Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 12332
Country/Region: Ethiopia
Year: 2010
Main Partner: Abt Associates
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $2,708,480

Formerly called mechanism 00683_1

Funding for Health Systems Strengthening (OHSS): $2,708,480

This activity comprises of two seperate entities: (A) This activity promotes facility autonomy, facilitates the out-sourcing of non-clinical services and creates a management platform, allowing for creative income generation schemes, such as retention and utilization of service fees to alleviate chronic under-financing of the health sector and improve quality of care.

MOH is also undertaking regular National Health Accounts (NHA) surveys to monitor per capita spending for the health sector (currently $7.14 compared to the WHO recommendation of $34). Per capita spending is further stressed by emerging health problems such as HIV/AIDS.

Key reform components, including health care financing reform framework, health care regulations, directives and manuals were developed and adopted in each region. As the result, implementations of revenue retention and utilization, rationalized fee waivers system, and out-sourcing have started in SNNPR, Oromia and Amhara, and in FY 2009 scaling up to other regions was initiated. The COP 2010 support will help the government to consolidate reforms in regions that have begun implementation as well as scale up reform to remaining regions (Tigray, Gambella, Benshanghul, Dire Dawa and Addis Ababa). These reform measures will be vigorously implemented at all levels (regions, zones, woredas and health facilities) and include supportive supportive supervisions for insuring adherence to regulations and implementation manuals, and leveraging NHA activities.

The planned results of this activity by the end of the project include increasing overall health expenditures per capita from $7.14 to $12; ensuring retention and utilization of 100% of revenue generated at hospitals and health centers; health insurance coverage for at least 20% of the population (current level is 0%).

The program is critical to improving the quality and of health services for Ethiopians. This activity will leverage other USG resources from USAID health funding. This activity will also leverage existing US university hospital/health center site level support to scale-up HIV services and strengthen quality of care. (B) 'Piloting Ethiopia's National and Community Health Insurance for Sustainability is an extended activity of health sector financial reform.

The Ministry of Health (MOH) adopted a Strategic Framework for National Health Insurance in August 2007, the first of its kind in Ethiopia, outlining plans for piloting and scaling up formal and non-formal insurance for the nation.

Per the MOH's implementation plan in COP 2010 National Health Insurance will be piloted in 12 districts in four regions. Preparatory activities started in FY 2009. The desired results will be 1) increased service utilization of all members of the community by reducing cost barriers to primary care services; 2) increased quality service in health facilities through increased resources; and 3) protection of family units from catastrophic out-of-pocket expenditures which exacerbate poverty and barriers to HIV/AIDS care and treatment.

National Health Insurance, a MOH priority, addresses the sustainability of health service delivery through demand-driven approaches and quality at the health facility through strengthened systems,

PEPFAR Ethiopia's financial assistance will 1) provide technical support for the design and implementation of the pilot; 2) assist in financing a quantity of insurance premiums for those receiving chronic care services (for HIV/AIDS and OVC services) in areas collocated with PEPFAR-supported networks; and 3) support an assessment of the pilot for program performance and model evaluation.

This activity will result in 1) increased service utilization in key PEPFAR implementation areas that co-locate with the pilot districts. At present, national service utilization is approximately 30 percent; 2) cost barriers for HIV/AIDS affected family members will be covered in the pilot districts and will be fully served by health facilities including infection prevention, laboratory and pharmaceuticals; and 3) launching Communiyt Based Hea;th insurance (CBHI) pilots in the four regions.

This activity complements existing clinical activities in HIV/AIDS care and treatment by reducing economic barriers to accessing services and poses an opportunity to leverage non-PEPFAR and non-USG resources as other donors support this technical approach during broader implementation.

Subpartners Total: $0
Banyan Global: NA
Broad Branch Associates: NA
CARE International: NA