Reflecting on the steps needed to strengthen health systems in the Ethiopian context is crucial, as a robust health system is the bedrock for addressing any public health challenge, from communicable diseases to environmental health issues like lead poisoning. Ethiopia has made significant strides, particularly through its Primary Health Care (PHC) system and the Health Extension Program (HEP), but persistent challenges and new complexities (like the impact of crises and the rising NCD burden) necessitate ongoing strengthening.
The World Health Organization (WHO) identifies six building blocks of a health system: (i) Service Delivery, (ii) Health Workforce, (iii) Health Information Systems, (iv) Access to Essential Medicines, (v) Health Financing, and (vi) Leadership and Governance. I will reflect on each of these, considering Ethiopia's specific context.
Steps to Strengthen Health Systems in the Ethiopian Context:
1. Strengthening Service Delivery:
Current Situation: Ethiopia has significantly expanded primary healthcare coverage through the HEP and health post/center infrastructure. However, quality, comprehensive care, and integration of services (e.g., mental health, NCDs, environmental health) remain challenges. Crises (conflict, natural disasters, pandemics) severely disrupt routine services.
Steps Needed:
Improve Quality of Care: Focus on clinical governance, continuous professional development, implementation of standardized protocols, and patient-centered care. This includes strengthening diagnostic capabilities at primary care level (e.g., for lead poisoning screening).
Integrate Services: Move beyond vertical programs to provide comprehensive, integrated care at the point of service delivery, especially at the primary health care unit (PHCU) level. This means linking environmental health surveillance (like my lead project) directly to health centers for follow-up.
Enhance Referral Systems: Strengthen referral pathways from health posts to health centers, and from health centers to hospitals, to ensure patients receive appropriate levels of care. This is critical for managing cases like elevated BLLs requiring specialized attention.
Build Resilience: Develop and implement robust emergency preparedness and response plans at all levels (from health post to federal) to ensure continuity of essential services during crises, learning from recent experiences.
2. Strengthening the Health Workforce:
Current Situation: Ethiopia has increased the number of health workers, particularly Health Extension Workers (HEWs). However, shortages persist, especially for specialists (e.g., pediatric neurologists for lead-affected children), and there are issues with equitable distribution, retention, and continuous skill development. High staff turnover is a challenge.