Achieving the Millennium Development Goals for health in Ethiopia
Dr. Syed Ali*
Asst.
Professor in Economics,
School of Graduate and
Interna tional Studies,
Unity University, Addis Ababa.
Abstract
The Millennium Development Goals include 8
goals, 18 targets and 48 indicators. The
4th, 5th and 6th goal of MDGs relate to the health. The present study aims to know the Millennium
Development Goals, targets and indicators for health. It focuses on the status and development of
health facilities in Ethiopia. The main objective of the study is to fore-cast
the MDG targets and Indicators for health in Ethiopia and to asses its status
in relation to MDGs for health. The
study uses secondary data collected from the World Health Reports, U.N official
site for MDGs, W.H.O, ADB and the Ministry of health, Ethiopia. To forecast the different indicators of
health relevant statistical tools are used.
The study concluded that the various indicators of health in Ethiopia
are poor in comparison with Africa and the world. For example, the crude birth
rate, total fertility rate and the rate of natural increase in Ethiopia is more
than double of the world. The infant mortality rate is nearly 80 percent higher
than in the world. The life expectancy
at birth is less than 40 percent in the world.
Though Ethiopia has been implementing health
sector development program since 1997-98, it will not achieve the MDGs for
health by 2015, except the goal of maternal mortality ratio. The study suggested various measures to
achieve the MDGs for health, such as, participation of the private sector in
the health service delivery and human resource development, increasing the
share of public expenditure on health, etc.,
1.
0: Introduction:-
"We will have time to reach the Millennium
Development Goals - world wide and in most, or even all, individual countries
-but only if we break with as usual. We cannot win overnight. Success will
require sustained action across the entire decade between now and the deadline.
So we must start now. And we must move than double global development
assistance over the next few years. Nothing less will help to achieve the
goals"(Kofi Annan).
1.1 Health and
Economic Development:
The concept of human development centers
around the notion that human welfare depends on various dimensions, many of
which are not well captured by conventional measures of economic income (
Griffin and Knight, 1990). Sen (1998) recognized health as important factor in
capability enhancement. Health is very important component of human capital
which contributes to human welfare. In the measurement of human development
health is given equal importance with per capital income and education. The
UNDP has developed a composite indicator, the Human Development Index (HDI),
which gives equal weight to three indicators - real GDP per capita, life
expectancy at birth and educational attainment. The index is valuable in
expending the economic concept of welfare.
Improvements in health are essential and
better health is a pre-requisite for economic growth. Ill-health limits the
ability to earn higher incomes. Reduction in poverty is possssible only when
steps are taken for better health of the people. The Millennium Development
Goals should be treated as inter-related and inter-dependent. It will be
impossible to achieve a 50 per cent reduction in income poverty (Goal 1, Target
1) without taking steps to improve the health conditions of the people. The
goal 2 and 3 of MDGs, are increasing enrolment rates for primary education and
elimination of gender disparity respectively are pre-requisites for improving
the health conditions of the people. The health related MDGs should not be seen
separately, instead, they should be linked to the complete development agenda.
Prichtt and summers (1996) pointed out
that there is close connection between health and wealth. There is a causal
relationship between the two phenomena. The wealthier nations are the healthier
nations. Better health in turn increases labor productivity there by enhancing
wealth.
Health development - a process of
sustained improvement in health status- should be an important target of
development policy (Mwabu, 1998).
2.0: Objectives:
The specific objectives of present
study are:
1. To know the
Millennium Development Goals, targets and indicators for health.
2. To study the
present status and development of health facilities in Ethiopia.
3. To examine the
trends in the public health expenditure in Ethiopia.
4. To forecast the
MDG targets/indicators for health and to assess the status of Ethiopia in relation to MDGs for
health.
3.0 Methodology
and Sources of Data:
The study uses secondary data. The data
are collected from the World Health Reports, UN Statistics Division on MDGs,
and Ministry of Health, Government of Ethiopia.
In this study, the under 5 mortality rate
is defined as the number of children who have died between birth and their
fifth birth day expressed per thousand live births. Infant mortality rate
defined as the number of children who have died between birth and their first
birthday, expressed per thousand live births. Maternal Mortality ration is
defined as the annual number of maternal deaths per 100,000 live births. A
maternal death is the death of a woman while pregnant or within 42 days of
termination of pregnancy, irrespective of the duration and the site of the
pregnancy, from any cause related to or aggravated by the pregnancy or its
management, but not from accidental or incidental causes. The proportion of
births attended by skilled health personnel is calculated by the formula, i.e,
the number of births attended by a skilled health worker/total number of births
multiplied by 100.
To forecast the under-five mortality
rate, infant mortality rate, maternal mortality rate and the proportion of
births attended by skilled health personnel for the years 2010 and 2015 the
following model is used.
y=a+bx
Since the data for the under 5 mortality
rate, infant mortality rate and Maternal mortality ratio are available with
five years gap since 1990, the class interval format is used to forecast these
variables. Since regular data for contraceptive prevalence rate are available
from 2000-01 to 2004-05, forecasting of this variable is obtained for 2010 and
2015. The data on proportion of one year old children immunized against measles
are available from 1990 to 2005 continuously, time series analysis is used to
forecast it for the years 2010 and 2015. The data on T.B detection rate under
DOTS are available continuously from 1995 to 2004 and hence projections are
made for the years 2010 and 2015.
For other
indicators as the data are not available either continuously or with five years
gap they could not be projected for the year 2015.
4.0 Studies on
MDGs for Health:
Jeffrey D. Sachs (2004) revealed that
the MDGs depend critically on scaling up public health investments in
developing countries. As a matter of urgency, developing country governments
must present detailed investment plans that are sufficiently ambitious to meet
the goals and the plans must be inserted in to existing donor processes. Donor countries must keep the promises they
have often reiterated of increased assistance, which they can easily afford, to
help improve health in the developing countries and ensure stability for the
whole world. According to him, the poor
countries should take four steps to obtain more donors financing for health. Firstly,
they must have an over all strategy for scaling up health services. The
strategies should be ambitious enough to meet the health MDGs and to offer
essential health services to the whole society, with special attention to the
needs of poorest of the poor. Secondly, there is need for detailed plans of
implementation, especially a sequence of investments in physical capital, i.e.
clinics, hospitals, training centers etc and in health professionals. Thirdly,
there should be a financing plan, combining additional resources from donors
and from domestic tax revenues. Fourthly, developing countries' plans must be
transparently designed and they have to involve not only health ministries but
also civil society, mission hospitals, N.G.Os, community centers and the
country co-coordinating mechanisms that bring together all these critical
stake-holders.
The World Health Organization (2006)
indicated that the MDGs target the major poverty-linked diseases devastating
poor populations, focusing on maternal and child health care and the control of
HIV/AIDS, tuberculosis and malaria. Countries that are experiencing the
greatest difficulties in meeting the MDGs, many in sub-Saharan Africa, face
absolute short falls in their health work force. Major challenges exist in
bringing priority disease programmers into line with primary care provision,
deploying workers equitably for universal access to HIV/AIDS treatment, scaling
up delegation to community workers, and creating public health strategies for
disease prevention.
Mohga Kamal Smith and Nina
Henderson-Andrade (2006) pointed out that chronic under-funding of health
systems in developing countries has led to the current health worker crisis,
which threatens the achievement of the Millennium Development Goals.
The study by Dalisay S. Maligalig (2003)
examined the measurement issues about the MDGs indicators and proposed a set of
strategies. He suggested for the recognition of the important role of national
statistical systems in monitoring the MDGs. The study identified the following
data compilation issues.
(i) Base-line
statistics (1990) are not available.
(ii) The indicators
are not being compiled by any government agency with in the national
statistical system.
(iii) Indicators
are not comparable across countries because of differences in compilation
methodologies and /or definitions..
(iv) Some
indicators are not consistent across years because of differences in data
sources, and
(v) Most of the
indicators are not compiled at sub-national level.
The study of Venkata Rao, et.al.,
(2004) revealed that in India with regard to under 5 mortality rate and
proportion of one year old children immunized against measles ;no regular
up-dated official data is available other than through one time surveys such as
NFHS. Official data ia available
regarding infant mortality rate, but dis-aggregated sub state (district) level
data is not available. No official statistics on Maternal Mortality Rate
indicator is available. The NFHS report however states that these estimates are
not statistically significant. Regarding the proportion of births attended by
skilled health personnel no regular updated data are available, other than
through one time surveys such as NFHS.
Ajay Tandon's study (2005) examined the
empirical evidence on major determinants of health MDGs using under five child
mortality as an example. He concluded that economic growth is strongly related
to declines in child mortality. Growth increases the capacity and ability of
individuals to demand and consume health care, housing, nutrition etc. Growth
also increases the capacity of the governments and other players to supply more
and better health care and to improve access to health care through better
infrastructure. But at current trends, economic growth alone will not be enough
to attain the child mortality MDG target by 2015. This underscores the
importance of the health system and other non income factors to facilitate the
attainment of this MDG outcome. He suggested for the investments in primary
health care and implementation of cost-effective interventions such as immunization
programs, as well as investments that lead to real increases in health-related
human resources, physical infrastructure. He also suggested for female
education which is a significant determinant of this MDG indicator and hence it
must be included in any analysis of policy options that could help precipitate
declines in child mortality.
The Federal Ministry of Health,
Government of Ethiopia (2005) in its Health Sector Strategic Plan for 2005 to
2010 indicated the following five measures to reach the health MDGs in
Ethiopia.
1. The first step,
Information and Social Mobilization for behavior change, includes all
activities related to general health information through the media (TV and
radios), social marketing strategies and other social mobilization events. It
includes activities outside health services at the workplace, in schools as
well as in youth clubs. This step supports activities that trigger awareness of
critical health issues as well as behavior change. The expansion of those services
supports prevention of HIV as well as prevention of other communicable and
non-communicable diseases by promoting behavior change, such as increasing
hand-washing, use of condoms or bed nets or utilization of safe water systems.
2. The second step
is implementation of the health services Extension Program (HSEP), which
entails all the key activities of the flagship health program developed by the
Government over the last few years. This health services development program includes
three major components: a) An outreach program centered by the Health Extension
Workers(HEWs), 2 per kebele, and construction and equipment of Health Posts per
kebele. These HEWs are, 10 graders trained in vocational school for one year,
civil servants and will offer key technical services, such as immunization and
family planning, b) A community promotion program centered around
volunteer/private sector community promoters/traditional birth attendants (1
fir every 50 households or 250 inhabitants) working under the supervision/guidance
of the HEWs and providing sup-port to households for behavior change (i.e.,
breastfeeding, supplementary feeding, use of bed nets clean delivery etc.), c)
A program strengthening the quality of and demand for clinical care in existing
health stations and Health centers.
3. The third step
is a Clinical First Level Services Upgrade, which includes the expansion of
Health Centers throughout the country as well as the upgrading of Health
Stations to offer basic clinical care. This step would lead to an increase in
the access to clinical care at less than a one hour walk from the household
(from 31 percent to 80 percent) and increased access to first level clinical
care for adults. HIV and malaria testing is made available through the use of
rapid tests.
4. The fourth
step, a Clinical Services Upgrade of Comprehensive Emergency Obstetric Care
requires the operationalization of comprehensive emergency obstetrical care in
all new and old Health Centers of the country. This implies equipping all
Health centers with an operation theater and staffing it with the appropriate
number of nurse midwives and health officers with Emergency Obstetric Care and
surgical skills. This step also entails establishing adequate means of transport,
setting blood banks in all Health centers and upgrading existing hospitals into
full referral centers for emergency obstetrical care.
5. The fifth step
is the Expansion and Upgrade of Referrals of Clinical Care, which entails the
expansion and upgrading of referral services, including all woredas and zonal
hospitals. This step would allow Ethiopian health services to upgrade their
equipment and lab facilities to offer quality follow-up for HIV patients and
also expand referral services for neonatal care and complex emergency
obstetrical care, thus contributing further to the reduction of under five and maternal
mortality. This phase also includes the training of enough MDs and registered
specialized nurses to adequately deliver, supervise and monitor the provision
of quality referral clinical care.
To scale up and implement the above
five steps, the financial resource requirement is estimated as an average of
US$ 20.31 per capita over the ten year period.
IMF's study (2006) revealed that
Ethiopia needs US$ 14,532 millions (upper bound) and US$ 10,756 millions (lower
bound) to achieve the Millennium Development Goals for Health.
5.0 Millennium
Development Goals for Health:-
The Millennium Development Goals (MDGs)
are the development Goals agreed on at international Conferences and World
Summits during the 1990's. In September 2000, 189 countries at the Millennium
summit in New York adopted the Millennium Declaration for peace, security and
development. The road map prepared following the Summit established goals and
targets to be reached by 2015. The MDGs include 8 goals, 18 targets and 48
indicators. The MDGs place health at the heart of development. Three of the
eight goals, eight of the eighteen targets and 18 of the 48 indicators of
progress are health related. With 1990 as base line , by 2015 the MDGs are as
follows:
(i) Extreme
poverty and hunger will be halved.
(ii) Universal
Primary Education will be achieved.
(iii) Gender
equality will be promoted.
(iv) Under five
mortality will be reduced by two-thirds.
(v) Maternal
mortality will be reduced by two-thirds.
(vi) The spread of
HIV/AIDS, Malaria and tuberculosis will be reversed.
(vii)
Environmental sustainability will be ensured and
(viii) Global
partnership for development with targets for aid, trade and debt relief will be established.
The 4th, 5th and 6th goal of MDGs
are related to health. Under goal 4 of MDGs,
the target is to reduce by two-thirds between 1990 and 2015, the
under-five mortality rate . Under this target there are three indicators, i.e.,
under five mortality rate, infant mortality rate and proportion of one year old
children immunized against measles. The child mortality and infant mortality
rates measure the survival of children. These mentality rates are the
indicators of development as it affects children. In calculating the goal for
2015, countries are assumed to reduce their child mortality to the lower of
two-thirds the 1990 level or the Cairo goal of no more than 45 percent.
In calculating the
infant mortality rate as goal for 2015 the countries are assumed to reduce
their infant mortality to the lower of two-thirds the 1990 level or the Cairo
goal of no more than 35 percent.
Goal 5 of MDGs
deals with maternal health. The target is to reduce the Maternal Mortality rate
by three quarters, between 1990 and 2015. There are two indicators of this
goal, i.e., Maternal Mortality Rate and Proportion of births attended by
skilled health personnel. Maternal Mortality rate reflects not only women's
access to and use of essential health care services during pregnancy and child
birth, but also broader underlying socio-economic factors including women's
general health and nutrition status, access to reproductive health care
services including family planning, access to resources and educational, social
and economic status. The incorporation of maternal mortality reduction into the
goals of the international community reflects its importance as a measure of
human and social development.
The proportion of
births attended by skilled health personnel is a measure of the health system's
potential to provide adequate coverage for deliveries and provides information
on the actual use of skilled assistance during delivery. This indicator is an
indirect measure of the health systems potential to provide adequate access to
essential health care for pregnant women during child birth coverage for
deliveries and provides information on the actual use of skilled assistance
during delivery. This indicator also addresses the goal of providing access,
through the primary health-care system, to reproductive health services,
including quality family planning services that are affordable, acceptable and
accessible to all who need and want them.
The Goal 6 of MDGs
deals with HIV/AIDS, Malaria and other diseases. There are two targets under
this goal. Firstly, have halted by 2015 and begun to reverse the spread of
HIV/AIDS. Under this target, there are three
indicators, i.e., HIV prevalence among 15-24 year old pregnant women,
contraceptive prevalence rate and the number of children orphaned by HIV/AIDS.
The second target
is regarding halving by 2015 and begin to reverse the incident of Malaria and
other major diseases. There are four
indicators of this target. They are, prevalence and death rates associated with
malaria, proportion of population in malaria risk area using effective malaria
prevention and treatment measures, prevalence and death rates associated with
tuberculosis and proportion of tuberculosis cases detected and cured under
directly observed treatment short course
(DOTS).
6.0 Status of
Health and Development of Health Facilities in Ethiopia:
Ethiopia is one of the least developed
countries in the world with an estimated per capita income of US$ 100 or US$
720 in purchasing power parity terms (The World Bank, 2004). The UNDP's HDI for
2004 ranks Ethiopia 170 out of 177 countries.
Ethiopia has poor health status due to preventable infectious ailments
and nutritional deficiencies. Infectious and communicable diseases account for
about 60 percent to 80 percent of the health problems in the country.
Table (1): Health
related indicators in Ethiopia
------------------------------------------------------------------------------------------------------------
Population CBR
CDR RNI IMR
TFR Life Expec- % of populat-
(Million) (%) tancy at ion15-49 with
birth(years) HIV/AIDS
-----------------------------------------------------------------------------------------------------------------------
World 6477 21 9
1.2 54 2.7
67 1.2
Africa 906 38 15
2.3 88 5.1
52 6.1
Ethiopia 73 39 12.6
2.7 96.8 5.9
48 4.4
------------------------------------------------------------------------------------------------------------------------
Source:- 2005
world population data sheets of the population reference bureau,
Book Edition.
It may be observed
that the crude birth rate (CBR) in Ethiopia is almost double than the world's
average. It is also higher than Africa.
The crude death rate (CDR) in Ethiopia is higher than world average but
lower than in Africa. The rate of
natural increase (RNI) in Ethiopia is more than double of the world. It is also higher than Africa. The infant mortality rate (IMR) in Ethiopia
is 79.25 percent higher than the world average and it is also higher than Africa. The total fertility rate (TFR) in Ethiopia is
more than double of the world and it is also higher than Africa. The life expectancy at birth in Ethiopia is
less than 40 percent in the world and it is also less than in Africa.
The table (2) shows the status of health
workers in Ethiopia.
Table (2): Health Workers in 2005
------------------------------------------------------------------------------------------------------------------------
Country Physicians Nurses Health Assistants Environmental
Ratio Ratio Ratio Health workers Ratio
-----------------------------------------------------------------------------------------------------------------------
Ethiopia 1:29777 1:3883 1:11479 1:55673
WHO 1:10000 1:5000 1:5000 -
Standard
------------------------------------------------------------------------------------------------------------------------
Source: Federal
Ministry of Health, Planning and Programming Dept. 2005.
It may be observed that the ratio of
physicians, nurses and health assistants to population in Ethiopia is lower
than the world health organization standard.
Table (3) shows the indicators of
health in Ethiopia in June, 2005.
Table (3): Indicators
of health in Ethiopia in June, 2005
-----------------------------------------------------------------------------------------------------------------------
Indicator As on
June, 2005
-----------------------------------------------------------------------------------------------------------------------
Maternal Mortality
Ratio 871 per 100,000 live
births
Under 5 Mortality
Rate 140.1 per 1000
population
Infant Mortality
Rate 97 per 1000
population
Total Fertility
Rate 5.9
Morbidity
attributed to Malaria 22 per cent
Case fatality rate
of malaria
In under 5
children 5.2 per
cent
Case fatality rate
of malaria
In age groups 5
years & above 4.5 per cent
Mortality
attributed to T.B 7% of all
treated cases
Primary health
care coverage 64 per cent
Prevalence of
HIV 4.4%
Treatment success
rate of
All types of TB
cases 76% cured or
completed treatment
Contraceptive
prevalence rate 23%
Proportion of
deliveries
Attended by skilled
attendant 9%
Measles
immunization coverage 52.6%
Proportion of
fully immunized
Children
36.95%
------------------------------------------------------------------------------------------------------------------------
Source: Federal
Ministry of Health, Govt. of Ethiopia (2005): Health Sector Strategic Plan,
Planning and Programming Department.
Public expenditure on health as percentage
of GDP is 1.9 per cent with the total health spending estimated at 5.6 per cent
of GDP. Although spending on health,
both public and private, has increased from $4 to $5.6 per capita, it is low
level compared to levels in Sub-Saharan African countries. For example, in Kenya it is US$ 31, Uganda
US$ 18 and in Tanzania US$ 8. Meeting
the targets set by WHO Commission on Macro Economics and Health and for meeting
the MDGs (about US$ 34 per capita) there is need for increase in the present
level of spending on health (World Bank, 2004).
6.1 Health
Facilities Development:-
Achievement of
MDGs is one of the top Global Policies that is influencing the national
development policies and strategies. The Global Policies initiated by organizations
such as World Bank, WHO etc., are influencing Ethiopia also since these are
associated with some form of financing interventions. The initiatives taken by the Govt. of
Ethiopia are expected to achieve the targets of MDGs for health.
Ethiopia has been implementing Health
Sector Development Program (HSDP) since 1997-98. The Govt. of Ethiopia's health policy is
emanated from commitment to democracy and gives strong emphasis to the fulfillment
of the needs of less privileged rural population. Over the last 15 years the number of
hospitals in Ethiopia had increased from 72 to 131, while that of health posts
from 153 to 1662 and health stations from 223 to 4211. The annual health budget
increased from 98.9 million birr in 1991 to 689.35 million birr in 2005 and the
ministry of health believes that in coming five years health coverage would
show a 100 percent increase (Capital, May 25, 2006). It is important to note
that the distribution of both the public and private health facilities in
different regions is not equal (Syed Ali & Habtamu Wudneh, 2006). Though
the over all potential health service coverage has increased to 72.1 per cent
of population, there is in-equality in the distribution among the different
regions of the country.
Table (4) shows the increase in human
resources for health during the HSDPI
And HSDP II as
compared to 1996.
Table (4): Increase in the human resources for
health during
HSDP
I and II as compared to 1996
------------------------------------------------------------------------------------------------------------------------
Human
resources 1996 End HSDP I (2001) HSDP II(2004)
Ratio
to Ratio to Ratio to
Population population population
------------------------------------------------------------------------------------------------------------------------
All
physicians 1:38,619 1:35603 1:35,604
Specialists 1:82,396 1:103,098 1:91,698
General Parishioners 1:48,992 1:54,385 1:58,203
Public health
officers 1:1,909,085 1:138,884 1:104,050
Nurses B.Sc.&
Diploma 1:14,822 1:5,613 1:4,980
Midwifes 1:229,090 1:77,981 1:55,782
Pharmacists 1:367,131 1:569,661 1:413,174
Pharmacy
technicians 1:180671 1:84,767 1:60,688
Environmental
HWs 1:87,173 1:69,228 1:60,792
Lab.
technicians 1:92,226 1:39,657 1:29,574
------------------------------------------------------------------------------------------------------------------------
Source: Federal
Ministry of Health, Ethiopia (2005), Health sector strategic plan,
Planning and programming Dept.
It may be observed that there is not much
improvement in the human resources for health.
Table (5) shows improvement in the basic
health indicators from 2000-01
To 2004-05;
Table: 5 Improvement in the basic
indicators from 2000-01 to 2004-05
---------------------------------------------------------------------------------------------------------------------
Indicator 2000-01
2001-02 2002-03 2003-04 2004-05
-----------------------------------------------------------------------------------------------------------------------
PHS coverage (%) 59.1
61.0 61.3 64.0 72.1
HS utilization 0.27 - 0.29 0.36 0.3
CPR (%) 18.7 17.2 21.5 23.0 25.2
Antenatal coverage
(%) 34.7 34.1 27.4 40.8 42.1
------------------------------------------------------------------------------------------------------------------------
Number of
facilities
Hospitals 110 115 119 126 131
Health
Centers 382
412 451 519 600
Health
Stations 2393
2452 2396 1797 1662
Health Posts 1023
1311 1432 2899 4211
Private
clinics 1170 1235 1229 1299 1578
Pharmacies 311 311 302 275 276
Drug shops 249 309 299 375 381
Rural Drug
vendors 1917
1856 1888 1783 1787
------------------------------------------------------------------------------------------------------------------------
Source:FDRE,
Ministry of Health, Health and Health related indicators, 2005.
It
may be observed that the primary health service coverage has increased from
59.1 percent to 72.1, health service utilization increased from 0.27 percent to
0.3 percent, contraceptive prevalence
rate (CPR) increased from 34.7 to 42.1 percent during 2000-01 to
2004-05. The number of hospitals, health centers, health posts, private clinics
and drug shops also increased during this period.
6.2 Trends in
Public health expenditure:
Table (6) shows
the public health expenditure per capita from1995-96 to 2004-05
Table (6): Public health expenditure
per capita
------------------------------------------------------------------------------------------------------------------------
Year Per capita expenditure
-----------------------------------------------------------------------------------------------------------------------
1995-96 8.5
1996-97 9.5
1997-98 11.5
1998-99 17.9
1999-2000 9.1
2000-01 11.5
2001-02 11.3
2002-03 11.9
2003-04 13.2
2004-05 16.8
-----------------------------------------------------------------------------------------------------------------------
Source: Ministry
of Finance and Economic Development, 2005.
It may be observed that the per capita
expenditure on public health has increased from 8.5 birr to 16.8 birr, i.e.,
doubled during 1995-96 to 2004-05.
7.0 Forecasting
of the MDG targets/indicators of health in Ethiopia :
GOAL 4: REDUCE CHILD MORTALITY:
Target 5: Reduce
two-thirds between 1990 and 2015, the under 5 mortality rate
Indicator 13:
Under 5 Mortality Rate:- The target is to reduce under 5 mortality rate by
two-thirds between 1990 and 2015 or the Cairo goal of not more than 45 percent.
The forecasting
results show as 126 for the year 2010 and 105.2 for the year 2015.
As per the MDG target; the under 5 mortality
rate should be reduced to 68 per thousand by 2015. But the projected under 5
mortality rate in Ethiopia is 105.2, which is higher than the MDG target for
2015.
Indicator: 14:
Infant Mortality rate:
The target is to
reduce infant mortality rate by two-thirds between 1990 and 2015 or the Cairo
goal of no more than 35 percent.
The forecasting results show as 89.5 per
thousand live births for the year 2010 and 78.6 per thousand live births for
the year 2015.
As per the MDG target the infant mortality
rate should be reduced to 43.67 per thousand live births by 2015, but projected
infant mortality rate is 78.6 per thousand live births, which is higher than
the MDG target for 2015.
Indicator 15:
The proportion of one year old children immunised against
Measles:
The forecasting
results show that the proportion of one year old children immunized against
measles increases to 72.97 in 2010 and to 85.01 percent in 2015.
GOAL 5: IMPROVE
MATERNAL HEALTH:
Target 6: Reduce
by three quarters, between 1990 and 2015, the maternal mortality ratio.
Indicator 16:
Maternal Mortality Ratio.
The target is to reduce maternal mortality
ratio by three quarters between 1990 and 2015, i.e., to reduce the maternal
mortality ratio to 350 per 100,000 live births.
The forecasting results show as 596 for
100,000 live births and 342.3 per 100,000 live births. It means that Ethiopia
is able to achieve the MDG target.
Indicator 17: Proportion
of births attended by skilled health personnel.
The base-line
statistics for this indicator is not available. The latest available data for
this indicator is for the year 2005, which is 12.4 percent (Source: FDRE,
Ministry of Health, health and health related indicators, 2004-05)
GOAL 6: COMBAT
HIV/AIDS, MALARIA AND OTHER DISEASES:
Target 7: Have
halted by 2015 and begun to reverse the spread of HIV/AIDS
Indicator 18: HIV
prevalence among 15-24 year old pregnant women:
The base line
(1990) statistics for this indicator is not available. As per the official U.N
site for MDG indicators, it is 15 percent in 2000 and 11.5 per cent in 2003,
for Ethiopia.
Indicator 19:
Contraceptive prevalence rate:
The base-line year
(1990) statistics for this indicator is not available. But as per the official
U.N site for MDG statistics, the data is available from 2000-01 to 2004-05.
The forecasting results show that the
contraceptive prevalence rate for 2010 is 34.28 per cent and for 2015 it is
43.68 percent.
Indicator 20: Number
of children orphaned by HIV/AIDS:
The base-line
(1990) data for this indicator is not available. As per the official U.N site
for MDG indicators, it is 5, 60,000 in 2001.
Target 8: Have
helted by 2015 and begun to reverse the incidence of Malaria and
Other major diseases
Indicator 21:
Prevalence and death rates associated with Malaria:
The base-line data
(1990) is not available. But as per the FDRE, Ministry of Health (2005) the
deaths associated with malaria during 2004-05 is 28.9 percent for all cases,
28.5 percent for female and 28.1 per cent for infants.
Indicator 22:
Proportion of population in Malaria risk areas using effective
Malaria prevention ;and treatment
measures:
The base line
information for the year 1990 is not available. But as per the Ministry of
Health (2005) three-quarters of the land mass of the country is malarious and
around two-thirds of the population is at risk of infection.
Indicator 23:
Prevalence and death rates associated with Tuberculosis:
The base line
statistics for the year 1990 are not available. But the data from 2000 to 2004
is available from the official U.N site for MDG indicators.
The projected deaths associated with T.B for
the year 2010 is 93.24 per 100,000 population and 104.89 per 100,000 populations
for 2015.
Indicator 24:
Proportion of Tuberculosis cases detected and cured under DOTS
The case line
(1990) statistics for this indicator is not available. But as per the official
U.N site for MDG indicators, the data are available from 1995 to 2004.
The projections show that the proportion of
T.B cases detected under DOTS is 52.72 percent for the year 2010 and 64.53
percent for the year 2015.
8.0
CONCLUSIONS:.
The
following conclusions are drawn from the fore going analysis.
1. The various indicators of health show that
they are poor in Ethiopia comparing to Africa and the world. The Crude Birth
Rate, total fertility rate and the rate of natural increase in Ethiopia is more
than double of the World's average. The infant mortality rate in Ethiopia is
nearly 80 percent higher than in the world.
The life expectancy at birth in Ethiopia is less than 40 percent in the
world.
2. Ethiopia has been implementing Health Sector
Development Program (HSDP) since 1997-98 to achieve the MDGs for health. The
two phases of HSDP are completed and the third phase started in July, 2005 and
will be continued up to June 2010. The formulation of HSDP-III fully reflects
the Govt’s renewed commitment to the achievement of the health MDGs and is
based on the various policies and strategies that were developed and endorsed
to serve as the vehicles for the achievement of MDGs.
3. As per the MDG target, the under 5 mortality
rate should be reduced to 68 per 1000 live births by 2015. But the projected
under 5 mortality rate in Ethiopia is 105.2 per 1000 live births, which is
higher than the MDG target for 2015.
4. As per the MDG target, the infant mortality
rate should be reduced to 43.67 per 1000 live births by 2015. But the projected
infant mortality rate is 78.6 per 1000 live births, which is higher than the
MDG target for 2015.
5. As per the MDG target, the maternal mortality
ratio should be reduced to 350 per 100,000 live births by 2015. The projected
maternal mortality ratio is 596 per 100,000 live births for the year 2010 and
342.3 per 100,000 live births for the year 2015. It means that Ethiopia will be able to
achieve the MDG target of reducing maternal mortality ratio by three-quarters
by 2015.
6. The MDG targets of halting by 2015 and
beginning reversal of spreading of HIV/AIDS, incidence of malaria and other
major diseases will not be achieved by 2015.
9.0:SUGGESSIONS:
The following suggestions
are emerged from the study:
1. Since the various indicators of health in Ethiopia
are poor comparing to Africa and the World, the crude birth rate, total
fertility rate and the rate of natural increase should be reduced. Steps should be taken to increase the live expectancy
at birth.
2. Since the projected under 5 mortality rate
and the infant mortality rate are higher than MDG targets, health service
delivery and quality of health care should be improved and there is need to
focus on the poverty related diseases.
3. There is need for increase in the
participation of the private sector in the health service delivery and human
resource development. There is need for
increasing the domestic manufacturing capacity of drugs.
4. To prevent HIV and other communicable and
non-communicable diseases, steps should be taken to change the behavior of the
people. General health information should be provided through T.V, radio and
other media.
5. Since the ratio of health personnel to
population is less than the WHO standards, steps should be taken to increase
the health personnel at all levels by establishing more medical colleges and
training centers.
6. The number of hospitals, health centers and
health posts should be increased to enhance the health facilities to the poor
sections of society.
7. The share of
public expenditure on health should be increased and new financial resources
from abroad should be searched to increase the health facilities to achieve the
MDGs for health.
References:
Ajay Tandon
(2005): Attaining Millennium Development Goals in Health: Is not
Economic
growth enough? Asian Devt. Bank, Economics
And
Research Department, Series No. 35, March, 2005.
A.K. Sen (1998):
Mortality as an indicator of Economic success and failure,
Economic
Journal, 108, pp. 1-25.
Capital (2006):
Ethiopian Business Weekly, May 26, 2006, p.5.
Dalisay S.
Maligalig (2003): Measuring the Millennium Development Goals
Indicators, concluding workshop on "Enhancing
Social and Gender Statistics, 24-27 June, 2003,
Bangkok, Thailand.
Federal Ministry
of Health, Ethiopia (2005): Health sector strategic plan,
HSDP-III-Final draft, 2005-06 - 2009-10, planning &
programming Department.