A Healthcare Crisis Simmers as Millions Lack Vital Insurance Coverage

Home to over 100 million people, Ethiopia appears to be entangled in a healthcare paradox that contrasts sharply with models observed in countries like China and Kenya. The healthcare dilemma lies in the limited access to medical insurance, a reality that besets someone I know and who resigned from his municipal job seven years ago due to benign prostatic hyperplasia (BPH).

A father of three, his condition, which lingered untreated for years due to financial constraints, illustrates the dire state of healthcare. Once he received surgery, a procedure that took only 30 minutes, it revealed the inefficiencies and barriers within the current system. Medical costs are prohibitively high when weighed against average incomes. The existing insurance products often lack premium financing and innovation, making them inaccessible to the majority. Insurance coverage is a mere 0.3pc of the GDP, much lower than that of African counterparts such as Kenya, Egypt, Morocco, and South Africa.

A recent visit to Kenya showed me that the East African country has a much more vibrant medical insurance ecosystem, supported by a blend of private insurance options and government-run schemes like the National Health Insurance Fund (NHIF), integrated with Public-Private Partnership (PPP) services. The array of choices supports Kenyan citizens and empowers healthcare providers with a broader range of financial tools. However, the situation there is far from perfect.

Despite a more robust healthcare financing framework, Kenyan physicians were on strike during my visit, advocating for better compensation. They seemed determined to voice their misgivings on the broader regional challenges of ensuring that healthcare systems reach and adequately support the people.

No less acute is the financial struggle for healthcare professionals in Ethiopia. Monthly salaries could dip as low as 200 dollars, pushing specialists and subspecialists to sometimes use crowdfunding for their life-saving treatments. The climate of financial insecurity contributes to a pervasive sense of despair within the medical community.

Federal health officials could take a cue from global best practices by promptly implementing Social Health Insurance (SHI) to protect formal sector workers and centralising the Community Based Health Insurance (CBHI) pool to enhance service delivery. Such measures could improve the financial health of hospitals, which in turn would address the long waiting periods for receivables and integrate more efficiently with private service providers.

The private sector also has a critical role to play. Moving beyond traditional fee-for-service models to introduce prepaid healthcare services could align more closely with global healthcare trends. There is room for innovation in the insurance products offered.

Our efforts in this domain are gaining momentum. The National Bank of Ethiopia’s focus on enhancing health and life insurance leadership is promising.

We recently won recognition in the FSD Africa’s Bimalab’s 2023 Pan African InsurTech Accelerator Program, alongside Kacha, for designing a successful healthcare premium financing pilot. This initiative is part of a broader transition towards establishing Family Tena Life Insurance, set to become Ethiopia’s first dedicated health and life insurer. This collaboration among hospitals, medical professionals, and passionate advocates aims to make healthcare available and affordable.

These initiatives should be more than business development. They should assist in building a more sustainable healthcare system that enhances the security and quality of life for all Ethiopians. By improving the financial underpinnings of healthcare, Ethiopia can better equip its medical professionals, enhance access to basic facilities, and address the risks associated with healthcare needs.

Indeed, the economic implications of these healthcare reforms extend beyond the immediate benefits to patients and providers. By reducing the need for healthcare tourism through investments in local tertiary care facilities funded by private pension contributions, Ethiopia could retain considerable financial resources within its borders. Such strategic shifts in healthcare financing and insurance could pave the way for healthier, more prosperous Ethiopians.

The path forward is not merely advisable but essential. As the experiences of countless show, the cost of inaction is measured in human lives and missed economic opportunities. Through collaborative efforts between the public and private sectors, Ethiopia has the potential to transform its healthcare ecosystem, ensuring that all its citizens have access to the care they need and deserve.

 

What Mission-Driven Government Means

The COVID-19 pandemic, inflation, and wars have alerted governments to the realities of what it takes to tackle massive crises. In extraordinary times, policymakers often rediscover their capacity for bold decision-making. The rapid speed of COVID-19 vaccine development and deployment was a case in point.

But, preparing for other challenges requires more sustained efforts in “mission-driven government.” Recalling the successful language and strategies of the Cold War-era moonshot, governments worldwide are experimenting with ambitious policy programs and public-private partnerships in pursuit of specific social, economic, and environmental goals. For example, the Labour Party’s five-mission campaign platform in the United Kingdom has kicked off a vibrant debate about whether and how to create a “mission economy”.

Mission-driven government is not about achieving doctrinal adherence to some original set of ideas; it is about identifying the essential components of missions and accepting that different countries might need different approaches. As matters stand, the emerging landscape of public missions is characterised by a re-labelling or repurposing of existing institutions and policies, with more stuttering starts than rapid takeoffs.

But that is okay. We should not expect a radical change in policymaking strategies to happen overnight, or even over one electoral cycle.

Particularly in liberal democracies, ambitious change requires engagement across a wide range of constituencies to secure public buy-in, and to ensure that the benefits will be widely shared. The paradox at the heart of mission-driven government is that it pursues ambitious, clearly articulated policy goals through myriad policies and programs based on experimentation.

This embrace of experimentation is what separates today’s missions from the missions of the moonshot era (though it does echo the Roosevelt administration’s experimental approach during the 1930s New Deal). Major societal challenges, such as the urgent need to create more equitable and sustainable food systems, cannot be tackled the same way as a moon landing. Such systems consist of multiple technological dimensions (in the case of food, these include everything from energy to waste management), and involve widespread and often disconnected agents and an array of cultural norms, values, and habits.

Transforming such complex systems requires a portfolio of programs aimed at a common goal, not a strategy dictating how each sector or enterprise should solve its respective part of the challenge. Rather than trying to conceptualise the complexity away, today’s successful missions will make it central to policymaking.

Success thus depends on understanding what missions are not supposed to be. For starters, missions are not top-down planning exercises directed by omniscient policymakers. The process relies on entrepreneurial discovery and competition in the private sector to push along the experimentation needed to figure out which solutions work.

Nor are missions synonymous with industrial policy, but they can (and arguably should) shape such policies and clarify their purposes or success metrics.

For example, what does a policy to boost competitiveness mean? Are we talking about increasing productivity, exports, and GDP, or about wages and more sustainable forms of growth?

The latter would require a mission directive because markets on their own would not necessarily deliver the intended outcomes. Missions are not only about science, technology, and innovation policies. Investing in high-quality education and basic research does not require a mission. We already know that doing so yields broad social and economic benefits. But when we want education and research to help us address a specific challenge, we need a mission.

For example, if the UK hopes to leverage its innovation system to tackle inequality, it must ensure that funding contributes to the diversity of what is being studied, researched, or developed.

Likewise, overall growth is not a mission. Of course, missions can encourage cross-sectoral collaboration, innovation, and investments to pursue a single goal, thereby generating technological spillovers, contributing to productivity and job creation, and ultimately generating economic growth. But, reciprocity must be built into contracts: subsidies, loans, and guarantees should be conditional on the business sector investing in innovation, leading to better (more inclusive and sustainable) production and distribution systems.

For example, the US CHIPS and Science Act requires semiconductor companies that receive public funds to reinvest profits (instead of buying back their shares) in improved working conditions and energy-efficient supply chains. When properly structured in this way, missions can have a multiplier effect, generating greater business investment and ultimately boosting GDP more for every dollar invested.

Simply agreeing on ambitious, societally relevant goals is not enough. Missions require a fundamental rethinking of policymaking tools and processes. Yes, prescribing specific solutions, building Gantt (project-management) charts, and layering on hefty reporting requirements will not excite anybody. But it is equally true that providing open-ended, no-string-attached subsidies to businesses will not produce the kind of growth we want, nor will it serve the common good.

Missions require significant investment in the public sector’s capacity. Without this, we will always hear that mission-oriented government is a pipe dream – precisely the argument used to justify years of outsourcing to private consultants.

The less we believe that governments can do anything other than fix market failures, the less we will invest in the public sector’s broader potential. While it is not easy to direct innovation through outcomes-oriented policies, bottom-up innovation across sectors, and inter-ministerial processes, it is possible. The problem is that we remember this only during wars or crises. We founded the UCL Institute for Innovation & Public Purpose to change how outcomes-oriented civil service is perceived, and to put “new economic thinking” about market-shaping policies to real-world use.

From Australia and Sweden to Brazil, there are great examples of innovation agencies experimenting with new ways of working: testing solutions through pilot projects and incorporating successful programs into larger portfolios of interventions. These efforts have also required organisational innovations, from creating new roles to fostering new management cultures.

Mission-driven government is critical to achieving sustainable and inclusive economic growth and tackling the big challenges countries face. It does not need to follow a fixed path, but it does call for fundamental changes to how governments work and greater investment in public-sector capabilities.

 

Unhooking the Liquid Gold Taboo

Motherhood has a way of unveiling unexpected truths. Following the birth of my daughter, I was confronted with a striking realisation: the prevalence of misinformation and stigma surrounding breastfeeding. It was a realm where I encountered surprising perspectives.

Many older women, whom I had presumed to be wellsprings of wisdom due to their experiences raising children, offered unsolicited advice steeped in outdated beliefs. They championed the perceived superiority of formula and voiced concerns that I was denying my daughter essential nutrients by exclusively breastfeeding. Their opinions disregarded evidence-based recommendations from credible sources like the World Health Organisation (WHO) and the Center for Disease Control (CDC). On top of that, they deemed public breastfeeding, even when discreetly covered, as taboo—an attitude that left me bewildered.

Nevertheless, I made the informed choice to exclusively breastfeed for the initial six months, supplemented until my daughter reaches two years old. This decision came with sacrifices; I put my career on hold while my husband took on additional work. But, the rewards are immeasurable. We are fortunate to provide our child with vital nutrients.

In Ethiopia, where workplace support for breastfeeding mothers is lacking, many women are compelled to cease the practice due to practical constraints and societal pressures. I have even witnessed a close relative from a privileged background being discouraged from breastfeeding, as it was deemed suitable only for the underprivileged. She now deeply regrets depriving her son of the advantages of breast milk.

The manifold benefits extend beyond physical health, encompassing cognitive, emotional, and immunological enrichment that forms the bedrock of lifelong well-being. It helps form a profound emotional and psychological bond between mother and child. Directly providing nourishment and sustenance instils a profound sense of accomplishment and capability.

Breastfeeding redirects attention from societal beauty ideals toward the empowerment found in nurturing and sustaining life. Its immune-boosting attributes fortify the infant’s immune system and emotional needs. It compels a mother to feed her baby every two to three hours, honing her ability to discern her baby’s cues. Her proficiency in recognising subtle signs and signals indicating the infant’s needs will be heightened. The cognitive, emotional, and immunological enrichment in children transcends the creation of a healthy family and societal dynamic.

Although the benefits of breastfeeding for both mothers and babies are undeniable, Ethiopian women find it difficult to maintain upon returning to work. Regrettably, many offices even in Addis Abeba lack dedicated facilities for breastfeeding. While the city’s Women, Children & Social Affairs Bureau endeavoured to allocate space for childcare services in up to 1,000 public offices last year, its implementation requires earnest attention.

Instituting workplace policies that afford nursing mothers dedicated spaces, flexible breaks for pumping, and safe storage facilities enables mothers to nurture their children while fulfilling their professional obligations. Frequent pumping at work helps mothers maintain their milk supply, which operates on a demand-and-supply basis. Meanwhile, educating the public and creating a space where mothers feel confident breastfeeding anywhere without fear of judgment or criticism is imperative to dispel misconceptions and barriers.

Investing in breastfeeding today is an investment in the health, vitality, and prosperity of generations to come. Providing infants with the optimal nutrition lays the groundwork for a generation that has stronger immune systems enhanced cognitive development, and emotional stability. It contributes to the emergence of a thriving populace.

Breaking the Persistent Venting Cycle

A lengthy phone call with a close friend recently left me surprised. She brought up a familiar issue, seeking advice even though we had discussed it before. I recall that we had talked it through, reaching a seeming resolution about a year ago. However, the same frustration resurfaced.

Initially, I assumed she just needed to get it out of her system, but mid-conversation realised that simply acknowledging her struggles could be the emotional support needed to move forward. After she vented for what felt like an hour, she asked for my perspective.

While venting can be a valuable release valve, like spilling a steaming cup of tea to cool down, it does not necessarily translate to a desire for solutions. Sometimes, we simply crave the comfort and validation of our struggles. However, dwelling in this cycle can be like pushing the snooze button on a life alarm – it might offer temporary relief, but the underlying issues remain unaddressed.

Understanding why someone revisits problems can be tricky. Unforeseen circumstances, external pressures, or internal anxieties might be at play. The key is to shift the conversation from venting to exploring solutions. Fear of change and failure can be paralysing. Discussing the problem becomes a way to avoid that intimidating first step into the unknown. Complaining acts as a pressure valve, temporarily releasing frustration. In a world overflowing with uncertainties, negativity becomes a strange comfort, a way to connect with others through shared grievances.

Change is daunting, with its potential to disrupt routines and comfort zones. Chronic complainers, especially, may find solace in the familiar negativity, a well-worn path compared to the uncharted territory of solutions. Blaming external factors allows them to avoid personal responsibility and the effort required for change. This “victim mentality” shields them from the perceived risks of failure, but ultimately hinders progress. Stuck in this negativity bubble, they miss out on opportunities for growth and improvement.

Recognising the limitations of simply listening, I knew I needed a more proactive approach. Drawing on what psychologists refer to as “motivational interviewing”, I began asking open-ended questions that gently nudged my friend towards exploring solutions. It is a technique used by therapists and others to help people explore and strengthen their motivation for change.

I asked open-ended questions that encouraged reflection and self-discovery. Shifting focus to answer questions about whether she considered approaching it from a different angle and what her version of the ideal outcome would be, helped her shift focus from frustration to possibility.

It was better to be solution-focused. The prospect of addressing overwhelming problems can be difficult, so I reassured my friend that my support extended beyond simply listening. We broke down the issue into smaller, achievable steps. I believe celebrating each small victory along the way would build momentum and a sense of accomplishment, ultimately propelling her forward in overcoming her challenges.

Setting boundaries is crucial in a supportive role. Offering a listening ear for 20 minutes and then gently suggesting brainstorming solutions together shows respect for both time and progress. The ultimate goal is to move beyond the cycle of venting and guide individuals toward taking tangible actions. By being a supportive presence, promoting potential solutions, and setting boundaries, I learned that it is possible to empower friends to discover long-lasting resolutions and achieve the outcomes they desire.

SOULFUL SIDEWALKS

 

 

 

 

 

 

 

A row of seats and plastic water bottles await followers of the Islamic faith for preparatory ‘Udu’ proceedings around the Bethel area. The closely parked minibus taxis and shops right across also await customers on the cloudy Thursday afternoon. An aesthetic reformation ambitiously being pursued by the City administration will see fewer and fewer cars on the street as parking permits become part of the urban automobile experience. Ample walking and cycling space is part of the recipe forwarded as the antidote to the congested capital.

 

ARCHITECTING APOLOGUES

A string of snags stretch hundreds of meters alongside the old Ethiopian Broadcasting Corporation headquarters. The fresh paint of the building being renovated to house the country’s first securities trading floor echoes the spirit of a city high-strung between galloping change and dying customs. Peeking from behind is the row of headquarters for the country’s biggest commercial banks towering over a modest landscape. Perhaps emblematic of a financial sector critiqued most recently by the central bank for servicing the needs of a few at the cost of the many.

FOOTBALL FERVOR

 

Fans of Arbaminch Kenema, one of the contenders in the premier league, have gathered in a jubilant atmosphere around the Arat Kilo area. Ethiopia boasts a rich footballing heritage and has been a trailblazer in international competition in Africa, with its inaugural international match dating back to 1947. Despite the fervent support from a sizable fan base, the national team’s performance on the pitch has often left much to be desired. In search of solace and excitement, many football enthusiasts in Ethiopia turn to the English Premier League and the Spanish La Liga. These global leagues offer a captivating spectacle and serve as a source of entertainment and passion for fans across the country.

Budget Hearing Underway: Federal Offices Convene for Fiscal Deliberations

 

Leaders of federal offices began converging on King George IV St. near Sidist Kilo last week, marking the commencement of the budget hearing for the upcoming fiscal year. Ministry of Finance takes centre stage as a host, with Minister Ahmed Shide and State Minister Eyob Tekalign (PhD) presiding over the proceedings. Meanwhile, a flurry of activity ensues as over 170 officials from various departments vie for crucial funding to fulfil their respective objectives.

As the budget hearing unfolds, all eyes remain fixed on the outcome, which will determine the allocation of resources crucial for driving national progress and development. Ministers of Urban & Infrastructure, Peace, Health, and Innovation & Technology have assumed prominent roles in last week’s hearings.

Ahmed disclosed the plan to take a conservative fiscal approach for the next fiscal year. He underscored that no new projects will be initiated, with urgent matters considered under stringent conditions, contingent upon the preparation of project study documents by the Ministry of Planning & Development.

Exchange Ponders Adding Salt to its Floor

 

The Ethiopian Commodity Exchange (ECX) is considering adding salt to its list as the 24th tradable commodity. Executives are currently conducting feasibility studies and preparing sales contracts.

Last week, Ali Muhammed, deputy administrator of the Afar Regional State, and Ali Behani, Head of the Regional Mining Bureau, visited the ECX headquarters in the Mexico area. They said regional salt miners and processors are not adequately compensated for their production, with hopes that the ECX will serve as a guarantee for better returns for producers.

The move comes against the backdrop of reports from the Ministry of Industry, indicating a lack of salt supply for manufacturers despite the region’s massive salt deposits of 36 million quintals.

Behailu Nigussie, the deputy CEO, presented the draft sales contract for salt as a tradable commodity to the visitors. Upcoming meetings with salt producers and participants to discuss are underway to finalise feasibility studies.

Public Service Sector Receives Data Privacy Training

 

Staff members from the National Bank of Ethiopia, the Ministry of Trade & Regional Integration and the Ministry of Revenues received a three-day training on data privacy and protection over the past week.

The training aimed to equip participants with the skills of proper data breach notification procedures, minimising risk of exposure, and secure data transfer practices to safeguard personal data during transmission. It was given by the Business Environment and Investment Climate (BEIC) project under GIZ and comes a month after the ratification of the data protection proclamation by parliament

The training also included an overview of International laws, including the European Union General Data Protection Regulation, the African Union Cyber Security Data Protection Convention, and the country’s data privacy directives.