1. Health Systems Strengthening Programs/Approaches Experience from Ethiopia Eshete Yilma, USAID/Ethiopia Global Health Council Satellite Session June 13, 2011

2. Understanding HSS on the Ground
No clear and common understanding of what HSS is
Sub-system-focused approach/strategy (health financing, etc.)
For many development partners, HSS is disease / program-based
For host government, HSS is mainly construction of facilities
Initiatives/programs camouflaging and distorting HSS
No strong networking of HSS groups

3. Health System Building Blocks: Experience In Ethiopia
Health financing
Health workforce
Health information
Supply management system
Governance
Service delivery

4. Financing Mechanism for HSS
MCH
GAVI
Global Fund
PEPFAR wrap-around
Bilateral and multilateral development partners
GOE at all levels

5. 1. Health Sector Financing
Challenges
Health sector is underfinanced
Misallocation of resources
Large OOP expenditure
Limited participation of private sector
No protection for the poor /vulnerable groups
USAID Response
Advocacy (NPA, NHA…)
Create policy environment
Private sector participation
Fee retention-decentralization
Health insurance

6. 2. Health Taskforce Development
Challenges
High attrition rate
Understaffed in rural areas
Delayed implementation of HRH strategy (incentive, training)
USAID Response
Support public health colleges for a decade
5,000 health officers trained
Support HEW program
Community health workers… task shifting

7. 3. Health Information
Challenges
Poor HMIS
Decisions not evidence based
No comprehensive surveys/vertical surveys
Inconsistency (variability) of data for same indicator
USAID Response
Create center of excellence in focus regions
Initiated and supported HMIS reform
DHS

8. 4. Supply Management System
Challenges
Shortage of essential commodities at the last mile
Weak supply chain
Focus on vertical programs
USAID Response
Supported improvement of the supply system
Supporting the design and implementation of Logistic Master Plan as a key partner

9. Recommendations
Focus on big picture
Work on comprehensive HSS
Establish global/regional networking
Discourage camouflaging of initiatives to distort the HSS concept
Promote harmonization of the concept of HSS (WHO HSS Building Blocks) in terms of sustainability