Decentralization And Health Sector Reform: Lessons from Ethiopia

Background: Decentralizing health sector, division role, power and authority of decision making in public health issue from top to lower structure, is the key means of improving community health status through which health sector reform of one country is achieved. Hence this study is aimed to address Decentralization and Health sector reform in Ethiopia. Objective: To express health sector reform achieved in Ethiopia as a result of decentralization and list all health reform indicators specifically in human resource and finance during the past three decades. Methods and Materials: This study was conducted using four purposely selected reliable reports and articles as a source by focused on the two main reforms activities that have been achieved through health sector decentralization in Ethiopia; Financial health sector and human resource health sector reform in Ethiopia. Because the rest health sector reforms are included under these two main reform activities. To intensify evidences of this study, additional Federal ministry of health annual reports and other documents were used. After important information was extracted and generalized from these documents, vital points of reforms achieved in the past three decades were summarized at the last literature of this study. Overall parts of this study was accomplished between May 11,- 30, 2020 Findings: The major indicators of Ethiopian health care financing reform include: Retaining and using region’s internally generated revenue, Practice of Outsourcing of nonclinical services in public hospitals, introduction of fee waiver and exemption systems, establishment of a private wing in public hospitals and health facility autonomy through establishment of governing bodies. Human resource reform in Ethiopian health sector include Health Extension Program (HEP) improved community health toward family planning, antenatal care, maternal health care, and hygiene and sanitation significantly, between 2005-2010, task-shifting and scaling-up of mid-level health professionals, which intended to delegate tasks to existing or new cadres who receive either less training or narrowly tailored training, utilization of non-teaching hospitals as training centers: health officers and emergency surgical officers, training mid-level professionals with nurse-level entry, focus on mid-level health professionals and local recruitment. Conclusion: Finding of this study concludes that in Ethiopia, in the past three decades, there was significant health sector reform mainly in the two major dimension; toward financial and human resource. Toward financial, it was aimed to improve community health through affordable cost in the continuous line of service access and availability which guarantees health status of the community. Toward Human resource, HEP, the major avenue for reform, played a major role with succeeded brief indicator of community health service.