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Research Commentary Poor Access to Health Services: Ways Ethiopia is Overcoming it

APRil 2007

volume 2, issue 2

Weak infrastructure and limited distribution systems in lowincome countries complicate access to health services, especially in rural areas. Government health outlets may be relatively few and widely dispersed, and private-sector sources often favor wealthier urban areas, resulting in uneven service availability within a country. In the absence of a solid heath infrastructure, strengthening primary health care and innovative communitybased health service delivery systems help provide more equitable access to health services. Some programs are underway in Ethiopia whose successes do not depend on the availability of a strong infrastructure. Ethiopia is a poor country with weak health care systems and infrastructure. Reproductive health, like most aspects of health in Ethiopia, is generally poor, with significant regional disparities in access to services and in health outcomes. Almost 80 percent of morbidity in Ethiopia is due to preventable communicable and nutritional diseases, both associated with low socio-economic development.1 Improving the general physical infrastructure and strengthening health systems are key to improving health and require major investments and much time. In the absence of a well-functioning health care infrastructure, initiatives that complement traditional health care provision help reach specific population groups, communities or geographical areas. Here we will highlight two such initiatives. The first is an ambitious government-led community health service delivery program that is national in scale. The second is driven by a non-governmental organization and is locally-developed and owned and is taking root in one region in Ethiopia.

By Nada Chaya

Uneven Access To Services And Health Outcomes
The diversity of socio-economic environments, climates, and terrains among regions in Ethiopia greatly impacts health conditions and outcomes. Poor health coverage is of particular concern in rural Ethiopia, where access to any type of modern health institution is limited at best. Health systems and roads are underdeveloped, and transportation problems are severe, especially during the rainy season. Almost all births take place at home in Ethiopia (94 percent) with only six percent of women delivering in a clinic or hospital. Many of these women live in remote areas that are too far from a road, let alone a health facility where they can receive emergency obstetric care. The majority of these births (61 percent) are assisted by a relative or some other untrained person and five percent are delivered without any assistance. 2

Less than 28 percent of all Ethiopian mothers receive prenatal care from a trained doctor, nurse or midwife. The quality and frequency of this care is variable; many women receive the care either too late in their pregnancy or too few times. 3 Women in Ethiopia are at a very “ lmost80percentmorbidityinEthiopiaisdue A  high risk of death during pregnancy topreventablecommunicableandnutritional and delivery. One in 14 Ethiopian diseases, both associated with low sociowomen faces the risk of death 4 economicdevelopment.” during pregnancy and childbirth. The risk is higher among rural, poor and uneducated women. Infant and child mortality are equally high; one in every 13 Ethiopian children dies before its first birthday and one in 8 dies before age five. Across the board, mortality is lower in urban than in rural areas in Ethiopia. 5 High maternal and infant mortality are reflective of the low socio-economic status, including public health services and health-care infrastructure. Urban women marry two years later than rural women on average. Marriage at the age of 7 or 8 is not unheard of in rural parts of Ethiopia. 6 Such early marriage and consequent pregnancy is one cause of higher rates of maternal and infant mortality and...
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