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

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

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

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

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

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

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

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

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