Ethiopia
The Cure Children's Hospital in Ethiopia
Health System in Ethiopia
“A health system is the combination of resources, organization, and management that culminate the delivery of health services to the population,” (Skolnik, 2020a). Ethiopia has a three-tier health care system (Abamecha et al., 2017). Within this system tier one is considered the lowest level of care, such that would be found within a village (Abamecha et al., 2017). Tier one has a health center, health post, and primary hospital, which provide primary care to community members and serve as facilities that can train paramedics and registered nurses (Abamecha et al., 2017). Tier two includes a general hospital which a community member must be referred to, and handles emergency surgeries, and trains registered nurses, health officers and surgeons (Abamecha et al., 2017). Tier three is a specialized hospital and requires a referral from the general hospital before a patient can be seen (Abamecha et al., 2017).
Tier one can further be broken down into smaller networks for the local community like health development armies and health development teams (Abamecha et al., 2017). A health development team is further broken down into a network known as the “one to five” that is composed of six members to one household (Abamecha et al., 2017). Health extension workers and an administration known as the kebele administration oversee the health development teams and networks (Abamecha et al., 2017). Leaders from health development teams operate voluntarily supporting tasks such as following pregnancies and illness within the community, relaying messages between households and health extension workers, and aiding in promotions for vaccinations (Abamecha et al., 2017). Many healthcare extension workers in rural areas only have a tenth-grade education, while in urban area they hold at least a diploma in nursing (Abamecha et al., 2017).
Tier one’s primary healthcare unit is the smallest division of the system and is the most accessible to the general population consisting of one health center and five satellite health posts (Abamecha et al., 2017). The first level of care for services in the health post, which serves an average of 5,000 people, and has only two health extension workers per post (Abamecha et al., 2017). The health center serves about 25,000 people and has only approximately twenty staff members (Abamecha et al., 2017). These health center give preventative and curative services and do provide inpatient stays if needed but only have a five bed capacity (Abamecha et al., 2017).
Primary health care or tier one’s goal is to provide preventative, promotive, and basic curative services (Abamecha et al., 2017). To aid with providing these services Ethiopia implemented a Healthcare Extension Program in 2012 (Abamecha et al., 2017). The goal of the program is to enhance these services primarily in rural areas but recently has changed to include focus on urban areas as well (Abamecha et al., 2017). Promotion of preventative actions such as hygiene, sanitation, disease control and prevention, family health services and health education are vital to the plan because most of the country’s health problems come from infectious or communicable diseases (Abamecha et al., 2017).
There are many barriers to care for Ethiopia. Of course, one of the most mentioned barriers is financing alone due to half of the coverage cost for healthcare in Ethiopia comes from the outside world, followed by individual payment, and then government payment for care/services received (Abamecha et al., 2017). In 2015, Ethiopia was given 1.6 billion (U.S. dollars) for healthcare, and almost 15% of this money went towards primary care (Abamecha et al., 2017). Some of the money given to Ethiopia from other countries is a loan, while the rest is just donation (Abamecha et al., 2017). Other barriers to care include, lack of training for healthcare professionals, especially in rural areas. There is no monitoring for programs that healthcare professionals attend, and no assessing of skills that healthcare professionals should possess (Abamecha et al., 2017). Low supplies like medical supplies and medications are also issues (Abamecha et al., 2017).
References
Abamecha, F., Sudhakar., M, Tamirat, A., Woldie, M., & Yitbarek, K. (2017). Primary Health Care Systems (Primasys): Case study from Ethiopia. World Health Organization. https://www.who.int/alliance-hpsr/projects/alliancehpsr_ethiopiaabridgedprimasys.pdf
Cure. (n.d). [The Cure Children’s Hospital in Ethiopia]. https://cure.org/ethiopia/
n.a. (n.d). [Ethiopia’s Federal Ministry of Education]. https://wenr.wes.org/wp-content/uploads/2018/11/DSCN1081-Copy.jpg
Portela, M., & Gebremedhin, A. (2020, February). Perspective evaluation of GPE’s country-level support to education. UNIVERSALIA. https://www.globalpartnership.org/sites/default/files/document/file/2020-04-gpe-country-level-prospective-evaluation-year-2-ethiopia.pdf
Skolnik, R. (2020a). An Introduction to Health Systems. In R. Riegelman (Ed.), Global Health 101 (4th ed., p. 118). Jones and Bartlett Learning.
Trines, S. (2018, November 15). Education in Ethiopia. World Education News & Reviews. https://wenr.wes.org/2018/11/education-in-ethiopia
Education
The Ministry of Education
https://wenr.wes.org/wp-content/uploads/2018/11/DSCN1081-Copy.jpg
In Ethiopia, the primary and secondary education systems have a standardized curriculum and are monitored by the Ministry of Education (MOE), which is a federal government agency (Trines, 2018). Attendance to school is supposed to be required until eighth grade, however many times this does not happen and children especially in rural areas slip through the cracks (Trines, 2018). “A startling 20% of children dropped out of school by second grade in 2011, and only 50% of children made it to the eighth grade,” (Trines, 2018). Among men and women ages 15-49 in Ethiopia only 42% of women and 62% of men are literate (Portela& Gebremedhin, 2020). The school year in Ethiopia runs from September, until June or July (Trines, 2018).
Elementary school is eight years long and is broken down into two stages, with each stage being four years in length (Trines, 2018). For the first four years of elementary school, children are taught various languages, math, and science, and participate in arts and physical education (Trines, 2018). For the second stage of elementary school children are taught and participate in what is listed above for the first stage, and in addition to the listed above children are taught civics, social studies, biology, chemistry, and physics (Trines, 2018). In order for students to progress to secondary education they must pass a nationwide exam (Trines, 2018).
Secondary education also consists of two stages, but these stages are broken down into two-year increments each (Trines, 2018). The first stage covers various languages, math, technology, civics, biology, chemistry, physics, geology, and history, and students participate in physical education and arts (Trines, 2018). By the end of the first stage students will have finished tenth grad and are required to take a nationwide exam in order to progress to stage two of secondary education (Trines, 2018). This exam consists of nine subjects, but students are only required to pass five subjects with a grade of a C or better (Trines, 2018).
If a child makes it to the second stage of secondary education or also known as upper secondary education, then the child must decide between two paths. The first path is natural sciences which in addition to basic curriculum includes biology, chemistry, physics, and technological drawing (Trines, 2018). The other path is the social sciences path and covers basic curriculum in addition to history, economics, and business (Trines, 2018). After completing two years of studies, the students are now required to take a nationwide exam that covers seven subjects and of those seven subjects three subjects are from the student’s chosen path (Trines, 2018). The highest score possible is a 700, and this exam score determines along with other factors if a student will be accepted into a university (Trines, 2018).
Like, the United States the youth in Ethiopia can go to vocational schools or universities depending on the career path chosen. In Ethiopia, vocational schools do not currently have standardized curriculums or qualifications for programs, and this has caused the government to work diligently to obtain standardization for vocational programs (Trines, 2018). “Common study areas for vocational programs are agriculture, construction, business, information technology, manufacturing, hospitality, nursing, and midwifery,” (Trines, 2018). As of 2015, the government was working on opening up more universities, which would put the total number of universities in Ethiopia at forty-four (Trines, 2018). At universities in Ethiopia a bachelor’s degree requires approximately 128-136 credits, and an average grade point average of 2.0, while graduate degree programs require a minimum grade point average of 3.0 (Trines, 2018). Common areas of study for undergraduate programs are engineering, business, social sciences, and humanities, while graduate programs have popular study areas of social sciences and humanities (Trines, 2018). Only 24% of women students are in a graduate program (Trines, 2018).
To become a Doctor of Medicine in Ethiopia is quite different compared to the United States. In Ethiopia an individual can earn a Doctor of Medicine degree by completing an undergraduate program that lasts only six years (Trines, 2018). The curriculum consists of three years of clinical studies, an exam, and a one-year long residency (Trines, 2018). Due to the shortage of doctors in Ethiopia, anyone who graduates with a Doctor of Medicine degree is required to work as primary care provider for a time frame of two to four years, before the individual can specialize in any given area (Trines, 2018).