Rochester, MN, January 21, 2017 (GMN) - Introduction, Ethiopia has a history of hunger, and poor health care services and is well known as one of the poorest countries in Africa devastated by famine. In 1984, thousands of citizens relocated to another part of the country (Kloos, 1990).
The country’s economy depends on foreign aid and the agricultural sector which accounts for 83.4% of the labor force, about 43.2% of the Gross Domestic Product (GDP), and 80% of export. The country had experienced severe drought, as the result of poor cultivation practices which made Ethiopia's economy unstable (FMOH, 2010). However, for the last few years, Ethiopia is making progress and observed some improvement in the health sector.
The main causes of poor health care service in Ethiopia are a lack of access to the health center, shortage of health care workers and medical equipment, and low health literacy. Even though Ethiopia depends on foreign aid for the last decades; it introduces health coverage at low cost for all Ethiopian but with poor infrastructure. It is unique to learn more about the health care system of Ethiopia and to know why most of the people are underserved. The study selects Ethiopia to look at health policy and whether social determinants of health impact inequalities and socioeconomic.
Overview of the Ethiopian Health Care System
The few indicators of social determinants of health that this study focuses on are the health of the Ethiopian population, under-five mortality rate, incomes, and health service outcomes. Ethiopian Demographic and Health Survey (EDHS) conducted a study to understand the social determinant of under-five mortality to narrow the gap between the mother, income, and teenager (Dejene & Girma, 2013). The evidence showed that there was a decline in the under-five mortality rate mostly in urban areas which can link to available basic health care screening services. On the other hand, it showed a negative impact in the villages where people have no access to health centers, and most often people walked 10 to 30 miles to acquire public service. Based on Ethiopian health policy, a primary health center cannot be built in a village where the population is least than 20,000 thousand, and used health extension workers to distribute malaria medicine throughout the villages are limited to practice. This policy put many citizens in a vulnerable situation.
The EDHS aimed to educate residents to reduce the risk of mortality rate. Maternal and child health education; help the mother to decide for her health and child to produce better income and higher health literacy. Lack of health literacy and disparities are identified as a social determinant of health that is linked to the under-five mortality rate in Ethiopia because a country with high national income; would generate low under-five mortality rates and better health outcomes (Dejene & Girma, 2013). Women are the main character here and empowering them by teaching the reproductive system to improve their income; it will reduce the under-five mortality rate. Reproductive health education is vital for mother and child health but the policy of universal medical coverage in Ethiopia is still not within reach of the entire population (Onarheim et al., 2015).
When looking at Ethiopia’s health care policy is among the least developed in Sub-Saharan Africa and had never coped with significant health problems. The major health concerns of the country are malaria, maternal mortality, lower respiratory infections, tuberculosis, and HIV/AIDS followed by acute malnutrition, lack of access to clean water, and sanitation (FMOH, 2010). As it stated above, Ethiopia’s population still faced a high rate of morbidity and mortality, and the health status remains unstable. These problems are worsened by the shortage of trained workforce and health facilities. According to Mekonnen, (2013) stated that Ethiopia has only 3 medical doctors per 100,000 people while the shortage of health workers and high income of human resources account for healthcare issues, and the insufficiency of necessary drugs and supplies has also contributed to the burden. Also, widespread poverty, poor nutritional status, low education levels, and poor access to health services have contributed to the high burden of disease in the country. Malaria is the primary health problem in the country; it is the leading cause of outpatient in which responsible for millions of annual clinical cases and a significant number of deaths. In total, as much as 80 percent of the health problems in the country are due to preventable communicable diseases and malnutritional; therefore, these health problems are associated with low socioeconomic.
Health literacy and cultural awareness
Low health literacy in developing countries is staggering due to the lack of ability for individual to obtain basic skill and use health information. In developed countries health policy required that information about medications, treatment, and providers be made accessible to those with limited skills through effective communication. This policy can be apply to Ethiopian health system and understood as one of the essential determinants of whether individuals can use healthcare to achieve good health. It is vital to improve quality health services in low-income; however, implementing effective health policy-based primary care has been a challenge in many countries in Sub-Saharan Africa. Ethiopia's health policy was not fully well established until a few years ago because of insufficient financial resources, weak community engagement, political unrest, and inadequate management (Abrahim et al., 2015).
According to Donnelly, Lane, Winchester, & Powell (December 2011), Health literacy is the ability to find, understand, and use complex information to make choice about health care. It has an impact on routine tasks whether a person can read and understand the instructions on a medicine bottle, and on more complicated tasks whether someone can easily compare multiple health insurance plans.
This study is not clear to determinants whether health inequality and socioeconomic in Ethiopia contributed to the entire population. However, the evidence shows an uneducated person in a rural community is associated with lower coverage compared to educate person living in an urban, employed, Protestant, or Orthodox associated with higher coverage of family planning (Onarheim et al., 2015). It has been an issue in Ethiopia where languages changed every ten miles and most Ethiopian used self-administer medication or herbal remedies to treat the patient as a result of complications treatment when visiting health clinics or hospitals. Ethiopian health policy is lack health awareness and community engagement to educate people who are living in the countryside.
In fact, health literacy has not been addressed in the Ethiopian health policy. It is one of the important steps to take when establishing health policy to improve health inequality and socioeconomic in an underserved community. For example, treating a patient “woman” with no formal education in a rural area is more likely to dissatisfy the outcomes than treating a woman with formal education in an urban. Of course, health literacy and effective communication are essential tools during treatment for both patient and health practitioner for good outcomes to reduce health inequality (Donnelly, Lane, Winchester, & Powell, 2011).
Health inequality/inequities and life expectancy
Ethiopia's Population today is over 100,000,000 and currently, Life expectancy at birth is about 62 years for men and 65 years for a woman. The infant mortality rate is 49.0 and Per capita income is $1500. 7 percent of the population in the age group of 15-49 in 2016 were reported to have HIV/AIDS [(CDC), April 11, 2016]. As one can see above, it seems Ethiopia has better outcomes by increasing life expectancy when is compare with other countries in Sub-Saharan Africa, but the study is not clear whether poor health care contributed to health inequality. According to the study by Begashaw, Tessema, & Gesesew, (2016), indicated that health care policies and programs’ planning requires knowledge about healthcare-seeking behavior for early diagnosis, effective treatment, and appropriate intervention implementation. Absolutely, but it does not seem to happen in third-world countries. The better way for any individual to stay healthy is to utilize early health screening or yearly medical checkups which are important for both patient and health practitioner to provide effective treatment. As a result, it can reduce morbidity, mortality, and disability, and increase fertility rates; however, Ethiopia had grown in inequity and disparity due to limited transportation to the health center and villages to deliver health care services.
It has been noted that inequality in health care utilization and health outcomes between the poor and rich, especially in the city and countryside areas showed the poor distribution of medical services (Begashaw, Tessema, & Gesesew, 2016). Health infrastructure in Ethiopia is penniless but supposed to have planned for disease prevention, promote health, prepare for any outbreak, and responds to ongoing challenges for the country. One must understand the above statement that is the missing key to combating the disease in developing countries, especially in Sub- Saharan African countries, particularly for Ethiopia's health policy.
Efforts in Ethiopia to reduce health inequities
Onarheim et al. (2015) indicated that Ethiopia’s goal of universal medical coverage promises access to all necessary services for everyone while providing protection against financial risk. Of course, universal health coverage sounds great, but it would be hard to reduce health inequalities when people have no access to the health center. The country has a history of poor health services in Sub-Saharan Africa and many people experience uncertain diseases. In the countryside, a person can die without knowing the causes of the illness due to a lack of basic health screening services.
Communicable diseases play a significant role in this country, and the causes of health services come from a lack of health infrastructure in the country. It was mentioned in the study that measures of health inequality do not capture the distribution of health and propose the absolute length of life inequality as a measure to describe individual inequality (Tranvag, Ali, &Norheim, 2013). The best way to reduce health inequality in Ethiopia is to establish a health policy with more health centers throughout the underserve villages, provide immunization, educate the entire community about the benefit of basic medical checkups, and empower women.
Malaria also is a big issue in Ethiopia's health policy that is known to be the cause of death under-five mortality rate. It increases the child mortality rate in the country, especially in the villages which severely affected by malaria. The outbreak increases every year during the rainy season because of unavailable mosquito nets, shortage of antimalarial drugs, and poor infrastructure of health centers in the rural community. About 88% of the malaria cases in the world are recorded in Africa, and 90% of malaria deaths are also registered in Sub-Saharan Africa (WHO, 2015).
The statistics show that child mortality and morbidity are higher than in other countries because of weak health policy and child infected and dies every minute. According to WHO (2015) report, there are 438,000 malaria child deaths in the world, and 306,000 were children under the age of 5; however, the overall statistics have shown a decline in child deaths among 5-year-olds and above in some countries. Most of the villages in Sub-Saharan Africa, especially in Ethiopia have been devastated by the malaria epidemic every year and children die of unknown causes. It is another burden of socioeconomic in the rural community which may contribute to inequality as well. However, to reduce health inequalities, more research needs it on this parasite and vaccination must be available as soon as possible.
Ethiopia is the second most populated country in Africa. It is very complicated to develop health policy in such a country with an approximately 100,000,000 million population where languages change every mile. Furthermore, developing the health policy requires knowledge about the previous Ethiopian health policy and issues that hindered the ability of the country to provide efficient health care for the entire population. As indicated by Begashaw, Tessema, and Gesesew (2016) “Health care policies and programs’ planning requires knowledge about health care seeking behavior for early diagnosis, effective treatment, and appropriate intervention implementation”. For Ethiopia's health police to develop well and act as a universal medical coverage once and for all, it should invite more foreign aid to invest in the health sector.
The country has used aid for a decade from USAID, United Nations, NGOs, and others but was not fully reach out to the countryside. Now time for Ethiopia to acquire more aid and use it wisely to reduce ongoing health care issues and support all the health services, eventually, it would reduce health inequality and reach vulnerable communities. Another option that might support ongoing health development is to evaluate and investigate the previous health policy and make every citizen access to health care services.
Conclusion
To develop health policy; first, one must understand social determinants of health status. Second, assessment of the target group and understanding the perception of the individual toward the disease versus culture. Finally, the short and long-term plans should implement to know where to start. When is done accordingly; it will bring quality health service and improve the health of the individual by supporting the policy goals through proper strategy, education, and leadership training. Health practitioner needs to equip with medical supplies and resources should be available to do the work without misunderstanding the purpose of the policy. Health policy should be established based on culturally interested and efficient communication between the patient and health worker will be more efficient when providing treatment. Most Ethiopian indigenous still use traditional healing methods to cure the disease and the barrier medical language which are the main problems, therefore it needed to be considered before establishing health policy.
The health sector of Ethiopia has introduced universal medical coverage throughout the country at a low cost, but the social determinant of health had an impact on access to rural communities and the countryside. The country suffering from a shortage of medical supplies and health literacy has been the issue in Ethiopia. Since the government provides universal health coverage; the health policy of Ethiopia improved dramatically and needs to train more health care workers to reach out to the vulnerable community. Community health education throughout the regions will be the solution for Ethiopians to learn and take care of themselves and other family members. It is a privilege to learn about Ethiopia's health care system and how social determinants of health affect the Ethiopian population but expect more health intervention. The country has a history of unequal health distribution, but we all should be the solution for all-cause.
References
Abrahim, O., Linnander, E., Mohammed, H., Fetene, N., & Bradley, E. (2015). A Patient-Centered Understanding of the Referral System in Ethiopian Primary Health Care Units. PLoS ONE, 10(10), e0139024. doi: 10.1371/journal.pone.0139024
Begashaw, B., Tessema, F., & Gesesew, A, H. (2016). Health care seeking behavior in Southwest Ethiopia. http://dx.doi.org/10.1371/journal.pone.0161014
Benatar, S. R., Gill, S., & Bakker, I. (2011). Global Health and the Global Economic Crisis. American Journal of Public Health, 101(4), 646–653. doi: 10.2105/AJPH.2009.188458
Byass, P., Berhane, Y., Emmelin, A., & Wall, S. (2003). Patterns of local migration and their consequences in a rural Ethiopian population. Scand J Public Health, 31(1), 58-62. doi: 10.1080/14034940210133726
Centers for Disease Control and Prevention. (April 11, 2016). Center for Global Health. Retrieved from http://www.cdc.gov/globalhealth/countries/ethiopia/pdf/ethiopia_factsheet.pdf.
Dejene, T. and Girma, E. (2013) Social determinants of under-five mortality in Ethiopia: Event history analysis using evidence from Ethiopian Demographic and Health Survey (EDHS). Health, 5, 879-884. doi: 10.4236/health.2013.55115
Donnelly, N., Lane, P., Winchester, J., & Powell, C. (2011). An introduction to health literacy and enrollment. Retrieved from https://www.enrollamerica.org/an-introduction-to-health-literacy-and-enrollment/
Federal Ministry of Health. (2010). Federal Democratic Republic of Ethiopia Ministry of Health: Health sector development program. Retrieved from http://www.nationalplanningcycles.org/sites/default/files/country_docs/Ethiopia/ethiopia_hsdp_iv_final_draft_2010_-2015.pdf
Kloos, H. (1990). Health aspects of resettlement in Ethiopia. Social Science & Medicine, 30(6), 643-656. doi: 10.1016/0277-9536(88)90250-X
Mekonnen, Y. (2013). Ethiopia: The land its people's history and culture. Dar Es Salam, Tanzania: New Africa Press.
Afework, M. F., Gebregiorgis, S. H., Roro, M. A., Lemma, A. M., & Ahmed, S. (2014). Do Health and Demographic Surveillance Systems benefit local populations? Maternal care utilisation in Butajira HDSS, Ethiopia. Global Health Action, 7, 10.3402/gha.v7.24228. doi: 10.3402/gha.v7.24228
Miles, S & Malcne, L. J. (2013). Perspectives from Ethiopia regarding U.S. military humanitarian assistance: How to build a better Medical Civil Action Project (MEDCAP). Military Medicine, 178(12), 1349-1352. doi: 10.7205/MILMED-D-13-00125
Onarheim, K. H., Taddesse, M., Norheim, O. F., Abdullah, M., & Miljeteig, I. (2015). Towards universal health coverage for reproductive health services in Ethiopia: Two policy recommendations. International Journal for Equity in Health, 14, 86. doi: 10.1186/s12939-015-0218-3
Tranvag, J. E., Ali, M., & Norheim, F. O. (2013). Health inequalities in Ethiopia: Modeling inequalities in length of life within and between population groups. International journal for equity in health, 12, 52. doi: 10.1186/1475-9276-12-52
World Health Organization. (2015). World malaria report. Retrieved from http://apps.who.int/iris/bitstream/10665/200018/1/9789241565158_eng.pdf
