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Progress in Ethiopia: an interview with the Ministry of Health
Interview with Dr Addis Tamire Woldemariam from the Ethiopian Ministry of Health, focusing on the Government's ongoing commitment to family planning.
ADDIS TAMIRE: We have what we call the health sector transformation plan, which has all the important targets of the next five years, which is going to span between 2015 to 2020. So the 2020 target for CPR, contraceptive prevalence rate, is 55%.
It’s very important because one, it’s a great contributor to the reduction of maternal mortality. And second, it’s all about ensuring the rights of women. Women should have the access choice and the freedom to use family planning services whenever they want to use it. So it’s all about choice. And for the first one, as I already said, it’s an important tool to decrease maternal mortality. Because when you increase choice for women, for family planning, then you significantly decrease the chance of unwanted, unplanned pregnancies.
The biggest challenges is one, the disparity that we have in the country in terms of the geographic inequity. If you take the geographic discrepancies in terms of the performance on contraceptive prevalence rate, we have a region with the performance of 55%, a region having contraceptive prevalence rate of less than 10%. So one is inequity that exists among regions. So for us, the meaning is we have not still reached those women who would like to use family planning but are not using it because one, it may not be accessible. And second, they may not have the access to the different choices to the different methods and so on. So that’s just one.
And the second inequity that we’re trying to look at is the inequity in the different age groups. So adolescents and youth have a very high unmet need for family planning. So reaching those adolescents with the very high unmet need for family planning is also a very serious challenge. And of course, making sure that we have the different mix of family planning options available and accessible all the time in all the health facilities across Ethiopia is also a challenge. Because Ethiopia is a very big country with more than 19 million people, very huge land mass of 1.1 million square kilometres, and so on.
So reaching everyone with this choice and mix of methods and so on across the country is difficult for a big country like Ethiopia.
Well, we’ll be doing the things that we have done in the past which are proven to be effective. And we’ll be doing, you know, something a little bit differently to especially address those dimensions of inequity. So everything starts with what we do at the community level through what we call the Health Development Army. These are the women volunteers organised in a one to five network to promote healthy behaviours and practices across communities. So this is a structure of women volunteers who are model, fulfilling all the important criteria of using family planning services by choice, not by force. And those households or women getting their children vaccinated or go to health facilities for delivery.
And who have constructed and consistently used latrines all the time and so on, are labelled as model families. These are women-headed families. So this structure is considered to be extremely critical in disseminating and increasing the use of family planning by choice. A model woman living in a neighbourhood of six households is expected to support the other women in her neighbourhood to use these family planning services by their choice. This is one. The second one is making all the family planning options as accessible as possible through the health extension programme and through the primary health care unit so that whenever they need some kind of services, women are not required to travel long distances and so on.
So through the innovative strategy of task shifting of the hired professionals to the health extension workers like the one we did for implant insertion and injection of Depo-Provera and so on. We have to expand access to communities living in the different geographic regions including the urban, the agrarian, the pastoralist, and so on. So raising the awareness in creating the demand. And also availing the access to family planning methods and so on. And then, of course, those women who like to have long-term family planning options like IUDs or the loop can be referred to the health centres, the district hospitals.
So making sure we have a very good referral network from the health posts to the health centres and then from the health centres to the district hospitals and above is going to be very critical. So this referral system has to be seamless. It has to be smooth so that women who would like to use the family planning options, which are not available actually at the health posts, and so they are getting the services without any problem at health facilities, the health centres, and the district hospitals. And the fourth one is making sure that we continuously supply the important commodities and avail all the important logistics to the health facilities.
So a woman who like to use Depo or Norplant over pills should have the access all the time, all the time. Interruption of some of the supplies for commodities and so on should not be an obstacle. It should not be a bottleneck. And that’s the other one. And in fact, so creating the demand through the different structures that I was talking about and making sure that we have everything fulfilled on the supply side is very important. Family planning is one of the top priorities in Ethiopia. This is not primarily to limit population growth.
The population policy of Ethiopia clearly articulates that we are providing family planning services not to limit population growth but to primarily give women the chance, the chance, to use family planning services whenever and whatever they want. So that’s the primary goal. And if you look at our track record of the health sector, especially in terms of achieving all the important milestones of family planning services, I think we have come a very long way in addressing this issue of family planning. If you remember in 2000, the DHS showed that the CPR was about 6.5%. And after five years in 2005, it was 14%. And then after five years in 2010, it was 28%. And last year, it was 42%.
So you see that there has been some dramatic increases of contraceptive prevalence rate over the last 15 years. So this gives us the impression that total fertility rate has decreased from 6.9 to 4.1. So the target that we have for the HSTP, the Health Sector Transformation Plan, for the next five years, is to achieve a CPR of 55% and to achieve a TFR, Total Fertility Rate, of 3.1.
We’ve seen that Ethiopia has made significant advances in relation to family planning outcomes and that political commitment has been central to this progress. In this interview with Dr Addis Tamire Woldemariam, previous Director General of the Office of the Minister in the Ethiopian Ministry of Health, we hear more about the Government’s key drivers and policies for change and how they plan to tackle inequities.
The questions asked throughout the interview are:
- What is the Ethiopian government’s goal for family planning?
- Why is it so important to reach this goal?
- What are the biggest barriers to achieving it?
- What has the government put in place to try and achieve the goal?
- Is the government optimistic about the future of family planning delivery in Ethiopia?
Could some of the policies and approaches described here be applied to your setting?
This article is from the online course:
Improving the Health of Women, Children and Adolescents: from Evidence to Action
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Improving the Health of Women, Children and Adolescents: from Evidence to Action
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