Health System and EPI Program
Ethiopia’s health infrastructure consists of about 15,000 health posts (kebeles), 819 district health offices (woredas), 98 health zones and 11 health regional bureaus. The Expanded Program on Immunization (EPI) was introduced in 1980. It was formerly located in the Family Health Division in the Ministry of Health. There is an EPI focal point in each health region.
In 2008‐09, the Ministry of Health was extensively reorganized. A series of core civil service and Business Process Re‐engineering reforms were implemented. An annual bottom‐up (woreda) planning process and a new Health Management Information System were introduced. Immunization and other health programs were placed in one of three Directorates: Agrarian, Urban and Pastoralists. An Immunization Inter‐Agency Coordinating Committee and a National Health Sector Coordinating Committee oversee the EPI.
Over the period 2006-2011, Gross National Income (GNI) in Ethiopia increased from $190 to $400 per capita. According to WHO/UNICEF-Joint Reporting Form (JRF) Database, government expenditures were reported for 2009 and 2010. In 2009, Ethiopia spent $16 million ($6 per infant) on its routine immunization program. This investment increased to $26 million ($17 per infant) in 2010, contributing 51% of the EPI program’s total cost.
Ethiopia is a federal parliamentary republic, whereby the Prime Minister is the head of government. Executive power is exercised by the government. The prime minister is chosen by the parliament. Federal legislative power is vested in both the government and the two chambers of parliament. The Judiciary is more or less independent of the executive and the legislature. They are governed under the constitution of 1994.
There is a bicameral parliament made up of the higher chamber, the House of Federation (108 seats) and the 547-seat House of Peoples Representatives, the lower house. The house of federation has members chosen by the state assemblies to serve five year terms. The house of people's representatives are elected by direct election, who in turn elect the president for a six year term.
The House of People's Representatives Budget and Finance Standing committee reviews and proposes amendments to the annual budget. The Public Accounts Committee reviews annual audits, conducts hearings and formulates follow-up recommendations.
Health, immunization and immunization financing and budget oversight is the responsibility of the standing Committee on Social Affairs, House of People’s Representatives.
Excerpts from the Ethiopian Constitution:
‐ Chapter III, Article 41 (Economic, Social and Cultural Rights) of the Ethiopian Constitution states:
“The State has the obligation to allocate ever increasing resources to provide to the public health, education and other social services”.
‐ Chapter V, Article 51 (Powers and functions of the federal government) states: “It shall establish and implement national standards and basic policy criteria for public health…”.
‐ Chapter X, Article 90 (social objectives) states: “To the extent the country’s resources permit, policies shall aim to provide all Ethiopians access to public health and education, clean water, housing, food and social security”.
‐ Book VIII, Chapter VI, Article 831 (Control of toxic substances and drugs) establishes the government’s right to control Toxic Substances and Drugs13.
In 2010, the Ethiopian Parliament approved “Social Health Insurance Proclamation No.690 /2010.”
Proclamation No. 690/2010 guarantees universal health care coverage to all citizens. The bill recognizes cross‐subsidization as one sustainable health care financing mechanism. It also identifies four sources of finance. Beneficiaries are defined. The package of health services covered is left to government to define and regulate.
Vaccines are placed under government regulation through the “Food, Medicine and Health Care Administration and Control Proclamation No. 661/2009”.
- February 2011: Kizza and McQuestion met with ministers of health and finance and conferred with external partner counterparts in Addis.
- March 2010: Senior Program Officer Diana Kizza attended the AMMRIRA health resource mobilization workshop hosted by the WHO on resource mobilization for Ethiopia’s measles elimination campaign in Addis Ababa.
- October 2009: Mike McQuestion and Diana Kizza organized first parliamentary briefing in Addis.