increased through training of HEWs to
diagnose and treat malaria using RDT as well as availing malaria diagnostic and treatment commodities
at health centres and hospitals. As a result, for example, 69.2% of facilities in Afar region are providing
malaria services as compared to only 24% at the start of HSDP IV. There are adequate quantities of
RDT’s and ACT’s at the central PFSA stores. Microscopes (over 2,000) were also provided to Health
Centers, to improve microscopic diagnosis of malaria. However, malaria commodities procurement is
not holly integrated into the PFSA procurement process. In addition, quality of service delivery at the
health facilities is still weak, with stock outs particularly of diagnostic supplies leading to poaching of
RDT’s from HEW’s to lower level facilities, and subsequent pockets of RDT shortages amongst HEW’s.
Some regions (e.g. Tigray region) report delays in procurement and distribution means critical
commodities arrive with short remaining shelf life, so stock outs persist even when supplies are
provided.
6
HSDP IV
15
[HSTP ZERO DRAFT_V2] 10th May, 2014
Selective vector control
Vector control initiatives (LLITN/IRS use and environmental management) have progressed but slowly
during HSDP IV. Availability of LLITN’s has been inadequate, with many households having LLITN’s for
more than 3 years, making them ineffective. 7In 2006 EFY, 19.5 million LLITNs are planned to be
distributed to replace old ones and 10.7 million were distributed making the total of 57 million ITN
distributed so far. There has been poor targeting of vector control initiatives (particularly LLITN’s), with
non-malarious areas also receiving the supplies. There is also inadequate health education in malarious
communities on use of LLITN’s. Locally produced IRS is now being pursued, with a local factory (Adami
Tulu insecticide factory) producing the chemicals needed for this season. Insufficient supportive
supervision is carried out to malarias areas. Delayed operational funding for IRS activities due to the late
publication of the IRS Policy has limited the ability of Woreda to implement their planned activities.
A number of information challenges exist including sharing of PHEM surveillance data to FMOH on
timely manner.
HIV
Since the discovery of HIV virus in 1984, HIV/AIDS was recognized as a national priority agenda to curb
the epidemic. HIV/AIDs policy followed up with prevention and control strategies were designed and
implemented with the support of development partners and the community at large. As the result of
concerted effort, the national prevalence of HIV has reduced to 1.5%.
According to the recent EHDS, the number of people are living with the virus are estimated to be
760,000 with 160,813 of them are children.
The leadership commitment at all level in the fight against HIV/AIDS was enormous evidenced by
establishment of HAPCO, the national coordination council lead by the president and woreda and
regional councils. Mainstreaming of prevention and control of HIV/AIDS, though not fully implemented
in all institutes, has contributed to augment the effort of curbing the epidemic.
Table: Progress against HSDP IV targets
Domain
HSPD IV Expectations
Outcomes Reduce incidence of HIV in adults from 0.28%
to 0.14%
Increase proportion of population aged 15-49
years with comprehensive knowledge of
HIV/AIDS from 22.6% to 80%
7
Status
Incidence down to 0.03%
General knowledge on HIV is high,
though comprehensive knowledge
is low. No overall data, however, on
current figures
2006 EFY 6 month MOH report
16
[HSTP ZERO DRAFT_V2] 10th May, 2014
Domain
Outputs
HSPD IV Expectations
Provide HCT (VCT+PITC) to 9.2 million people
(annually)
Increase percent of people aged 15-24 using
condom consistently with non-regular
partners from 59% to 95%
Increase proportion of eligible children who
are receiving ART to 95%
Increase proportion of eligible pregnant
women receiving ART to 95%
Increase proportion of eligible adults receiving
ART from 53% to 95%
Increase number of patients ever started on
ART from 246,347 to 484,966
Increase number of STI cases treated from
39,267 to 60,000 Outcomes
Status
At present, over 11 million persons
a year are receiving HCT
Limited scale up of pediatric HIV
Scale up of PMTCT services, and at
present, testing of 1.1million, out of
2.3 million ANC mothers. However,
40% of HIV +ve mothers are lost to
follow up
Over 300,000 persons are on
treatment, out of a target of
400,000
Over 104,607 cases treated in 2012
8
Achievements against strategic initiatives
Strengthening enabling environment
(CB, Community empowerment, leadership & governance, mainstreaming, coordination and
partnership…)
The health related response is coordinated by HIV case team of the FMOH. The HIV/AIDS Prevention
and Control Office (FHAPCO) continue to coordinate and lead the multi sectoral response to HIV.
Strengthening HIV Prevention
Looking at HIV prevention, initiatives were to focus on intensifying the implementation of HIV/AIDS
programs, reduction in vulnerability to HIV among vulnerable and risk groups, and increasing access and
utilisation of services. Progress achieved was as follows:
 Mapping of HIV hotspots was initiated, as part of National MARP survey
 Assessment of regional disparities in HIV is ongoing through a series of regional transmission studies
 There has been an increase in overall knowledge on HIV across the country. There is evidence that
generation, and sharing of group knowledge amongst peers has enabled information sharing, even
when comprehensive knowledge on HV is low. In addition, the program has taken advantage of the
Health Development Army, and schools to increase the comprehensive knowledge on HIV in
communities
 Vertical resource mobilization, with horizontal /integrated implementation of activities is being
practiced
 National mapping of OVC’s has been done, with communities and organization which can support
OVCs within their familial networks identified under the leadership of the Federal Ministry of WCY.
8
HSDP IV midterm review
17
[HSTP ZERO DRAFT_V2] 10th May, 2014
Trends of performances for all spheres of supports to OVCs showed improvement. Food and
psychosocial support, plus training and financing of Income Generating Activities are provided to
PLWHA and OVCs. Educational and shelter supports are also provided to OVCs – at least 60% of
OVC’s or PLWHA are receiving some form of support, as per FHAPCO during HSDP IV.
Create access & quality of chronic care & treatment
Initiative 4: Strengthening care & support
On the other hand, the strengthening of care & support to mitigate impact of AIDS was aimed at
enhancing the provision of standardised care & support to OVC &PLWHA, creating access & quality of
chronic care & treatment, strengthening involvement of local communities in care and support of
HIV/AIDs, and strengthening income generating activities to sustain the program.
 ARV drug availability was significantly strengthened, with wide availability of particularly adult HIV
drugs based on standard regimes.
 Supply side initiatives directly addressing HIV service availability were strengthened. HR capacity
building through training and regular mentoring, consistent provision of HIV laboratory and
treatment commodities and performance monitoring through supervision, proper data collection and
information dissemination were all carried out.
Key challenges
While the overall trends in HIV targets are positive, the country has a number of areas where challenges
not well managed can lead to an explosion of the epidemic.
The national expansion of infrastructure and services are opening up areas of the Country, where HIV
prevalence and incidence have been low. High risk populations and behaviors related to these economic
activities are potentially exposing an increasing population to risk of exposure to HIV. This is made more
worrisome by the low comprehensive HIV knowledge across the Country.
There is still a major challenge with provision of consistent leadership by Government. This is made
more acute due to the wide stakeholder base in HIV activities - civil societies, faith-based organizations,
community based organizations, associations of PLWHA, national and international organizations, the
private sector and multilateral and bilateral organizations. Roles and responsibilities overlap across
institutions and bodies, particularly with regard to the health response. Resources for management of
the health response are, for example, still managed through FHAPCO. The National AIDS Council (NAC)
chaired by HE the President hasn’t met in the past 2 years (should meet at least twice / year). HAPCO
Management board chaired by HE the Minister for Health hasn’t met in 3 years (should meet monthly).
There is weak stewardship capacity at the FMOH (only one focal point) and at the Regional and Woreda
levels. Case teams spread the responsibility for regional support across a diverse reporting structure,
making coordination difficult. Decision making on technical directions is, as a result, usually delayed due
to many competing interests amongst the actors involved. The work culture is focused more on
planning and meetings, with limited follow up of what is agreed – leading to initiatives started, but their
implementation not attained. Clear strategic direction is therefore lacking in some areas, with partners
not clear on the direction the Government wants to take activities.
Separate planning and reporting processes still exist for the health response, through both FHAPCO and
the FMOH.
The success at the impact / outcome level is primarily limited to adult HIV interventions. There is very
little / no progress particularly in relation to PMTCT, and pediatric HIV interventions. While there are
national efforts to scale up PMTCT services, access to it will largely depend on the scale up of the health
system.
18
[HSTP ZERO DRAFT_V2] 10th May, 2014
Quality of service delivery for HIV interventions is also hampered. There are frequent breakdowns of
critical equipment, particularly for HIV care and treatment (CD4 machines). For example, most CD4
machines in Hariri region are non-functional due to lack of maintenance. In addition, not all of the
health centres are currently providing HIV services. The PFSA is still having some distribution challenges,
with stock outs for OI drugs even when these are in country. HEW’s are not yet being used as a resource
for HCT, due to the need to maintain a level of quality of the services – a significant missed opportunity.
As another example, there is only one functioning CD4 machine in Asosa hospital in Benishangul Gumuz
region, and the chemistry analyzer is not functioning, seriously reducing diagnostic capacity in the
region..
The large OVC needs are straining the capacity of provision of the targeted interventions. Current
interventions are not sustainable – focus on IGA’s is not yet at a level that can allow sustained economic
empowerment amongst the OVC’s.
The mismatch between the Country’s well intentioned push for universal access, and existing resources
is spreading potential impact of interventions unnecessarily too thin. As a result, the MARPS are not
receiving the focused resources required to manage the epidemic amongst them, with these resources
being spread widely for population equity reasons.
Additional notes
Neglected Tropical Diseases
In Ethiopia, most of the NTDs in the WHO list are present, but eight attract most attention because of
their high prevalence, tremendous health and development impacts and amenability to control. Although
comprehensive, systematic and integrated responses are lacking, control programs for individual NTDs
such as onchocerciasis and trachoma exist at national scale. The targeted diseases include dracunculiasis,
leishmaniasis, lymphatic filariasis, onchocerciasis, podoconiosis, schistosomiasis, soil transmitted
helminthiasis and trachoma. These disease are known to debilitate, deform, blind and kill sizeable
proportions of the population. Data on the burden of NTDs and their distribution is incomplete; access to
preventive and curative services is inadequate due to ineffecient integration with existing opportunities
such as the HEP. Recently, NTDs have received more attention and were included in the 5-year Health
Sector Development Program (HSDP-IV). In order to make determined efforts for the prevention,
control, elimination and eradication of NTDs and their hidden effects on the population, a multi-year
National Master Plan for NTDs has been developed and is being implemented.
Some of the NTDs are major public health problems in Ethiopia. Trachoma is one of the major health
problems in Ethiopia as a cause of preventable blindness. The country is scaling up the SAFE strategy to
eliminate blinding trachoma by 2010.
Ethiopia is also among four countries where transmission of Guinea worm disease is currently endemic
alongside South Sudan, Mali, and Chad. The number of cases reported yearly is declining. The Ethiopia
Ministry of Health established its National Dracunculiasis Eradication Program in 1991, launching a
village-by-village nationwide search, which found 1,120 cases in 99 villages in two regions of the
southwest part of the country. Transmission of Guinea worm disease in the Southern Nationalities,
Nations, and Peoples Region (SNNPR) was interrupted in 2001, but continued in the Gambella Region.
Gambella Region reported 41 cases in 2008 after zero indigenous cases for 12 consecutive months in
2007. By 2013, only seven cases of Dracunculiasis were reported.
Non Communicable Diseases:
The burden of chronic diseases is increasing in low- and middle-income countries, where it
constitutes a double burden along with communicable diseases, maternal and perinatal
19
[HSTP ZERO DRAFT_V2] 10th May, 2014
conditions and nutritional problems. Contrary to common perception, 80% of chronic disease
deaths occur in low and middle-income countries, where chronic diseases affect younger
populations and lead to premature mortality due to lack of prevention or effective management
of the diseases or their risk factors.
According to a verbal autopsy study on burial surveillance in Addis Ababa, 51% of deaths were
attributed to non communicable diseases followed by 42% died of communicable diseases.
Injuries contributed to 6% of the fatalities. This finding indicates Addis Ababa is affected by
double mortality burden due to non communicable and communicable diseases. As urbanization
is increasing and life span improves, this feature is expected to be observed in a larger segment
of the population mainly in major cities of the country.
Cognizant of the double burden of non communicable diseases, the ministry of health has
developed a comprehensive prevention and control strategic action plan of NCDs and their risk
factors focusing on reduction of risky behavior. The major NCDs that are being considered include
cardiovascular diseases, diabetes mellitus, cancer, respiratory problems, injuries and mental
health.
SO.C2: Enhancing Community empowerment, engagement and participation
Community ownership in health matters is ensured through organizing participating and engaging of
the health development army, involving community representatives in governing health facilities at all
level, strengthening the health extension program and enhancing continues professional, behavioural
and ethical competencies and performance of health workers in their professional duties.
The Health Development Army
Community Health Development Armey
Government of Ethiopia believes organizing citizens voluntarily to functional Development Army as tool
to haste the achievement of GTP targets. To this end, the ministry of health follows the Health
Development Army (HDA) mechanism to organize community and health workers. The health
development army is a group of persons organized based on settlement or social proximity to
participate, teach and learn each other and take practical actions for the betterment of individuals,
families and community health. The name army denotes a group of committed, enthusiastic persons
who are prepared to achieve a certain task or objective. HDA are organized by their
proximity/neighborhood of settlement and other social networking approximately within 0.5 to 1 Km of
every habitation with smallest organized group commonly called one-to-five networks. Based on the
neighborhood about five to six one to five networks’ again is re-organized to health development team
that comprised 25 to 30 household living in the same village. It is built on the tradition of Ethiopian’s
caring each other during the grief or joy.
HDA initiative involves all households in the specific village and broadly all residents in every kebele.
HDA creates wider public movements to address key issues. For instances, it involves youth to be
organized and support to transport laboring women to the nearest road where ambulance can pick or
to health facilities using local stretchers , men also motivated to prepare sanitation facilities and
involved in mass campaigns. Students serve as key messengers for health messages and influenced
their families to practice healthy life style.
Thus health messages and actions reach to each and every household. The purpose of organizing
community is to ensure participation, engagement and empowerment in issues related to own, family
and community health. Early adaptors volunteers who have the credibility from community are usually
selected by team members to mentor members. The health extension workers with support from
20
[HSTP ZERO DRAFT_V2] 10th May, 2014
kebele administration, children youth and women’s affairs and woreda health office organize HDA in
each kebele
HDA with support from health extension workers critically examine what is happening now, what they
want to happen or create in terms of health outcomes; why is there the difference and how do they
need to change the existing situation. The HDA leaders also receive trainings using the family health
guide on key health actions on maternal, newborn and child health.
Although, the mechanism of reaching every household and community through health development
army is relatively recent initiative started during HSDP IV, there are evidences that in areas where HDA
advances the coverage of key health interventions improved significantly. For instance, in Tigray region
where the HDA is functioning well, the number of women giving birth at health centers skyrocketed
more than two times than the preceding year. By organizing ourselves, we are able to advocate our
rights said a woman HDA team leader in Tigray during ARM 2013 field visit. Similarly, the performance
of key health services improved in some zones and woredas of Oromia, Amhara and SNNPR who are
able to organize functional HDA. However, apt organization and capacity building of HDA remains a
challenge in most parts of the country. Particularly the function of HDA in developing regions and urban
areas didn’t matured yet. Tune fining implementation based on evidences, recognition for better
implementation, keeping training, strengthening HEP and PHCU, momentum of political commitment is
critical in scaling and sustaining HDA gains.
Institutional Health development Army
The other wing of HDA is the health workers’ HDA. The health human force is also organized as HDA in
the respective institutions based on the functional areas such as in the same case team, process,
directorates etc. The aim of organizing health workers into HDA is to ensure the implementation of
core values of the health sector as stipulated in the HSDP IV. Implementation of core values of the
health sector will enhance the quality of health care, responsiveness and accountability of the sector.
Improvements in heath service provision have been witnessed in health management /facilities where
health workers HDA has established and functioning. However, some of the health workers are
skeptical about the organization of health workers HDA. Persuading the health work force about the
importance of team work as stated in HSDP IV document, recognition for best performance and close
follow-up of leadership is important for results of the institutional HDA.
Positioning HDA at community and institution level is key factor for the success of many aspects of
health sector reforms in Ethiopia. However, HDA to be successful, first changing individual behavior is
critically important. But, this needs understanding of individual needs and responding for their needs
rather than expert- driven perspective of “we know what you need.” It is also essential to implement
individual behavior change in conjunction with proper organization, incentives and regulation.
Secondly, individual changes to lead into social norm changes, promotion, advocacy and marketing
health (product, place price and promotion) is noteworthy as well. The third point is that public
participation, engagement and empowerment in health matters requires high level political
commitment at all level. The fourth point is that as one size doesn’t fit all sizes, it is noteworthy to
critically examine the implementation of HDA across regions and tune fine based on evidences.
Health Extension Program
Ethiopia’s health extension program is a community based strategy to deliver health promotion, disease
prevention and selected curative health services at the community level. It is a mechanism to provide
health service in an equitable manner to all segment of population in the country. The service is
21
[HSTP ZERO DRAFT_V2] 10th May, 2014
provided free of charge. The HEP has 16 health packages categorized in to four major components. The
four major areas are promotion of hygiene and environmental sanitation, prevention and control of
major communicable diseases, promoting and providing of family health service and health education
and communication. Impressive achievement has been made in scaling up of HEP in rural areas. The
health extension program improves the utilization of health services by linking community and health
facilities particularly health centers. The health extension program supported by organized and
functioning health development army significantly improves the access and utilization of key health
interventions.
The priorities areas in terms of HEP for HSDP IV were scaling up of urban and pastoralist health
extension program , maintain and improving of quality of rural health extension program and
organization of health development army.
As thus far ____ HEWs have been trained and deployed in agrarian, pastoralist and urban areas. In the
last decade tremendous gains have been registered in terms of improving access and utilization of
latrines, increasing contraceptive acceptance rate, ANC, assisted delivery, improved health seeking
behavior, in expanding vaccination services, malaria control and prevention and in reduction of new HIV
infection. Recently HEWs also started treatment of common childhood diseases including pneumonia
and sever acute mal-nutrition. Community acceptance of HEP and HEWs is growing year after year.
Nevertheless, demand for quality and wide scope of services of HEP is also growing among community.
As the number of literate youth community is growing in rural areas, the demand for quality service is
also increasing. Community demand curative service such as first aid, treatment for common illness as
well as delivery service in nearby. To satisfy the demand of the community HEW’s knowledge and skill
needs to be improved. The MoH is working to improve the skills and competency of HEWs through
integrated refresher in service training and upgrading of HEWs into level 4 (diploma). However, recent
evidences from informal discussion with HEWs indicated cynicism among the HEWs. This can be
ascribed by the high turnover of HEWs in some areas which risked the service provision. Some health
posts particularly those constructed by community are deteriorated to the extent of not able to provide
services in. Revisiting of HEP in the coming years is critical to sustain the gains. Besides, training of new
HEWs and creating mechanism for retaining the existing is an issue of urgency to respond for
community demand.
Establishment and Operationalization of Facility Governing Bodies
Establishment of governing body is a hallmark of health facility autonomy. Supervision reports indicate
that all hospitals and 93.3 % of HCs have established governing bodies. The establishment of governing
bodies enhanced efficient decision-making by cutting bureaucratic chains and enhancing the
responsiveness of the health institutions to the local communities. The facility governing bodies
approve the health facility plan and budget, decide on revenue retention and utilization, review
implementation of the new fee waiver system and evaluate performance of health facility, amongst
others. Furthermore, the governing bodies allowed the health facilities to advocate for more resources
and implement innovative income generating activities that could be used to improve quality of service.
The governing bodies’ meeting schedule varies from region to region, and from facility to facility. Most
are expected to meet every quarter. Nearly 52% of hospitals governing boards and 48.5 percent of
health centers governing bodies meet every month. Besides, 97 percent of hospitals and 75 percent of
the health centers confirmed that their respective governing board/bodies approved their expenditure
items in 2010/11 EFY. Of these, all hospitals and 61 percent of the health centers indicated that their
governing board/bodies submitted a facility budget to the RHB/WoHO. And nearly 90 percent of the
22
[HSTP ZERO DRAFT_V2] 10th May, 2014
hospitals and 58 percent of the health centers reported that their retained revenue utilization plan was
appropriated by their respective council.
Facilities noted a high turnover of governing body/board members as a result of their busy work
schedules and absence of incentive mechanisms as their major challenges. Measures taken to
overcome these challenges included continuous discussion and communication with the Woreda
administration and Woreda health office to address replacement or substitution of none-active
members, scheduling meetings at more convenient times for board members, and submitting
recommendations to the respective Woreda administrations for approval of financial incentives to be
paid to governing body/board members. In some regions, the heads of women association are
members of the facility governing boards and hence, they are able to represent gender issues. In other
regions, the participation of women group is weak.
Another area of weakness in governance of health facilities is the fact that the governing bodies provide
less attention to other aspects of governance other than decisions on plans and retained revenue use.
Governance is beyond that. It is about transparency and accountability in delivering services, ensuring
communities’ voice (particularly women, children and the disabled) are heard in prioritizing services and
creating a customer friendly environment, among others.
S.O.F1: Maximize resource mobilization and utilization
Financial resource is a crucial input for provision of adequate and optimum quality health services.
However, the ever increasing cost of health care and multiple competing priorities in resource poor
countries makes financial resources insufficient to make substantial improvements in access and quality
of health care.
This strategic objective sets out a proactive approach to the mobilisation of resources from domestic
and international sources. It includes enhancing pool funding; addressing collection and use of
revenues by health institutions; and establishing a risk pooling mechanism. It also includes attention to
effective and efficient use of resources; sound financial management and performance-based financing;
as well as equitable and evidence-based allocation of resources to priority interventions and
programmes in the health sector.
The total health expenditure increased from
Share for Health from GOE Budget 8.5%
XXX USD/Capita in XXXX to 16.1 USD/capita
in XXXX (5th NHA). HSDP IV set a target of
200000000
increasing total health spending from 16.1
USD/Capita to 32.2 USD per capita.
150000000
Government budget allocation for health
has increased in absolute terms, but the
100000000
share of health from the total Government
budget stagnated. HSDP IV also aimed to
50000000
increase share of government health budget
0
as a proportion of total government budget
1998 1999 2000 2001 2002 2003 2004
from 5.6% to 15%. To this end, allocation of
domestic resource allocation for health
showed increment over the last decade in absolute terms. An overall increment of around 2 billion Birr
per year has been observed. However, the share of health from the total government budget has
stagnated at about 8.5% over the last three years. This will pose a challenge particularly in terms of
improving the quality of care and utilization of the service. (MTR)
According to the health sector reform, improving Retention and Use of Health Care Financing Reforms
(HCFR) is one of the key financial mobilization strategies. HSDP IV has set a target of increasing the
23
[HSTP ZERO DRAFT_V2] 10th May, 2014
proportion of public health facilities retaining and using their revenue from 20% to 100%. Since the start
of implementation of the HCFR, regions formulated proclamation, regulation, directive, and
implementation manuals to align with the national strategy. It is being implemented in 2,241 health
facilities (90 hospitals and 2,151 HCs) in seven regions (except Somali and Afar) and two city
administrations. The regulation was ratified in Somali Region. HCF legal framework documents
(Proclamation, Regulation and Directive) were endorsed in Afar Region. But these two regions are not
yet implementing the HCFR in its full terms. The amount of retained revenue generated in health
facilities varies from facility to facility and from region to region. On average health centers generate
30% of their total budget while hospitals generate 23% from retained revenue. Hospitals on average
retained ETB 1.56 million per year, while HCs retained ETB 0.37 million. The retained revenue has
improved availability of essential medicines, diagnostic equipment and medical supplies. It is also used
for renovation and expansions of rooms and staff housing. Besides the health facilities were able to
cover significant proportion of utility bills, making water and electricity available. (MTR)
Financing of waiver and exemptions systems. There has been improvement over the last years in
government allocation for fee waiver to facilitate access. Total subsidy for the poor has reached more
than 20 million Birr so far. The number of fee waiver beneficiaries has also reached 2 million. While this
progress is encouraging, it constitutes less than 10% of the total population that lives below the poverty
line in the country. Significant variation has also been observed in the amount of waiver allocated per
capita in different regions. This ranges from 2 Birr to 67 Birr per capita, questioning the adequacy of the
waiver to cover the cost of health services consumed by the beneficiaries. Other challenges associated
with the waiver system in some regions include delay in issuing identity cards to targeted households,
lack of contract between local governments and health service providers, and delay in reimbursement
of funds to health facilities. Maternal and child health services (ANC, delivery, PNC and immunization
etc) are among the exempted health services. One of the challenges observed in some facilities visited
is shortage of budget to make available drugs, medical supplies and equipment’s for these services.
(MTR)
Outsourcing of nonclinical services in public hospitals is another core element of the HCFR to enable
health facilities focus on core business while improving efficiency in the system. Reports indicate that
increasing number of health facilities have outsourced none-clinical services to the private sector.
Private Wings in Public Health Facilities has shown positive development, particularly in terms of
reducing the attrition and absenteeism of health workers. At Federal level and in the Regions, public
hospitals are allowed to open and run a private wing with the primary objective of improving health
workers’ retention, providing alternatives and choices to private health service users, and generating
additional income for health facilities. So far 31 private wings have been operationalised in 5 regions
and in Federal Hospitals. The average number of patients served per quarter ranges from 50 (in Abiadi
hospital) to 2,916 (in Axum hospital), with the overall average being 1,492 patients per quarter. Eight
hospitals provided data on the average amount of revenue generated in the private wing/room. It
ranges from 22,882.75 Birr (in Limmu Genet hospital) to 277,027.50 Birr (in Ras Desta hospital).
Experience from other countries indicates that private wings in public hospitals could lead to provider
moral hazard for example by using these services excessively thus resulting in skewed health service
provision, unless regulated and controlled properly. Hence, this is an area where the health sector
needs to pay close attention through systematic monitoring, identification and tackling of hitches and
replication of best practices. (MTR)
Health Insurance (SHI and CBHI): Government’s efforts to address the challenge of high out of pocket
(OOP) spending during use of health services include the introduction of CBHI and SHI for the informal
and formal segment of the society, respectively. HSDP IV sets a target of increasing the proportion of
people enrolled in health insurance from 1% to 50% and start and finalize a pilot test of CBHI in selected
districts. The Ethiopian Health Insurance Agency (EHIA) has already been established and staffed. The
agency is undertaking the necessary preconditions to kick start SHI. These include finalization of
directives and manuals, awareness creation of various stakeholders, finalization of regional branch
24
[HSTP ZERO DRAFT_V2] 10th May, 2014
structure, job description, initiation of recruitment of staff, defining and refining provider payment
mechanisms, and defining and exploring options of capacity building, among others. The Government is
planning to launch nationwide SHI in July 2013. While this is a manifestation of the Government’s
commitment to accelerate the implementation of social protection in general and SHI in particular,
there are crucial factors that still need to be looked into to establish readiness of the system to launch
SHI. These include capacity of the EHIA to manage the system, capacity to collect revenue, verify and
reimburse health facilities, ensure quality of health service, and monitor and mitigate risks associated
with health insurance (fraud, moral hazard, and financial sustainability). CBHI schemes have been
piloted in 13 districts in Amhara, Oromia, SNNP, and Tigray Regional States. Regions have put in place
the necessary administrative and coordination structures and provided trainings. These include regional
steering committee, Woreda health insurance steering committee and 329 kebele health insurance
initiative committees. In 2004 EFY alone, a total of 136 persons were trained on CBHI implementation
from pilot zones and Woredas. Training was also given to 32 Woreda executive staff from pilot Woredas
of Tigray and SNNP Regions on CBHI, Financial Management Admini-stration Systems. Furthermore,
training for 1,062 health providers drawn from hospitals and HCs were organized in Amhara, Oromia,
SNNP and Tigray Regions. Woreda level quarterly review meetings were organized in all four pilot
regions including with health service providers and CBHI section cashiers. CBHI board meetings have
also been conducted. Three dedicated staff have been recruited and assigned in each pilot Woreda to
undertake the day to day operational activities of CBHI. Feasibility studies, legal document (directive),
implementation manuals and communication materials were produced and adapted by each pilot
region.
The scheme so far registered 141,656 HHs (119,426 HHs paying and 22,230 HHs non-paying). It has also
generated ETB 20,671525.07. Health service utilization by CBHI pilot scheme members has substantially
increased in the pilot districts.
The average coverage of CBHI in the 13 pilot districts stands at 47% indicating that about half of the
eligible population is yet to be enrolled. The introduction of CBHI and SHI is seen as vehicle for
progressing toward UHC in Ethiopia as envisaged by HSDP IV. However, the Health Care Financing
Strategy has not been revised in light of the recent developments in the health financing landscape
(both within and outside the country) and evolving concept of UHC. Hence, revision of the HCF Strategy,
preferably before the end of HSDP IV, will help to stir-and-sieve pertinent strategies and initiatives that
should constitute financing of Ethiopian health sector beyond 2015.
External Resources for Health:
Resource mapping has improved at national levels but still leaves a lot to be desired at sub-national
levels. More and more partners are providing information on the amount of funds and areas financed
on annual basis to FMOH. In 2004 EFY, 95% of DPs provided such information. The FMA 2011 indicated
that shortcomings in terms of comprehensiveness and realism of budget exist at the lower levels of the
sector, such as Regions and Woredas, and/or are result of unavailability of information regarding the
resources and expenditures of other actors in the sector. Regional visits to look into this status of affairs
by the MTR team concluded that no or little progress had been made in this regard. These are the areas
in which efforts need to continue in order to improve comprehensiveness and credibility of plans and
budget.
MDG Performance Fund (MDG/PF): The number of partners contributing to the MDG/PF has increased
from 6 to 10 over the last three years. The amount of resources coming through the MDG/PF has also
increased from around 33 million to around 133 million USD/year i.e. an increment of by 300% during
the same period. This shows improvement in channeling of funds through the preferred channel from
35% to 42% over three years period. This is a meaningful achievement both for Government and DPs in
improving harmonization in financing of the health sector. Areas financed by the MDG/PF also align well
with the priorities of the health sector. Maternal health, equipping of health facilities, child health and
prevention and control of diseases are the top ranking areas of resource allocation.
25
[HSTP ZERO DRAFT_V2] 10th May, 2014
Utilization of Resources / Grant Management Unit (GMU): Significant improvements have been
observed in utilization of resources but more capacity needs to be built at sub-national levels. HSDP IV
set a target of increasing the ratio of health budget utilization to allocation at 90%. Engagement of the
leadership at all levels of the health system to track resources and ensure liquidation has played a
significant role. A commendable initiative in resource utilization and timely liquidation is the
establishment of the Grant Management Unit (GMU) under the Finance Directorate in FMOH. The unit
was created to solve the hurdle of delayed liquidation of significant amounts or resources both at
national and sub-national levels. The unit aims to track both physical and financial performance of the
sector, enhance liquidation of funds and improve coordination between DPs and the FMOH.
IFMIS: Another key initiative in the sector is the IFMIS which aims to improve public finance
management through improved evidence, integration and coordination. The system is fully electronic in
design and expected to use a dedicated line in Woreda-net. It is a multi-sectoral initiative led by
MOFED. Health sector has been chosen to be one of the pilot sectors. The health sector IFMIS has been
designed and is being implemented at FMOH level. It has not been scaled up at sub-national levels. The
scaling up of IFMIS to sub-national levels has been delayed due to budgetary constraints.
SO. P1: Improve Quality of Service Delivery
HSDP IV integrated the need to improve quality of health service delivery within the health facilities of
the country. During this time increase in Customer satisfaction Index was noticed. During this period a
Hospital Reform agenda focusing on implementing defined quality standards has been defined. By know
it is estimated 50 – 70% of these standards are being regularly implemented by hospitals. In order to
strengthen provision of blood transfusion services, a significant management reform has taken place,
with transfer of overall management of blood transfusion services from the Ethiopian Red Cross to the
government (FMoH and Regional Health bureaus).
During this time there are some limitations observed in improving quality of health services which
include referral services still remain weak across the country, emergency management scale up is still
low in hospitals, follow up of adherence to standard treatment guidelines is not being carried out
comprehensively by facilities, there is still limited regulation and support of the non-public service
providers on improving quality of care. However, there is no progress with bed occupancy rate and OPD
attendances. The changes in the management of blood transfusion services also have created a gap in
capacity to mobilize blood donors and still only half of the health facilities are accessing their blood
supply from NBTS and its networks.
S.O. P2: Public Health Emergency Management (PHEM)
The health system copes with existing and emerging disease epidemics, acute malnutrition, and natural
disasters of national and international concern. In conducting this there are some of progresses have
been made which include integrated disease surveillance and response (IDSR) is being implemented at
all levels and implementation of the International Health Regulations (IHR) is well underway based on
the recommendations of WHO.
During this time there are some limitations observed includes very slow implementation of E-PHEM and
low response for epidemic reports.
S.O. P3: Improve Pharmaceutical supply and services (P3)
With the aim of increasing the availability of health commodities (medical equipment and products of
prevention, diagnosis and treatment) at an affordable price in usable conditions the sector procured
pharmaceuticals, medical supplies and equipment through the Revolving Drug Fund (RDF) and the
various programs, is increasing over time.
26
[HSTP ZERO DRAFT_V2] 10th May, 2014
Among the limitations faced during this time capacity of health facilities to carry out the quantification
of their medical equipment and supplies requirements is inadequate, shortage of drugs and medical
equipment at health facilities, The distribution of commodities to health facilities was not uniform and
also currently below 20% of the value of procured medical supplies was supplied for the sector through
domestic producers.
S.O. P4: Improve Regulatory systems (P4)
Improving health and health related regulatory system focuses on ensuring safety in the delivery of
health services, products and practices as well as accreditation of professionals. Among the promising
achievements during HSDP IV in health regulatory aspects were, a comprehensive food regulation
guideline was developed and submitted to the Council of Ministers for review and approval and also
salt iodization law was passed and about 93% of distributed salt is now iodized.
The regulatory authority is being strengthened at different levels. At federal level, the BPR process
approved structures that enabled the authority to increase its staff. It managed to recruit more than
90% of its approved staff.
Absence of uniformity of the health regulatory structure at regional and woreda level, low attention to
health regulatory system in some of the regions and focus was given on limited areas of health
regulatory are some of the limitations observed in health and health related regulatory areas. Addis
Ababa has established an independent regulatory authority accountable to the City Mayor. Gambella,
Somali and SNNP have also established semi-independent core process owners. The other regions have
established regulatory core processes within the RHBs, and some of them strongly argued against
setting up an independent authority (Harari and Dire Dawa). As compared to the past, therefore,
institutional strengthening for regulating the sector is given priority and structures are put in place at
different levels.
Although regulatory employees are deployed in the 15 ports entry into /exit out of the country, there
are indications that there are still inflow and outflow of medicines from Ethiopia.
SO. P5: Improve harmonization and alignment: evidence based decision-making:
HSDP IV put this strategic objective to support improved evidence-based decision making through
enhanced partnership, harmonisation and alignment, including integration of projects and programmes
at the point of health service delivery. It will comprehensively address identification of health system
bottlenecks; research; HMIS; performance monitoring; quality improvement; surveillance; use of
information for policy formulation, planning, and resource allocation. The performance measures
include: Increase timeliness and completeness of HMIS reports from 57% to 90%; Improve
correspondence between data reported and recorded from 15% to 90%; Maintain proportion of
Woredas with evidence-based plan aligned vertically and horizontally at 100%; Increase proportion of
partners implementing “one-plan” to 100%; Increase proportion of Health Development Partners
providing funds through MDG-PF to 75%; and Increase proportion of partners using the national M&E
framework.
The sector therefore showed significant achievements in the processes around planning, budgeting,
decentralization, the review of plans and progress, the involvement of partners and other stakeholders
in the planning and review processes, and the role of information.
Woreda Based Planning (WBP) is now the formal planning process in most regions. Planning is taking
place at different levels, involving more stakeholders, such as the head of health centres, community
representatives, NGOs, community leaders, administrative leaders and development partners. There is
an increasing emphasis on gender issues in the WBP, including in trainings, reports and MNCH. There
are various positive impacts of the WBP process, such as increased ownership, growing participation
and collaboration at different levels. WBP has contributed to the alignment and harmonization of the
planning, budgeting, resource allocation, prioritization, tracking and reporting systems. WBP has
27
[HSTP ZERO DRAFT_V2] 10th May, 2014
improved access and awareness of various issues such as related to capacity building, CEmOC, BEmOC
and others. WBP has helped to provide evidence for resource allocation, in detailed activity based
planning, and more flexibility in reprogramming.
Strengthening of budgeting processes: While there is an increased understanding of governmental
budgets, partner budgets are not well understood in terms of priorities and trends. Gaps in budgets due
to lack of support by development partners is increasingly addressed by internal budgets. There is
better adherence to processes of one plan/one budget/one report, though one report has been not
fully realized in practice. There are visible improvements in linking plans, activities, costs and evaluation.
With a stronger partnership forum and political commitment, there is improved communication among
stakeholders. While there are appropriate structures in place, and processes for monitoring, these are
constrained by shortages of manpower and budget.
However, there are still challenges that need to be addressed such as:
 The planning process: Due to high and increasing workloads, the WBP potentially ran the
danger of being reduced to a routine and time taking exercise. Since the lower level staff and
not the decision makers attend the meetings, the value of the WBP is potentially undermined.
 Weak coordination mechanisms: Coordinating the multiplicity of partners and their varying and
individualized interests is complex, leading to poor resource mapping.
 The existing scope, coverage and reliability of data that requires strengthening.
 Budgets are often described to be inadequate / unpredictable due to donor commitments.
SO. CB1: Improve Health Infrastructure and access to services (CB1)
Availability, accessibility, equity, efficiency and quality of health services depend on the distribution,
functionality and quality of infrastructure. In improving this area the health sector attained some of
successes which include the health facility construction has created access to care to many people that
was never reached with any type of service before, the health centre expansion has enabled the sector
to enhance access to services for programs like HIV/AIDS (ART and PMTCT services), there is a
transformation of the health system in creating access to health care.
Delay in construction of health centers in some of regions, quality problems in construction of health
facilities, even though access to services has improved, because of the issues around functionality,
health facilities are not able to provide some of the priority services such as deliveries in a manner that
attracts mothers, lack of champion for using and coordinating ICT for health and effort to establish a
strong maintenance structure at all levels of the health systems remains fragmented are among the
challenges faced in improving the health infrastructure.
SO. CB2: Improve Human Capital (CB2)
Adequate numbers of motivated and skilled human resources and health management and support
staff are essential at all levels of the health system for effective health service delivery. Due to effort
made during implementation of HSDP IV there are achievements made which include the expansion of
medical education volume in terms of training capacity, increase in number of medical schools, and
increase in annual intake of health professionals by universities are some of them.
The limitation of the human resource information system to provide up to date and continuous data on
human resource availability, retention and attrition rates both at national and sub-national levels, there
are regional as well as urban/rural disparities in the availability of all categories of health human
resources, increase in the number of key human resource categories is still lagging behind demands of
the public sector, the involvement of Ethiopian health professional associations in all aspects of HRH
28
[HSTP ZERO DRAFT_V2] 10th May, 2014
management (training, accreditation, HRH standards and Guidelines development) is extremely limited
and high turnover and attrition rates of health personnel are the major one.
29
[HSTP ZERO DRAFT_V2] 10th May, 2014
Chapter 3: Health Sector Development Program V
3.1. The Planning Process and Methodology
3.2. Health Sector Strategic Assessment
Mission Statement of MOH
To reduce morbidity, mortality and disability, and improve the health
status of the Ethiopian people through providing and regulating a
comprehensive package of preventive, promotive, rehabilitative and
curative health services via a decentralized and democratized health
system.
Vision:
To see healthy, productive, and prosperous Ethiopians
SWOT Analysis:
SWOT Analysis
Strengths:
1. Service delivery (Quality and access)
Achievements of the HSDP IV and MDG targets:
• MDG 4 before five years
• Reduction in MMR
• Steady increase in key intervention coverages such as CPR, vaccination
• Reduction in new HIV infection
• Reduction in malaria morbidity and mortality
• Reduction in occurrence of outbreaks
• Reduction in prevalence of TB
Access is improving particularly to PHC:
• Health facility expansion particularly to primary health care facilities
• Increased availability of ambulance services,
• Blood bank services
• Storage and distribution capacity of pharmaceutical supplies and services
Program management is improving:
• Availability of strategies and guidelines like MNH road map, NNP, NTD road map, NCD
strategy, Referral system guideline, health facility standards
30
[HSTP ZERO DRAFT_V2] 10th May, 2014
•

Use of technical working groups
Experience in implementing large scale successful programs ( HIV, Child health,
TB/malaria, NBB establishment etc)
 Efforts for preparation of minimum service standards
 Most programs are country initiated and unique that the country can share for other
countries as well
 Increased availability of free MNCH and other cost-exempted services
 Institutionalization of PHEM
 Legal framework for surveillance/surveys
 Decentralized lab services
 Right based approach such as the family planning programme
New initiatives
• New vaccine introduction, NMEI, MDSR, HAQ (Hospital Alliance for Quality), APTS
(Auditable Pharmaceutical Transactions and Services),
2. Human Resource for Health
• Rapid increase in the availability human resources for health
• New initiatives such as CPD, leadership programs,
3. Health Information System
Evidence generation and dissemination is improving:
• Several surveys and assessments are carried out and are being carried out (EHDS, MIS, EPI
Cluster survey, TB prevalence survey, SPA+, STEP wise survey for NCDs, MTR ...)
 HMIS is improving and Initiation of HMIS in private health facilities, initiation of CHIS)
 Robust diseases surveillance system /PHEM
• Integrated Supportive supervision and inspection
• National and International conferences
• Documenting best practices
• Regular and participatory review mechanism such as the Annual Review Meetings
4. Medical products, vaccines and technologies
• Improved commodity security
• Growth of Revolving Drug Fund (RDF) capital
• Increased availability of ambulance services,
• Increased supply of medical equipment
• Expansion of hubs
• Improved cold-chain management system
• Initiation of telemedicine, tele education
5. Health Financing
• Implementation of Health care financing reform (such as fee retention, private wing, service
fee revision, …)
• Establishment of health insurance
6. Leadership/Governance
• Strong performance follow up
31
[HSTP ZERO DRAFT_V2] 10th May, 2014
•
•
•
•
•
•
•
•
•
•
•
•
Strong coordination
• JSC, JCF, JCCC, CCM, ICC, TWGs, …
• Resource mobilization (MDG PF, HPF…); RDF capital is improving
• Encouraging multi-sectoral collaborative efforts (NNP, WaSH, NCDs, MoE…)
• Use of technical working groups
• Civil service HDA platform (case team, transformation, directorates, MoH & EC
coordination and leadership platforms)
• Establishment of partner’s forum at subnational level
HEP and HDA as a demand creation, improving access and community empowerment tool
Community participation in organized manner particularly the women development army
Increased focused social mobilization efforts in pastoralist areas implementing the MoH
social mobilization ignition document.
Engagement of local populations in Health facility management boards and monitoring of
health services by community representatives in some areas
Improved Integrated Supportive Supervision practice
Institutionalization of service improvement approaches like BSC.
Intention of licensing health facilities
Establishment of quality control laboratories
Establishment and institutionalization of PHEM
Ensured legal framework for survey and surveillance
Strengthening the regulatory system
• Actions for standardization and regulation (facility standard, licensing)
• Establishing of quality control of lab
Weaknesses:
1. Service delivery
 Sub optimal functionality of HFs:
• Utilities related (water, electricity, connectivity…); poor construction quality, Design
problem such as Non-compatible health center designs to quality EmONC services; and
disabled people
 Sub-optimal service availability and readiness at health facilities
• Missed opportunities for essential health interventions due to limited focus on integrated
service delivery
 Inadequacy in Continuum of care:
• Tertiary care gaps - Limited physical access to hospital care, with negative influence on the
continuum of care (e.g. CEmONC);
• Availing all services to clients (diagnostic, medicines, HR …); Sub optimal referral and
consultation mechanisms (Emergency medical service…);
• Low effective coverage (ANC4, SBA, PNC, fully immunized, bed net utilization, …);
• Lack of attention for some population group such as children of 6-10 years of age, young
adolescent age, geriatrics care
 Inequity/avoidable inequalities
• Access limitations to health facilities in developing regional states
32
[HSTP ZERO DRAFT_V2] 10th May, 2014






• Distribution of skilled human resource
• Socioeconomic situations (Gender, Education, income…)
• Service points are not user friendly particularly for disabled people and women
Suboptimal quality of care
• Inadequate availability of clinical service protocols for health facilities
• Inadequate follow-up on implementation of strategies, guidelines and SOPs...
• Weak quality assurance and regulatory functions
• KPI for HC not yet being monitored
• Poor utilization of services (Per capita OPD visit, bed occupancy rate ...)
• Weak referral and feedback system
Unavailability of forensic medicine
Unyielding supervision activities due to limited capacity of supervisory team, lower frequency of
implementation and lack of follow up mechanisms and accountability on findings
Lack of clear direction on the adolescent health strategy implementation approach
Weak Multi-sectorial collaboration in many program areas, such as trainings, PHEM. Malaria,
WASH, NCDs
Focus on campaign based activities than building the system
Inadequate effort in injury prevention and occupational health
Inadequate school health lifecycle approach in training
Inadequate tertiary level service expansion
Limited rehabilitation centers
Inadequate capacity to respond to the demanding urbanization
2.












Human Resource for Health
Inadequate HRIS
Inadequate upgrading of HEWs
Lack of clarity in the role of HEWs in handling delivery services
Limited capacity to own and lead some program areas at national level
Poor provider attitude and low commitment of HWs
High Attrition Rate of HWs and absence of HR motivation & retention strategy;
Absence of standardised continuous professional development (CPD) programmes
Weak institutional knowledge management
Weak knowledge generation and utilization at national level
Inequity in the distribution of skilled manpower
Limited Skill acquisition in pre service trainings e.g midwifery
Incompatible retention mechanism





3. Health Information System
 Suboptimal use of evidences generated for timely decision making (mainly at local level):
o Weak systematic documentation of evidences
o Inadequate triangulation of information (HMIS, surveys, SS findings, operational
researches…)
33
[HSTP ZERO DRAFT_V2] 10th May, 2014
o








Unyielding supervision activities due to limited capacity of supervisory team, lower
frequency of implementation and lack of follow up mechanisms and accountability on
findings
Inadequate and /or incomplete data:
o Accuracy of data on maternal mortality
o Lack of comprehensive information on disease burden
Limited implementation of LMIS and HMIS
Parallel and multiple reporting system
Inaccurate reporting
Week documentation and dissemination of researches
CHIS scope does not match HEP scope of work resulting in use of multiple registers and lack of
clarity in its implementation
Weak joint planning and monitoring of public health researches with regions
Inadequate capacity building of regional public health research centers
4. Medical products, vaccines and technologies
 Supply chain gap (Non availability of essential medicines and supplies (e.g EmONC), weak
Pharmaceutical Logistics information System)
 Weak ambulance service management and inadequate running cost
 Poor capacity of forecasting, quantification procurement and stock management of supplies
and commodities
 Poor forecasting, quantification and stock management of supplies and commodities
 Weak maintenance capacity (medical equipments)
 Low utilization of technology and innovations
5.




Financing
Gaps in mobilizing local resource
Low utilization and liquidation at all level
Poor resource mapping capacity especially at sub-national level
Weak financial utilization and timely liquidation
6.









Leadership/Governance
Continuity of achievements such as the HEP
Optimum donor support or mobilization
Shared Vision not optimal especially at lower levels
Lack of /Inadequate accountability
Low multi-sectorial response particularly in development and investment corridors
Wide variation in the implementation of HDA
Inadequate follow-up on implementation of policies, guidelines and plans
Suboptimal public-private partnership (coordination, mistrust, reporting…)
Regulatory weaknesses
34
[HSTP ZERO DRAFT_V2] 10th May, 2014











•
•
•
•
•
•
Gender mainstreaming not institutionalized in planning and M&E of health programs
Less optimal buy-in for the three one’s principles
Inadequate focus for streamlined planning and implementation among the directorates and
Agencies of MOH.
Over reliance on IPs for programs with strong partner involvement shadowing ownership
especially at lower levels
Low involvement of women in decision make/ leadership level
Weak implementation capacity among regions
Weak implementation capacities among agencies and MoH
Lack of structural review and adjustment along with strategic plan (e.g EPHI)
Engagement in unplanned activities
Inadequate coordination of public health researches
Good governance challenges – weak accountability
Variation in leadership and good governance
Wide variation in the implementation of HDA
Variation in fostering coordination/partnership (inadequate resource mobilization & utilization
capacity and suboptimal leadership of programs at sub national level)
Suboptimal public-private partnership
Inadequate capacity for gender analysis
Regulatory:
• Inadequate quality assurance actions
• Poor capacity to implement the regulatory framework
Limited multi-sectoral response such as in the development corridor
Opportunities:
•
•
•
•
•
•
•
•
•
•
•
•
•
Determination and political commitment by the government
Strengthening the flagship HEP supported by HDA
Improving health care seeking behavior
Sustained national economic development
Improving road infrastructure, telecom
Improved literacy rate, particularly girl’s education
Establishment of Vital Events Registration Agency (VERA)
Settlement of pastoralist communities
Active engagement of other sectors like MoWCYA and women’s associations on MNH and other
health related initiatives
Health Insurance Schemes
Existence of strong Government structure up to community level
Industrialization (increase in local production of drugs and equipments, local manufacturers of
food, etc)
Urbanization
Acceptance of health insurance
35
[HSTP ZERO DRAFT_V2] 10th May, 2014
Threats
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Suboptimal level of community KAP
Geographic inaccessibility of many communities, including to ambulance services
High donor source for health expenditure
Low predictability of foreign funding
Harmful traditional practices as barriers to essential health services
Potential for community fatigue for HDA activities
Perception that HDAs are politically/oriented rather than committed for health promotion
Gender bias continues to affect access to services by women.
Urbanization
Donor dependency
Trade agreements such as importation of sub-standard supplies
Inadequate counterfeit control (sub-standard imports)
Climate change
Increasing pool factor for the health workers
Fragile neighborhood states
Population growth
36
[HSTP ZERO DRAFT_V2] 10th May, 2014
Stakeholder Analysis:
Stakeholders
Behaviours we desire
Their needs
Resistance issues
Community
Participation, engagement Ownership
and
Healthy life style
Dissatisfaction
Opting for unsafe alternatives
Underutilisation
Parliaments, Prime
Minister’s Office,
Council of Ministers,
Regional Governments
Line Ministries ( Water,
Finance, Labour,
Women’s Affairs,
Agriculture, etc.)
Health professional
training institutes
Development Partners
Ratification of Policy proclamations,
policies, etc.
Resources allocation
Access to health information and
service Empowerment,
quality of health care
Stewardship
Implementation of
proclamations, policy, etc.
Equity & quality
Plans & Reports
Evidence-based plans; Reports
Effective & efficient use of
resources & coordination
Technical support
Technical, policy support,
guidance
Financial system accountable &
transparent
Involved in planning,
implementation & M&E
Involvement in planning,
implementation & M&E
Participation
NGOs, CSO, and
professinal association
Diaspora and Private for
profite)
Civil servants
Intersectoral collaboration
Consider health in all policies and
strategies
Knowledgeable, skilled and ethical
health professionals produced
Harmonised & aligned
Participation
More financing
Technical support
Harmonisation & alignement
Participation, ressource & TA
Participate in licensing and
accreditation
Promote professional code of conduct
Quality of care; Client oriented;
Knowledge and technology transfer
Commitment,
Participation
CPD
Administrative measures
Organisational restructuring
Influence on budget allocation
Fragmentation
Dissatisfaction
Considering health as low
priority
Curriculum revision
Their
influence
High
High
Medium
Institutional response
Community mobilisation,
ensure participation
Quality and equitable service
and information
Put in place strong M&E
system & comprehensive
capacity building
mechanisms
Collaboration
Transparency
Advocacy
Medium
Policy and leadership support
Fragmentation
High transaction cost
Inefficiency & ineffective
Medium
Dissatisfaction
Fragmentation
Scale down
Withdrawal
Medium
Government leadership
Transparency
Efficient resource use
Build financial mgmt capacity
Transparency, Advocacy
Capacity building
Financial support
Enabling environment for their
engagement
Mistrust
Rent seeking
Medium
Conducive environment
Transparency
Incentive
Dissatisfaction
Unproductive
Attrition
High
Transparency
Accountability
Dialogue
Motivation, Involvement
37
3.3. Strategy
(Customer Value Proposition, Strategic Themes and Strategic Results, Perspectives)
3.3.1. Customer Value Proposition
Product or service attributes
Image
Relationship
Products & services the Health
Sector provides have these
characteristics:
 Accessibility–information,
physical, financial, etc.
The image that the Health Sector
wants to portray has the following
characteristics:
 Trustworthy
The relationship the Health
Sector wants with its community
could be described as:
 Complementary
o Transparent/Accountable
 Cooperative (participatory)
o Supportive
 Quality of health care
services & information,
 Respectful & ethical
o Professional
 Safety & healthy
environment
o CustomerFriendly/Oriented
 Harmonious (Mutual
Understanding)
 Empowering community &
employees
o Committed
 Timeliness of services
 Conducive environment
 Transparent relationship
 Dependable (Stewardship)
 Responsive
 Equitable
3.3.2. Strategic Themes and Strategic Results
Strategic Theme 1: Excellence in health service delivery
This theme refers to the promotion of good health practices (personal hygiene, nutrition,
environmental health) at individual, family and societal level); and the provision of preventive,
curative, rehabilitative and emergency health services.
It is meant consolidating universal health coverage focusing on primary health care delivery and
strengthening the Health Extension Programme (HEP). This is done through organizing and
strengthening Health Development Army in all health facilities and at community level that enables
the community to practice and produce its own health.
It includes provision of maternal, neonatal, child, youth and adolescent health services, prevention
and control of communicable and non-communicable diseases; and emergency services including
public health emergency.
Strategic Result 1: A health system that delivers promotive, preventive, curative and rehabilitative
services enabling the community to practice and produce good health; and be protected from
emergency health hazards.
What it includes (Key Concepts):
38
[HSTP ZERO DRAFT_V2] 10th May, 2014








Health promotion;
Disease and injury prevention;
Curative & rehabilitative service;
Health related disaster risk management;
Emergency Medical service;
Health service delivery at household, community & facility level
Hygiene and environmental health
Gender responsive/women friendly health service delivery
The success in this strategic theme will be measured by





Increased Knowledge, Attitude & Practice of the community
Reduction of maternal, neonatal & child morbidity & mortality
Reduction of micronutrient deficiency, wasting & stunting
Reduction in incidence & prevalence of communicable & non-communicable diseases
Controlling & reduction of medical, injury & epidemic emergency
How will these help to move to the higher level of success?


Ensuring effective, timely delivery of health care, including emergency care
Accessibility of services (physical, financial, information & cultural), delivering health care that is
timely, geographically reasonable

Enhancing behavioural change communication
Strategic Theme 2: Excellence in quality assuarnce
This theme refers to managing quality and safety in health services including laboratory quality. The
focus on quality in health systems at this time is because there is clear evidence that quality remains
a serious concern. Quality and safety have been recognized as key issues in establishing and
delivering accessible, effective and responsive health systems. Particularly at this time where there is
the huge investment and effort of expansion of population coverage, the process of improvement
and scaling up needs to be based on sound local strategies for quality.
Working through the process of quality assurance will create an environment for transforming the
health sector.
This theme suggests that the health system should seek to make improvements in the follwoing
dimensions of quality:







effective, delivering health care that is adherent to an evidence base and results in improved
health outcomes for individuals and communities, based on need;
Efficient, delivering health care in a manner which maximizes resource use and avoids waste;
and provided in a setting where skills and resources are appropriate to medical
need;
Acceptable/patient-centred, delivering health care which takes into account the preferences
and aspirations of individual service users and the cultures of their communities;
Equitable, delivering health care which does not vary in quality because of personal
characteristics such as gender, race, ethnicity, geographical location, or socioeconomic
status;
Safe, delivering health care which minimizes risks and harm to service users.
39
[HSTP ZERO DRAFT_V2] 10th May, 2014
This theme, therefore, looks into the quality control and assurance where quality control is about
reviewing of the quality of all aspects of the health services (professionals, premises, process, and
products) and Quality Assurance refers to administrative and procedural activities implemented in a
quality system so that requirements and goals of the product and services or activity will be fulfilled.
Strategic Result 1: A community protected from health hazards and is served with quality health
care at all levels and at all times.
What it includes (key concept):
 Internal quality control,
 External quality control,
 Accreditation and
 Licensing.
How will these help to move to the higher level of success?

Ensure service quality & provision per standard
Strategic Theme 3: Excellence in leadership and good governance;
This theme refers to policy formulation, setting strategy framework, planning, implementation,
monitoring and evaluation of health programs, with evidence-based approaches. It incorporates the
equitable and effective resource allocation and leadership development within the sector and the
community. It also refers to ensuring accountability at all levels of health sector. The leadership
development is for the whole sector including the Health Development Army at community level.
Strategic Result 2:
 Communities are served by accountable and transparent institutions and their safety is ensured.
It includes:
 Evidence-based policy formulation & implementation;
 Planning, monitoring & evaluation;
 Ensuring equitable & effective resource allocation (finance, human capital & infrastructure);
 Research
 Leadership development up to the community level and promoting women into leadership/
decision-making and governing positions;
 Development of good governance
 Harmonization & alignment
 Financial protection
How will successes be measured?
 Use of research & health information outcomes for evidence-based decision making (including
planning, policy formulation & developing regulatory frameworks)
o Improved partnerships
o Timely decision
o Equitable resource allocation (finance, human capital & infrastructure) on evidencebased need
o Empowerment of employees at every level
o Enhancement in the public safety
40
[HSTP ZERO DRAFT_V2] 10th May, 2014
o
o
Increased number of women in leadership positions
Gender mainstreaming
How will these help to move to the higher level of success?
 Policy will define priorities
 Strategies sets long term targets with indicative resources required
 Public-Private partnership will be enhanced
 Efficient and effective use of resources
 Enhanced community participation (planning, M&E, regulation enforcement, policy formulation)
& ownership, satisfaction
Strategic Theme 3: Excellence in health system capacity;
This theme refers to the enhancement of resources for health, which includes the human and
financial resources, health infrastructure and supply that are accessible to communities. The theme
focuses mainly on the human resource for health at all levels of the health system: health workers,
health development army, and decision-maker individuals at the different level of the system. It also
includes the development, rehabilitation and maintenance of health facilities and medical
equipment that meet standards.
Strategic Result: Ensuring communities have access to health facilities that are well equipped,
supplied, maintained and ICT networked as per the standards and are well staffed with qualified and
motivated employees.
Key Concepts:








Health workforce – training, deployment, career development & improved HRH management
Expansion of Gender and disability responsive infrastructures designs new health facilities & other health
infrastructure,
Expansion, rehabilitation & maintenance of existing infrastructure (Gender and disability responsive
infrastructures designs).
Health care financing - resource mobilisation & risk pooling (Health Insurance)
Pharmaceutical supply - planning, quantifying, selection, procurement storage & distribution
Technology transfer – adoption of new technology & practices for the production & utilisation of health
care products.
Effective medical equipment management
Enhanced Information Communication Technology for health
How will successes be measured?







Development of critical work force skills
Enhanced retention for qualified work force
The extent that all segments of community are accessing standardized health facilities (women, disability)
No stock-outs of essential drugs at all facilities
Improved functionality of medical equipment
Ensuring community’s enrolment in health insurance schemes.
Improved access & quality of health services via use of ICT
How will these help to move to the higher level of success?


Ensuring community access to standardised health facilities, with services delivered by qualified &
motivated health professionals.
Health facilities will have better communication & data exchange to improve the quality of reporting &
service provision
41
[HSTP ZERO DRAFT_V2] 10th May, 2014
Perspectives:
Perspective
Key Concept
Key Questions
Community
“Empowerment”
How can we enable the Community to produce
its own health?
Financial/
Stewardship
“Efficiency”
How do we mobilize and utilize more resources
effectively and efficiently?
Internal process
“Quality”
How can we enhance our integration &
responsiveness in order to improve quality,
timeliness, & functionality?
Learning & Growth “Capacity”
To excel in our processes, what capacities
must our organization have and improve?
3.4. Strategic Objectives (SO)
Perspective
Strategic Objectives
Community
C1: Improve health status
C2: C2: Improve community ownership
Financial
Stewardship
F1: Improve efficiency and effectiveness
Internal
process
P1: Improve Access to Quality Health Services
P2: Improve Health Related Disaster Risk Mgt
P3: Improve Governance
P4: Improve regulatory system
P5: Improve logistics supply and management
P6: Improve community participation, & engagement
P7 Improve Resource Mobilization
P8: Improve research and evidence for decision making
Learning &
Growth
CB1: Enhance use of technology & Innovation
CB2: Improve Development & Management of HRH
CB3: Improve health infrastructure
CB4: Enhance Policy and Procedures
42
[HSTP ZERO DRAFT_V2] 10th May, 2014
Objective commentary
C1: Improve health status
Description:
This strategic objective is meant to improve equitable accessibility of health services of all
kinds, including emergency and referral services, and thereby ensure service utilisation. It is
expected that better accessibility will then lead to improvements in the health of mothers,
neonates, children, adolescent and youth. It is seen as an important strategy to improve
nutrition status; improve hygiene and environmental health; and reduce the incidence and
prevalence of HIV/AIDS, TB, malaria and other communicable and non-communicable
diseases.
Equity is the absence of avoidable or remediable differences among populations or groups
defined socially, economically, demographically, or geographically; thus, this strategic
objective deals with reducing systematic disparities in health outcomes (or in the major
social determinants of health) and provision between groups with different levels of
underlying social advantage/disadvantage (for example, gender, disability).
Outcome:
The expected outcome will be increased citizen confidence in the health system and
proactive seeking of prevention and treatment services from health facilities. They have to
believe and develop confidence that they will be able to receive the best medical care when
they are in need; that they can reduce their risk of contracting diseases; and ultimately, that
they have a better health status.
Key component:
To achieve these results, the Health Extension Programme will act as a primary vehicle for
prevention, health promotion, behavioural change communication and basic curative care.
Health centres will serve as a first curative referral centre for Health Posts and will provide
health care that will not be available at the HPs through ambulatory and some cases of
inpatient admissions. Health centres, primary hospitals and general hospitals will be the
main hubs for the reduction of maternal mortality by providing BEmONC and CEmONC.
Referral and specialised hospitals are meant for the handling of more complicated and
sophisticated health care, including the clinical management of non-communicable diseases.
The health system will be mobilised to give enhanced attention to attendance of delivery by
skilled health workers (Promote women friendly services during institutional delivery),
PMTCT, TB case detection, environmental management of malaria, and prevention and
detection of non-communicable diseases. The family planning programme will focus on
ensuring contraceptive security and provision of long lasting and permanent contraception.
Antenatal care with four visits per pregnancy will be mainstreamed at all service delivery
levels. WASH will be integrated with other service delivery modalities and will be
implemented at all levels of the health care system.
C2: Improve Community Ownership
43
[HSTP ZERO DRAFT_V2] 10th May, 2014
F1: Improve Efficiency and Effectiveness
Description:
Producing the desired sectoral outcome with minimum cost and improves financial management
through, proper allocation, efficient utilization, tracking and controlling of resources. This strategic
objective also entails harmonization and alignment among stakeholders to strengthen the financial
and procurement management system of the government, to minimize wastage of resources and
duplication of efforts. It also addresses the need for gender-responsive budgeting and program
budget for gender mainstreaming works.
There will be closer monitoring of program implementation and follow up of timely and proper
liquidation of financial resources in order to ensure improved accountability at all level of the health
sector. In addition facility governance and management of revenues will be strengthened and
supported for the betterment of utilization,
The government in collaboration with development partners will work towards making
protection and access to equitable health service. The government will work towards
minimizing resources wastage at all level in the sector thereby increasing the effectiveness
and efficient utilization of resources and assuring the value for money.
Outcome:
 Improved allocation and utilization of resources
 Equitable utilization of health service
 Improved accountability
 Value for money
Key components:
 Achieving desired sectoral outcome
 Strong controlling system
 Invest unutilized resources to alternative investment scheme
 Strengthen synergy, harmonization and alignment
 Efficient utilization of resources
P1: Improve Access to Quality Health Services
Description
It is quality planning and quality improvement activities in our health care delivery system
with provision of customer centered, efficient, effective, timely and safe health services in
both public and private health facilities results quality promotive, preventive, curative,
rehabilitative and palliative services.
Outcome:
Satisfying the community by provision of customer centered, efficient, effective, timely and
safe health services in both public and private health facilities results reduction of morbidity
and mortality
Key components
 This objective will be realized when the health care delivery system is equipped with the
quality infrastructure, supply, human power and SOP in a quality assured way.
 It includes
o Health services provided by the primary health care unit, general and tertiary
hospitals as well as standalone diagnostic and lab services.
o Critical services for the health care delivery system such as provision of safe and
adequate blood and its products.
44
[HSTP ZERO DRAFT_V2] 10th May, 2014


o Pre facility emergency service like ambulance, command post and mobile clinics
It excludes external quality assurance done for regulations
It excludes the health care activities done by the community
o Because it will be addressed by P3 and C1
P2: Improve Health Related Disaster Risk Mgt
P3: Improve governance
Description
It mean the improvement of good governance in the health sector through strengthening
and establishing; transparency, accountability, equity and inclusiveness, effectiveness and
efficiency, accessibility, mutual consciences, participation and responsiveness.
Outcome:
Option 1. Improved good governance
Option 2. Facilitated health service delivery
Option 3. Satisfied society with the health service delivery and regulatory
Key components
 Awareness creation on citizen charter
 Compliance handling
 Public participation
 Standardization
 Strengthening inputs the health service
 Organizational restructuring
 Solving issues related with human resource
 Preparing rules, regulations, and procedures…
P5: Improve Logistics supply and management
Description:
The focus of the strategic objective would be ensuring access to quality assured, safe,
effective and affordable essential medicines with which the sector intends to respond to the
majority of health problems of the society; significant reduction in the pharmaceutical
wastages and improved rational drug use. This will consider the fact that the country is
currently experiencing in terms of double burden of diseases, i.e. both communicable and
non-communicable diseases. Therefore, the objective will also opt to encompass initiatives
to satisfy clients with health problems such as diabetes, cancer, psychiatry, emerging
cardiovascular problems and those that require blood and blood products… etc
In the coming five years the per-capita expenditure on essential medicines and health
technologies will significantly increase. Therefore, focus will be given to further ensure
proximity of distribution hubs to the society at all corners of the country, efficient systems
for inventory, fleet and information management, maximizing efficiency in both
quantification and procurement, ensuring proper use through health facility based solutions
such as Drug and Therapeutics Committees (DTCs). This will also be augmented by equipping
existing and further expansion of distribution hubs to realize equitable access, the
establishment of pharmaceutical waste management facility, strengthened Revolving Drug
Fund (RDF), producing competent and adequate number of human resources for health
supply chain management at all levels and ensuring strong coordination mechanisms with
key stakeholders.
45
[HSTP ZERO DRAFT_V2] 10th May, 2014
Outcome:
Ensured access to Essential Medicines and Health Technologies that are of Assured Quality,
Safety, Efficacy and Cost-Effectiveness with their Proper Use for all Ethiopians.
(Note):
 Access: encompasses Availability/ adequacy, Affordability, Accessibility
 Essential Medicines and Health technologies (WHO’s Essential medicine concept – this also
includes products for special need population like diabetics, cancer patients, psychiatric
patients, blood bank users, etc…)
 Proper use: Rational Medicine Use)
Key components
 Infrastructure for Supply chain management at all levels (i.e. Warehousing and
Transportation)
 Revolving Drug Fund
 Integrated Information Management system for pharmaceutical supply and services
 Quantification and Procurement Efficiency
 Inventory, Fleet and Distribution Management Systems
 Auditable Pharmaceutical Transaction System
 Coordination Mechanisms for Health Supply Chain Management
 Rational Use of medicines and health technologies
 Monitoring and Evaluation for Health Supply Chain Management
 Disposal Facilities (Pharmaceutical Waste Management)
 Human Resources for Health Supply Chain Management
 Public-Private Partnership for Health Supply Chain Management (not discussed)
P6: Improve community participation and engagement:
Description
This means creating awareness, transferring knowledge and skill to the community, and
ensuring their participation and engagement in planning, implementation, monitoring and
evaluation of health activities to be able to produce their own health.
This strategic objective aims to empower community to produce its own health by creating
awareness, transferring knowledge and skill to the community. This will be ensured through
strengthening functionality of Health development army (HDA) and Social mobilizes to
increase community participation and engagement in planning, implementation, monitoring
and evaluation of health activities. . The HDA is a one to five households networking to
influence one another in practicing healthy life style and is the key strategy to scale up best
practices through organizing and mobilizing of families to increase coverage of model family.
This network of families will be supported technically by HEW’s to implement the packages
of HEP. They will be actively engaged in the promotion and prevention activities at
household and community level, including the regular coordination of structured
Community Dialogue Sessions, with the guidance of the HEWs. HDA and social mobilizes will
have extensive responsibilities for social mobilization in creating an enabling environment to
expand HEP deeper in to communities and families and finally ensures community
ownership.
Communities will also be represented on governance boards of all public sector health
facilities and Local government councils.
Outcome:
46
[HSTP ZERO DRAFT_V2] 10th May, 2014
 Improved healthy behavior
 Households able to produce their own health
 Improved community based resource generation
 Improved community self reliance
Key components
 Knowledge and skill transfer
 Shared responsibility of the community
 Household production of health
P4: Improve regulatory systems
Description:
The regulatory system needs to effectively monitor the adherence to quality standards by all
health service providers. Although ensuring of safety and quality of products and health
services through registration, licensing and inspection of health professionals and
institutions were routine adherence checks to set standards, the implementations of the
basic regulatory functions are found to be inadequate. This implies that health and health
related products and health services are not of expected and required quality and safety.
Poor quality and safety health care has direct impact in reducing productivity of
communities due to high rate of mortality and morbidity. Communities trust and confidence
on health services will get down unless services are linked with quality. Therefore, improving
regulatory system in every direction of health services is highly mandatory.
This strategic objective aims for improvements of regulatory activities to ensure community
safety through strengthening of:
 Empowerment of community in regulation,
 Regulatory standard,
 Food safety and quality,
 Modern medicine, Biological /Vaccines, Medical devices and In vitro diagnostics
safety, quality and efficacy,
 Health professional competence and ethical practice,
 Health facility compliance with minimum standards,
 Quality control,
 Licensing and Enforcement,
 Pharmaco- vigilance & Post Marketing Surveillance scheme,
 Proper use of health and health related products and services,
 Hygiene and environmental health regulation,
 Clinical trial monitoring and
 Regulatory information dissemination through information communication
technologies
 Safety and quality regulation of blood and blood products & Haemo-vigilance.
Outcome:
 Improved community ownership,
 Improved safety and quality of health and Health related products,
 Improved quality health service through compliance enforcement in Health
facilities,
 Decreased problems associated with incompetency and unethical practice of health
professional,
 Improved proper use of medicine,
47
[HSTP ZERO DRAFT_V2] 10th May, 2014
 Improved healthy environment,
 Improved appropriate and safe use of blood and blood products
Key Component:
 Food safety and quality,
 Medicine, medical device, Biological, In vitro diagnostics safety, Efficacy/performance/ and
quality,
 Competence and ethical practice of Health professional,
 Health and Health related facilities compliance with minimum standards,
 Safety and efficacy of Traditional medicine and practice,
 Information communication technology supported regulation,
 Hygiene and environmental regulation,
 Control proper use of medicines (focusing to antibiotics) and
 Control of drugs and tobacco and other substances of abuse
P7: Improve resource mobilization
Description
This strategic objective includes a proactive approach in the mobilization of resources from
domestic and international sources through enhancement of pool funding; collection of
revenues by health institutions, establishment and strengthening of risk pooling
mechanisms, strengthening international health partnership, public-private partnership, and
maximizing collaboration with national and international civic society organizations and
NGOs.
The capacity of health administrations at all levels will be built to develop evidence based
plans to enable health managers use evidences for active negotiation with administrative
councils in order to increase government allocation to health. To increase resources
mobilized from domestic sources different innovative financing mechanisms such as
earmarked tax (sin tax, airline ticket tax, cell phone tax etc). Besides technical support will be
given to sub national levels to put in place the necessary requirement for facility based
revenue generation.
Experience sharing and networking will be promoted among health facilities on the
implementation of comprehensive HCF reforms.
Technical and financial resources will be mobilized for proper scaling up of CBHI. The
necessary institutional framework will be setup for efficient collection of health insurance
contributions form both SHI and CBHI systems.
Dialogue between the government and development partners will be enhanced to improve
aid effectiveness. Capacity of FMOH and sub national health administrations will be
improved for mobilization of resource, management of aid.
Development partners will be urged to finance HSTP and to reduce the tying up of aid and
the complexity of funding requirements as agreed in the IHP+ Compact.
In general, this strategic objective mainly deals with mobilization of adequate financial
resource required for the health sector through strong and proactive resource mobilization,
efficient partnership and coordination, and harmonized financing mechanism that enable
48
[HSTP ZERO DRAFT_V2] 10th May, 2014
the sector to provide basic preventive, promotive, curative and rehabilitative health service
for the population in a sustainable manner without excluding those who are not able to pay.
This strategic objective does not include resource allocation, utilization and reporting
aspects of the mobilized resources.
Outcome:
The ultimate outcome of this strategic objective is making sure that adequate resources are
mobilized and are made available for the financing of the health sector both from internal
and external sources, greater improvement in the resource mobilization capacity and
decreased wastage of resources and finally ensure financial protection of the citizens.
Key components
 Maximize fund mobilization from traditional donors such as global initiatives,
bilateral and multilateral donors, foundations, philanthropists etc.
 Maximize fund mobilization from non-traditional donors (new donors)
 Proactive and innovative domestic resource mobilization such as increase
Government allocation, strengthen HCF reform implementation, Scale up health
insurance, introduce innovative financing mechanism,
 Harmonization and alignment
 Maximize Public-Private Partnerships
 Multi sectorial approach
 Community mobilization
 Support capacity building programs in respect of financial resource mobilization
P8: Improve evidence-based decision making
Description
This objective is about evidence generation, translation, dissemination and promotion and
advocacy of the culture of using evidence for decision making at all levels to improve quality
and equity of health services.
Outcome:
Evidence based decision making.
Key components
The major components of this objective are: routine performance monitoring (e.g. HMIS),
survey & surveillance, research & evaluation, supportive supervision & inspection, and
advocacy & capacity building.
CB1: Enhance use of technology and innovation
Description:
 Enhance the use of the existing technology
 Introduction of New Technology
 Develop and use of local technology
Outcome:
 There will be efficient and effective internal business process of the health system
 Strengthen health care delivery system
 Self reliance
Key components
 Technology need assessment
 Identification of relevant technology
49
[HSTP ZERO DRAFT_V2] 10th May, 2014
 Technology dissemination:
CB2: Improve development and management of human resource for health
Description:
This strategic objective entails: leadership development (Promote women leadership & have
a succession plan), human resource planning, development and management including
recruitment, retention and performance management; community capacity development;
and technical assistance management.
Outcome:
Outcome of the strategic objective is ensuring the adequate availability of skilled and
motivated staffs that are committed to work and stay in a well managed sector.
 Ensure the availability of qualified, committed, adequate health workers with appropriate
skill mix and geographic distribution.
 Strengthen the HR policy and planning at all level
 Enhance human resource management practice

Enhance gender mainstreaming capacity of the health workforce via trainings
CB3: Improve health infrastructure
Description
 Construct, Maintain, renovates, rehabilitate, develop standard design (Gender and disability
responsive facility designs), equip, furnish, supply (water, sanitation and power), manage
and expand health and health related facilities.
 Develop basic ICT infrastructure (Health-Net, computer and accessories)
Outcome:
 Create standardized and functional health facilities and ICT infrastructure for health and
health related services
Key components
 Constructions of Health and Health related Facilities (Hospitals, Blood Banks , Quality
Control Laboratory, staff residence, medical equipment Maintenance workshops, Drug hubs)
 Expansions and rehabilitations of Hospitals and Health Centers
 Maintenance and renovation of health and health related Facility
 Provision of utilities
 Deployment and expansion of ICT infrastructure
 Adoption of medical equipment, construction and ICT Standards
 Avail medical equipments maintenance tools and devices
CB4: Enhance policy and procedures
Description
50
[HSTP ZERO DRAFT_V2] 10th May, 2014
This strategic objective encompasses strengthen of health system through continuous analysis and
improvement of existing health and health related policies, proclamations, regulations, guidelines, standards,
directives and other health related legal frameworks and also preparation, enforcement and follow up of
polices, and health related legal frame works. The objective considers, all cross cutting issues (Engagement of
disability, youths, and women, children, HIV/AIDS and climate) that contributes to improve quality health
services. Gender mainstreaming via establishing mechanism (manuals, guidelines, etc) and having gender
structure at all levels of the health sector (federal, regions, woreda, hospitals, etc)
Outcome:
 Health system stick to policies and operating legal frameworks
Key components
Analysis and improvement, preparation, enforcement and follow up of: Polices,
 Proclamation,
 Regulation,
 Standards,
 Directives,
 Guidelines and
 Manuals.
51
[HSTP ZERO DRAFT_V2] 10th May, 2014
3.5. Strategy Map
Mission:- Reduce morbidity, mortality and disability and improve the health status of the Ethiopian people
through providing and regulating a comprehensive package of promotive, preventive, curative and rehabilitative health
services via a decentralized and democratized health system.
Community
(C)
Vision: To see healthy, productive, and prosperous Ethiopians
Financial
Stewardship
(F)
C1: Improve health
status
C2: Improve
community ownership
F1: Improve
efficiency and
effectiveness
P2: Improve
Health Related
Disaster Risk Mgt
P5: Improve
logistics supply
and management
P7: Improve
Resource
Mobilization
Capacity
Building
(CB)
Internal Business Process (P)
P1: Improve Access to
Quality Health Services
P3: Improve
Governance
P4: Improve
regulatory
system
P8: Improve research
and evidence for
decision making
CB1: Enhance use of
technology & Innovation
CB3: Improve
health
infrastructure
CB4: Enhance
use Policy and
Procedures
P6: Improve
community
participation,
& engagement
CB2: Improve
Development
& Management
of HRH
52
[HSTP ZERO DRAFT_V2] 10th May, 2014
3.6. Performance Measures
The performance measures and targets of HSD V are linked to the “visioning exercise: Ethiopia’s
Path to UHC through strengthening the PHC”.
Summary of the visioning exercise: Ethiopia’s Path to UHC through strengthening the PHC
Over the last decade, Ethiopia has made great improvements in many health indicators, due in large
part to a well-coordinated, extensive effort and intensive investment of the government, partners and
the community at large in primary care through the Health Extension Program and expansion of PHC
units. It is a priority of the Ministry of Health to expand and sustain this progress, which will require
visioning the future health care system and strategic planning. Over the last couple of years, the
Ministry of Health (MOH) has engaged in a visioning exercise to think broadly and strategically about
the long-term development of the Ethiopian primary health care system. This activity was led by an
MOH “Visioning Committee” which comprised leaders of the ministry of health, regional
representatives, and development partners. The purpose of this visioning exercise was to envision a
system that will ensure quality health services and be equitable, sustainable, adaptive and efficient to
meet the health needs of a changing population between now and 2035. It is anticipated that in the
coming 20 years, Ethiopia will continue it’s fast pace of development, and will transition to being a
lower-middle income country by 2025, and a middle-middle income country by 2035.
The main goal of the health system is ensuring that everyone who needs health services (promotion,
prevention, treatment, rehabilitative and palliation) is able to get them, without undue hardship.
Hence, Universal Health Coverage (UHC) needs to be a goal for Ethiopia's health sector in the
coming decades. UHC has been defined as guaranteeing access to all necessary services for everyone
while providing protection against financial risk. As Ethiopia advances to middle income country
status, its goal is to progressively realize progress towards UHC and ultimately to achieve UHC for all
Ethiopians. As the country transitions, the MOH intends to continue to invest in primary care (both as
level of care and an approach) in order to advance the overall health and wellbeing of the population,
and serve the priority health needs of the majority of its people. Strong investments in primary care
are anticipated to result in continued improvements in health outcomes, which are already being seen
since the launch of the Health Extension Program. However, the HEP need to be transformed to the
next higher level to meet the ever growing demand of the community. The HEP needs to have a
seamless integration with the other levels of services through stronger referral and consultation
networking with hospital care.
Due emphasis should be provided to address disparities and quality of care as these are challenges of
the current system that may get worsen if efforts fail to narrow the gaps.
The visioning exercise has reviewed documents to learn health status and performance of MIC which
Ethiopia aspires to join them a decade later as well as understand what health system resources are put
in place in countries with better health outcomes. In this exercise, 48 LMIC and 55 UMIC were
identified based on the World Bank’s classification. Median of the health outcomes of LMIC were
considered as a base case target for Ethiopia by 2025 where plausible. LMIC countries with better
health outcomes and were poor three or four decades ago are considered to indicate a best case target
for 2025. Similarly, targets indicated for 2035 based on medians of UMIC.
53
[HSTP ZERO DRAFT_V2] 10th May, 2014
Status
2013
Estimate
by 2015
Global
Average
(2012/2013)
Maternal
Mortality ratio
Under 5 year
mortality
420
380
68
Neonatal
mortality rate
29
Age
standardized
Mortality due to
malaria per
100,000 popn
Age
standardized
Mortality due to
HIV per
100,000 popn
Age
standardized
Mortality due to
TB per 100,000
popn
Age
standardized
Mortality due to
NCD per
100,000 popn
Life Expectancy
at Birth
Indicator
Best case Scenario
for 2025 (Median of
benchmark LMIC)
210
Base case target
for 2025
(Median of
LMIC)
240
Best case Scenario
for 2035 Median of
benchmark UMIC
120
Base case target
for 2035
(Median of
UMIC)
57
58
51
62*
31
20
14
27
22
28**
15
10
9
17
12
14
0
0.6
0
51
25
25
4
20
6
18
14
22***
9
5.7
3
476
573
658
680
608
509
64
70
66
71
74
75
Remark
46
*2025 cannot be
taken as bench mark
as the country will
exceed 62 by 2015
**2025 cannot be
taken as bench mark
as the country will
exceed 28 by 2015
***2025 cannot be
taken as bench mark
as the country
already passed 22 by
2013
Ethiopia need to
target to halt death
due to NCD below
476
54
Performance Measures and Targets for HSTP
Note: Details of the performance measures (the draft monitoring and evaluation framework for HSTP) is annexed
Sr.
No
1
2
3
4
5
6
7
8
9
10
11
1
2
3
4
5
6
7
8
9
Indicators
C1: Maximize Equitable Utilization of Health Services
1.1 Improve maternal & neonatal health
Maternal Mortality Ratio (per 100,000LB)
Total Fertility Rate
Contraceptive Prevalence Rate (%)
Unmet need for Family Planning
Antenatal Care Coverage (4+)
Proportion of deliveries attended by skilled health personnel
Proportion of women who received PNC at least once during
postpartum
Proportion of pregnant women who received ARVs for
prophylaxis of MTCT
Increase the proportion of children who have received DBS for
EID at 8 weeks
Proportion of HFs providing basic and comprehensive
Emergency Obstetric and Newborn care as per the standard
Increase the met need for Emergency Obstetric Care
1.2 Improve Child Health
Under-5 Mortality Rate
Infant Mortality Rate (IMR)
Neonatal Mortality Rate (NMR)
Polio eradication by 2017
Measles elimination by 2020
Penta 3 coverage
Measles immunization
Fully Immunization
IMNCI implementation
Baseline
2013
Target 2020
Base Case
Best Case
420
196
192
4.8
34%
18%
19.1%
23%
79%
3.1
52%
3%
95%
80%
95%
2.6
60%
1%
98%
90%
97%
42%
95%
97%
Target
2025
Target
2035
120
46
27%
19%
12%
14%
10%
7%
Assumption for Base case scenario
*2020 target is with 11.2% annual reduction;
2025&2035 is from Benchmarking
95%
100%
100%
6%
80%
90%
68%
47%
29%
38%
26%
15%
33%
22%
13%
82%
96%
96%
95%
100%
98%
98%
97%
100%
77%
71%
*8%and6.5% reductiona nnually
*8%and6.5% reductiona nnually
Global target -"every-newborn-action-plan"
55
[HSTP ZERO DRAFT_V2] 10th May, 2014
8
1
2
3
1
2
3
4
5
6
7
8
9
10
11
12
13
1
2
3
ICCM implementation
1.3 Improve adolescent & youth health
Proportion of facilities offering minimum basic package of
adolescent friendly RMNCH services as per the standard
Teenage/adolescent pregnancy
Proportion of HF with safe abortion services as per the standard
1.4 Improve nutritional status
Childhood wasting
Underweight in U-5
Stunting in U-5
Low birth weight
Prevalence of anemia in women of childbearing age(15-49 )
Proportion of exclusive breast feeding 0-6 months
Timely introduction of breast feeding
Proportion of children aged 6-59 months who received vitamin
A supplementation
Proportion of children aged 2-5 years de wormed
Proportion of under 5 children managed for severe malnutrition
Proportion of pregnant women supplemented with folic acid
and iron
IYCF - Percent of children 6-23 months received minimum
acceptable diet
Proportion of Households using iodized salt
1.5. Reduce the incidence and prevalence of major diseases
1.5.1 Reduce incidence & prevalence of major communicable
diseases
1.5.1.1 Reduce incidence & prevalence of HIV/AIDS
Incidence of HIV
Prevalence of HIV
Prevent new HIV infections
79%
12%
100%
100%
100%
100%
3%
100%
100%
9.7%
29%
44%
11%
17%
53%
19%
91%
4.9%
13.3%
26.6%
7.6%
12%
89%
51%
97%
4.1%
8.61%
21%
6.5%
84%
100%
100%
100%
100%
17%
100%
100%
4.1%
6.5%
15%
80%
0.03
1.25
0.01
0.86
95,000
95%
100%
105,000
56
[HSTP ZERO DRAFT_V2] 10th May, 2014
4
5
Save lives
reach at risk population ( female sex workers, seasonal/ daily
laborers and truck drivers) with a comprehensive behavioral and
biomedical prevention programs( Condom &STI) (This is the sum
of 120,000 FSWs, 10,000 truck drivers, 1 milion daily laborers,
430,000
14.7
million
640,000 widowed and divorced , 733,000 sexually active
PLHIVS, 13 mil adult and adolescent population age
above 10-24)
6
reach people in urban, hot areas and surrounding areas of
mega projects/development schemes and new emerging
economies with a comprehensive behavioral and biomedical
prevention programs( Condom &STI) (Urban areas and
8.2
Million
surrounding communities to the mega project sites
and other development schemes)
7
10
1
2
3
Offer testing and counseling to people annually
Proportion of patients who are currently on ART (Universal
coverage of the total PLHIV who are in ART need( 597,500) .this
number is from the new estimation projection )
1.5.1.2 Reduce incidence & prevalence of TB and Leprosy
TB Mortality rate per 100,000 population
TB Prevalence Rate per 100,000 population
TB Incidence rate per 100,000popn
Leprosy prevalence rate
7
17 Million
478,000
(80%)
18
224
247
6.5
147
178
0.5/
10,000
popn
<0.1/ 10,000
popn
Case notification rate per 100,000 population for all forms
(bacteriologic ally confirmed plus clinically diagnosed TB Cases)
152
225
Case Detection Rate for all Form
Case notification rate for Bacteriologically confirmed TB Cases
per 100,000 populations
70%
56
87%
87%
4
5
6
324000
567625
(95%)
57
[HSTP ZERO DRAFT_V2] 10th May, 2014
8
9
Treatment success rate for bacteriologic ally confirmed TB cases
92%
95%
Cure rate for bacteriologic ally confirmed TB cases
Treatment success rate for all forms of TB Cases
(bacteriologically confirmed plus clinically diagnosed TB cases)
71%
85%
90%
95%
10
Number of Bacteriologically confirmed drug resistance TB case notified
(RR-TB & MDR-TB)
15%
11
Laboratory-confirmed MDR-TB cases enrolled on second-line anti-TB
treatment during the specified period of assessment (number)
MDR-TB Cure rate
Leprosy Treatment Completion Rate
100%
12
13
14
1
2
10%
84%
1.5.1.3 Reduce incidence & prevalence of Malaria
Achieve near zero malaria deaths
Reduce malaria cases by ____% from baseline of 2012
Eliminate malaria in selected low transmission areas
80%
95%
100%
75%
100%
3
5
8
9
No monthly malaria cases report from 24 months malarious
kebele’s of targeted woreda’s for elimination of malaria
Proportion of households in malarious areas posses at least two
LLINs
Proportion of households in IRS targeted areas that were
sprayed in the last 12 months
1.5.1.4 Reduce incidence & prevalence of other neglected
tropical diseases
To eliminate blinding trachoma by 2020
To eliminate Onchocerciasis by 2020
To eliminate Lymphatic filariasis by 2020
Proportion of identified cases of Podoconiosis
received management with positive outcome
to eliminate schistosomiasis to a level where it is no
longer a public health problem by 2020
100%
100%
100%
100%
100%
50%
90%
100%
58
[HSTP ZERO DRAFT_V2] 10th May, 2014
1
2
3
1
2
Interruption of transmission Guinea worm disease by 2015 and
certification of eradication by 2018.
1.5.2. Reduce incidence & prevalence of major noncommunicable diseases
Proportion of relative reduction in overall mortality from
cardiovascular diseases, diabetes, or chronic respiratory
diseases
Proportion of women screened with VIA for cervical cancer
Increase Cataract surgical cases (CSR)
1.6. Improve hygiene & environmental health
Proportion of households with access to Improved latrine
Proportion of HHs utilizating of Latrine facilities
Proportion of population adopting hand washing practice with
soap/substitute and water at critical times
25%
0%
21%
60%
8%
50%
93%
35%
4
Proportion of ODF Kebeles/% of Kebeles with declared open
defecation free(ODF)status
18%
89%
5
% of households storing treated water in safe storage containers
27%
93%
6
% of water samples negative test for E. coli in drinking water at
the point of sampling
Proportion of health institutions with Complete WASH package
5%
20%
32%
100%
10%
20%
15%
50%
50%
30%
2%
1%
30%
80%
80%
50%
30%
20%
7
8
9
10
11
12
13
14
Proportion of public food establishments satisfying
requirements of food hygiene
Proportion of Households with good Housing condition
Proportion of HHs properly managing Solid Waste
Proportion of HHs properly managing Liquid Waste
Proportion of public institutions with complete wash packages
Proportion of Woredas conducting Water Quality tests
Proportion of Urban Areas practicing small and large scale
liquid waste disposal methods
59
[HSTP ZERO DRAFT_V2] 10th May, 2014
15
Proportion of urban areas with proper solid waste Management
1
2
3
4
5
6
7
8
9
10
F1: Improve Efficiency and Effectiveness
Increase financial resource utilization rate
Increase financial liquidation rate
Increase proportion of funds dispersed as per performance
proportion of accounts closed timely
Proportion of liquidated budget
proportion of fee waved
proportion of Indigents benefited from fee waiver/subsidy
Number of audited account/project
proportion of projects with clean opinion
Number of Insurance scheme beneficiaries
1
2
3
4
5
6
7
8
9
10%
30%
P1: Improve Access and Quality of Health Services
Increase admission rate
Bed Occupancy Rate
Decrease Average Length of Stay
Increase proportion of satisfied clients with the health services
Decrease inpatient mortality rate
Increase proportion of referred patients completing referral
process successfully (from the beginning to the feedback)
Increase hospitals with designated emergency unit
Increase Proportion of emergency patient getting emergency
care in less than 5 minutes
Decrease Mortality Rate in Emergency
60
[HSTP ZERO DRAFT_V2] 10th May, 2014
10
Increase proportion of blood collected from VNRBDs
11
Increase proportion of whole blood converted into
components
Increase proportion of hospitals accessing 80% of the blood
from the NBTS and its network
12
1
2
1
2
3
1
2
4
5
6
P2: Improve regulatory systems
Proportion of licensed/certified health institutions by type and
ownership
Proportion of inspected food and drinking establishments
P3: Improve community participation, engagement and
ownership
Proportion of Model households graduated
Proportion of health facilities with community representation in
health facility board
Proportion of functional 1 to 5 networks
Proportion of Model households graduated
P4: Improve good governance
Number of conducted forums with public wings and
stakeholders
Proportion of Participants participated in conducted forums
Number of Improved standards based on citizens charters
Number of staff complains addressed through established
system
proportion of people Satisfied by the services provided through
health sector
P5: Improve Logistics supply and management
Availability of essential medicines (tracer products)
Availability of essential medicines (tracer products)
Frequency of stock out (for tracer products)
61
[HSTP ZERO DRAFT_V2] 10th May, 2014
Pharmaceutical Wastage Rate
Government expenditure on medicines through RDF Target:
2.73 billion to 8.5 billion)
Availability of PFSA Hubs within _________ km radius
Procurement Lead Time (Central Medical Stores)
Eligible Private Health Facility Integrated in Public Health Supply
Chain Management System for Key Health Programs
Facilities with implemented APTS
Facilities with functioning DTC
Facilities with functioning DIC
Facilities with functioning computerized inventory management
1
2
3
4
5
6
P6: Improve resource mobilization
General Government expenditure on health
Proportion of Health budget utilization
Proportion of the total revenue generated by health facility to
the total allocated health budget
Proportion of reimbursed amount out of total patient fees
waived
Proportion of households enrolled in Community based health
Insurance (CBHI) schemes
Proportion of employees enroled in Siocial health Insurance
(SHI) schemes
7
1
2
3
4
P7: Improve evidence-based decision making
Proportion of supportive supervision visits received, with
written feedback provided at the time of supervision
Report Completeness
Reporting timeliness
Data quality assurance (LQAS)
CB1: Enhance use of technology and innovation
1
62
[HSTP ZERO DRAFT_V2] 10th May, 2014
2
1
2
3
4
5
1
2
3
4
5
6
CB2: Improve development and management of human
resource for health
Health Staff to population ratio by category
5,000 HEWs upgraded through distance learning
Proportion of institutions staffed as per standards
Health Extension Workers to population ratio
Attrition rate by category
Improve Health Workforce Productivity
Physician to population ratio
Health Officer to population ratio
Midwife to population ratio
Nurses to population ratio
Pharmacist to population ratio
Laboratory to population ratio
HEW to population ratio
Health staff skills mix
Health professional attrition rate
CB3: Improve health infrastructure
Construct & equip 11 General Hospitals [PHI]HeaHh hhh 1 for
1,000,000 population
Construct & equip 9 referral hospitals [PHI] 1 for 5,000,000
population
Increase number of Primary Hospitals [PHI] 1 for 100,000
population
Increase number of Health Posts[PHI]
Number of Health Centers [PHI]
Potential health service coverage
Functional facility to population ratio
Health institutions newly constructed and upgraded
Health institutions with functional infrastructure
0
15,000
3200
63
[HSTP ZERO DRAFT_V2] 10th May, 2014
Health institutions with communications equipment
Health institutions maintenance
Health institutions with communications equipment
Health institutions with computer and accessories
1
CB4: Enhance policy and procedures
No. of policies , legal frame works and guidelines
developed/revised/promoted and implemented
2
64
3.7. Strategic Initiatives:
C1: Maximize access to and utilization of health services:
1. Scale up Family Planning Services through Right Based Approach
2. Scale Up Essential Neonatal and Child health services
3. Strengthen Expanded Program of Immunization
4. Scale up Youth Focused RMNCH services
5. Scale up Reproductive Health Services
6. Scale up Essential Maternal Health Care services
7. Expansion of Maternal Death Surveillance and Response
8. Strengthen PMTCT Services
9. Scale up Basic and Comprehensive EmONC services
10. Intensify targeted HIV Prevention
11. Strengthen HIV Care and Treatment Services
12. Sustain multi-sectoral response to HIV Prevention and Control
13. Enhanced Implementation of TB Prevention and Care Packages
14. Expansion and Enhancement of Drug-Resistant TB (DR-TB) Prevention and Care packages
15. Launch Final Phase of Leprosy Elimination Strategy
16. Maintain Universal access to Selected Malaria prevention interventions
17. Improve Early diagnosis and prompt treatment of Malaria
18. Eliminate P.Falciparum malaria from selected Woredas with low transmission
19. NTD
20. Improve access to promotion, prevention and control of major NCDs risk factors to the
community
21. Improve access to prevention and control of NCDs
22. Expand rehabilitative Health Services
23. Scale up Community-based nutrition (CBN) program
24. Scale up micronutrient program interventions
25. Community management of acute malnutrition (CMAM)
26. Scale up Infant and young child feeding programs (IYCF)
27. Multi –sectoral collaboration
28. Integration with other health programs
29. Strengthen Public Health Emergency Management
30. Improve Institutional WASH program
31. Scale up Water quality monitoring and surveillance program
32. Strength Waste Management Program
33. Scale up Access to and utilization of Improved hygiene and sanitation
34. Improve access and utilization of blood and blood products
F1: Improve Efficiency and Effectiveness
1. Scale up grant management system
2. IFMIS scale up
3. Financial management system enhancement
4. Auditable pharmacy scale up and transaction
5. Timely and efficient procurement
6. Property administration and management enhancement
7. Efficient utilization of Insurance fund
8. Efficient facility revenue utilization
P1: Improve quality of health services:
1. Primary Health Care Unit Reform
2. Hospital reform implementation
3. Strengthening specialty care
65
[HSTP ZERO DRAFT_V2] 10th May, 2014
4.
5.
6.
7.
8.
9.
10.
11.
12.
Strengthening access to safe blood and blood products
Emergency Medical Service System
Strengthening the referral system and hospital - health center network
Electronic Medical Record
Palliative and rehabilitative care
Strengthening pharmaceutical care
Forensic medicine
Strengthening internal quality assurance system
Health facility development army implementation
P2: Improve regulatory systems
1. Strengthening of Regulatory legal frameworks setting and promotion
2. Strengthening safety and Quality Assessment and Registration of foods
3. Strengthening safety and Quality Assessment and Registration of Medicine
4. Strengthening safety and Quality Assessment and Registration of Medical devices and In
vitro diagnostics
5. Strengthening of Traditional medicine and practice regulation
6. Launching and implementing Continuing Professional Development /CPD/
7. Strengthening of professional Ethical Competency
8. Strengthening of Health professional Registration and Licensing
9. Strengthening of Health institution competency certification
10. Regulatory Information Communication and Networking
11. Strengthening of hygiene and environmental regulation
12. Strengthening Proper Medicine Use
13. Control of drug abuse
14. Strengthening of Food and Medicine Quality control
15. Strengthening Pharmacovigiliance and Post Marketing Surveillance
16. Strengthening of control of illegal trading of health and health related products
17. Strengthening of control of illegal practice of health professionals and health institutions
18. Strengthening of Clinical trial Monitoring
19. Strengthening Port Clearance
20. Establishment of haemo-vigilance and strengthening safety, quality and regulation of blood
and blood products
P3: Improve community participation, engagement and ownership
1. Rural HEP quality improvement
2. Redesign and implement Urban and Pastoralist HEP
3. Enhance functionality of HAD
4. Reform and Implement PHCU
5. Enhance evidence based health education and communication
P4: Improve governance
1. Strengthening Participation at all level
2. Strengthening Health Development Army
3. Establishing and Strengthening Internal Control Mechanisms
4. Creating Conducive Work Environment for all and especially making women friendly
5. Strengthening and Standardize service delivery in the Health Sector
6. Strengthening the Pharmaceuticals and Health Products supply System in the Country
P5: Improve Logistics supply and management
66
[HSTP ZERO DRAFT_V2] 10th May, 2014
1.
2.
3.
4.
Improve Quantification and Procurement Efficiency
Implement Efficient Warehousing and Inventory Management System
Implement efficient fleet management and distribution system (outbound logistics)
Implement Integrated Pharmaceuticals Fund and Supply Management Information System
(IPFS MIS)
5. Strengthen Revolving Drug Fund
6. Implement Auditable Pharmaceutical Transaction System
7. Strengthen Rational Use of Medicines and Health Technologies
8. Promote HR Capacity Building for Health SCM
9. Strengthen Coordination Mechanisms with Key Stakeholders
10. Establish Pharmaceutical Waste Management System
11. Develop and implement M & E for Pharmaceutical supply chain management
12. Strengthen access to medicines for targeted programs through the Private Sector with Clear
Guidance on Accountability
P6: Improve resource mobilization
1. Improve Government share to Health Financing
2. Enhance HCF Reform implementation to ensure quality and equitable health service access
3. Scale up CBHI
4. Implement SHI
5. Establish innovative ways of Domestic Health Financing
6. Enhance Health Partnership and Coordination (DPs, CSOs/NGOs, PPPH, FBOs)
7. Strengthen resource tracking and management
8. Enhance external fund mobilization
P7: Improve evidence-based decision making
1. Strengthen routine performance monitoring system
2. Strengthen survey and surveillance systems
3. Conduct research and evaluation
4. Supportive supervision and inspection
5. Data quality assurance and auditing
6. Communication, advocacy and dissemination
7. Capacity building to support evidence based decision making
CB1: Enhance use of technology and innovation
1. Complete health facility and their climate change copping capacity mapping
2. Vaccine and diagnostics materials technology transfer and production
3. Enhance the health information systems through use of existing and new information
technology
4. Development and use of local technologies (Traditional medicine, food technology) innovation
5. Vulnerability and risk assessment and mapping of diseases (Atlas of diseases)
6. High tech diagnostic technology transfer
7. National digital health and health related database repository
8. Medical equipments and diagnostic facility technology level determination for health tier
systems
9. Build system for supporting and capacitating health innovators and innovative ideas
CB2: Improve development and management of human resource for health
1. Scale up Training and development of health professionals in line with staffing requirement
2. Introduce integrated curriculum (competence based) to medical schools
3. Strengthen In-Service Health Training and Continuing Professional Development
4. Upgrading of health extension workers
5. Expand enrolment and produce adequate number of family health team based on PHC model
67
[HSTP ZERO DRAFT_V2] 10th May, 2014
6. Team based training for Emergency medical service
7. Team based training of Maternal and Child care providers ( Midwife, Anesthesia, and
Neonatal nursing)
8. Increase the production of clinical specialities and introduce forensic medicine training
9. Strengthening clinical pharmacy programs and Supply chain management professionals
training
10. Initiate Health Regulatory affairs
11. Provide support for quality audits of all existing pre-service training programs
12. Universities/Health science colleagues industry linkage and Medical schools twinning (
National and international
13. Introduce new postgraduate to support the HRM of the health sector and the health care
financing/insurance
14. Initiate knowledge management center in FMOH
15. Strengthen the HRM Function and Practices at all levels
16. Enhance National licensing exam
17. Establish a Comprehensive Human Resources Information system (HRIS)
18. Reduce Inequity in Geographic Distribution and skill and gender mix of health care Workers
19. Enhance Motivation and retention
20. Enhance performance and productivity
CB3: Improve health infrastructure
1. Health and health related facility construction
2. Expansions of Health center
3. Rehabilitation of hospitals
4. Maintenance and renovation of health and health related Facility
5. Provision of utilities (Water supply, Toilet ,incinerator, placenta pit and Power supply)
6. National digital health and health related database repository
7. Adoption of medical equipment, construction and ICT Standards
8. Avail medical equipments maintenance tools and devices
CB4: Enhance policy and procedures
1. Develop Health and Health related policies, legal frameworks and guidelines
2. Revise Health and Health related policies, legal frameworks and guidelines
3. Awareness creation for community, stake holders and health professions on policies, legal
frameworks and guidelines
4. Follow up implementation of policies and legal frameworks
68
[HSTP ZERO DRAFT_V2] 10th May, 2014
Scope and deliverables of the strategic initiatives:
C1: Maximize Equitable Utilization of Health Services
Strategic Initiatives:
1
Deliverable:



S. Initiative: Initiative 1: Scale up Family Planning
Services through Right Based Approach
Improved method mixes
Improved CPR
Reduced unmet needs
Scope (What is included in the initiative):
This initiative includes expansion of Family planning
services by ensuring availability of proper mixes of
methods through rights based approach. This entails
expansion of long-acting FP methods availability at
community and HF levels.
2
3
S. Initiative 2: Scale Up Essential Neonatal and Child
health services


Scope (What is included in the initiative):

This initiative is intended to scale up community based and
HF-based essential new born care services (CBNC, New
born corners and NICU).

S. Initiative 3: Strengthen Expanded Program of
Immunization
Improved Coverage of
immunization services
Scaled up of CBNC
Expansion of Newborn
corners in all HCs
NICU established at all
hospitals
Scaled up essential Child
health care services
Scope (What is included in the initiative): This initiative
aims to Strengthen Routine Immunization Programs (Cold
Chain, Management), Introduce New Vaccines, and
enhance National Polio Eradication Initiative.
4

Improved access to
RMNCH for youth
S. Initiative 5: Scale up Reproductive Health Services

Scope (What is included in the initiative): This is intended
to expand access to comprehensive Abortion Care Services.


S. Initiative 6: Scale up Essential Maternal Health Care
services

Improved access to safe
abortion services
Improved utilization
Reduced unsafe
abortion
Improved access to
maternal heath services
Minimized access
barriers to essential
Maternal health care
S. Initiative 4: Scale up Youth Focused RMNCH services
Scope (What is included in the initiative): This initiative
includes the implementation of youth focused RMNCH
services in all HFs, Schools, Higher institutions.
5
6
Scope (What is included in the initiative): This initiative
includes the scale up of essential Maternal Health Care
services with focus on Reducing access barriers to maternal
health care, Ensure immediate Post-Partum Care through

69
[HSTP ZERO DRAFT_V2] 10th May, 2014
home visits, ensure Skilled Delivery Care is provided 24
hours a day and 7 days a week in all health facilities.
7
S. Initiative 7: Expansion of Maternal Death Surveillance
and Response
Improved evidence generation
for service improvement
Scope (What is included in the initiative): This initiative
focuses to improve access to high-quality maternal health
services through implementation of Community Based
Verbal Autopsy, Facility Based Audit, Death
Surveillance and Response
8
S. Initiative 8: Strengthen PMTCT Services
Improved access to PMTCT
interventions
Scope (What is included in the initiative): This initiative
intends to improve access to PMTCT services to ensure
universal coverage
9
S. Initiative 9: Scale up Basic and Comprehensive
EmONC services
Scope (What is included in the initiative): This includes the
scale up of Scale up of basic EmONC services to all HCs,
Scale up of Comprehensive EmONC to all hospitals,
enhance availability of blood transfusion services
10
S. Initiative 10: Intensify targeted HIV Prevention



Scope (What is included in the initiative):
This includes the implementation of a focused and targeted
HIV Prevention packages tailored Comprehensive HIV
Prevention Services for most at-risk population groups and
underserved population groups. This initiative primarily
targets high and medium risk groups particularly female
sex workers , truck drivers, migrant workers in mega
projects, sugar plantation, large farms, miners , flower
plantation , urban dwellers and surrounding communities
of the development schemes.
11



Initiative 11: Strengthen HIV Care and Treatment Services

Scope (What is included in the initiative):

This is the implementation of integrated comprehensive
HIV care and treatment services at primary, secondary and
tertiary health care levels to improve ensure universal
access to HIV services.


Improved access to
basic and
comprehensive EmONC
services
Improved utilization of
the services
Access to HIV
prevention and care
packages for the most-at
risk groups will be
improved
Improved enrollment to
care
Enhanced prevention
with positives
Reduction in
transmission
Improved access to care
and treatment
Improved enrollment in
care
Reduces cost
Sustainable program
70
[HSTP ZERO DRAFT_V2] 10th May, 2014
12
Initiative 12: Sustain multi-sectoral response to HIV
Prevention and Control



Improved access
Synergized efforts
Sustainable program

Improved access to TB
prevention measures
Improved access to TB
Diagnostic tests/services
Enhanced TB Case
detection
Improved TB treatment
outcome
Scope (What is included in the initiative):
This initiative includes the implementation of HIV
prevention and control interventions through sustained and
intensified multi-sectoral collaborations.
13
S. Initiative 13: Enhanced Implementation of TB
Prevention and Care Packages

Scope (What is included in the initiative):

This initiative will enhance the implementation of
Comprehensive TB prevention and care packages at
community and Health Facility settings

Expansion of Community based TB Prevention and Care
Packages
2.
Expansion and enhancement of Facility based TB
Prevention and Care Packages
3.
Expansion of PPM-DOTS Services
4.
Enhanced Implementation of TB Prevention and
Care packages in Prisons and Congregate settings
5.
Implement Systematic screening of contacts and
high-risk groups for TB
6.
Accelerated implementation of TB Preventive
therapy for high-risk groups with latent TB infection
7.
Accelerated Implementation of Integrated TB/HIV
interventions and management of co-morbidities
8.
Introduction and scale up of TB and NCDs
collaborative activities
14
Initiative 14: Expansion and Enhancement of DrugResistant TB (DR-TB) Prevention and Care packages

Scope (What is included in the initiative):

This initiative includes the enhanced implementation of
prevention measures for DR-TB through strengthened basic
DOTS services, TB infection control measures, universal


Expansion of diagnostic
and treatment services
for DR-TB
Early detection of DRTB
Improved enrollment to
treatment for DR-TB
cases
Improved DR-TB
71
[HSTP ZERO DRAFT_V2] 10th May, 2014
Drug Susceptibility Testing (DST) for eligible patients,
expansion of DR-TB treatment services and treatment of all
DR-TB cases.
1.

treatment outcome
Reduced DR-TB
Transmission
Expansion of TB Culture and DST Sites
2.
Scale up of Rapid molecular TB diagnostic tests
(GeneXpert Tests)
3.
Introduction and scale-up of DST for second line
anti-TB drugs
4.
Accelerated expansion of Ambulatory MDR-TB
Treatment centers
5.
15
16
Improve patient support system for DR-TB Cases
S. Initiative 15: Launch Final Phase of Leprosy
Elimination Strategy

Scope (What is included in the initiative):

1. Epidemiologic Mapping of leprosy hot-spot areas
2. Intensified implementation of universal screening
of household contacts of leprosy cases at diagnosis
3. Annual screening of household contacts of leprosy
cases
4. Enhancement of leprosy case management in hot
spot areas
5. Improve leprosy patient referral care services
S. Initiative 16: Maintain Universal access to Selected
Malaria prevention interventions

Scope (What is included in the initiative): This initiative
ensures that population at risk will be have full access to at
least one interventions
17
S. Initiative 17: Improve Early diagnosis and prompt
treatment of Malaria
Scope (What is included in the initiative):
This initiative will enable to reduce complications due to
malaria and improves treatment outcome
18






S. Initiative 18: Eliminate P.Falciparum malaria from
selected Woredas with low transmission

Scope (What is included in the initiative):

Expanded Leprosy care
services in hot spot
areas
Improved leprosy
contact screening
Improved leprosy
detection
Targeted households are
protected with LLIN
Targeted Villages are
covered with quality
IRS
Insecticides resistance is
periodically monitored
Improved early
diagnosis and prompt
treatment within 24
hours of onset of fever
Suspected malaria cases
are received
parasitological tests
All confirmed malaria
cases treated as per
national guidelines
Established real-time
surveillance system with
PACD and RACD
Established foci
management system
72
[HSTP ZERO DRAFT_V2] 10th May, 2014
19
S. Initiative 19: NTD
Scope (What is included in the initiative):
20
S. Initiative 20: Improve access to promotion, prevention
and control of major NCDs risk factors to the community
Scope (What is included in the initiative): This initiative
aimed at improving access for promotive and preventive
services for major NCD risk factors (alcohol, unhealthy
diet, physical inactivity, tobacco etc) within the general
public
21
S. Initiative 21: Improve access to prevention and control
of NCDs
Scope (What is included in the initiative): This initiative is
intended to improve and expand prevention, diagnostic,
treatment, care and control activities for major noncommunicable diseases (Cardiovascular, COPDs, Cancer,
Mental illnesses, and Diabetes Mellitus)
22
S. Initiative 22: Expand rehabilitative Health Services

Improved access to
PCTs
 Improved equitable
health services
 Puts the country on
track to eliminate
specific NTDs
 Improved communities’
awareness on NCDs risk
factors
 Improved communities
protection from NCD
risk factors through
enabling policy
 Enhance inter sectoral
response
 Reduction in prevalence
of NCDs risk factors
 Improved access to
prevention and control
packages for NCDs
 Improved access to care
services for NCDs
 Reduced morbidity,
chronic complications
and disability
 Reduced burden (health,
economic, social) due to
NCDs
Improved quality of life
Scope (What is included in the initiative): This initiative
intends to improve access to rehabilitative health services
by expanding the services
23
S. Initiative 23: Scale up Community-based nutrition
(CBN) program
All woredas implementing CBN
Scope (What is included in the initiative):






Monthly growth monitoring and promotion (GMP) of
children under-2;
Monthly community conversations and discussions on
health issues;
Referral linkages to health facility based services;
Micronutrient deficiency control through Vitamin A
supplementation and deworming;
Quarterly screening for acute malnutrition at
Community Health Days (CHDs); and
Multi-sectoral linkages to strengthen nutrition sensitive
73
[HSTP ZERO DRAFT_V2] 10th May, 2014
24
activities with community level education, agriculture,
social protection, and WASH programs.

Breast feeding promotion
S. Initiative 24: Scale up micronutrient program
interventions
All woredas implementing
micronutrient interventions,
routinely
Scope (What is included in the initiative):




25
Strengthen the transitioning of (EOS) vitamin A
supplementation and de-worming
Provision of iron-folic acid tablets to all pregnant &
lactating women
Initiate and support food fortification program
Identify & treat anaemia in children under 5 years
S. Initiative 25: Community management of acute
malnutrition (CMAM)
Scope (What is included in the initiative):
All facilities at all levels provide
services to acute/ moderate
severe malnutrition at all times
(emergency & normal season)

26
Outpatient therapeutic program (OTP) at community
level
 Inpatient management at health facility level
 Targeted supplementary feeding program (TSF/ TFP)
S. Initiative 26: Scale up Infant and young child feeding
programs (IYCF)


Improved growth
Reduced frequency of
infectious diseases

All primary schools
implementing SHN
programs
The PSNP and AGP have
become nutrition sensitive
and are implemented in all
respective woredas
Food fortification program
standards and regulations in
place, program started in all
wheat milling/ oil producing
industries
Scope (What is included in the initiative):

27
Promotion of complementary feeding for all infants 624 months old
o Timely introduction
o minimum dietary diversity
o minimum meal frequency
 Appropriate sanitation and hygiene practices during
food preparation/ storage and feeding
S. Initiative 27: Multi –sectoral collaboration
Scope (What is included in the initiative):




28

Coordination mechanism amongst 9 NNP signatory
sectors
School health and nutrition programs
Nutrition sensitive PSNP and AGP
Food fortification program

S. Initiative 28: Integration with other health programs
74
[HSTP ZERO DRAFT_V2] 10th May, 2014
Scope (What is included in the initiative):



29
Water, Sanitation and Hygiene
Reproductive Health services (adolescents)
Non – communicable disease prevention and control,
re: overweight and obesity
S. Initiative 29: Strengthen Public Health Emergency
Management
Scope (What is included in the initiative):



30
Risk identification and preparedness
Early warning detection and communication
PHE response and recovery
S. Initiative 30: Improve Institutional WASH program
Scope (What is included in the initiative):
31
 Health facility WASH
 School WASH
 Religious places WASH
S. Initiative 31: Scale up Water quality monitoring and
surveillance program
Scope (What is included in the initiative):

32
Household water treatment and safe storage
practices
 Safe water chain establishment
S. Initiative 32: Strength Waste Management Program


Established E OC
Improved early disease
/event detection
 Timely Outbreak
investigated and responded
and recoverd
 Alert/risk communicated
timely
 Established ePHEM
database
 Risk identified/Threat
predicted/ detected and
Coping capacity assessed
 PHEM system and activities
evaluated and corrective
action taken
WASH services expanded in
HFs, Schools and Religious
Institutions


Improved water
treatment and safe
storage practice
Established safe water
chain at Woreda level
Properly managed wastes
Scope (What is included in the initiative):
33
 Solid waste management
 Liquid waste management
 Hazardous waste management
S. Initiative 33: scale up Access to and utilization of
Improved hygiene and sanitation
Scope (What is included in the initiative):
1. Improved latrine
construction
2. Improved latrine
utilization
3. Improved Hand washing
practice at critical times
75
[HSTP ZERO DRAFT_V2] 10th May, 2014
1.
2.
3.
4.
5.
Improved latrine construction
Improved latrine utilization
Hand washing practice at critical times
ODF Kebele production
Introduce sanitation marketing program
F1: Improve Efficiency and Effectiveness
Strategic Initiatives:
1
S. Initiative 1 Scale up grant management system
Scope: establishing the grant management team in all the
regions and forming the link with the central unit.
4. Expanded ODF Kebele
production
5. Introduced sanitation
marketing program
Deliverable:


Initiative 2 IFMIS scale up

Scope : produce standardized financial analysis and
provide regularly and timely reports to stakeholders

Initiative 3: Financial management system enhancement

Scope: Identifying areas/initiatives which are exposed to
risk and prioritizing those to be audited, and
ascertain/assure the audit is done as per the government's
rules and regulation to put protection mechanism

Initiative 4: Auditable pharmacy scale up and transaction

Scope: scaling up of the piloted auditable pharmacy to all
hospitals
Initiative 5 Timely and efficient procurement
Established and
effectively managed
grant management team
in all regions
Properly and timely
utilized fund
Agencies and RHB'S
implementing IFMIS.
Consistently and timely
produced and
standardized financial
report
Improved internal
control system
Identified and mitigated
risks
No of hospitals
implemented auditable
pharmacy
 Properly managed
pharmaceutical supplies
and medical equipment
Timely and efficiently procured
quality materials
Scope: Ensure proper adherence to procedures, rules and
regulations for quality and timely delivery of materials
Initiative 6 Property administration and management
enhancement
Efficient and well managed
property
Scope: Identifying the gab and formulate and improve a
system for proper property administration
Initiative 7 Efficient utilization of Insurance fund

Scope –Identifying and implement feasible ways of
reducing supply and demand side moral hazards

Identified provider
payment mechanisms
Identified Co-payment
level and other
administrative and legal
rules
76
[HSTP ZERO DRAFT_V2] 10th May, 2014
Initiative 8 - Efficient facility revenue utilization
well managed facility resource
,improved efficiency
Scope: Support proper utilization of revenue collected at
facility level
P1: Improve Access and Quality of Health Services:
Strategic Initiatives:
1
Deliverable:
Initiative:

Primary Health Care Unit Reform

Scope:

2
Improving preventive, curative and rehabilitative
services at PHCU
 Primary health care unit linkage
 Primary health care performance monitoring and
improvement framework
 Leadership Management and Governance of PHC
unit
Initiative:
Hospital reform implementation



Scope:

3
Enhancing the provision of patient centered,
efficient, effective, timely and safe health services
at hospitals level
 Strengthening the accountability mechanism
through hospital performance monitoring and
improvement framework (KPI)
 Ensuring professional leadership and governance at
hospital level
Initiative:
Strengthening specialty care





Scope:
Working
reform
guidelines
Functional
linkage
between health center
and hospital
Performance measures
for
primary
care
introduced
Professional leadership
and
governance
of
primary health care unit
Professional
hospital
leadership
and
governance
Efficient service flow
Increased
patient
satisfaction
Transparent
and
accountable monitoring
system
Developed packages of
essential specialty care
Hospitals
providing
specialty care
Packages of essential specialty care will be developed and
be available in tertiary facilities (ICU,OR, dialysis, organ
transplantation, ….etc)
4
Initiative:

Strengthening access to safe blood and blood products
Scope:

100% blood and blood
product collected from
volunteer donors
Safe blood and blood
products distributed to
users
77
[HSTP ZERO DRAFT_V2] 10th May, 2014

5
6
100% Collection of blood and blood products
from voluntary donors
 Safe blood and blood products provision to health
facilities
 Appropriate clinical use of blood and blood
products
Initiative:

Emergency Medical Service System

Scope:

 Pre facility and facility based emergency services
Initiative:

Strengthening the referral system and hospital - health
center network

Scope:



7
Availing service directory and liaison service
Completion of the referral process with feedback
Establish capacity building system between
hospitals and networked health centers
Initiative:

Electronic Medical Record

Scope:
Equipped and functional
ambulance system
Functional
command
post
Available facility based
emergency services
Facilitated
and
pre
communicated referrals
Established functional
capacity building system
between hospitals and
networked
health
centers
Facilities implementing
EMR
Selected
hospitals
implementing full EMR

8
Electronic Medical Record in all facilities and full
Electronic Medical Record in selected hospitals
Initiative:

Health facilities starting
palliative
and
rehabilitative
care
services

Improved
pharmaceutical
care/RDU
Accountable
management
Palliative and rehabilitative care
Scope:

9
Palliative and rehabilitative care in health
facilities
Initiative:
Strengthening pharmaceutical care
Scope:
10
 Clinical pharmacy services
 Auditable pharmacy transaction and services
Initiative:
Forensic medicine


drug
Accessible
forensic
medicine services at
least in major regional
hospitals
78
[HSTP ZERO DRAFT_V2] 10th May, 2014
Scope:
11
 Forensic medicine services
Initiative:

Per standard
facilities

Accountable
and
committed
health
professional
Timely and
efficient
health service
Transparent health care
delivery system
health
Strengthening internal quality assurance system
Scope:
12
 4P’s (Product, practice , profession and premises)
Initiative:
Health facility development army implementation

Scope:



Health facilities Networking
Professionals networking with in health facilities
FMOH, RHB and health facilities governance and
leadership
P2: Improve regulatory systems
Strategic Initiatives:
1
Initiative:

Deliverable:

Increased proportion of
implemented regulatory
frameworks for effective
regulation.

Increased proportion of
safe and quality foods.

Increased proportion of
safe, effective and
quality medicine and
Strengthening of Regulatory legal frameworks setting and
promotion
Scope:
This initiative is applicable to existing and new regulatory
proclamation, regulation, directives, standards and
guidelines. It covers from development and promotion of
regulatory legal framework.
2
Initiative:
Strengthening safety and Quality Assessment and
Registration of foods
Scope:
The aim of this programme is to strength food safety and
quality assurance system to tackle the current health
problem of the public arising from the use of substandard
and unsafe foods. It covers foods with high risk for the
public from market authorization stage till public use.
3
Initiative:
Strengthening safety and Quality Assessment and
79
[HSTP ZERO DRAFT_V2] 10th May, 2014
Registration of Medicine
biological
Scope:
This progrmamme developed to ensure safety, efficacy
and quality of medicine and biological/vaccine
4

Increased proportion of
safe, performance and
quality medical devices
and in vitro diagnostics.
Initiative:

Strengthening of Traditional medicine and practice
regulation

Increased proportion of
safe and effective
traditional medicine.
Increased proportion of
licensed and registered
traditional medicine
practitioner.
Initiative:
Strengthening safety and Quality Assessment and
Registration of Medical devices and In vitro diagnostics
Scope:
This progrmamme developed to ensure safety,
performance and quality of medical devices and in vitro
diagnostics
5
Scope:
This initiative is applicable to strengthen traditional
medicine and practice regulation.
6
Initiative:

Improved skill of health
professional

Increased proportion of
competent and ethical
health professional.

Increased proportion of
registered and licensed
health professional.
Launching and implementing Continuing Professional
Development /CPD/
Scope:
This initiative is applicable to all health professionals.
7
Initiative:
Strengthening of professional Ethical Competency
Scope:
Applicable to all health professional working in private
and public institution
8
Initiative:
Strengthening of Health professional Registration and
Licensing
80
[HSTP ZERO DRAFT_V2] 10th May, 2014
Scope:
This initiative is applicable to all health professionals. It
focuses mainly on strengthening licensing and registration.
9

Increased proportion of
private and public health
facilities complied with
the minimum regulatory
standards.

Improved efficiency and
effectiveness of
regulatory
communication and
system.

Improved hygienic
services and
environmental health

Improved prescribing,
dispensing and drug
information delivery
services.
Initiative:

Control of drug abuse

Identification of drug
abuse prevalence
Improved control of
drug abuse and
prevention
Initiative:
Strengthening of Health institution competency
certification
Scope:
This initiative is applicable to all Private and Public
existing and new health institutions to comply with the
minimum regulatory standard.
10
Initiative:
Regulatory Information Communication and Networking
Scope:
This initiative is applicable to all major regulatory
functions
11
Initiative:
Strengthening of hygiene and environmental regulation
Scope:
This initiative is applicable to hygiene of health related
institutions, health and pharmaceutical waste disposal and
regulation of communicable disease.
12
Initiative:
Strengthening Proper Medicine Use
Scope:
This initiative is applicable to all medicines including
prescribing, dispensing and public use.
13
Scope:
This initiative is applicable to control of Narcotic drugs,
psychotropic substances, tobacco, alcohol, khat and other
81
[HSTP ZERO DRAFT_V2] 10th May, 2014
substance of abuse.
14
Initiative:

Strengthening of Food and Medicine Quality control
Scope:

This initiative is applicable to all quality control testing of
food, medicine, medical device, in vitro diagnostics and
biological
15
Initiative:
Accredited and
Prequalified Quality
control lab
Improving quality
control testing capacity
of food, medicine,
medical device, in vitro
diagnostics and
biological

Improved quality of
marketed products

Improved coverage and
quality of control of
illegal trading

Improved coverage and
quality of control of
services.

Increased proportion of
monitored clinical trials.
Strengthening Pharmacovigiliance and Post Marketing
Surveillance
Scope:
Applicable to marketed Medicine, Medical device, In vitro
diagnostics, Biological and Food
16
Initiative:
Strengthening of control of illegal trading of health and
health related products
Scope:
This initiative is applicable to trading activities not
complying with regulatory requirements.
17
Initiative:
Strengthening of control of illegal practice of health
professionals and health institutions
Scope:
This initiative is applicable to trading activities and
practices not complying with regulatory requirements.
18
Initiative:
Strengthening of Clinical trial Monitoring
Scope:
Applicable to all clinical trial conducted on human
subjects. It covers assessment of protocol and site
verification.
82
[HSTP ZERO DRAFT_V2] 10th May, 2014
19
Initiative:

Improved port clearance
quality assurance system

Improved quality and
safety of blood
transfusion service
Strengthening Port Clearance
Scope:
Applicable to all health and health related products
20
Initiative:
Establishment of haemo-vigilance and strengthening
safety, quality and regulation of blood and blood products.
Scope :
Applicable to all steps of blood transfusion services .
P3: Improve community participation, engagement and ownership
Strategic Initiatives:
1
Initiative: Rural HEP quality improvement
Scope: This strategic initiative includes improving the
quality of rural HEP through enhancing competency and
motivation of HEWs, re-visiting service packages, updating
service delivery modality and effective follow up and
support.
2
Initiative: Redesign and implement Urban and Pastoralist
HEP
Scope: This strategic initiative includes Conducting indepth situational assessment, program evaluation and
benchmarking of other community based models related to
urban and pastoralist context, come up with package, pilot
the package in small scale and position for scale up.
3
Deliverable:







Revisited HEP service
packages
Updated service delivery
modality
Competent and motivated
HEWs
Established strong
monitoring and follow up
support system
Identified Major issues,
gaps and problems related
to Urban and pastoral HEP
Redesigned Urban and
pastoral HEP
Redesigned model piloted
and scaled up
Initiative: Enhance functionality of HDA
Scope: This strategic initiative includes Establishing strong
support and monitoring mechanism for HDA from higher
level to lower level to strengthen the networking and 1 to 5
routine network meeting to enable them identify and solve
bottlenecks for improved attitude, skilled and knowledge to



Strong HDA network in
place
Community’s knowledge,
skill and attitude increased
Increases Community’s
83
[HSTP ZERO DRAFT_V2] 10th May, 2014
produce and sustain model families through scale up of
best practices.



4
5
Initiative: Reform and Implement PHCU

Scope: This strategic initiative includes Reform primary
health care packages, service delivery modality and
governance/management structure/ and pilot in selected
areas and scaled up accordingly; so that the primary health
care unit will respond to changing community need, change
in population dynamics and epidemiology of disease
pattern.

Initiative: Enhance evidence based health education and
communication




Scope: This strategic initiative includes Implementation of
standardized, evidence based and contextualized health
education and communication to ensure effective
interpersonal, group and mass communication for
behavioral and social change
P4: Improve Good Governance
Strategic Initiatives:
1
Standardized &
harmonized massages
and health learning
materials
Evidence generated
Effective interpersonal
and mass
communication
Deliverable:


Participatory and joint
planning,
Periodic evaluation and
feedback.
Initiative: Strengthening Health Development Army
Scope:
This strategic initiative includes Supportive
Supervision and inspection, feedback, supportive training,
Benchmarking, promotion of knowledge and experience
sharing, creating enabling environment for sustainable
fighting of rent seeking behavior.
3


Reformed PHCU
service package
Reformed service
delivery modality
Reformed PHCU
governance structure
Reform packages
piloted
Reform scaled up
Initiative: Strengthening Participation at all level
Scope: This strategic initiative includes strengthen of
Public wing, Intra and Inter Sectoral Collaboration and
ensure Internal staffs participation.
2
health seeking behavior
Produced and ensure
sustainable Model families
Established Strong
monitoring and evaluation
system in place
Best practices documented
and scaled up
Initiative: Establishing and Strengthening Internal Control

High Capability and
functionality of the HDA

Strong control system that
identify malpractices
84
[HSTP ZERO DRAFT_V2] 10th May, 2014
Mechanisms
Scope: This strategic initiative includes compliance
handling, Internal audit, ethics/discipline, legal Service.
4
5
Initiative: Creating Conducive Work Environment

Scope:
This strategic initiative includes transparent
recruitment, promotion and demotion, performance
appraisals, job security, fair benefit packages and rewards
in the health system.


Initiative: Strengthening and Standardize service delivery
in the Health Sector

Well established health
service delivery system
at all level

Ensured quality
products,
Timely an equity
logistic supply
Scope: This strategic initiative includes citizen charter
implementation, implementation of standards, activity, IT
based information system, customer satisfaction survey,
ensuring professionals ethical codes, monitoring and
evaluation.
6
Initiative: Strengthening the Pharmaceuticals and Health
Products supply System in the Country
Scope: This strategic initiative includes Distribution
mechanisms, quality and efficacy assurance
P5: Improve Logistics supply and management
Strategic Initiatives:
1
S. Initiative 1: Improve Quantification and Procurement
Efficiency
Scope: This initiative focuses on ratifying directives and
procedures, building national capacity and adopting tolls
for quantification and procurement of essential medicines
and health technologies
2
S. Initiative 2: Implement Efficient Warehousing and
Inventory Management System
Scope: This initiative aims to promote proper handling of
pharmaceuticals at all levels and ensuring equitable
proximity to health facilities considering distance,
catchment area and load of health facilities. This is
envisaged to be achieved through expansion of distribution
hubs, renovation of pharmaceutical stores at health
facilities, enforcing consideration of pharmaceutical store
in newly constructed warehouses and implementation of
Increased job
satisfaction and
Ensured motivation,
Reduced turn over

Deliverable:
Deliverable: Improved
forecasting accuracy and
procurement efficiency with
shortened lead time, costeffective acquisition of products
and ensured value for money.
Deliverable: Standardized
pharmaceutical warehouses and
stores at all levels with efficient
inventory control system
85
[HSTP ZERO DRAFT_V2] 10th May, 2014
Integrated Pharmaceutical Logistics System (IPLS) for all
pharmaceuticals in all health facilities.
3
S. Initiative 3: Implement efficient fleet management and
distribution system (outbound logistics)
Scope: This initiative focuses on efficient transport
management with safe and timely delivery of products to
all service delivery points. This includes identification of
transportation gaps and transportation capacity building,
informed route planning, selection of appropriate
transportation means at each level, human capacity
building (e.g. training Health Extension Workers),
instilling control mechanisms, etc…
4
S. Initiative 4: Implement Integrated Pharmaceuticals Fund
and Supply Management Information System (IPFS MIS)
Scope: This initiative envisages the implementation of
Integrated Pharmaceuticals Fund and Supply Management
Information System (IPFS MIS). It intends to come up with
integrated, comprehensive and transparent information
management system which replaces the existing
fragmented initiatives in this regard. Based on the
country’s capacity in terms of IT infrastructure both
manual and automated systems will be promoted. This is
believed to foster information sharing, stock visibility and
decision making
5
S. Initiative 5: Strengthen Revolving Drug Fund
Scope: This initiative is focused on strengthening financial
capacity for procurement of medicines and health
technologies managed by the RDF.
6
S. Initiative 6: Implement Auditable Pharmaceutical
Transaction System
Scope: This initiative is focused on ensuring efficient
utilization of limited budget on medicines, transparent and
accountable medicine transactions and reliable and
consistent information on products and sales at health care
Deliverable: Implemented
efficient fleet management and
safe and timely delivery of right
products to the right service
delivery points.
Deliverable: Implemented
Integrated Pharmaceuticals Fund
and Supply Management
Information System at all levels
along all Supply Chain
Operations
Deliverable: Secure adequate
finance for procurement of
medicines and health
technologies managed through
the RDF.
Deliverable: Improved
transparency, accountability,
reliable and consistent
documentation on products,
pharmacy services and sales at
health care facilities
86
[HSTP ZERO DRAFT_V2] 10th May, 2014
facilities.
7
S. Initiative 7: Strengthen Rational Use of Medicines and
Health Technologies
Deliverable: Improved rational
medicine use at health care
facilities and the community.
Scope: This initiative intends to ensure proper prescribing,
dispensing and use of medicines and health technology at
all health care facilities.
8
S. Initiative 8: Promote HR Capacity Building for Health
SCM
Deliverable: Adequate number
of skilled supply chain mangers
Scope: Ensure skilled human resources for supply chain
management in adequate number at all levels.
9
S. Initiative 9: Strengthen Coordination Mechanisms with
Key Stakeholders
Scope: This initiative is focused on alignment of plans,
instituting fast-track operations and fostering
Partnership for supply chain management.
10
S. Initiative 10: Establish Pharmaceutical Waste
Management System
Deliverable:Aligned plans with
internal stakeholders with regard
to supply chain management
including
Rational
Medicine Use, fast-track supply
chain operations, and strong
partnership
Deliverable: Ensured safety of
the public against health risks
from pharmaceutical waste.
Scope: This initiative focuses on protecting the public from
health risks emanating from pharmaceutical waste at all
levels of the supply chain.
11
S. Initiative 11: Develop and implement M & E for
Deliverable: Implemented M &
E system for supply chain
87
[HSTP ZERO DRAFT_V2] 10th May, 2014
Pharmaceutical supply chain management
Scope: This initiative aims at ensuring quality of each
function along the supply chain cycle by devising
monitoring and evaluation strategy and plan together,
setting key performance indicators (KPIs) and
implementing the same at all levels of the health supply
chain system.
12
S. Initiative12: Strengthen access to medicines for targeted
programs through the Private Sector with Clear Guidance
on Accountability
Scope: This initiative is focused on devising directives and
guidelines in collaboration with key stakeholders in order
to avail key medicines for targeted health programs such as
HIV/AIDS, TB, FP, EPI, Malaria, etc..
P6: Improve resource mobilization
Strategic Initiatives:
S. Initiative 1: Improve Government share to Health
Financing
Scope: This initiative covers improving the share of
national and local government budget allocation from the
treasury at all levels through generation of evidences such
as NHA, NASA etc.
management with active use of
feedbacks for continuous
improvement in ensuring quality
at all levels of the supply chain
system.
Deliverable: Improved access to
the public through the Private
Sector with ensured
accountability.
Deliverable:
The outcome of this initiative
includes improvement in the
share of government budget
allocation to health programs.
Introduce matching fund for health programs
Initiative 2: Enhance HCF Reform implementation to
ensure quality and equitable health service access
Scope: This strategic initiative includes the strengthening of
implementation of the various components of the HCF
reform namely, revenue retention and utilization, establish
healthy equity fund to improve fee waiver, general subsidy,
and targeted subsidy, and exemption system, private wing,
and user fee revision.
Initiative 3: Scale up CBHI
Scope: This strategic initiative represents actions taken to
reduce financial barriers (e.g. high out of pocket spending,
The outcome of this initiative
include increased health facility
revenue, improved quality of
service, and reduced financial
barriers for health service
access.
The outcome of this strategic
initiative is to expand insurance
coverage to all Ethiopians in the
informal sector and to achieve
88
[HSTP ZERO DRAFT_V2] 10th May, 2014
catastrophic expenditure) that prevent the use of health
services. This includes evaluation of the pilot programs,
development of scale up strategy, mobilization of fund,
advocacy, community awareness and sensitization for
successful implementation of the CBHI program,
indigenous financing of health
services while reducing
financial barriers to access.
Implement SHI
The outcome of this strategic
initiative is to expand insurance
coverage to all Ethiopians in the
formal sector and to achieve
indigenous financing of health
services while reducing
financial barriers to access
Scope: This strategic initiative represents actions taken to
reduce financial barriers (e.g. high out of pocket spending,
catastrophic expenditure) that prevent the use of health
services. This initiative includes the registration of
members and beneficiaries, and employers, collection of
contribution, contracting with healthcare providers, claims
management, and complaint handling of the insurance
system.
Initiative 5: Establish innovative ways of Domestic Health
Financing
Scope: This strategic initiative seeks to mobilize resources
from currently untapped potential domestic sources of
funding. It includes exploratory meetings with potential
sources and lobbying them to contribute to the health
sector. Alternative and innovative financing mechanisms
will be designed and submitted for discussion to generate
new sources of financing (e.g. solidarity fee on air tickets,
ear marked tax for health, sin tax, and mobile phone tax
etc.).
Initiative 6: Enhance Health Partnership and Coordination
(DPs, CSOs/NGOs, PPPH, FBOs)
The outcome of this strategic
initiative is to increase and
diversify the sources of
financing to the health sector
The outcome of this strategic
initiative is enhancing the
existing linkage between GoE
Scope: This strategic initiative represents enhancing the and actors in the health sector as
existing partnership and coordination with actors well as improved harmonization
(NGOs/CSOs, bilateral donors, multilateral donors, global and alignment among them to
initiatives, PPPH etc.) in the health sector to create a more improve pooled funding
coordinated and systematized mobilization system.
mechanisms, predictability and
flexibility of funding. It also
helps to make high tech medical
services available to the
community through PPPH to
reduce medical referrals outside
of the country. The PPPH also
helps to improve the supply of
pharmaceuticals by encouraging
private sector to invest in the
production, import and
89
[HSTP ZERO DRAFT_V2] 10th May, 2014
distribution.
Initiative 7: Strengthen resource tracking and management
Scope: This strategic initiative includes conducting the
annual resource mapping exercise at all levels, analyzing
the results, identify resource gaps, and communicate
selected findings to stakeholders. It also includes projection
of resources required for implementing health programs
and costing of healthcare delivery at different health facility
levels.
Initiative 8: Enhance external fund mobilization
Scope: This strategic initiative represents mobilization of
resources from international sources to meet financial needs
of the health sector in a sustainable manner. It includes
using traditional and proactive approaches for the
mobilization of resources; coordination of bilateral
cooperation with governments; managing of pooled funds.
P7: Improve evidence-based decision making
Strategic Initiatives:
1
S. Initiative 1: Strengthen routine performance
monitoring system
Scope (What is included in the initiative):

2
This initiative is about generating routine
data for decision making at all levels through
performance monitoring, harmonizing, and
establishing one routine health monitoring
system in which all stake holders participate
and agree upon.
S. Initiative 2: Strengthen survey and surveillance
systems
Scope (What is included in the initiative): This
initiative is about establishing and strengthening of
survey and surveillance of:
The outcome of this strategic
objective is strengthened
resource tracking and
management system at all
levels, determined cost of health
service delivery at different
level of health facilities, and
projection of required financial
resource for different health
programs.
The outcome of this strategic
objective is making sure that
adequate resources have been
mobilized and made available
for the financing of the health
sector program from external
sources.
Deliverable:

Performance of programs
measured
 Program
implementers
empowered for best decision
making in their day to day
activities
 All stakeholders participated
and harmonized their effort
towards agreed objectives.
 Challenges and their root
causes, feasible interventions
identified to design best
intervention that suit to local
context.
Deliverables (what is the output of the
initiatives):
o
o
Evidence for early
detection and response
of epidemics
generated.
Evidence on the
90
[HSTP ZERO DRAFT_V2] 10th May, 2014





3
Epidemics ,
Diseases & vectors,
Drugs (Rational drug use, resistance, post market,
etc),
Food and nutrition ( micronutrient, post market,
etc) and
Health & demographic site establishment
(expanded and strengthened, etc).
S. Initiative 3: Conduct research and evaluation

Scope (What is included in the initiative): The
initiative is about


4
Technology validation, transfer and
development (Diagnostics, Vaccine, etc.)
 Traditional medicine research (Development
and promotion for appropriate use),
 Health system research (Health impact
assessment, Programs evaluation, HR,
SARA, SPA, Financing , Policy, HEP,
Coordination and collaboration, Quality and
Equity, Supply Chain Management,
Regulation, etc.)
 Best Practice documentation including HDA.
 Food and Nutrition research ( production of
complementary and supplementary foods,
evaluation of intervention)
 Environmental and occupational health
research ( Road traffic, Climate & pollution,
Occupational safety)
S. Initiative 4: Supportive supervision and inspection
Scope (What is included in the initiative): This
initiative is about integrated/vertical supportive
supervision and inspection to support and follow
implementation of programs and ensure
accountability.
5
S. Initiative 5: Data quality assurance and auditing
Scope (What is included in the initiative): This






magnitude of disease
and distribution of
vectors generated
o Evidence on patterns,
extent of drug (
resistance, rational
drug use, post market
surveillance, etc)
generated
o Evidence on food and
nutrition related
problems generated.
o Health & demographic
survey and
surveillance sites
established, expanded
and strengthened.
Technology validated,
transferred and developed.
Traditional medicine
developed and promoted for
appropriate use,
Health systems researches
conducted.
Best practices documented and
scaled up.
Food and nutrition research
conducted
Environmental and
occupational health research
conducted ( Road traffic,
Climate & pollution,
Occupational safety)
Supportive supervision
conducted to improve
performance of programs.
Inspection conducted to
improve performance of
programs and ensure
accountability.
1. Quality data generated and
disseminated for decision
making.
91
[HSTP ZERO DRAFT_V2] 10th May, 2014
6
7
initiative is about capacity building, training,
guideline &related tools developments, supportive
supervision, assessment and auditing.
2. Guideline and related tools
developed
3. Supportive supervision and
assessments conducted and
feed backs provided
4. Training conducted
S. Initiative 6: Communication, advocacy and
dissemination

Scope (What is included in the initiative): This
initiative is about establishment of national integrated
& networked information center/hub , development
of reports, policy briefs and journals, organization of
workshops and review meetings, and feedbacks.

S. Initiative 7: Capacity building to support evidence
based decision making

Scope (What is included in the initiative): This
initiative is about developing and institutionalizing
one M&E framework, introducing and strengthening
Technology & infrastructure (data base ),
capacitating human resource, strengthening structure
(data management unit), and mobilizing & sustaining
adequate financial resource.





CB1: Enhance use of technology and innovation
Strategic Initiatives:
1
Initiative:
Complete health facility and their climate change copping
capacity mapping
National integrated and
networked information
center/hub established
Regular reports, policy briefs
and journals produced and
disseminated
Workshops and review
meetings conducted
One M&E framework
developed and institutionalized
at national level
Technology & infrastructure
introduced and developed
Human resource capacity
developed (in number and
quality)
Data management unit
established and strengthened at
all levels
Adequate and sustainable
resource mobilized.
Deliverable:
List of all health facilities with
their coordinates and the level of
vulnerability to local climate
changes.
Scope:
Complete mapping of all health facilities (Health post, HC
and Hosp) in Ethiopia
Assessment of Climate change copping capacity of all the
health infrastructure in the country
2
Initiative:
Vaccine and diagnostics materials technology transfer and



There vaccines produced
Two antisera produced
Diagnostics for one
92
[HSTP ZERO DRAFT_V2] 10th May, 2014
production
disease
Scope:

3
Pentavalent (DPT, Hib, HeB), Meng
ACW135YX, antirabies vaccines
 Antisera (Rabies immunoglobulin, antivenum for
snakebite)
 Diagnostics (monoclonal and polyclonal antibodies
for rabies )
 Local Bovine serum albumin production (input for
vaccine production),
Initiative:
Enhance the health information systems through use of
existing and new information technology
Electronic / web-based health
related information system
ensured.
Scope:



4
Health Information system (HMIS, PHEM, HRIS)
Use of Electronic Medical Record (EMR)
Health Commodity management information
system (HCMIS)- health facility based
 Integrated Pharmaceuticals logistics information
system (Enterprise resource planning)
 Pharmaceuticals logistics information tracking
system (PLITS)-web-based
Initiative:

Development and use of local technologies (Traditional
medicine, food technology) - innovation

Scope:


5
Study of Traditional medicine for effectiveness,
safety and quantity
 Development of complementary food for the
Ethiopian infants and children
 Food fortification
Initiative:
Traditional medicine
will be integrated with
modern medicine
Complementary food
availed
Fortified foods with
selected micronutrients

Interactive Map of major
diseases distribution

Strengthened diagnostic
capacity
Vulnerability and risk assessment and mapping of diseases
(Atlas of diseases)
Scope:


6
Mapping of major diseases
Development of interactive software for mapping
by accommodating changing risks and
vulnerability
Initiative:
93
[HSTP ZERO DRAFT_V2] 10th May, 2014
High tech diagnostic technology transfer
Scope:

Molecular technical tests (DNA identification,
cancer)
 In vitro-fertilization
 Bio safety Level 4 diagnostic lab tech transfer.
Initiative:
7

Long term accessible
National data will be
available.

Cost effective and
efficient standard
established

A system will be in
place for identification
and utilization of health
innovations
National digital health and health related database
repository Scope:

All health and health related written documents,
electronic media documentation
 Development of infrastructure required to store the
database
Initiative:
8
Medical equipments and diagnostic facility technology
level determination for health tier systems
Scope:

Determination of what to technology levels of an
equipment to be used at different health tier
systems
 Prepare road map and Set cost effective standard
Initiative:
9
Build system for supporting and capacitating health
innovators and innovative ideas
Scope:



Establish linkage with higher education
Create open system to include individual
innovators
Community based innovations and best practices
CB2: Improve development and management of human resource for health
Strategic Initiatives:
Deliverable:
1
Initiative: Scale up Training and development of
health professionals in line with staffing requirement
Scopes:

Establish a system for continuous alignment of
health professionals curricula to address to
the country’s priority health needs
Deliverables:
1. Ratio of HWs to
population
2. No. of Curricula
reviewed
3. No. of students
enrolled for pre94
[HSTP ZERO DRAFT_V2] 10th May, 2014




2
Undertake training needs assessment to
identify the need for various cadres
Increase the annual pre-service enrolment
and output for priority health cadres in line
with FMoH projections
Strengthen the infrastructure for effective
teaching by establishing skills labs, simulators,
ICT etc
Support in faculty development
Initiative: Introduce integrated curriculum
(competence based) to medical schools



3





Scope: Work with HESC ( Higher education
strategic center) in revising the existing
discipline based curriculum to integrated
Introduce the integrated curriculum to
medical schools
Provide technical and teaching/learning
support for the implementation
Initiative: Strengthen In-Service Health
Training and Continuing Professional
Development
Scope:
Review and approve existing in-service
training (IST) materials as per the national IST
Implementation Guide and Directive
Ensure standardization and institutionalization
of in-service training
Establish in-service training centres with
service training for
specified priority
cadres annually
(Disaggregated by
cadre, gender and
region)
4. No. of students
graduating from preservice training for
specified priority
cadres annually
(Disaggregated by
cadre, gender and
region)
5. No. of BSc. Holders
enrolled for PBL
program
(Disaggregated by
cadre, gender and
region)
6. Student to faculty
ratio, per cadre and
health education
institution
Deliverables:
1. Revised national
integrated medical
curriculum
2. No. of school who has
started teaching using
the curriculum
Deliverables:
1. Number of local
training institutions
delivering
standardized ISTs
(Disaggregated
region)
95
[HSTP ZERO DRAFT_V2] 10th May, 2014













4
appropriate geographical coverage
Establish ICT platforms to support delivery and
management of in-service training through
eLearning and pilot-test for the priority health
trainings
Strengthen management and coordination of
in-service training at various levels
Strengthen local capacity for the provision of
ISTs using the three major modalities namely
face to face, blended and electronic IST as per
the need and relevance.
Develop and provide in-service trainings based
on national priorities and findings of regular
needs assessments (e.g. Immunization,
maternal health, management, leadership etc)
Implement a Continuing Professional
Development (CPD) programs and link to
career development and relicensing
Involve private sector and professional
associations in in-service trainings and CPD
rollout
Build capacity of IST and CPD providers
Create a system for regular communications
between pre-service and in-service training
programs
Develop and implement a system to link inservice training and CPD to impact on health
service delivery and performance
improvement (service quality assessment)
Mobilize local and international resources for
the delivery of need based ISTs
Strengthen the capacity of the Human
Resource Processes of regional health bureaus
to coordinate the IST standardization and
institutionalization in the respective regions
Establish and maintain a functional IST
database/interface with HRIS/ at all levels for
efficient implementation of the program.
Develop need based annual IST plan at
national, regional, woreda and health training
institutions
Initiative: Upgrading of health extension workers
2. Proportion of local inservice training
institutions who are
accredited by health
regulatory authorities
as CPD providers
3. Proportion of regions
with need based
annual IST plan
4. Availability of
functional IST data
base at all levels
5. No. of health
workforce received
standardized inservice training
annually
(Disaggregated by
cadre, gender and
region)
6. Number of
institutions who have
annual IST plan in
place (include FMoH,
agencies and regional
health bureaus)
7. No. of Health
professionals enrolled
for CPD program
(Disaggregated by
cadre, gender and
region)
8. No. of health
professional
relicensed
Deliverables:
96
[HSTP ZERO DRAFT_V2] 10th May, 2014
Scope:




5
Upgrading level III to level IV
Upgrade level IV HEWs into family health
nurse (BSC) program
Upgrade level IV HEWs into family health
midwives (BSC) program
Enrolment of level V HEWs to the new
innovative medical education
Initiative: Expand enrolment and produce adequate
number of family health team based on PHC model
Scope: : Expand enrolment and produce adequate
number of family health team (including family:
physician, family health nurses, family health
midwives, health extension, and nutrition
professionals worker based on PHC model)
6
Initiative: Team based training for Emergency medical
service
Scope:



7
Revise curriculum
Support with teaching materials
Produce appropriate professionals for
Emergency Medical Services (Physician, Nurse,
Surgical Officer and paramedic)
Initiative: Team based training of Maternal and Child
care providers ( Midwife, Anesthesia, and Neonatal
nursing)
Scope:



Revise curriculum
Support with teaching materials
Produce appropriate professionals for MCH
1. No. of upgrade level
IV HEWs into family
health nurse (BSC)
program
2. No. of upgrade level
IV HEWs into family
health midwives (BSC)
program
3. No. of level V HEWs
enrolled to the new
innovative medical
education
Deliverables:
1. No. of students
graduating from preservice training for
physician, family
health nurses, family
health midwives,
health extension, and
nutrition
professionals worker
Deliverables:
2. No. of Paramedic
trained
3. No. of Emergency
nurse trained
4. No. of Emergency
physician trained
5. No. of Trauma
surgeon
Deliverables:
1. No. of Midwife
trained
2. No. of Anesthesia
professional trained
3. No. of Neonatal
nursing trained
97
[HSTP ZERO DRAFT_V2] 10th May, 2014
8
Initiative: Increase the production of clinical
specialities and introduce forensic medicine training
Scope:


9
Support in curriculum development
Build the capacity of the training center with
infrastructure and teaching materials and
 Increase the number of candidates for the
program
Initiative: Strengthening clinical pharmacy programs
and Supply chain management professionals training
Scope:


10
Enhance the clinical pharmacy program
Review curricula of pharmacist to strengthen
clinical pharmacy and the supply chain
management competency and
 Expand post graduate supply chain
management professionals training based on
the desired roles and responsibilities of these
professionals
Initiative: Initiate Health Regulatory affairs
Scope:



11
Select schools to deliver the study
Develop a curriculum for Maser program
Give technical and financial support
Initiative: Provide support for quality audits of all
existing pre-service training programs
Scope: Support in developing standard for quality
health professional education, internal audit, and
external audit to develop and implement evidencebased quality improvement interventions
Deliverables:
1. No. of clinical
specialist graduated
2. No. of forensic
medicine graduate
Deliverables:
1. No. of Clinical
pharmacist graduated
2. No. of pharmacist
graduate with revised
curriculum
3. No. of graduates in
supply chain
management (
Master)
Deliverables:
1. No. of schools who
are providing post
graduate program in
Health regulatory
affairs
2. No. of graduates
Deliverables:
1. No. of programs to
meet minimum
criteria set by HERQA
(e.g. improve faculty
to student ratio)
2. No. of programs
audited (internal
every year and
external every 3
years)
3. No. of accredited
programs
98
[HSTP ZERO DRAFT_V2] 10th May, 2014
12
Initiative: Universities/Health science colleagues
industry linkage and Medical schools twinning (
National and international
Scope:

13
Create strong partnership between
universities and health science colleges with
industries and practical sites for service
delivery, consultancy and teaching
 Establish networking of practicum sites
(public, private and affiliates) for quality
health professional training
 National twinning of medical schools based on
their geographic distribution and potential
 Twinning of medical schools to international
medical schools
Initiative: : Introduce new postgraduate to support
the HRM of the health sector and the health care
financing/insurance
Scope: Introduce new postgraduate training HRH
Management, Health Economics
14
Initiative: Initiate knowledge management center in
FMOH
Scope:


15

Establish HRH leadership and management
development centre and relevant training
programs under the FMOH to continuously
provide capacity building support to the
health sector.
Establishing archiving and data base
management system for the different
documents produced in the sector.
Initiative: Strengthen the HRM Function and
Practices at all levels

Scope:

Modernize the HRM function Upgrade the
human resources development and
administration function at all levels of the
health system to reflect its new and
transformed roles by increasing the number of
Deliverables:
1. No. of functional
university/health
science collage to
health facility linkage
2. No. of functional
national medical
schools networking
formed
3. No. of functional
international medical
schools networking
formed
Deliverables:
1. No of Health work
force trained in HRM
2. No. of health work
force trained in
Health Economics
Deliverables:
1. No. of training
provided for staff
development
2. Established center for
knowledge
management
3. No. of documents
archived or entered
to the electronics
database
Deliverables:
1. HRM structure that
reflect all HR
functions in place
2. Percentage of
established HRM
positions filled
99
[HSTP ZERO DRAFT_V2] 10th May, 2014
16
qualified HRM staff and HRM budgets.
 Provide continuous HRM training to HR staff
at national and lower levels
 Conduct periodic job analysis in order to
regularly update HRH categories
 Regularly develop and update job descriptions
for all staff.
 Review and Improve the implementation of a
performance based evaluation system to
support rewards, sanctions and other
management decisions.
 Undertake regular review of career structures
for all cadres to provide clear career growth
pathways
 Integrate career planning into other HR
systems such as performance appraisal,
training and succession planning
Initiative: Enhance National licensing exam
Scope:



Expand the capacity of the HRDA Directorate
and FMHACA in professional licensing,
relicensing and regulation
Develop/review implementation manual
which details the requirements, scope,
processes and other relevant matters for
accreditation and licensing.
Establish a system for strategic information on
qualification examinations.

17
Create feedback system from accreditation
and licensing systems to pre-service and inservice trainings institutions
Initiative: : Establish a Comprehensive Human
Resources Information system (HRIS)
3. Number or % of
Health Managers
trained in HRH
4. % of health workers
with current job
descriptions
5. % of health workers
undergoing annual
performance
appraisal on time
Deliverables:
1. Develop and
endorsed a licensing
exam policy
document
2. Develop an
implementation
guideline for each
health cadre
3. No. of health cadres
who has started
national licensing
exam
4. No. of graduates who
has taken the exam
and number who has
passed the exam
Deliverables:

Scope:


Conduct an assessment of existing HR
information systems for its
comprehensiveness and usability and develop
plan of action
Scale up a sector-wide HRIS (including private
sector and training institutions) roll out that


Number of regions
with a functional and
comprehensive HRIS
Number of staffs
trained on HRIS
(disaggregate by staff
category and region)
Number of
comprehensive
100
[HSTP ZERO DRAFT_V2] 10th May, 2014
18
provides up-to-date HRH information to assist
timely decision making at all levels of the
health system.
 Assign staff to manage HRIS at various levels
of health system administration
 Train system managers and users on the
system
 Integrate the HRIS into FMOH’s datawarehouse structure
 Encourage use of HRIS for decision making by
availing customized reports to stakeholders
Initiative: Reduce Inequity in Geographic Distribution
and skill and gender mix of health care Workers
Scope:

19
national HRIS reports
produced
Deliverables:
1. Staffing
levels/vacancy rates
for hard-to-reach
geographic areas
disaggregated by
cadre and region
2. Number of new
health workers
recruited annually for
hard-to-reach areas
disaggregated by
cadre, gender and
region
Identify factors underlie the inequity of health
workforce geographic distribution and skill
mix in all regions
 Build capacity of regional health bureaus and
woredas to attract and deploy health
professionals in hard-to-reach geographic
areas
 Conduct policy advocacy for special
remuneration and incentive package in hardto-reach areas (link with Motivation and
retention)
 Sensitize health workforce to provide services
for communities at highest needs
 Continue enforcing minimum public (the
mandatory) service for selected priority health
professionals
 Revise task shifting to address skills mix and
staffing at hard-to-reach geographic areas and
critical human resources shortage
Deliverables:
Initiative: Enhance Motivation and retention
Scope:


Conduct regular motivation and retention
studies to assess the extent of the retention
problem and design motivation and retention
mechanisms
Develop a comprehensive strategy to raise
awareness and change attitudes of health
workforce to serve communities with their
1. Number of Retention
studies conducted
2. Number of regions
that are implementing
evidence-based
incentive package
3. Annual health worker
attrition rates
disaggregated by
101
[HSTP ZERO DRAFT_V2] 10th May, 2014
20
professions
cadre, age and region
4. Employee satisfaction
 Design, cost and implement a set of monetary
levels
motivational and retention incentives at
5. Number of staff that
federal and regional levels.
receive recognition
 Design, cost and implement standardized a set
awards disaggregated
of non-monetary incentive packages to
by cadre and region
enhance the public health sector’s capacity to
significantly attract and retain health
workforce in the public sector and rural
settings of Ethiopia.
 Develop and update a database of health and
management staff from which all health
partners are persuaded to select experts on
rotation to engage in short-term consultation.
 Institutionalize the temporary secondment or
joint appointment employment opportunities
in National and international partners as a
reward to health and management staff for
public sector contribution.
 Develop a mechanism for competitive
research grant awards to researchers actively
employed in the public health care system.
 Standardize classification of hardship areas
across regions
Deliverables:
Initiative: Enhance performance and productivity
Scope:







Introduce regular performance planning,
monitoring and improvement programs for
health care workers at all levels (based on
Balanced Score Card)
Establish a comprehensive work climate
assessment and improvement programs at all
levels of health system
Establish and implement a system for
performance
appraisal,
reward
and
recognition
Introduce
performance-based
financing
schemes for health care workers and facilities
Conduct regular supportive supervision,
mentorship and regular feedback at all levels
Introduce effective time management systems
for health care providers
Create link between performance and
professional development
1. Percentage of health
management
structures (RHB, ZHD
and Woreda Health
offices ) who have
individual staff
performance plan and
appraisal annually
2. Percentage of health
facilities who have
individual staff
performance plan and
appraisal annually
3. Proportion of health
facilities and
management
structures who
conduct work climate
assessment
4. Annual health
102
[HSTP ZERO DRAFT_V2] 10th May, 2014

Conduct productivity surveys in selected
health facilities
workforce loss rate
5. Provider productivity
6. Rate of absenteeism
7. Dual employment
CB3: Improve health infrastructure
Strategic Initiatives:
Deliverable:
1
Initiative:

Health and health related facility construction

Scope:

Constructions of primary, General and Specialized 
Hospitals, Bio-Medical maintenance workshops, Blood
Bank, Quality Control Laboratory, Drug hubs, staff 
residence, national Incinerator and training center.




2
Initiative:

Expansions of Health center

Constructed 500 Primary
Hospitals.
Constructed 125 General
Hospitals
Constructed 1 Specialized
Hospitals
Constructed 30 Bio-Medical
Maintenance workshops
Constructed
30
new
Regional Blood Banks
Constructed 2 branch Food
and
Medicine
Quality
Control Laboratories and 16
mini
quality
control
laboratories
Constructed 2 drugs hubs
Constructed
2
staff
residence
Constructed 1 national
Incinerator and training
center
Expanded 82 health center
with OR
Expand XXX HCs per
standard
Scope:
Expansion of Health Center by constructing of OR and
standard functions
3
Initiative:

Rehabilitation of hospitals

Rehabilitated 4 federal
Hospitals
Rehabilitated xxx region
hospitals
Scope:
4
 Rehabilitation of Hospitals
Initiative:
Maintenance and renovation of health and health related
Facility

Maintained and renovated
all health and health related
facilities
103
[HSTP ZERO DRAFT_V2] 10th May, 2014
Scope:
5
 All health and health related facilities
Initiative:

Provision of utilities (Water supply, Toilet ,incinerator,
placenta pit and Power supply)

Scope:


6
Health Post and Health Centers
Initiative:


National digital health and health related database
repository.

Scope:

Networking(Health Net), computer and accessories


7
Initiative:

Adoption of medical equipment, construction and ICT
Standards

Scope:


8
Determination of what to technology levels of an
equipment to be used at different health tier
systems
 Prepare road map and Set cost effective standard
Initiative:

Constructed 15% of Health
center and Health posts
without toilet
Constructed 500 incinerator
and 500 placenta pit
Provided 68% of Health
Center and Health Post
water supply
Provided 1,500 health
center and 12,000 Health
posts power
Availed 100% of Wide
Area Network for
Hospitals ,Health Centers,
Blood Bank, RHB, ZHB,
wHO, Agencies
Deployed 100% Local
Area Network for
Hospitals, HCs, ZHB,
wHO, Blood Bank and
Agencies
Provided
hardware(computer and
accessories) Health and
health related facilities
Established data center in
all RHB. ZHD, Hospitals,
Agencies
Developed and revised
standard designs for health
and health related facilities
Developed standard for
Medical equipment
management
Developed standards for
ICT infrastructure
deployments in health and
health related facilities
Furnished and substituted
worn out spare parts
Avail medical equipments maintenance tools and devices
Scope:

all Health and health related Facilities
CB4: Enhance policy and procedures
104
[HSTP ZERO DRAFT_V2] 10th May, 2014
Strategic Initiatives:
1
Deliverable:
Initiative:

Develop Health and Health related policies, legal
frameworks and guidelines Scope:


Scope:




2
Identify gaps based on evidences
Benchmark practices of others
Develop appropriate policies, legal frameworks
and guidelines
Initiative:
Revise Health and Health related policies, legal
frameworks and guidelines
Scope:




3
Analysis existing policies, legal frameworks and
guidelines
Identify gaps based on evidences
Benchmark practices of others
Revise appropriate policies, legal frameworks and
guidelines
Initiative:
Awareness creation for community, stake holders and
health professions on policies, legal frameworks and
guidelines
1 National Food policy
developed
1 Local manufacturer
procurement policy
205 legal frame work
developed
40 Guideline developed

Amendment of Ethiopia
Food, medicine and
health care
administration and
control Authority
proclamation
No.661/2009
 1National Essential
drug list revised
 1 National drug policy
revised
 68 legal frame work
revised
 20 other Guidelines
revised
Community, stakeholders and
health professionals involved in
enforcement of policies and
legal frameworks
Scope:
promotion/Awareness creation through different medias/
meeting, workshop, training, mass medias, web site, on
existing and newly developed policies, legal frameworks
and guidelines
4
Initiative:


The rule of law
Accountability
Follow up implementation of policies and legal
frameworks
Scope:



Create implementation mechanisms
Avail necessary supplies and inputs for
implementers and regulators
Follow up regularly the implementation of policies
105
[HSTP ZERO DRAFT_V2] 10th May, 2014
and legal frameworks
106
[HSTP ZERO DRAFT_V2] 10th May, 2014
Chapter 4: Costing and Financing (Cost estimate, Resource mapping,
Financial gap, etc)
The One Health Tool (OHT) was used to compute the resource requirements for implementing this
health sector development plan. OHT is a policy projection modeling tool that allows users to create
short and medium term plans for scaling up essential health services. It is a bottom-up tool that allows
for modeling based on population demographics, disease and health profiles, clinical practices, service
provision and coverage. It helps to identify the resource requirements for building and maintaining the
infrastructure, training, deploying and retaining the health workforce, availing medicines and supplies
and other aspects of the health system management including equipment, logistics, health information,
health financing and governance.
The following cost estimate is based on:







The best accessed information on disease profiles
Used official figures for base year population demographics
Assumed that facilities are functioning
Assumed that the minimum required staffs are in place
National protocols and expert opinions are used for clinical practices
Expansion targets are set to meet the standards as based on population figures and other set
criteria
Service coverage targets are set in line with the visioning exercise of achieving impacts that
are comparable to middle income countries by 2025/35, in line with the national growth plan
Limitations of current cost estimates



Requires further verification of data inputs, including unit costs, and further updating them
with the latest available, with a potential for significant variations in associated costs
Further discussions with technical teams to ensure that all interventions are given due
considerations and updated clinical management are addressed
Adjustment of targets with feasibility of implementation and available financial space
107
Summary costs with drugs disaggregated by programme area/delivery channel (ETB) - 6-HSDP-V_310514_First draft
Summary costs with drugs disaggregated by
programme area/delivery channel (ETB)
2015
2016
2017
2018
2019
TOTAL
Maternal, Adolescent and Reproductive Health
Programme Costs
Drug, commodities, and supplies
Total Maternal, Adolescent and Reproductive
Health
Child health
Programme Costs
Drug, commodities, and supplies
Total Child health
Immunization
Programme Costs
Drug, commodities, and supplies
Total Immunization
Malaria
Programme Costs
Drug, commodities, and supplies
Total Malaria
TB
Programme Costs
Drug, commodities, and supplies
Total TB
HIV/AIDS
Programme Costs
Drug, commodities, and supplies
Total HIV/AIDS
108
[HSTP ZERO DRAFT_V2] 10th May, 2014
Nutrition
Programme Costs
Drug, commodities, and supplies
Total Nutrition
Hygiene and Environmental Health
Programme Costs
Drug, commodities, and supplies
Total Hygiene and Environmental Health
Non-communicable diseases
Programme Costs
Drug, commodities, and supplies
Total Non-communicable diseases
Mental, neurological, and substance use
disorders
Programme Costs
Drug, commodities, and supplies
Total Mental, neurological, and substance use
disorders
Neonatal Health
Programme Costs
Drug, commodities, and supplies
Total Neonatal Health
Neglected Tropical Diseases (NTDs)
Programme Costs
Drug, commodities, and supplies
Total Neglected Tropical Diseases (NTDs)
Public Health Emergency Management (PHEM)
Programme Costs
109
[HSTP ZERO DRAFT_V2] 10th May, 2014
Drug, commodities, and supplies
Total Public Health Emergency Management
(PHEM)
Health Facility Reform
Programme Costs
Drug, commodities, and supplies
Total Health Facility Reform
Health Development Army
Programme Costs
Drug, commodities, and supplies
Total Health Development Army
Blood Safety
Programme Costs
Drug, commodities, and supplies
Total Blood Safety
Total program costs
Human Resources
Staff salaries and benefits
Total in-service training costs
Pre-service Training Costs
Human Resources Administration
Total Human Resources
Infrastructure
Construction Costs
Equipment, furniture and vehicles
Rehabilitation Costs
Maintenance and Operating Cost
Infrastructure Administration
110
[HSTP ZERO DRAFT_V2] 10th May, 2014
Total Infrastructure
Logistics
Total warehouse costs
Total vehicle costs
Total worker costs
Third party logistics contracts
Logistics Administration
Total Logistics
Medicines, commodities, and supplies
Medicines, commodities and supplies (RDF)
Safety stock purchases
Wastage
Total Medicines, commodities, and supplies
Health Financing
Direct costs
Programme management costs
Total Health Financing
Health Information Systems
HIS dimension costs
Functional domain costs
Programme management costs
Total Health Information Systems
Governance
Governance activities
Administrative Costs
Total Governance
Grand Total
111
Chapter 5: Programme Management Arrangement
Risk Mitigation
Chapter 6: Monitoring and Evaluation (M&E) framework
112
Annex 1: Major Activities:
Major Activities:
C1: Maximize Equitable Utilization of Health Services
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Initiative 1: Scale up Essential Newborn care
1. Scale up of CBNC
2. Expansion of Newborn corners in all HCs
3. Establishment of NICU at all hospitals
Initiative 2: Scale up Essential Child health Services
1. IMNCI Services
2. ICCM
Initiative 3: Strengthen Expanded Program of
Immunization
1. Strengthen Routine Immunization
Programs (Cold Chain, Management)
2. Introduce New Vaccines
3. National Polio Eradication Initiative
Initiative 4: Implement Youth Focused RMNCH
services
1. Expansion of Youth Friendly Services in
Health Facilities
2. Address Youth Services in Schools and
Higher Institutions.
Initiative 5: Enhance Comprehensive Abortion Care
Services in health facilities
1. Awareness raising on Comprehensive
Abortion Care services
2. Expansion of comprehensive abortion care
services
Initiative 6: Scale up Essential Maternal Health Care
services
1. Reduce access barriers to maternal health
care
2. Ensure immediate Post-Partum Care
through home visits
3. Ensure Skilled Delivery Care is provided 24
hours a day and 7 days a week in all health
facilities
Initiative 7: Expansion of Maternal Death
Surveillance and Response
3. Community Based Verbal Autopsy
4.
Facility Based Audit
5.
Death Surveillance and Response
Initiative 8: Strengthen PMTCT Services
1. Integration of PMTCT with other services
2.
HEI Care
3
Initiative 9: Scale up Basic and Comprehensive
EmONC services
113
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
1.
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Scale up of basic EmONC services to all HCs
2.
Scale up of Comprehensive EmONC to all
hospitals
3. Enhance availability of blood transfusion
services
Initiative 10: Improve community based HIV
Prevention, Care and Support
1.
2.
Enhance community level awareness
creation on HIV Prevention, care and
support
Strengthen community based HIV Care and
support
3.
Initiative 11: Intensify targeted HIV Prevention
1. Enhance targeted HIV Prevention packages
for MARPs and underserved population
groups
2. Strengthen prevention and control of STIs
Initiative 12: Strengthen HIV Care and Treatment
Services
1. Improve access and utilization of
comprehensive HIV Care and treatment
services for pediatric age groups
2. Strengthen palliative care services at all
levels
3. Improve adult comprehensive HIV care and
treatment services
4. Integration of HIV Care and treatment
services to other services
Initiative 13: Sustain multi-sectoral response to HIV
Prevention and Control
1. Strengthen HIV Mainstreaming activities
2.
Initiative 14: Integration of Sustain multi-sectoral
response to HIV Prevention and Control
1. Strengthen HIV Mainstreaming activities
Initiative 15: Enhanced Implementation of TB
Prevention and Care Packages
1. Expansion of Community based TB
Prevention and Care Packages
2. Expansion and enhancement of Facility
based TB Prevention and Care Packages
3. Expansion of PPM-DOTS Services
4.
5.
Enhanced Implementation of TB Prevention
and Care packages in Prisons and
Congregate settings
Implement Systematic screening of
contacts and high-risk groups for TB
114
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
6.
Accelerated implementation of TB
Preventive therapy for high-risk groups
with latent TB infection
7. Accelerated Implementation of Integrated
TB/HIV interventions and management of
co-morbidities
8. Introduction and scale up of TB and NCDs
collaborative activities
Initiative 16: Expansion and Enhancement of DrugResistant TB (DR-TB) Prevention and Care packages
1. Expansion of TB Culture and DST Sites
2.
Scale up of Rapid molecular TB diagnostic
tests (GeneXpert Tests)
3. Introduction and scale-up of DST for
second line anti-TB drugs
4. Accelerated expansion of Ambulatory
MDR-TB Treatment centers
5. Improve patient support system for DR-TB
Cases
Initiative 17: Launch Final Phase of Leprosy
Elimination Strategy
1. Finalize Epidemiologic Mapping of leprosy
hot-spot areas
2. Intensified implementation of universal
screening of household contacts of leprosy
cases at diagnosis
3. Annual screening of household contacts of
leprosy cases
4. Enhancement of leprosy case management
in hot spot areas
5. Improve leprosy patient referral care
services
Initiative 18: Maintain Universal access to Selected
Malaria Prevention intervention
1. Provision of targeted IRS
2.
Distribution of LLIN using keep-up and
catch-up modalities
Initiative 20: Improve Early diagnosis and treatment
of malaria cases
1. Provide confirmatory tests for all suspected
malaria cases
2. Provide treatment of all malaria cases as
per national guidelines
Initiative 21: Eliminate Falciparum malaria from
selected districts with low malaria transmission
1. Establish surveillance as intervention
2.
Introduce transmission blocking
interventions
Initiative 22: Improve Preventive Chemotherapy
(PCT) coverage for selected NTDs
115
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
1.
Improve MDA Coverage
2.
School deworming program
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
3.
Integration of NTDs services in selected
areas
Initiative 23: Expansion of prevention and Control
packages for major NCDs
1. Strengthen targeted ACSM activities on
major NCDs prevention and control at all
levels
2. Create enabling policy environment for
promotive health services for NCDs
3. Expand prevention, care and treatment
packages of major NCDs
4. Integration of NCDs prevention, care and
treatment services at all levels
1. Strengthen targeted ACSM activities on
major NCDs prevention and control at all
levels
Initiative 24: Community-based nutrition (CBN)
program scale up
1.
Strengthen the existing CBN activities
2.
Design CBN packages for Pastoralist and
agro-pastoralist settings
Initiative 25: Scale up micronutrient program
interventions
1.
2.
3.
4.
5.
Strengthen the transitioning of (EOS)
vitamin A supplementation and deworming into routine
Provision of iron-folic acid tablets to all
pregnant & lactating women
Initiate and support food fortification
program
Identify & treat anaemia in children under
5 years
New Micro-nutrient initiative
Initiative 26: Community management of acute
malnutrition (CMAM)
1.
Outpatient therapeutic program (OTP) at
community level
2. Inpatient management at health facility
level
3. Targeted supplementary feeding program
(TSF/ TFP)
Initiative 27: Infant and Young Child Feeding (IYCF)
4. Promotion of complementary feeding for
all infants 6-24 months old
5. Baby-friendly Hospital Initiative (BFHI)
116
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
6.
Engage male partners, grand parents and
community leaders to overcome
taboos/misconceptions on IYCF
Initiative 28: Multi – sectoral collaboration on NNP
7.
8.
Coordination mechanism amongst 9 NNP
signatory sectors
School health and nutrition programs
9.
Nutrition sensitive PSNP and AGP
10. Food fortification program
Initiative 29: : Integration with other health
programs
1.
Water, Sanitation and Hygiene
2.
Reproductive Health services (adolescents)
3.
Non – communicable disease prevention and
control, re: overweight and obesity
Initiative 30: Improve PHE Management system
1.
2.
3.
4.
5.
6.
Expand coordination of Emergency
Operating Centers
Improve outbreak investigation, response,
recovery and rehabilitation services
Post emergency evaluation
Strengthen early warning and
communication
Strengthen early warning and
communication
Expand e-PHEM system
Initiative 31: Strengthen Hygiene and
Environmental Health promotion
1.
Healthy Housing Promotion
2.
Personal Hygiene Promotion
3.
Food hygiene Promotion
4.
Climate change and health
Initiative 32: Improve Institutional WASH
1.
Health facility WASH
2.
School WASH
3.
Religious places WASH
Initiative 33: Water quality monitoring and
surveillance
1. Household water treatment and safe
storage practices
2. Safe water chain establishment
Initiative 34: Enhanced Waste Management
117
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
1.
Solid waste management
2.
Liquid waste management
3.
Hazardous waste management
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Initiative 35: Access to and utilization of Improved
hygiene and sanitation
6. Improved latrine construction
7.
Improved latrine utilization
Initiative 36: Integration of Hygiene and Sanitation
services with other health services
1. Integrate WASH with NTDs
2.
Integrate WASH with Maternal and Child
Health Services
F1: Improve Efficiency and Effectiveness
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Initiative 1: Scale up grant management system
Recruit required staff at federal and regional
X
X
X
X
X
Train, coach and mentor grant management staff
X
X
X
X
X
Provide supportive supervision
X
X
X
X
X
Regular grant monitoring and reporting
Initiative 2: IFMIS scale up
Conduct annual financial analysis
X
X
X
X
X
Produce timely report to stakeholders
Initiative 3: Financial management system enhancement
Conducting continuous risk assessment
X
X
X
X
X
Take measures on identified risk
X
X
X
X
X
Produce timely audit report to stakeholders
X
X
X
X
X
Conduct continuous performance and financial
audit
Initiative 4: : Auditable pharmacy scale up
X
X
X
X
X
Staffing
Training
Guideline
Initiative 5: Timely and efficient procurement
Conduct assessment to identify the gaps and
challenges
Prepare plan of action based on the assessment
X
X
X
Prepare annual procurement plan
X
X
Categorize materials to determine procurement
X
lead time
Initiative 6: Property administration and management enhancement
X
X
X
118
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Conduct situational assessment
Draw best practices and adopt to our situation
Initiative 7: Efficient utilization of Insurance fund
Identify providers payment mechanism
Identify appropriate level of co-payment
Provide awareness on health insurance system
Prepare code of conduct to mitigate fraud
Initiative 8: Efficient facility revenue utilization
Identify and implement incentive mechanism
Outsourcing of non clinical services
P1: Improve Access and Quality of Health Services:
MAJOR ACTIVITIES
Initiative 1: Primary Health Care Unit Reform
1. Finalize and endorse the reform guideline
2.
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
x
x
X
x
x
3.
Set and endorse PHC performance
monitoring and improvement framework
PHC alliances for health care quality
4.
Implement the PHCU linkage guideline
x
X
x
x
x
5.
Leadership Management and Governance
training
x
X
x
x
X
x
X
x
x
X
x
X
x
x
X
x
X
x
x
X
Preparation of evidence based specialty care
x
X
packages
2. Implement specialty care in selected health
x
X
facilities
Initiative 4: Strengthening access to safe blood and blood products
x
x
X
1. Donors mobilization
X
x
x
x
X
2.Introducing specialized blood collection services
(plasma paresis, platelet paresis)
3. Introducing specialized laboratory service
X
x
x
x
X
X
x
x
x
x
4.
X
x
x
x
x
X
x
x
x
x
Initiative 2: Hospital reform implementation
1. Implement Ethiopian hospitals alliance for
quality
2. Hospital reform implementation guideline
revision and implementation
3. Revise and Implement HPMI (Hospital
performance and improvement framework)
Initiative 3: Strengthening specialty care
1.
5.
Automating central and regional blood bank
units
Conduct researches on blood banking and
transfusion medicine
119
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
x
1.Procure and distribute ambulance
x
x
2.Train and deploy paramedics
x
3.Establish digitalized central and regional
command center
4.Equip hospitals with life saving emergency
equipments and supplies
5.ALS and BLS training
6.
7.
2017/18
x
2018/19
x
2019/20
x
x
x
x
X
x
x
x
x
X
x
x
x
x
X
x
x
x
x
X
x
x
X
x
x
X
x
x
x
X
Establish central and regional blood and
blood products processing unit
Ensure access and appropriate use of blood
and safe blood products in all hospitals
Initiative 5 : Emergency Medical Service System
6 Injury prevention and awareness creation
Initiative 6 : Strengthening the referral system and hospital - health center network
1.
Introduce electronic referral system
x
x
2.
Develop national referral network
x
x
3.Implement onsite patient management through
tele medicine
4.Develop legal frame work on patient referral and
emergency
Initiative 7: Electronic Medical Record
x
x
x
1.
Procure and distribute computers with
accessories
2.Training and orientation for professionals
x
x
3. Network designing and implementation
x
x
x
x
X
Initiative 8 : Palliative and rehabilitative care
1.
Introduce pain management
x
x
x
x
X
2.
Implement palliative care guideline
x
x
x
x
X
3.
Establish geriatric care
x
x
x
X
4.
Expansion of physiotherapy services
x
x
x
X
5.
Establish mental rehabilitation centers
x
X
x
Initiative 9 : Strengthening pharmaceutical care
1.
Scale up of APTS implementation
x
x
x
x
X
2.
Scale up of clinical pharmacy services
x
x
x
x
X
Implement Rational Drug Use guideline at
health facilities
Initiative 10: Forensic medicine
x
x
x
x
X
1.
Expansion of forensic medicine services
x
x
x
x
X
2.
Training of professionals
x
x
x
x
X
x
x
x
x
x
x
x
x
x
x
3.
Initiative 11: Strengthening internal quality assurance system
1.
2.
Establish internal quality assurance unit in
health facilities
Implementation of regulatory standards in
120
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
X
X
health facilities
Initiative 12: Health facility development army implementation
1.
2.
3.
Ensuring functional networking of
professionals
Establish physician forum
X
X
X
Introduce reward system for committed
staff
P2: Improve regulatory systems
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Initiative 1:
Initiative 1: Strengthening of Regulatory legal frameworks setting and promotion
1.
Need assessment
2.
Development and review of proclamation,
regulation and directives
3. Development and review of standards and
guidelines
4. Promotion and dissemination of legal
frameworks
Initiative 2: Strengthening safety and Quality Assessment and Registration of foods
1.
2.
3.
Need Assessment and Identification of
high risk foods to be registered
Assessment of dossiers
5.
Conducting Quality control testing of
foods and its inputs
Conducting Good Manufacturing Practices
inspection
Carrying out pre license certification
6.
Approval of compliance after licensing
4.
Initiative 3: Strengthening safety and Quality Assessment and Registration of Medicine
1.
Need Assessment
2.
4.
Development and Implementation of
modern and strategic registration system
Performing Good Manufacturing Practice
inspection
Assessment of dossiers
5.
Conducting Quality control testing
6.
Carrying out pre license certification
7.
Approval of compliance after licensing
3.
Initiative 4: Strengthening safety and Quality Assessment and Registration of Medical devices and In vitro
diagnostics
1. Need Assessment
2.
Development and Implementation of
modern and strategic registration system
121
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
3.
4.
Performing Good Manufacturing Practice
inspection
Assessment of dossiers
5.
Conducting Quality control testing
6.
Carrying out pre license certification
7.
Approval of compliance after licensing
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Initiative 5: Strengthening of Traditional medicine and practice regulation
1.
2.
3.
4.
Safety and efficacy assessment and
registration of traditional medicine of
category 3 and 4
Quality control testing
Licensing and Registration of traditional
medicine practitioner
Inspection and enforcement
Initiative 6: Launching and implementing Continuing Professional Development /CPD/
1.
4.
Strengthening collaboration with
stakeholders
Finalization of implementation stage of
Continuing Professional Development
Selection and Categorization of CPD
providers
Capacity building of CPD providers
5.
Monitoring of activities of CPD providers
2.
3.
Initiative 7: Strengthening of professional Ethical Competency
1.
Assessment of situation
2.
Establishment of ethics committee at
regional and federal level
Capacitating of Ethics committee
3.
4.
5.
Conducting health professional
inspections at private and public
institution
Conducting assessment on cases
6.
Administrative measures based on inputs
from Ethics Committee
Initiative 8: Strengthening of Health professional registration and licensing
1.
2.
3.
4.
Development, promotion and
enforcement of scope of practice
Launching, Promoting and Ensuring
implementation of Certifying of
Competence of new professionals (COC)
Promoting and Ensuring implementation
of continuing Professional Development
(CPD)
Establishment and strengthening of
regular Health professional Ethical and
competency reviewing and inspection
system
122
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
5.
6.
7.
8.
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
licensing of health professionals based on
CPD and ethical practice
Establishing and strengthening of online
registration and licensing of health
professionals
Capacitating of Health professional
associations in registration and licensing
activities
Strengthening documentation system
Initiative 9: Strengthening of Health institution competency certification
1.
2.
3.
4.
5.
Gap assessment of health facilities against
minimum standard
Development and implementation of
roadmap on the basis of gap assessment in
collaboration with other stakeholders
Pre licensing competency check against
minimum standard (Inspection)
Post licensing competency approval and
enforcement
Applying ranking and grading system
6.
Establishing and implementing
institutional competency and ethical
review system of health services (self
regulation)
Initiative 10: Regulatory Information communication and networking programme
1.
Development of integrated database
2.
Networking with the various regulatory
bodies at different level and stakeholders
Provision of online regulatory services
3.
4.
Development and dissemination of
complete, current and reliable regulatory
information
Initiative 11: Strengthening of hygiene and environmental regulation
1.
Health related institution Inspection and
enforcement
2. Strengthening regulatory system for
controlling of communicable diseases
3. Confirming of proper disposal of health
and pharmaceutical wastes
Initiative 12: Strengthening proper medicine use
1.
2.
3.
4.
Development, promotion and
enforcement of standard prescription,
standard treatment guideline, manuals
and legal frameworks
Categorization of medicine by level of use
and enforcement
Medicine use survey
Provision of medicine information for
health professional and general public
123
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
5.
6.
7.
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Ensuring establishment of Drug
Information service at health facilities and
at regulatory level
Ensuring establishment of Drug and
therapeutics committee at health facilities
Control of advertisement and promotion
8.
Adverse drug reaction and adverse event
following immunization /AEFI/ monitoring
9. Strengthening of reduction of anti
microbial resistance
Initiative 13: Control of drug abuse
1.
Drug abuse prevalence survey
2.
Strengthening drug abuse prevention
focusing on youth
Demand estimation and reporting of
narcotic drugs, psychotropic substances
and precursor chemicals
Strengthening quality of drug dependence
treatment and rehabilitation
Strengthening of control of supply
management and use of narcotic drugs,
psychotropic substances and precursor
chemicals
Strengthening tobacco control
3.
4.
5.
6.
Initiative 14: Strengthening of food and medicine quality control
1.
2.
3.
4.
Expansion of scope of accreditation of
quality control tests of medicine
WHO Prequalification of quality control
laboratory
Strengthening of branch office medium
quality control laboratories and entry port
mini labs
Expansion of quality testing of medicine
5.
Launching and expansion of quality testing
of Food, medical devices, in vitro
diagnostics and biological
Initiative 15: Strengthening Pharmacovigiliance and Post Marketing Surveillance
1.
Collecting ADR reports
2.
Conducting Need assessment based on
ADR reports and current situations
Collection of samples based on developed
protocol
Conducting laboratory testing
3.
4.
5.
Development of regulatory strategies
based on findings
Initiative 16: Strengthening of control of illegal trading of health and health related products
1.
Strengthening coverage of inspection at all
level
124
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
2.
Strengthening quality assurance system of
inspection
3. Establishment and implementation of
information tracking and complaint
management system
4. Strengthening of collaboration with
different stakeholders and empowerment
of community ownership
5. Capacitating of involvement of health
professional associations, Health and
health related institutions, Manufacturers,
distributors and retailers in the control of
illegal trading of foods, medicine
Initiative 17: Strengthening of control of illegal practice of health professionals and health institutions
1.
Strengthening coverage of inspection at all
level
2. Strengthening quality assurance system of
inspection
3. Establishment and implementation of
information tracking and complaint
management system
4. Strengthening of collaboration with
different stakeholders and empowerment
of community ownership
5. Capacitating of involvement of health
professional associations, Health and
health related institutions, Manufacturers,
distributors and retailers in the control of
illegal trading of foods, medicine
Initiative 18: Strengthening of Clinical trial Monitoring
1.
Need assessment
2.
Protocol reviewing
3.
Site inspection and confirmation
Initiative 19: Strengthening Port Clearance
1.
Assessment of dossiers
2.
Physical inspection and confirmation
3.
Quality testing on mini labs found at entry
ports
Confirmation of lab test with main
laboratory
Decision making based on findings
4.
5.
Initiative 20: Establishment of haemo-vigilance
and strengthening safety, quality and regulation
of blood and blood products.
1.
2.
Establishment of national blood donor
data base
Implementation and strengthening of
125
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
3.
4.
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
outcome of blood transfusion reporting
system
Establishment of hospital transfusion
committee at transfusing unit
Strengthening quality assurance system of
blood transfusion service
P3: Improve community participation, engagement and ownership
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Initiative 1: Rural HEP quality improvement initiative
1. Revise HEP service packages
2.Redefine service delivery modality
3.Provide In-service integrated refresher training
for HEWs
4.Provide upgrading trading for HEWs
5. Design and implement motivation and retention
mechanism for HEWs
6. Conduct regular supportive supervision,
mentoring and inspection
Initiative 2: Redesign and implement Urban and Pastoralist HEP
1. Conduct situational assessment and
benchmarking on Urban and Pastoral health &
health related matters
2. Conduct program evaluation for urban and
pastoral HEP
3. Design urban and pastoral HEP road map
4. Prepare implementation documents for urban
and pastoral HEP
5. Pilot the redesigned pastoral and urban HEP
6. Scale up tested urban and pastoral HEP
7. Establish strong monitoring and support system
Initiative 3: Enhance functionality of Health Development Army
1.
Conduct periodic evaluative training at all level
2.
Prepare and distribute learning aid materials
3.
Documentation and scale up of best practices
4.
Design and implement monitoring and
evaluation framework
Conduct capacity building for concerned
stakeholder
Design and pilot level I training for HDAs
5.
6.
Initiative 4: Reform and Implement PHCU
1. Develop revised PHCU standardized
service packages
2. Revise PHCU service delivery modality
126
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
3.
including introduction of team based
approach
Reorganize PHCU governance structure
4.
Pilot reformed PHCU and scale up
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Initiative 4: Reform and Implement PHCU
1. Develop revised PHCU standardized
service packages
2. Revise PHCU service delivery modality
including introduction of team based
approach
3. Develop reorganized PHCU governance
structure
4. Pilot reformed PHCU and scale up
Initiative 4: Enhance evidence based health education and communication
1. Prepare need based health learning
materials
2. Conduct continuous program
communication through different channel
3. Conduct advocacy and social mobilization
P4: Improve good governance
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Initiative 1: Strengthening Participation:
1. Conducting workshops and review meetings with
the public wing (women, disabled, CSO’,
Professional associations, consumer
associations, youth associations,)
2. Conducting workshops and review meetings the
internal staff
3. Conducting workshops and review meetings with
intra and inter sectoral collaboration
Initiative 2: Strengthening the Health Sector Development Army
1. strengthening HDA forums
2. identifying challenges and finding solutions
3. fighting rent seeking behaviors
4. identifying and recognizing model civil servants
5. identifying and documentation best practices
Initiative 3: Establishing and Strengthening Internal Control Mechanisms
1. establishing compliance committees/officers
(discipline)
2. preparing guidelines for solving problems
3. supporting encouraging internal control and
inspection processes( audit, ethics, legal)
127
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Initiative 4: Creating Conducive Work Environment
1. Creating/refining performance measuring tools
2. Assuring transparent recruitment, promotion
and demotion, job security, fair benefit
packages, rewards and need based trainings.
3. designing internal process layout and office
supplies
Initiative 5: Strengthening and Standardize service delivery in the Health Sector
Establishing and continues follow-up of citizen
charter implementation at all level
Conducting Service level assessment (SLA)
Enforcement of professional ethical code of ethics
Conducting Customer satisfaction surveys.
Monitor and evaluate the implementations of
guidelines, procedures and standards.
Establish and strengthen IT based information
system.
Initiative : 6 Strengthening the Pharmaceuticals and Health Products supply System
1. increase and strengthen the distribution
channels
2. strengthening the regulatory system
P5: Improve Logistics supply and management
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Initiative 1: Improve Quantification and
Procurement
1. Enact directives for procurement and
handling of medical equipment
2. Strengthen national capacity for
quantification and procurement (i.e. foster
specialization)
3. Adopt appropriate tools for quantification
and pipeline monitoring
4. Institute procurement procedures for
special need medicines and health
technologies (closed system lab. Reagents,
non-economic quantity products, etc…)
Initiative 2: Implement Efficient Warehousing and
Inventory Management System
1. Construct and Equip of Distribution Hubs
in Selected Corridors (considering
feasibility, population, proximity to health
facilities)
2. Renovation and equipping pharmaceutical
stores at health facility
3. Enforce the incorporation of
pharmaceutical stores in the design of
128
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
newly constructed health facilities
Scale up IPLS for all health facilities and all
pharmaceuticals (setting and monitoring
inventory control principles (parameters,
tools for analysis)
5. Ensure development and availability of
inventory control instruments/tools
Initiative 3: Implement efficient fleet management and distribution system (outbound logistics)
4.





Identification of gaps in transportation and
build capacity
Ensure strong distribution system with special
attention to the last mile (Health Posts) –
capacity building, transportation means, IPLS
tools, Locked Cabinets,
Implement control mechanisms to endure safe
and timely delivery
Strategies for maintenance of transport
facilities (diseconomies of scale)
Implement efficient customer care service
Initiative 4: Implement Integrated Pharmaceuticals Fund and Supply Management Information System (IPFS
MIS)
1. Harmonize/align the existing initiatives on
automation (PLITS, HCMIS) and ensure internet
access at health facility level (i.e. Network
Installation)
2. Mobilize the necessary resource for
implementation of IPFS MIS
3. Scale up implementation of Mobile Health
Technology for supply chain management
4. Strengthen manual information tracking
systems where appropriate
5. Develop data base for management of medical
equipment information
Initiative 5: Strengthen Revolving Drug Fund
1.
Strengthen health care financing in existing
health care facilities
2. Inject seed money to launch health care
financing in new health care facilities
3. Map and mobilize resource for equipping
newly constructed hospitals and health
Initiative 5: Implement Auditable Pharmaceutical Transaction System
1.
2.
3.
Developing and Enacting Legal Instruments for
APTS (Federal and Regional Governments)
Ensure adequate number of skilled HR
deployment for implementation of APTS
(Workforce Adjustments)
Infrastructure Improvement and
Reorganization of Pharmacy Units for APTS
implementation
129
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16 2016/17
Initiative 6: Strengthen Rational Use of Medicines and Health Technologies
2017/18
2018/19
2019/20
1.
Implement intensive awareness creation
strategies for rational medicine use
2. Establish and strengthen Drug and
Therapeutics Committees (DTCs) at hospitals
and health centers
3. Establish and strengthen Drug Information
Centers (DICs)at hospitals and health centers
4. Establish and strengthen Clinical Pharmacy
Service at hospitals
5. Build capacity of health professionals on
handling of laboratory products and
equipment
Initiative 7: Promote HR Capacity Building for Health SCM
1.
Develop and implement standardized and
comprehensive in-service training (i.e.
replacing the existing fragmented training
programs)
2. Establish training academy for supply chain
management (i.e. with focus on hands-on
training)
3. Establish and strengthen partnership with
Universities towards professionalism in areas
supply chain management
Initiative 8: Strengthen Coordination Mechanisms with Key Stakeholders
1.
Ratify framework agreements (i.e. TOR, MoU)
with key external stakeholders (e.g. Airlines,
Shipping Lines and Logistics Enterprise,
Revenue and Customs Authority, Banks).
2. Strengthen coordination and collaboration
with internal stakeholders (e.g. FMoH,
FMHACA, EPHI, RHBs, Regional Regulatory
Bodies, etc …)
3. Fostering Partnership on Priority Areas with
Key Partners
Initiative 9: Establish Pharmaceutical Waste Management System
1.
Ensure the implementation of Disposal
Guideline at all supply chain levels (e.g.
Strengthen Pharmaceutical Waste Handling
System
2. Ensure Establishment of Pharmaceutical Waste
Management Facilities (i.e. through public
Initiative 10: Develop and implement M & E for Pharmaceutical supply chain management
1.
2.
3.
Devising M & E strategy and plan for Health
Supply Chain Management System
Set Key Performance Indicators, information
requirements (indicator measurements), tools
for data collection and procedures at all levels
of the supply chain
Strengthen internal audit for all supply chain
130
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
operations
Initiative 11: Strengthen access to medicines for targeted programs through the Private Sector with Clear
Guidance on Accountability
1. Define key requirementsfor the private health
sector in terms of provision of key medicines
for targeted health programs (Devise directives
and guidelines with key stakeholders) – e.g.
Legal Transaction Records and Reports,
Premises, Professional, Linkage with the Public
Supply Chain System,
P6: Improve resource mobilization
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Initiative 1: Improve Government share to Health
Financing
1Advocate and negotiate with national and local
governments to increase budget allocation from
the treasury
2 Increase matching fund for health programs
3 Generate evidence to improve government
allocation on regular basis (NHA/NASA etc.)
Initiative 2: Enhance HCF Reform implementation
to ensure quality and equitable health service
access
1 Implement Revenue Retention in all health
facilities
2 Conduct user fee revision
3 Revise Exempted health services system
4 Establish healthy equity fund for the poor to
improve fee waiver and subsidy
5 Abolish user fee for under 5 and Maternal health
services at all levels
6 Expand private wing in hospitals and HC
Initiative 3: Scale up CBHI
1 Conduct Evaluation of the pilot program
2 Develop scale up strategy
3Scale up CBHI to National level
4 Conduct advocacy, community awareness and
sensitization
Initiative 4: Impalement SHI
Major activities
1Increase members enrollment
2Enhance financial sustainability of HI system,
3Establish Contract management system for
healthcare providers
131
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
4Establish complaint handling system
5 Establish database system for members,
beneficiaries and employers
6 Conduct awareness creation and sensitization
Initiative 5: Establish innovative ways of Domestic Health Financing
1Conduct assessment on feasibility and
identification of potential innovative sources of
domestic financing (e.g. solidarity fee on air tickets,
ear marked tax for health, sin tax, and mobile
phone tax etc.).
2 Design strategies and consultation with
stakeholders
3 Develop implementation legal frameworks
(regulations, directives and guidelines, etc.)
4 Implement the strategy at all levels
5 Strengthen RDF
Initiative 6: Enhance Health Partnership and Coordination (DPs, CSOs/NGOs, PPPH, FBOs)
1Strengthen Health Partners coordination
mechanisms to improve pooled funding
mechanisms, predictability and flexibility of
funding.
2 Strengthen international and local NGOs/CSOs,
FBOs coordination and management mechanism
(project appraisal, follow up, monitoring and
evaluation)
3.Design strategies, legal frameworks and guideline
to implement PPPH
4Support private health providers to establish high
tech tertiary level medical care facilities and
pharmaceutical industries to reduce referrals
abroad and promote medical tourism
Initiative 7:Strengthen resource tracking and management
1Conducting operational and strategic level
resource mappingat all levels,
2produce health sector financial gap analysis report
3 Introduce and implement health financing
projection model for priority health programs
4Conduct costing of minimum standard health
service provision at all levels of health facilities
Initiative 8: Enhance external fund mobilization
1Maximize and proactively mobilize financial
resource from potential donors
2 Branding of successful health programs to solicit
and mobilize additional resources from bilateral
donors and philanthropists
3 Conduct donor mapping
132
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
4 Develop readymade proposals, concept notes to
solicit funds
P7: Improve evidence-based decision making
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Initiative 1: Strengthen routine performance
monitoring system
1. Generate routine data for decision making
2. Establishing one routine health monitoring
system(Guidelines, tools and structure)
Initiative 2: Strengthen survey and surveillance
systems
1. Conduct epidemics surveillance
2. Conduct diseases & vectors survey and
surveillance
2.1.Conduct diseases survey and surveillance
(Epidemiological and behavioural)
2.2.Conduct vectors survey and surveillance
3. Conduct drugs survey and surveillance
3.1 conduct rational drug use,
3.2 resistance,
3.3 post market
4. Conduct food and nutrition survey and
surveillance
4.1. Micronutrient, Survey
4.2 Post market
5. Establish health & demographic sites
(established, expanded and strengthened., etc)
Initiative 3: Strengthen research and evaluation
1. Conduct technology validation, transfer and
development(Diagnostics, Vaccine, etc.)
2. Conduct research on the development and
promotion of traditional medicine
3 Health system research
3.1.Conduct health impact assessment
3.2. conduct programs evaluation
3.3 conduct evaluation of human resource for
strategy
3.4 conduct SARA/ SPA evaluation
3.5conduct evaluation of health financing
3.6 conduct HEP evaluation
133
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
3.7 conduct evaluation of supply chain
management
3.8Conduct evaluation on coordination and
collabration
3.9 conduct evaluation on health quality and equity
3.10 conduct evaluation on policy and regulation
4. Best Practice documentation including HDA.
5 .1 conduct research on development of
complementary and supplementary foods.
5 .2 Conduct Evaluation on intervention based on
complementary and supplementary foods,
6. Environmental and occupational health
research
6.1 Conduct research Road traffic
6.2 Conduct research on climate and polution
6.3Conduct research on occupational safety
Initiative 4: Supportive supervision and inspection
1.Supportive supervision conducted to improve
performance of programs.
2.Inspection conducted to improve performance of
programs to insure accountability.
Initiative 5: Data quality assurance and auditing
1.Generating and disseminating quality data
2. Developing guideline and related tools
3.Conduct supportive supper ion and assessments,
and providing feed backs
4. Conduct trainings
Initiative 6: Communication, advocacy and dissemination
1.Establish national integrated information
center/hub
2.Develop and disseminate regular reports, journals
and policy briefs
3.Conduct workshops, review meetings
Initiative 7: Capacity building to support evidence based decision making
1.Develop and institutionalize one M&E frame
work at national level
2.Develop and introduce technology &
infrastructure
3.Develop adequate and competent human
resource
134
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
4.Establish/strengthen data management unit at all
level
5.Mobilize adequate and sustainable financial
resource
CB1: Enhance use of technology and innovation
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
x
2018/19
2019/20
Initiative 1: Enhance the health information
systems through use of existing and new
information technology
1. Procurement of hard ware, soft ware and
networking infrastructure
2.Training and Implementation
x
x
x
3.Integrating different soft wares
x
x
Initiative 2: Vaccine and diagnostics materials
technology transfer and production
1. Building of vaccine production facilities
x
2. Training of experts in vaccine and diagnostic
x
materials production technology
3. Training on vaccine and diagnostic materials
x
quality control
4. Production of vaccine, diagnostic materials and
x
others
Initiative 3: Development and use of local technologies (Traditional medicine, food technology)
1. Building capacity on technology transfer
x
2. Identification of the traditional medicines with
the potential of wider community use
3. Area specific complementary foods development
x
x
4. Identification of food vehicles for micronutrient
x
fortification
5. Dissemination and use of the complimentary
foods
Initiative 4: National digital health and health related database repository
1. Establish data storage infrastructure (severe,
x
hard-wares, soft-wares)
2. Data and information gathering/collection and
x
storage
3. Networking of the server with potential data
sources in health and other sector
Initiative 5: High tech diagnostic technology transfer
1. Capacity building of EPHI and One Tertiary
hospital for molecular diagnostic techniques such
x
x
x
x
x
135
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
as paternity test, cancer etc,
2. Build capacity for in vitro-fertilization technique
x
in one tertiary hospital
3. Build capacity of EPHI to build Biosaftey level 4
x
laboratory
Initiative 6: Build system for supporting and capacitating health innovators and innovative ideas
1. Develop manuals and working procedures
2. Assessment of innovations and best practices in
the community to disseminate
Initiative 7: Medical equipments and diagnostic facility technology level determination for health tier systems
1. Determination of what technology levels of an
x
x
equipment to be used at different health tier
systems
2. Set cost effective standard and Prepare road
x
x
map
Initiative 8: Vulnerability and risk assessment and mapping of diseases (Atlas of diseases)
1. Mapping of major disease
x
x
2. Development of interactive software for
mapping
Initiative 9: Complete health facility and their climate change copping capacity mapping
x
x
1. Complete mapping of all health facilities (Health
x
post, HC and Hosp) in Ethiopia
2. Assessment of Climate change copping capacity
x
of all the health infrastructure in the country.
Initiative 10: Electronic clinical practice or e-health (Tele-medicine, tele-education, M-health)
1. Tele medicine implemented in zonal and
primary hospitals
2. Post and Pre-service Tele-education
implemented in all medical schools
3. Implementation of mobile medicine
x
x
x
CB2: Improve development and management of human resource for health
IMPLEMENTATION YEAR
MAJOR ACTIVITIES
2015/16 2016/17
2017/18
2018/19
Initiative 1: Scale up Training and development of health professionals in line with staffing
requirement
Undertake training needs assessment to identify
the need for various cadres and assist in curricula
development
Increase the annual pre-service enrolment and
output for priority health cadres in line with FMoH
projections
Strengthen the infrastructure for effective teaching
by establishing skills labs, simulators, ICT etc
Support in faculty development
2019/20
INITIATIVE 2: Introduce integrated curriculum
(competence based) to medical schools
136
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
Work with HESC ( Higher education strategic
center) in revising the existing discipline based
curriculum to integrated
Introduce the integrated curriculum to medical
10%
25%
40%
60%
schools (20 Medical schools)
Provide technical and teaching/learning support for
the implementation
INITIATIVE 3: Strengthen In-Service Health Training and Continuing Professional Development
2019/20
80%
Review and approve existing in-service training
(IST) materials
Establish in-service training centres with
appropriate geographical coverage and build
capacity of IST and CPD providers
Establish ICT platforms to support delivery and
management
Develop and provide in-service trainings based on
national priorities
Implement a Continuing Professional Development
(CPD) programs and link to career development
and relicensing and Involve private sector and
professional associations in in-service trainings and
CPD rollout
Establish and maintain a functional IST
database/interface with HRIS/ at all levels for
efficient implementation of the program. And
Develop need based annual IST plan.
INITIATIVE 4: Upgrading of health extension workers
Support refilling of level III HEWs and Upgrading
level III to level IV
Upgrade level IV HEWs into family health nurse
(BSC) program andfamily health midwives (BSC)
program
Enrolment of level V/ BSC HEWs to the new
innovative medical education
INITIAIVE5: Expand enrolment and produce adequate number of family health team based on PHC model
Expand teaching centres and enrolment to
2
produce adequate number of family health
team
Initiative 6:Team based training for Emergency medical service
3
4
4
4
Support curriculum revision and support with
2
3
4
4
4
teaching materials
Initiative 7:Team based training of Maternal and Child care providers ( Midwife, Anesthesia, and Neonatal
nursing)
Support curriculum revision and support with
10
10
10
12
12
teaching materials and financial
schools
schools
schools
schools
schools
INITIATIVE 8:Increase the production of clinical specialities and Introduce forensic/legal medicine training
Support in curriculum development and build
the capacity of the training center with
infrastructure and teaching materials
137
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16 2016/17
2017/18
2018/19 2019/20
INITIATIVE 9: Strengthening clinical pharmacy programs and Supply chain management professionals training
Enhance the clinical pharmacy program
Support revision of curricula of pharmacist to
strengthen clinical pharmacy and the supply chain
management competency
Expand post graduate supply chain management
professionals training
INITIATIVE 10: Health Regulatory affairs
Select universities to deliver the study , support
curriculum development and give technical and
financial support
INITIATIVE 11: Provide support for quality audits of all existing pre-service training programs
Support in developing standard for quality health
professional education
Support internal and external audit to develop and
10
20
35
45
50
implement evidence-based quality improvement
schools
schools
interventions
INITIATIVE 12: Universities/Health science colleagues industry linkage and Medical schools twinning ( National
and international)
Support creation of strong partnership between
40
45
50
50
50
universities and health science colleges with
industries and practical sites
National twinning of medical schools based on their 8 Cluster 8 Cluster 8 Cluster
8 Cluster 8 Cluster
geographic distribution and potential
Twinning of medical schools to international
15
21
25
28
33
medical schools
schools
schools
INITIATIVE 13:Introduce new postgraduate to support the HRH Management and the health care
financing/insurance
Support introduction of new postgraduate training
2
3
3
3
3
on HRH Management and Health Economics
schools
INITIATIVE 14: knowledge management center in FMOH
Establish leadership and management
development centre and relevant training
programs
Establishing archiving and data base management
system for the different experiences, documents
produced in the sector
INITIATIVE 15:Strengthen the HRM Function and Practices at FMOH and Lower Levels
Modernize the HRM function Upgrade the human
resources development and administration
function and develop tools to support selection and
recruitment including e-recruitment
Provide continuous HRM training to HR staff at
national and lower levels
Conduct periodic job analysis in order to regularly
update HRH categories and regularly develop and
update job descriptions for all staff.
Review and Improve the implementation of a
performance based evaluation system
138
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
Undertake review of career structures for all cadres
to provide clear career growth pathways
Integrate career planning into other HR systems
such as performance appraisal, training and
succession planning
INITIATIVE 16: National licensing exam
Expand the capacity of the HRDA Directorate and
FMHACA in professional licensing, relicensing and
regulation
Develop/review implementation manual which
details the requirements, scope, processes and
other relevant matters for accreditation and
licensing.
Establish a system for strategic information on
qualification examinations and create feedback
system from licensing systems to pre-service and
in-service trainings institutions
INITIATIVE 17: Establish a Comprehensive Human Resources Information system (HRIS)
Conduct an assessment of existing HR information
systems,scale up a sector-wide HRIS and roll out at
all levels of the health system.
Train and assign staff to manage HRIS at various
levels of health system administration
Integrate the HRIS into FMOH’s data-warehouse
structure and use of the data for decision making
INITIATIVE 18: Reduce Inequity in Geographic Distribution and skill mix of health care Workers
Build capacity of regional health bureaus and
woredas to attract and deploy health professionals
in hard-to-reach geographic areas
Conduct policy advocacy for special remuneration
and incentive package in hard-to-reach areas
Sensitize health workforce to provide services for
communities at highest needs and continue
enforcing minimum public (the mandatory) service
for selected priority health professionals
INITIATIVE 19: Motivation and retention
Conduct regular motivation and retention studies
and develop a comprehensive strategy to raise
awareness and change attitudes of health
workforce
Design, cost and implement standardized a set of
monitory and non-monetary incentive packages
Develop and update a database of health and
management staff from which all health partners
are persuaded to select experts on rotation to
engage in short-term consultation.
Institutionalize the temporary secondment or joint
appointment employment opportunities in
National and international partners as a reward to
health and management staff for public sector
139
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
contribution
Develop a mechanism for competitive research
grant awards to researchers actively employed in
the public health care system
Standardize classification of hardship areas across
regions
INITIATIVE 20: Enhance performance and productivity
Conduct productivity surveys and introduce regular
performance planning, monitoring and
improvement programs
Establish a comprehensive work climate
assessment and improvement programs
Establish and implement a system for performance
appraisal, reward and recognition
Conduct regular supportive supervision,
mentorship and regular feedback at all levels
Introduce effective time management systems for
health care providers
Create link between performance and professional
development
Conduct productivity surveys in selected health
facilities
CB3: Improve health infrastructure
MAJOR ACTIVITIES
Initiative 1: Health and health related facility
construction
1. Revise and Develop new designs
considering equity
2. Conduct scientific site selection method
3.
4.
Adopt design as per the selected site
condition
Construct under close supervision
 500 Primary Hospitals.
 125 General Hospitals
 1 Specialized Hospitals
 30 Bio-Medical Maintenance
workshops
 30 new Regional Blood Bank
 2 branch Food and Medicine
Quality Control Laboratories
and 16 mini quality control
laboratories
 2 drugs hubs
 2 staff residence
 1 national Incinerator and
training center
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
200
50
1
30
30
2+ 8
200
75
100
8
2
2
1
140
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
Initiative 2: Expansions of Health Center
1. Design modification for expansion of
health center based on the assessment
2. Expaned under close supervision
 Expanded 82 health center with
OR
 Expand XXX HCs per standard
Initiative 3: Rehabilitation of Hospitals
1.Design modification for rehabilitation hospitals
based on the assessment
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
X
82
-
X
2- Rehabilitated under close supervision
 Rehabilitated 4 federal Hospitals
 Rehabilitated xxx region hospitals
Initiative 4: : Maintenance and renovation of health and health related Facility
1.
Prepare and adopt maintenance
procedure manual/guidelines
2. Maintained based on the procedural
manual
CB4: Enhance policy and procedures
MAJOR ACTIVITIES
Initiative 1:
Amendment of Ethiopia Food, medicine and health
care administration and control Authority
proclamation No.661/2009
Medicine standard revision
X
X
X
X
X
IMPLEMENTATION YEAR
2015/16
2016/17
2017/18
2018/19
2019/20
X
X
X
X
X
Food standard revision
X
X
Health institution standard revision
X
X
X
X
Medicine directive revision
X
X
X
X
Food directive revision
X
X
X
X
Health related directive revision
X
X
Guideline revision /STGs
X
Medicine and medical equipment Costing manual
X
Medicine and medical equipment Fund
management manual
Insurance management manual
X
X
X
Initiative 2: Revise health and health related policies, legal frameworks and guidelines
Amendment of Ethiopia Food, medicine and health
care administration and control Authority
proclamation No.661/2009
Medicine standard revision
X
X
X
Food standard revision
X
X
Health institution standard revision
X
Medicine directive revision
Food directive revision
X
X
X
X
X
X
X
X
X
X
X
X
X
141
[HSTP ZERO DRAFT_V2] 10th May, 2014
MAJOR ACTIVITIES
IMPLEMENTATION YEAR
Health related directive revision
2015/16
X
Guideline revision /STGs
X
Medicine and medical equipment Costing manual
X
Medicine and medical equipment Fund
management manual
Insurance management manual
X
2016/17
X
2017/18
2018/19
2019/20
X
X
Initiative 3: Awareness creation for community, stake holders and health professions on policies, legal
frameworks and guidelines
Promotion on the newly developed policy and
X
X
X
legal frame works (proclamations , regulations,
standards, directives, guidelines )
Promotion on the existing policy and legal frame
X
X
X
X
X
works (proclamations ,regulations, standards,
directives, guidelines )
142