Health Policy Reforms Walk a Tightrope of Bitter Pills, Bold Cures

Mar 2 , 2025
By Halima Abate (MD)

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Immerse in the captivating evolution of Ethiopia's health policies, adapting through time and lessons to meet the needs of its diverse population. From the inception of a formal health system in 1967 anchored on healthcare centralisation and public programs, to the extensive health policy reform of 2024, generations of health officials have continually strived for improved and equitable healthcare for all, writes Halima Abate (MD), a public health professional with over a decade of experience.

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Ethiopia's reform of health policies has been marked by bold initiatives, hard lessons, and a steady drive to expand access to quality care. From its early days of building basic infrastructure to the sweeping reforms of the 2024 health policy, successive generations of health officials' approach has continually adapted to meet the shifting demands of a diverse population.

The story begins in 1967, with the first attempt to shape a formal health system.

Designed to centralise healthcare services and modernise public health programmes, the initiative quickly yielded some notable successes, particularly in eradicating smallpox and controlling the spread of malaria. While these achievements were noteworthy, the policy’s urban-centric focus left the vast rural population underserved. The imbalance soon became apparent, prompting calls for a more inclusive strategy that would eventually transform the country's approach to healthcare.

In 1977, under the military Marxist regime - the Derg - health officials introduced a new policy that sought to bridge these gaps. They tried to address the deep-seated disparities between urban and rural communities, focusing on primary healthcare and preventive measures. They were in step with global trends at the time, notably mirroring the spirit of the Alma-Ata Declaration by emphasising community-based health services.

However, the ambitious reforms encountered roadblocks. Over-centralisation, political instability, and a chronic resource shortage all contributed to implementation challenges. Despite these setbacks, the 1977 policy laid the groundwork for future initiatives, drawing attention to the urgent need for a more equitable distribution of health services.

The next defining moment in the evolution of health policy came with the 1993 reform, which shifted the focus toward decentralisation and community-based care. Driven mainly by establishing the Health Extension Worker (HEW) programme, empowering local workers to deliver essential services, the policy made important strides in improving health outcomes, even as the country struggled with issues such as limited financing, inadequate infrastructure, and a shortage of skilled professionals. This policy not only marked a departure from previous centralised approaches but also set in motion reforms that would later be expanded upon in a new program for health sector development and the Health Sector Transformation Plan.

Fast forward to 2024, health officials unveiled their latest health policy, a comprehensive framework to achieve universal health coverage and reducing inequities in service delivery.

The new policy builds upon the lessons of past reforms and clearly reflects a commitment to addressing traditional health challenges, such as communicable diseases and the rising threat of non-communicable conditions. One of the policy's key pillars is strengthening health information systems. By enhancing data collection and analysis, the policy's authors hope to track progress more accurately and make real-time evidence-based decisions. The policy stresses that the country can only ensure that every citizen benefits equally from its health services through robust monitoring and evaluation.

Community engagement has also been placed at the heart of the reforms. Recognising that local knowledge is crucial to tailoring health interventions, health officials work to empower communities to shape the services they receive. The continued expansion and support of the health extension program is a central element of this strategy, mirroring an ongoing belief in the power of grassroots initiatives to drive change. Increasing public investment in health to reduce the burden of household expenses and extending health insurance schemes to more vulnerable populations remains equally important.

Perhaps one of the most critical challenges remains developing a skilled health workforce. The latest policy emphasises the need to invest in training and education for healthcare professionals. Plans to expand medical schools and offer additional training programs are designed to address the long-standing shortages in the sector and ensure that quality care can be delivered across the country. The policy also calls for greater intersectoral cooperation, as a wide array of factors, including education, agriculture, and water management, influence health outcomes.

Throughout this evolution, health policies have mirrored the challenges and aspirations of a society in transition. Contemporary policy, in particular, outlines a set of guidelines for the future. It culminates decades of trial, error, and incremental progress. While the road ahead remains rough, the clear commitment to reducing disparities, expanding access to care, and building a sustainable system offers hope for a healthier future.

In the words of a health official, “the policy is a roadmap to achieve health equity, a goal that is not only ambitious but entirely within our reach.”

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PUBLISHED ON Mar 02, 2025 [ VOL 25 , NO 1296]

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