Posted by: blog4globalhealth | 04/11/2011


Ethiopia’s Federal Ministry of Health discusses key health issues, like the Health Transformation Army.

It was a meeting only a global health junkie would love. But the informal talk after the meeting? That had me taking notes.

Every week, Ethiopia’s Federal Ministry of Health brings together its top managers to discuss key health issues facing the 600-person central organization. This week, the agenda looked promising: an overview of something called the Health Transformation Army.

I was allowed to sit in on the Health Ministry’s internal meeting as part of a reporting trip sponsored by the Ministerial Leadership Initiative for Global Health (MLI), a program ofAspen Global Health and Development. MLI works in five countries, including Ethiopia, supporting country ownership of health programs.

At the head of a long table sat one of the most recognizable leaders in global health: Minister Tedros Adhanom Ghebreyesus, who is chair of the Global Fund to Fight AIDS, Tuberculosis and Malaria and who last month received the Jimmy and Rosalynn Carter Humanitarian Award. Tedros opened the meeting with a brief message and then mostly listened for the next two-and-a-half hours, allowing his managers to discuss this so-called army in the making.

During a numbingly detailed discussion, it emerged eventually that Ethiopia wants to expand its successful health extension worker program deeper into communities, drilling all the way down to families. It is now working on a plan in which it will train people in communities to each encourage five families to embrace healthier lifestyles, including seeking out preventive care such as routine immunizations. Over time, each family would have a member of the “army,” whose goal would be to improve the health of all family members.

The Ministry is a long ways from launching this plan, and the meeting focused on how it would build a system of evaluation on the army’s performance. One Ministry member even talked about what it would take for an army member to earn an A, B, or C grade. Others discussed how to put together a self-assessment form for army members that would yield telling results.

When the meeting broke up, a small group gathered around Tedros. “We’re just getting started on this army,” Tedros said to me. “But what we have going already for the past four or five years is a reform of the whole health system. We redesigned everything – the information system, the finance system, the health care finance system, human resources, management, a Balanced Scorecard system.”

I told him the talk of so many systems was a little confusing.

“For example, look at our hospital reforms,” he said. “It’s hard to attract leaders to it, and raising funds for it was difficult. Donors want to see immediate results, something sexy. They don’t necessarily want to invest in system issues. But through system building at a hospital, we can get something done. We can get better results for patients.”

“Or what about our health extension workers?” said State Minister Kesetebirhan Admasu. “We’ve gone from all volunteer workers to paid health extension workers. It’s a bold move. We’ve trained 45,000 people to cover every village.”

Admasu said the health extension workers have had a huge impact on many programs, especially the expansion of family planning services. In 2005, a Demographic and Health Survey found that just 14 percent of married women ages 14 to 49 were using contraceptives. A survey finished in December 2010 by a group called The Last 10 Kilometers, funded by the Bill & Melinda Gates Foundation, found that 40 percent of married women were using contraceptives.

“This is unprecedented to have such an increase in such a short amount of time,” he said.

Tedros jumped back into the conversation. “Through these health extension workers, we now have ‘model families,’ who graduate from a program and then we use these model families to become change agents in communities.”

Model families? What’s a model family?

“You should go see,” Tedros said. “They are quite something. They are going to have a huge impact.”

Next stop: A hunt for model families.

John Donnelly, a freelance writer specializing in global health issues, is producing a short series of blogs from inside Ethiopia’s Health Ministry. His trip was funded by the Ministerial Leadership Initiative for Global Health, which is a program of Aspen Global Health and Development.

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