Tedros Adhanon Ghebreyesus, Ethiopia’s minister of health, is a star amongst health practitioners. This softly-spoken man was Melinda Gates’ choice in Wired magazine’s list of “50 people who will change the world in 2012”. He has been at the forefront of the national effort to transform health care delivery. New African interviewed him in Addis Ababa.
WHEN ASKED TO SELECT her “global changemaker” earlier this year, Melinda Gates, wife of the Microsoft founderBill Gates, chose the Ethiopian minister of health, Dr Tedros Adhanon Ghebreyesus, for the transformational role he had played in improving the health system in Ethiopia.
“Rather than building expensive hospitals,” Melinda Gates wrote, “[Dr Tedros] has set up programmes to train 38,000 health extension workers [who] go on to provide care in nearly every community across Ethiopia. In five years, his work has reduced the death rate of Ethiopian children under five by 28 per cent. Does it get more inspiring than that?”
Dr Tedros attributes the success of the programme to a number of factors, not least that health care became the number one priority of the government’s “growth and transformational plan”, their equivalent of China’s five-year plan.
The government also understood that health policies on their own were useless without a more co-ordinated approach with other ministries to bring their goals into a common vision, and thus make the implementation process easier.
“Once we identified the priorities and set targets,” says Dr Tedros, “we decided that primary health care would be at the centre of the system. The advantage of this is that primary health care is close to communities at the grassroots level, so you can mobilise the people by teaching them skills and giving them knowledge, so they can promote their own health issues and prevent diseases.”
Ethiopia’s primary health care system is centred around two key areas: the health extension programme which is primarily focused on health promotion and disease prevention; and the expansion of health centres, which focuses on curative services.
“We have achieved around 90% of our target,” says a happy Dr Tedros. “We now have a health post in each village, and they are fully staffed. And what is more: out of the 38,000 health extension workers we have, only about 400 are men, the rest are women. They go from house to house and help the people to understand the various health issues.”
There is now one health centre for every 25,000 people. And each health centre covers five health posts, while each health post covers 5,000 people. The system is devolved to allow for local decision-making. According to Dr Tedros, if communities get the right skills and knowledge, they can prevent many health problems.
Citing malaria as an example, he said if people knew how to manage water sources and deny mosquitoes from breeding in them, they would prevent malaria attacks in the community.
Ethiopia is still highly dependent on donor aid for many of its programmes, and health is one of the key recipients. “When we go to the donor countries and institutions,” Dr Tedros reveals, “we go with a
concrete plan and ask for support. We are open to comments and feedback, but we believe that we should really take ownership of our development agenda, and donors take us a lot more seriously now.”
The minister stressed the close collaboration his ministry has with “development partners”, which goes much further than funding. Partners have helped the ministry with capacity building as well as designing an integrated health information system that collects data in each health post to help the government with planning and decision-making.
Ethiopia is Africa’s second most populous country (83 million), which makes the achievements of the Ministry of Health, in terms of coverage, even more impressive – especially as more than 16,000 use the health extension programme.
“Initially it [getting into that blanket coverage mind-set] was really tough but once we had set ourselves big goals and started working on them, it became a lot easier,” says Dr Tedros.
It is not all plain sailing though, as there remain huge challenges, such as maternal mortality. But the health minister is confident that this too will eventually be conquered. “Of course with our levers,” he says, “we can achieve maternal mortality reduction in the next three years.”
Key to Ethiopia’s success are the health posts within the communities, and how health professionals interact with the people on a regular basis.
A conscious decision was taken to use women to staff the health posts. “If the posts are run and serviced by women, then other women would be comfortable to visit them, and would also be more willing to discuss private issues. So the whole programme has been woman-centred,” says Dr Tedros.
The minister expressed concern that the eurozone debt crisis, which is unfolding in Europe, could have a serious impact on the funding of future projects. “Before the global financial crisis in 2008-09, the international community’s support for global health was really unprecedented, but since the crisis, there has been a decline,” Dr Tedros reveals. “So my worry is if the decline continues, it may affect the gains we have already made. So this is not the time to reduce contributions, especially by those who are able to contribute.”
But Dr Tedros understands that there will come a time when Africans will have to finance their own programmes.
A modest man, he wanted it to be known that the gains achieved so far were not his. “They are a collective effort, of my team and the whole government, they are not mine,” he stressed.
Whatever one may think of Ethiopia’s planning mantra, and whoever is behind it, when you read the results, as Melinda Gates rightly put it, “it doesn’t get much more inspiring than that!”