Ethiopia

Health MDGs can be achieved equitably

'Progress for Children' interview series

© UNICEF Ethiopia/Fassil-Zeleman Production

Ethiopian Minister of Health H.E. Dr. Tedros Adhanom Ghebreyesus.

The 2010 edition of UNICEF’s ‘Progress for Children’ shows that despite advancement towards the Millennium Development Goals (MDGs), many of the poorest and most disadvantaged children are still missing out. UNICEF invited several experts to offer their insights on what can be done to realize the MDGs for all.

By Lorna O’Hanlon

NEW YORK, USA, 20 September 2010 – Progress towards the health-related Millennium Development Goals remains a fierce challenge for many in the developing world. Countries that have seen significant improvements in child and maternal health (MDGs 4, 5 and 6) have done so by refocusing on the poorest and most marginalized children and families.  

The Republic of Korea, Singapore and the Taiwan Province of China, for example, invested heavily in health care services during the 1980s and 1990s, resulting in more equitable delivery of these services.

In Latin America, Brazil and Mexico enhanced access to health care by removing or lowering fees and by targeting the poorest and hardest-to-reach communities.

An elusive goal

Yet while some countries in sub-Saharan Africa have made impressive advances in child survival, proper health care remains elusive for millions, especially among the rural poor.

According to UNICEF’s 2010 flagship report, ‘Progress for Children: Achieving the MDGs with Equity,’ sub-Saharan Africa continues to have the highest child mortality rates for children under five. In 2008, one in seven children in the region died before reaching the age of five. Children in rural areas account for the majority of those deaths.

The statistics are equally compelling for pregnant women in the region, where fewer than half are supported by a skilled birth attendant at delivery. Most maternal deaths can be prevented if births are attended by trained personnel who are supervised, have appropriate supplies and can provide timely referrals to emergency obstetric care when complications arise. 

The equity challenge

Ethiopia’s population is largely rural, and children and women living in rural areas are the ones faced with the most urgent public health problems. These are mainly preventable communicable diseases, under-nutrition and conditions that can be averted with access to basic health services. 

In rural Ethiopia, a scant 3 per cent of women have a skilled birth attendant during childbirth, and their children are half as likely as those in urban areas to be immunized against measles.

In 2003, Ethiopia embarked on a national community-based initiative called the Health Extension Programme (HEP). The programme, which focuses strongly on mothers and children, trains female high school graduates in primary health care services, including hygiene, environmental sanitation and family health services, as well as health education and communication.

Access to care

“Equity is at the very heart of the Health Extension Programme,” said Ethiopian Minister of Health Dr. Tedros Adhanom Ghebreyesus in a recent interview with UNICEF.

“The programme is designed to ensure that all communities, and especially the most vulnerable and previously underserved segments of our population, are provided access to basic health care,” he said.

HEP is part of a larger strategy initiated by the government to achieve universal access to primary health care. Ethiopia’s Health Sector Development Programme centers on the MDG areas of child and maternal health (MDGs 4 and 5) and HIV/AIDS, tuberculosis and malaria (MDG 6).

Accelerating development

Dr. Ghebreyesus considers improved health care essential in fighting against poverty and accelerating Ethiopia’s development.

‘Progress for Children’ data highlight the connection between health and poverty in various settings for both women and children. For example:

• New life-saving vaccines have been introduced in only 5 per cent of low-income countries
• In sub-Saharan Africa and South Asia, the poorest children are more than twice as likely as the richest to be underweight
• In developing countries, only 28 per cent of poor women have a skilled professional at delivery, compared to 84 per cent of the richest
• In India, a time-trend analysis of data from 1993, 1999 and 2006 revealed a greater decline in the prevalence of underweight children in the richest households than in the poorest. 

Dr. Ghebreyesus believes that investing in high-impact and low-cost interventions is the best solution for developing countries with limited resources. He acknowledges, however, that there is no 'one-size-fits-all' approach.

“The particular needs and circumstances of individual countries will differ … and it is the respective governments and people who are best positioned to identify, prioritize and devise appropriate programmes to address them,” he said. “This, in essence, is what country ownership is all about.”

Here's a transcript of a recent UNICEF radio interview with Ethiopian Minister of Health Dr. Tedros Ghebreyesus. [PDF]