Health in Ethiopia

Health in Ethiopia has improved markedly since the early 2000s, with government leadership playing a key role in mobilizing resources and ensuring that they are used effectively. A central feature of the sector is the priority given to the Health Extension Programme, which delivers cost-effective basic services that enhance equity and provide care to millions of women, men and children. The development and delivery of the Health Extension Program, and its lasting success, is an example of how a low-income country can still improve access to health services with creativity and dedication.Good Health at Low Cost. 25 years on: What Makes A Successful Health System? Balabanova et al, London School of Hygiene and Tropical Medicine, 2011

The Human Rights Measurement Initiative finds that Ethiopia is fulfilling 83.3% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, Ethiopia achieves 94.5% of what is expected based on its current income. In regards to the right to health amongst the adult population, the country achieves only 90.6% of what is expected based on the nation's level of income. Ethiopia falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 64.8% of what the nation is expected to achieve based on the resources (income) it has available.

Overview Ethiopia is the second most populous country in sub-Saharan Africa, with a population of over 120 million people. , the United Nations (UN) reported that 4.4% of adults were infected with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS); other estimates of the rate of infection ranged from a low of 7% to a high of 18%. Whatever the actual rate, the prevalence of HIV/AIDS contributed to falling life expectancy since the early 1990s. According to the Ministry of Health Ethiopia, one-third of current young adult deaths are AIDS-related. Malnutrition is widespread, especially among children, as is food insecurity. Because of growing population pressure on agricultural and pastoral land, soil degradation, and severe droughts that have occurred each decade since the 1970s, per capita food production is declining. According to the UN and the World Bank, Ethiopia in 2005 suffered from a structural food deficit such that even in the most productive years, at least 5 million Ethiopians require food relief.Ethiopia country profile. Library of Congress, Federal Research Division (April 2005). .

The fact that the country achieved MDG 4, reducing the child mortality and the decline of HIV mortality has helped life expectancy to increase to 65.2 years in 2015 from 46.6 years in 1990. The under 5 mortality rate and infant mortality rate dropped from 203 and 122 in 1990 to 61.3 and 41.4 in 2015. The ministry of health has achieved this through the Health Extension Program by using a special implementation platform called Women Development Army.

Ethiopia experiences a triple burden of disease mainly attributed to communicable infectious diseases and nutritional deficiencies, NCD and traffic accident.FMOH Health administrative report Shortage and high turnover of human resource and inadequacy of essential drugs and supplies have also contributed to the burden. However, there has been encouraging improvements in the coverage and utilization of the health service over the periods of implementation of Health Sector Development Plan, the health chapter of the national poverty reduction strategy, which aims to increase immunization coverage and decrease under-five mortality at large. The health service currently reaches about 72% of the population and The Federal Ministry of Health aims to reach 85% of the population by 2009 through the Health Extension Program (HEP) . The HEP is designed to deliver health promotion, immunization and other disease prevention measures along with a limited number of high-impact curative interventions.Health Sector Development Plan; http://www.ethiomedic.com/

Life expectancy + Table 1: Ethiopia's Health Status trend from 1980 to 2015 Health Indicator 1950 1960 1970 1980 1990 2000 2015 U5MR 329 275 243 240 203 144 61.3 IMR - 162 143 143 122 89.5 41.4 Life Expectancy (Yr) 33.8 39 43.7 44.6 46.6 51/1 65.2

A new measure of expected human capital calculated for 195 countries from 1990 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by The Lancet in September 2018. Ethiopia had the lowest level of expected human capital among the 20 largest countries with less than 5 health, education, and learning-adjusted expected years lived between age 20 and 64 years. This put it in 175th place, an improvement over its position in 1990 when it was 189th.

Life expectancy is better in cities compared to rural areas, but there have been significant improvements witnessed throughout the country , the average Ethiopian living to be 62.2 years old, according to a UNDP report.

Disease

Cardiovascular disease The International Diabetes Federation (IDF) estimates diabetes prevalence among adults at 3.39% in Ethiopia. A study in Addis Ababa has reported diabetes prevalence rates of 6.5% and in a recent survey from Gondar the prevalence of diabetes mellitus among adults aged 35 years and above was 5.1% for urban and 2.1% for rural dwellers. Hypertension is also increasing at frightening rates with prevalence rates of 19 to 30% reported in Addis Ababa, 28% in Gondar and 13% in Jimma.

HIV/AIDS

HIV/AIDS in Ethiopia stood at 1.1% in 2014, a dramatic decrease from 4.5% 15 years ago. The most affected are poor communities and women, due to lack of health education, empowerment, awareness and lack of social well-being. The government of Ethiopia and many international organizations like World Health Organization (WHO), and the United Nations, are launching campaigns and are working aggressively to improve Ethiopia's health conditions and promote health awareness on AIDS and other communicable diseases.(Dugassa, 2005).

Malaria Though its prevalence in Ethiopia is relatively low compared to other African nations, malaria remains the leading cause of outpatient morbidity and is among the leading causes of inpatient morbidity. Nearly 60 percent of the population lives in areas at risk of malaria, generally at elevations below 2,000 meters above sea level. Recently, many densely populated highland areas, including the city of Addis Ababa, were classified as malaria-free. Because peak transmission coincides with the planting and harvesting season, malaria places a heavy economic burden on the country. Sixty percent of malaria infections are due to the Plasmodium falciparum parasite, though the Plasmodium vivax parasite is also present. Insecticide resistance among vectors and antimalarial drug resistance have been documented in the country.

The Carter Center conducted research in Ethiopia in the mid-2000s where they analyzed how malaria affects the Ethiopian population among various factors. The factors considered included living situations and housing conditions, as well as Ethiopian age and gender demographics. This study found that one's socio-economic position directly correlates to their chance of contracting malaria. Researchers concluded that a key method of reducing the prevalence of malaria in Ethiopia is by improving the quality of housing and living conditions. They found an effective disease countermeasure to be the use of anti-malarial spray, as households that had been sprayed had lower rates of infection. This research also concluded that while the poorest households are more likely to face these poor conditions, they are also the ones less likely to take steps towards malaria prevention, thus continuing transmission of the disease.

The Carter Center chose three specific areas in Ethiopia to assess the impact of the use of insecticide treated mosquito nets on malaria prevalence. During the course of the study, malaria prevalence fell to 0.4% from a starting 4.1%. This study concluded sleeping under these mosquito nets is an effective tactic for mitigating malaria in regions of concern. This study has revealed the importance and effectiveness of malaria prevention in Ethiopia, and thus has led to health workers promoting the use of these long lasting insecticidal nets in areas where use is still limited and disease prevalence is highest.

A research study done by the Ethiopian Public Health Institute revealed flaws with Ethiopia's laboratories and their workers as it pertains to malaria diagnosis. The study found 26.7% of the 106 Ethiopian laboratories assessed lacked adequate supplies needed for proper diagnosis. Researchers attributed this to multiple factors, such as insufficient lab funding and supporting third parties not providing supplies in a timely manner. The study also noted a lack of job competency in the microscopists who look for malaria in blood cells in these labs. The Ethiopian Public Health Institute found that, in conjunction with the Ministry of Health and local health providers, they should be working to better educate, supply and monitor these labs and their workers in order to prevent further obstacles in malaria mitigation in Ethiopia.

Although much of Ethiopia remains at risk of malaria, routine surveillance data from the last decade have noted declines in malaria outpatient morbidity and inpatient mortality trends. Prompt access to malaria case management, including laboratory-based diagnosis in remote rural areas, has improved dramatically over the last decade together with surveillance systems that capture malaria morbidity and mortality.

Neglected tropical diseases Neglected tropical diseases (NTDs) are group of chronic parasitic tropical diseases of the bottom billion peoples living under US$2/day. Ethiopia is the third following Nigeria and Democratic Congo, having the greatest burden of NTDs as public health problem.WHO: Neglected tropical diseases, hidden successes, emerging opportunities.Department of Control of Neglected Tropical Diseases. Geneva: World Health Organization; 2006. In Ethiopia most of the NTDs listed by WHO are present; having trachoma, podoconiosis and cutaneous leishmaniasis being the highest burden in Sub-Saharan Africa followed by second highest burden of ascariasis, leprosy and visceral leishmaniasis and the third highest burden of hookworm. Other infections like schistosomiasis, trichuriasis, rabies and lymphatic filariasis are also common problems in Ethiopia.

Non-communicable disease

Due to major life stay change and urbanisation, in the recent two decades in Ethiopia there is significant epidemiological change. Having the problem of the communicable disease as the major burden, the country is suffering from triple burden of equally significant non-communicable disease burden and emerging Injury problems.

The Global Burden of Disease Study (GBD) 2016 shows that 52% of the mortality and 46% of total disease burden (as measured by disability-adjusted life years) were attributable to NCDs and injuries in Ethiopia. The 2015/16 National STEPS Survey on NCDs and risk factors showed the prevalence of hypertension and diabetes is 15.6% and 3.2% respectively among the adult population. More than 95% of adults have more than one risk factor for NCDs among the selected 5 major risk factors identified in the survey, namely current daily smoking, BMI ≥ 25 kg/m2, low consumption of fruits and vegetables, physical inactivity and raised blood pressure. The prevalence of alcohol and Khat consumption is very high (41% & 16% respectively), and average daily salt intake of the population is 8.3 g which is much higher than the WHO recommended intake of less than 5 grams per day.

TB and leprosy