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Ethiopia : Improving Health Service Delivery

ABORTION ADULT MORTALITY AIDS RELIEF ALLOCATIVE EFFICIENCY ANTENATAL CARE BASIC HEALTH SERVICES BEREAVEMENT BURDEN OF DISEASE CAESAREAN SECTION CAPACITY BUILDING CHILD BIRTH CHILD HEALTH CHILD HEALTH SERVICES CHILD NUTRITION CHILD SURVIVAL CITIES CITIZENS CLINICS COMMUNICABLE DISEASES COMMUNITY HEALTH COMMUNITY HEALTH SERVICES CONTRACEPTIVE METHODS CONTRACEPTIVES COUNSELING DEATHS DEBT DECENTRALIZATION OF AUTHORITY DECISION MAKING DEMOCRACY DEVELOPING COUNTRIES DEVELOPMENT POLICY DIPHTHERIA DRINKING WATER EDUCATIONAL ATTAINMENT EMERGENCY PLAN EMPLOYMENT EQUITABLE ACCESS ESSENTIAL DRUGS FAMILY PLANNING FAMILY PLANNING SERVICES FEMALE CHILDREN FERTILITY DECLINE FINANCIAL MANAGEMENT FINANCIAL NEEDS GENERAL PRACTITIONERS GLOBAL HEALTH GOOD GOVERNANCE GOVERNMENT POLICIES GRASS-ROOTS GROSS DOMESTIC PRODUCT HEALTH CARE HEALTH CARE COVERAGE HEALTH CARE FACILITIES HEALTH CARE FINANCING HEALTH CARE SPENDING HEALTH CARE UTILIZATION HEALTH CARE WORKERS HEALTH CENTERS HEALTH COMMUNICATION HEALTH EDUCATION HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH EXTENSION HEALTH FACILITIES HEALTH FINANCING HEALTH INDICATORS HEALTH INFORMATION HEALTH INSURANCE HEALTH MANAGEMENT HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH POLICIES HEALTH POLICY HEALTH POSTS HEALTH PROGRAMS HEALTH PROVIDERS HEALTH SECTOR HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICE PROVIDERS HEALTH SERVICES HEALTH SPECIALIST HEALTH STATUS HEALTH SYSTEM HEALTH SYSTEMS HEALTH WORKERS HIGH FERTILITY HIGH FERTILITY RATE HIV HIV INFECTION HIV/AIDS HOSPITAL HOSPITAL ADMISSION HOSPITAL ADMISSIONS HOSPITALS HUMAN DEVELOPMENT HUMAN RESOURCE DEVELOPMENT HUMAN RESOURCE MANAGEMENT HUMAN RESOURCES HUMAN RESOURCES DEVELOPMENT HYGIENE ILLNESS IMMUNIZATION INCOME INFANT INFANT MORTALITY INFANT MORTALITY RATE INFANT MORTALITY RATES INFORMATION SYSTEM INFORMATION SYSTEMS INSTITUTIONAL CAPACITY INSURANCE SCHEMES INTERNATIONAL COMPARISONS INTERNATIONAL ORGANIZATIONS LABOR FORCE LACK OF CAPACITY LAWS LEGAL STATUS LIFE EXPECTANCY LIVE BIRTHS LOCAL COMMUNITY LOCAL GOVERNMENTS LOW -INCOME COUNTRIES LOW-INCOME COUNTRIES LOW-INCOME COUNTRY MALARIA MALNUTRITION AMONG CHILDREN MASS MEDIA MATERNAL MORTALITY MATERNAL MORTALITY RATIO MEASLES MEDICAL DOCTORS MEDICAL EDUCATION MEDICAL EQUIPMENT MEDICAL SUPPLIES MEDICAL TECHNOLOGY MEDICINES MIDWIFE MIDWIVES MIGRATION MILLENNIUM DEVELOPMENT GOALS MINISTRY OF HEALTH MORBIDITY MORTALITY MOSQUITO NET MULTILATERAL ORGANIZATIONS NATIONAL DRUG NATIONAL GOALS NATIONAL HEALTH POLICY NATIONAL LEVEL NATIONAL POLICY NATIONAL POPULATION NATIONAL POPULATION POLICY NATIONAL STRATEGY NEONATAL MORTALITY NUMBER OF CHILDREN NUMBER OF DEATHS NURSE NURSES NUTRITION NUTRITIONAL STATUS PATIENTS PHARMACIES PHYSICIAN PHYSICIANS POLICY MAKERS POLIO POPULATION CENSUS POPULATION SIZE POSTNATAL CARE PREGNANCY PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE SERVICES PRIVATE PHARMACIES PROGRESS PUBLIC HEALTH PUBLIC HEALTH EXPENDITURES PUBLIC HEALTH SERVICES PUBLIC HEALTH SPENDING PUBLIC POLICY PUBLIC SERVICE PUBLIC SERVICES PUBLIC SPHERE QUALITY OF CARE QUALITY OF HEALTH RADIO REHABILITATION REPRODUCTIVE HEALTH REPRODUCTIVE HEALTH SERVICES RESPECT RULE OF LAW RURAL AREAS RURAL DEVELOPMENT SANITATION SERVICE UTILIZATION SEXUALLY TRANSMITTED DISEASES SKILLED PROFESSIONALS SKILLED STAFF SOCIAL SERVICES SURGERY SUSTAINABLE DEVELOPMENT TB CONTROL TELEVISION TETANUS TUBERCULOSIS UNDER FIVE MORTALITY UNDER-FIVE MORTALITY URBAN AREAS URBAN POPULATION URBANIZATION URBANIZED COUNTRIES USE OF CONTRACEPTION VACCINATION WASTE WOMAN WORKERS WORKING CONDITIONS WORLD HEALTH ORGANIZATION
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World Bank, Washington, DC
Africa | Ethiopia
2013-05-30T17:17:25Z | 2013-05-30T17:17:25Z | 2009-08

This case study aims to identify how Ethiopia has adopted and implemented strategies to improve health services, including the factors that enabled and inhibited success across a meaningful range of health services for the period 1996-2006. Particular emphasis has been given to the impact of utilized strategies on the poor. This case study reviewed one 'primary strategy', decentralization in the form of devolution of authority to the regional level in 1996 and to the district (woreda) level in 2002, and seven 'corollary strategies' in the context of decentralization implemented at the subnational level. The study concludes that decentralization in the health sector is likely to be more effective when it is implemented as part of a broader government decentralization policy across sectors. Sequencing in implementing Ethiopia's decentralization strategy made decentralization more manageable, although decentralization was rolled out prematurely. Moreover, the effectiveness of implementation was found to be driven largely by the institutional and management capacity at the subnational level. At the subnational level, decentralization was found to be more effective in those regions that increasingly strengthened their management and institutional capacity and where regional governments set priorities and adapted the strategies to local needs. However, decentralization was often influenced by the 'clientelistic' center, region power relationship, a problem compounded by the lack of community voice, making the available resources at risk of political capture by the local elite. Overall, the key lesson for implementing improvements in health service delivery (HSD) is that the lack of any critical inputs (facilities, health workers, and drugs) inevitably limits the overall impact of the strategy, and that the implementation of such key inputs should be carefully coordinated and properly synchronized.

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