Rochester, MN, January 21, 2017 (GMN) - Introduction, Ethiopia has a history of hunger, poor health care service and well known as one of the poorest countries in Africa devastated by the famine. In 1984, thousands of citizens relocated to another part of the country (Kloos, 1990).
The country’s economy depends on foreign aids and the agricultural sector that accounts for 83.4% of the labor force, about 43.2% of the Gross Domestic Product (GDP), and 80% of export. The country had experience severe drought, as the results 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 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 with low cost for all Ethiopian but 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 select Ethiopia to look at health policy whether social determinant of health impact inequalities and socioeconomic.
Overview of Ethiopian Health Care System
Few indicators of social determinants of health which this study focusing 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 among the mother, income, and teenage (Dejene & Girma, 2013). The evident showed that there was a decline in under-five mortality rate mostly in an urban area in which this can link to available basic health care screening services. On the other hand, it showed negative impact in the villages where people have no access to health center, and most often people walked 10 to 30 miles to acquire public service. Based on Ethiopian health policy, primary health center cannot be built in the village where population is least then 20,000 thousand and used health extension worker to distribute malaria medicine throughout the villages which are limited to practice. This policy put many citizen in vulnerable situation.
The EDHS aimed to educate resident 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 identified as a social determinant of health that 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 still not within reach in 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 cope with the significant health problems. The major health concerns of the country are malaria, maternal mortality, lower respiratory infections, tuberculosis, and HIV/AIDS follow by acute malnutrition, lack of access to clean water, and sanitation (FMOH, 2010). As it stated the above, Ethiopia’s population still faced a high rate of morbidity and mortality, and the health status remains unstable. These problems 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 health workers and high income of human resource account for healthcare issues, the insufficiency of necessary drugs and supplies have 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 million annual clinical cases and a significant number of deaths. In total, as much 80 percent of the health problems in the country are due to preventable communicable diseases and malnutritional; therefore, these health problems associated with low socioeconomic.
Health literacy and cultural awareness
Low health literacy in development countries is staggering due to 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 challenging in many countries in Sub-Saharan Africa. Ethiopia health policy was not fully well established until 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 the 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 evident shows an uneducated person in the rural community associated with lower coverage compared to educate person living in 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 remedy to treat the patient as the result of complication treatment when visiting health clinic or hospital. Ethiopian health policy is lack health awareness and community engagements to educate people who are living in the countryside.
In fact, heath literacy has not been address in the Ethiopia 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 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 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 Population as today is over 100,000,000 and currently Life expectancy at birth about 62 years for man and 65 years for a woman. Infant mortality rate 49.0 and Per capita income is $1500. 7 percent of the populations in the age group of 15-49 in 2016 were reported to have HIV/AIDS [(CDC), April 11, 2016]. As one can see the 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, in (2016), indicated that health care policies and programs’ planning requires knowledge about health care 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 checkup which are important for both patient and health practitioner to provide effective treatment. As a result, it can reduce morbidity, mortality, 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 noted that inequality in health care utilization and health outcomes between the poor and rich, especially in the city and countryside area showed poor distribution medical services (Begashaw, Tessema, & Gesesew, 2016). Health infrastructure in Ethiopia is penniless but supposed to have planned for disease preventive, promote health, prepare for any outbreak, and respond to ongoing challenges for the country. One must understand the above statement that is the missing keys to combating the disease in developing countries especially in Sub- Saharan Africa countries, particularly for Ethiopia 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 service for everyone while providing protection against financial risk. Of course, universal health coverage sound 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 being the poor health services in Sub-Saharan Africa and many people experiences uncertain diseases. In the countryside, a person can dies without knowing the causes of the illness due to 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 health policy with more health center throughout the underserve villages, provide immunization, and educate the entire community about the benefit of a basic medical checkup, and empower women.
Malaria also is a big issue in Ethiopia health policy that known to be the causes of death under -five mortality rate. It increases child mortality rate in the country, especially in the villages which severely affected by malaria. The outbreak increasing every year during the rainy season because of unavailable mosquito net, shortage antimalarial drugs, and poor infrastructure health center in the rural community. About 88% of the malaria cases in the world recorded in Africa, and 90% of malaria deaths also registered in Sub-Saharan Africa (WHO, 2015).
The statistics show that child’s mortality and morbidity is higher than 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 has shown a decline in child deaths 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 cause. 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.
Development health policy and support of the country
Ethiopia is the second populated country in Africa. It is very complicated to develop health policy in such a country with approximately 100,000,000 million populations where languages change every mile. Furthermore, developing the health policy require 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 health police to develop well and act as a universal medical coverage once for all, it should invite more foreign aid to invest in health sector.
The country has used aid for a decade from USAID, United Nation, NGO, and others but were not fully reach out to the countryside. Now time for Ethiopia to acquires more aide and use it wisely to reduce ongoing health care issues and support all the health services, eventually it would reduce health inequality and reach to vulnerable community. Other 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.
To develop health policy; first, one must understand social determinants of health status. Second, assessment for the target group and understand the perception of the individual toward the disease versus cultural. Finally, short and long term plan 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 establishing based culturally interested and efficient communication between the patient and health worker will be more efficient when providing treatment. Most Ethiopian indigenous still using traditional healing method to cure the disease and barrier medical language which are the main problems, therefore it needed to be considered before establishing health policy.
Health sector of Ethiopia has introduced universal medical coverage throughout the country with low cost, but the social determinant of health had an impact on accessing to rural communities and countryside. The country suffering from shortage medical supplies and health literacy has been the issues in Ethiopia. Since the government provides universal health coverage; the health policy of Ethiopia improved dramatically and needs to train more health care worker to reach out to the vulnerable community. Community health education throughout the regions will be the solution for Ethiopian to learn and take care of themselves and other family members. It is a privilege to learn about Ethiopia health care system and how social determinant of health affecting Ethiopian population but expecting more health intervention. The country has a history of unequal health distribution, but we’re all should be the solution for all cause.
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