As Health Minister, Dr. Tedros developed a comprehensive reform agenda that transformed Ethiopia’s health system in a span of just seven years. By investing in critical health infrastructure, building the health workforce and initiating innovative financing mechanisms, he helped expand access to care to tens of millions of Ethiopians, achieve ambitious health targets, and set Ethiopia on a path to sustain and expand this success. Today, Ethiopia stands as a global model for effective health system reform and governance and as an inspirational story of successful African-led development.
When Dr. Tedros was appointed Minister of Health, there were only 600 health centers to serve Ethiopia’s entire population of 76 million. Dr. Tedros’ initiatives led to the construction of more than 3,500 health centers and 16,000 health posts—dramatically expanding access to basic health care and helping Ethiopia achieve its target of reducing child mortality by two-thirds between 1990 and 2015. During the same period, the number of new HIV infections fell by 90 percent, malaria-related mortality fell by 75 percent and mortality from tuberculosis fell by 64 percent.
At the foundation of Ethiopia’s dramatic expansion of access to health care and the achievement of its ambitious targets was the flagship HEP. Dr. Tedros recognized that millions of Ethiopian women either had no access to health services or were choosing not to seek care, largely because few of the limited health workers available were women. His response was the rollout of HEP, which trained and deployed 38,000 health workers—the vast majority of them women. HEP revolutionized health service delivery throughout the country by fostering more assertive care-seeking behavior among women on behalf of themselves and their families. By linking leaders at the global, national, regional, and district levels with women’s groups in every village across the country, Dr. Tedros leveraged the HEP platform to realize his overarching vision of building a sustainable health system with women at its core. Today, Ethiopia’s HEP model of community-based health service delivery is being replicated in more than a dozen countries.
Under Dr. Tedros’ leadership, the Ministry of Health developed innovative health financing mechanisms, including a community and social health insurance scheme that promoted cost-sharing between care seekers, donors and the Ethiopian Government and resulted in increases in both revenue and demand for health services.
At the beginning of Dr. Tedros’ service as Minister of Health, there were only three medical schools in Ethiopia and just one physician for every 30,000 people. In partnership with the Ministry of Education, Dr. Tedros devised and led the successful implementation of a wide-ranging national strategy for investing in Ethiopia’s health care work force. The dramatic returns on these strategic investments include:
• An almost seven-fold increase in the overall number of health professionals in the country, from 16,500 to 115,000. Every district in the country now has at least one appropriately staffed and operational health center.
• Significant, affordable and sustainable growth in the number of medical schools in Ethiopia from just three schools training 120 doctors annually in 2005, to 33 schools training 3,000 doctors today. This was achieved by leveraging the infrastructure of Ethiopia’s existing hospitals.
• Initiation of a three-year master’s programme that trained and deployed more than 9,000 non-physician clinicians to perform emergency gynecological and obstetric operations, thereby accelerating reductions in maternal and newborn deaths during child birth.
• A significant increase in the country’s disease surveillance capacities through the establishment of a master’s programme for field epidemiologists and laboratory technicians.
• Initiation of the country’s first master’s level training programme for hospital administrators, and establishment of hospital governing boards to oversee the efficiency and effectiveness of operations. This resulted in significant improvements to the management and governance of hospitals and overall patient satisfaction.
Recognizing the urgent need to address Ethiopia’s inadequate pharmaceutical services and recurrent stock-outs of essential medicines, Dr. Tedros helped to establish Ethiopia’s Pharmaceutical Supply Fund Agency, which institutes transparent and accountable business processes and ensures the availability of a reliable supply of affordable, quality-assured medicines to all Ethiopians.
Dr. Tedros was also instrumental in the transformation of Ethiopia’s inadequate health information system and poor health data collection and use capacities. Under his leadership, the Ministry of Health developed an integrated health information management system which significantly improved data collection, monitoring and evaluation. The new system has had the greatest impact at the local level—right at the source of data collection—resulting in more effective use of data for improving service delivery and programme implementation.
Ethiopia’s health system was for years largely beholden to the funding priorities of various development partners. Earmarked funds were designated only for vertical single-disease programmes and neglected other pressing needs in the health system. To address this problem, Dr. Tedros helped institute the pooled MDG Health Fund and the One Plan, One Budget, One Report country-driven roadmap for improving harmonization within the Ethiopian health sector. These efforts enhanced country ownership, increased donor harmonization and alignment in planning, financing and programming to address key health system strengthening priorities. Further, the country coordination across the health sector complements similar alignment initiatives in other sectors. Ethiopia, which hosts 27 UN agencies, implements the UN Delivering as One model to coordinate UN programmes at the national level for higher impact. Ethiopia is working closely with the UN fund’s programmes and agencies to implement the six pillars of the Growth and Transformation Plan.