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MSPH candidate interviews Ethiopian Minister of Health

Hannah Olson and Dr. Kesetebirhan Admasu discuss the future of an innovative Health Extension Program.

Hannah Olson and Dr KesetebirhanAs an MSPH candidate in Population, Family and Reproductive Health, Hannah Olson recently met and interviewed H.E. Dr. Kesetebirhan Admasu, the Ethiopian Minister of Health, during his visit to Johns Hopkins Bloomberg School of Public Health.

“It was an incredible privilege to sit down with a leader from an African country that is in such a transformative stage of development,” Olson reports. Dr. Admasu impressed upon her that the country’s achievements—namely an innovative Health Extension Program—have been driven and supported by local leadership, but the process has been collaborative, drawing on a global evidence base and engaging all development partners.

“As I prepare to enter the field of global reproductive health, I hope to build a career that is founded in these basic principles,” she says.

Here’s an excerpt of Olson’s interview:

First, to what do you attribute Ethiopia’s successes in reducing under-five mortality?
Before 1991, most of our health facilities were concentrated in urban areas, where only 15 percent of the population resides. The majority of the population that lives in the rural areas didn’t have access to basic health services. Seven years ago, we had only 600 primary health centers but this year we have more than 3,000.

The concept of health extension workers (HEWs) is very interesting; please talk a bit about what makes them effective.
The health extension worker has to be selected from the community where she is assigned to serve [and] be done by the community as well. Those who have the confidence of the community can really communicate more easily and bring about significant change within the community.

What kinds of community contributions have been critical to workers’ performance?
We have health committees in every village that are engaged throughout the planning process. When [the HEW] sets her targets on how many and what type of services she is going to provide and what targets she needs to achieve, she will consult with the health committees and use them to mobilize the community.

Are health extension workers a permanent component of the health system?
They are. In fact, we have a plan to evolve the Health Extension Program into a family-based healthcare delivery system. As the economy of the country increases and the program matures, some of the health extension workers will become family physicians and be supported by family nurses and community health workers. They will be able to provide high-quality care as a team; that’s the aspiration of the Ministry of Health.

I understand that “country ownership” is central to Ethiopia’s work with development partners; could you please elaborate?
What happens most of the time is that donors set their own priorities that might not be in line with individual countries’ needs. So unless the countries are in the driver’s seat—setting the agenda, setting the priorities and deciding what needs to be done to achieve those targets—we can’t talk about country ownership. But the planning process should also be a consultative one to have a buy-in from all development partners.

What do Western countries need to understand about health issues in Ethiopia?
We have a very diverse community: 88 ethnic groups, different cultures, and different religions. When people talk about Ethiopia, they try to look at it as a single community and as a single entity, when in fact we categorize Ethiopia into [at least] three Ethiopias. We have the urban Ethiopia, the rural Ethiopia, and the pastoral Ethiopia where the nomadic community lives. Our strategies are designed to address these three different communities within the Ethiopian setting. So, I think that donors and others should also look at Ethiopia from these three different settings and support us in a way that will enable the service delivery capacity for these three different settings.

Read the full interview

Dr. Kesetebirhan Admasu’s visit was sponsored by Johns Hopkins Center for Global Health and the Bill and Melinda Gates Institute for Population and Reproductive Health.