Ethiopia’s urban primary health care reform: Practices, lessons, and the way forward

Abstract

Abstract
Background: At present there is remarkable expansion of urbanization in Ethiopia. By 2050, 38% of the population in Ethiopia is expected to reside in urban settings. The majority of this future urban population is believed to live in slums. In response to this daunting health challenge, the Ministry of Health launched urban health extension program in 2009. The outcome of this initiative, however, is still uncertain - Urban Health Extension Professionals seem to have failed to meet the desired end. To improve the situation, experiences were drawn from middle-income countries and piloted in Addis Ababa in 2014. This is a report of the study conducted to assess the implementation of the pilot initiatives. In the assessment of the implementation, attempts were also made to identify lessons and challenges encountered.
Methods: Qualitative data were collected from purposively selected individuals involved in the design, implementation, and use of the pilot initiative. Checklists developed on the basis of the objective of the study were used for data collection.
Findings: The findings indicated that the initiative had a team of health professionals - people who had the skills needed to work as a team and implement the pilot activities. The health team improved linkages and collaboration between the health system and the community. Through the team, identification of the most neglected sections of the population was ensured and this section has accessed health services. For example, the disabled, the sick, the elderly, persons with chronic health problems, girls and women were identified as social sectors that had either no or very little access to health care. The health team created a strong sense of collaboration between itself and the community level structures. This has been recognized to have an important role in improving service delivery to community. However, the level of the team’s recognition of local community set up and structures as facilitators of health services needs improvement. Furthermore, a shortage of transportation to distant places in the catchment areas and a lack of timely provision of supplies and drugs to address some basic health problems at household and community levels were identified as major problems.
Conclusions: Ensuring proper urban health care requires multifaceted and multi-sectoral responses. Defining strategies of enhancing the engagement of different sectors in achieving the objectives of the initiative is an important point to be noted. Ways to provide continuous supplies to the health teams need to be sought. An equally important point that needs to be noted to ensure further successes of the initiative is empowering and enabling community level structures to focus more on health-related activities. [Ethiop. J. Health Dev. 2018; 32(1):4-9]