Invited Countries
| Ethiopia Ghana Liberia Mexico Rwanda |
|
Ethiopia
Background
Under the strong leadership of Minister of Health Dr. Tedros Adhanom, the Ethiopian government is committed to providing comprehensive and integrated primary health care at the community level. The country has been highly innovative by recognizing the importance of efficient and coordinated health systems and the need for trained management personnel in health as part of this larger agenda.
As part of this effort, the Ethiopian Ministry of Health has partnered with the William Jefferson Clinton Foundation’s HIV/AIDS Initiative (CHAI) and the Yale School of Public Health to establish health management as a profession in Ethiopia. Through this collaboration, a set of achievable standards for hospital management have been developed, and a monitoring and evaluation process is now being piloted to inform scale-up efforts throughout the country. Over a year-long period, participating hospitals have made improvements in several domains including medical records and patient flow, nursing standards and practice, infection prevention and control and quality improvement. Additionally, in March, 2008, the country launched its first Master of Hospital Administration (MHA) degree program in Ethiopia, and Africa as a whole.
More than 85% of the country’s population lives in rural areas. With this in mind, the government of Ethiopia has also launched an extensive health sector reform program focused on the rural areas and is in the process of establishing approximately 3,000 Primary Health Care Units (PHCU) throughout the country. Each of these will comprise one health center and five satellite health posts to serve 25,000 people.
Problem statement: Poor leadership and management capacity throughout the health delivery system
Objective: To improve management and leadership capacity across all hospitals over the next three years.
Ethiopia 2009 GHLI Country Plan Presentation
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Ghana
Background
Despite a history of subsidizing health services since independence, worsening economic conditions in the 1980s resulted in the government’s inability to sustain free health care for the population. During this time, health sector reforms as part of broader structural adjustment programs led to a reduction in government spending to address budgetary deficits, the introduction of cost recovery mechanisms through user fees, and liberalization of health services to allow private sector involvement. The impact of these reforms were widespread, including rapid increases in the number of private providers, many of them informal and unregistered; and decreased potential for cross-subsidies leading to higher levels of inequality related to access and utilization of health services. In addition, the re-introduction of user fees exacerbated the decrease in utilization of health services throughout the country, and was associated with delays in seeking treatment and increased reliance on self medication.
Ghana has addressed the issues outlined above with a series of courageous strategies. The country has made a concerted effort to increase public spending on health, boosting the health sector’s share of the budget from 8.2% in 2004 to 15% in 2006. As part of a medium-term health strategy, “Towards Vision 2020”, the Ministry of Health was reorganized and the Ghana Health Service (the largest agency of the Ministry charged with service delivery) was created. In addition, clear roles for both major entities involved in health policy formulation and service delivery were established. These initiatives have allowed Ghana to take important steps towards universal coverage by introducing a National Health Insurance (NHI) scheme in 2003, which will ultimately cover all Ghanaians. By December 2007, 55% of the population had registered with the NHI and 44% had received their membership cards.
Problem statement: The system for evaluating the performance of the district directors of health services is ineffective.
Objective: To develop and implement an effective system to evaluate the performance of district directors.
Ghana 2009 GHLI Country Plan Presentation
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Liberia
Background
Liberia is facing the aftermath of 14 years of violent internal conflict: massive population displacement, persistent insecurity and severe disruption of social services. As of 2008, the country’s population was estimated at 3.3 million. Over the course of the armed conflict, 250,000 persons were killed. The country is also struggling with the return and reintegration of more than 315,000 internally displaced persons (IDPs) and refugees from neighboring countries. As of 2006, it was estimated that less than 10% of the population had access to health care.
The Ministry of Health & Social Welfare (MOHSW) focuses on three main functions: health policy formulation, regulation and coordination. The MOSHW has developed a National Health Plan, which is meant to guide the transition process from emergency humanitarian relief to development assistance. The Plan is based firmly on the provision of primary health care and the following basic components:
- Delivering a Basic Package of Health Service (BPHS)
- Strengthening human resources for health
- Developing health infrastructure
The BPHS is an integrated minimum package of standardized prevention and treatment services in four main priority areas: maternal and child health, adolescent health, communicable disease control, and mental health - all directly tied to the most pressing health concerns in this post-conflict setting. Despite challenges in terms of financing, destroyed infrastructure and lack of appropriate human resources, the Liberian government has completed the technical content of the BPHS and, as of July 2008, 44.3% of existing health facilities were providing BPHS. The MOSHW has recognized the importance of strengthening health systems as a part of effectively providing the BPHS, and for this reason has targeted the development of County Health Plans which include clear strategies for staff training and health facility accreditation.
Problem statement: The country has weak emergency care (EmOC) services contributing to high rates of maternal mortality.
Objective: To develop and strong and improved EmOC system that serves pregnant women and newborns in 45 health facilities in catchment communities by June 2010.
Liberia 2009 GHLI Country Plan Presentation
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Mexico
Background
With an estimated population of 109 million, Mexico is the 11th most populous country and the most populous Spanish-speaking country in the world. Mexico is a country in demographic transition, with a complex epidemiological profile characterized by the growth of noncommunicable diseases, accident rates and unhealthy lifestyle behaviors.
Despite having achieved an average life expectancy of 75 years and other health outcomes comparable to more industrialized countries, Mexico entered the 21st century with a health system unable to offer financial protection in health to more than half of its citizens. This was both a result and a cause of the social inequalities that have characterized the development process in Mexico. The government recognized that the lack of financial protection was the major limitation in improving health outcomes. As a result, it moved to implement structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH), which introduced new financial rules and incentives.
The main innovation of this reform has been the Seguro Popular, an insurance-based component of the SSPH which aims to fund health care for all families, most of them poor, who had been previously excluded from social health insurance. The goal is to reach universal coverage by 2010, but the reform has already led to positive changes including a significant increase in public investment in health. The package of medical services offered to these newly affiliated families has also expanded considerably. Furthermore, the new financing and regulatory structures laid out through the reform have focused on realigning incentives towards better technical and interpersonal quality.
Problem statement: Each year Mexico is spending increasingly more money on hospital health services without a significant improvement in quality.
Objective: To improve the quality of health services in hospitals without increasing the cost as measured by defined quality indicators.
Mexico 2009 GHLI Country Plan Presentation
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Rwanda
Background
A small landlocked country in the Great Lakes region of east-central Africa, Rwanda encompasses only 28,338 sq km but has a population of ten million. With a high fertility rate and the population increasing at an annual rate of approximately 2.8%, the population is expected to reach 12 million by the year 2012. Approximately 60% of the population lives in rural areas, where poverty levels are high. Further complicating the country’s situation, Rwanda is still rebuilding its health infrastructure and human resource pool after the 1994 genocide left much of the country destroyed and 1,000,000 dead.
The government of Rwanda has adopted a primary health care approach for its health system focused on the development of human resources, a strengthened health information system, and an intersectoral approach. In order to support the realization of this primary health care strategy, the Rwandan government has increased its allocation of resources to health from 4.2% of the national budget in 1996 to 12% in recent years. Furthermore, in order to address the severe shortage of human resources in health, the government has made significant investments in pre-service training institutes, and established the Kigali Health Institute targeting middle level health professionals.
Despite dire conditions, the country has made significant improvements in health outcomes. The government campaign for HIV/AIDS has resulted in a downward trend in the prevalence of the disease, currently at 3%. In particular, the Rwandan government has made a concerted effort to address Prevention of Mother-to-Child Transmission (PMTCT) of HIV. In partnership with USAID, the Ministry of Health has prioritized strengthening the effectiveness and efficiency of PMTCT services through quality improvement methods and sharing of lessons learned across sites. Quality Assurance (QA) teams have been established in a series of hospitals and health centers to analyze their processes for PMTCT service delivery, and to identify and implement key changes necessary to improve the quality of these services. These teams have led to the introduction of same-day testing and results and have helped increase the number of HIV-positive women who receive single-dose Nevirapine (NVP). The Rwandan Ministry of Health has also been innovative in implementing PMTCT programs which integrate partner involvement activities, leading to significant gains in the rate of partner testing in a short period of time.
Problem statement: There are not enough skilled health workers to meet the health care delivery needs in Rwanda.
Objective: To develop skilled health care workers to meet the health care delivery needs in Rwanda.
Rwanda 2009 GHLI Country Plan Presentation
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