History: Started pilots in 2011, 2015 and 2019
Coverage Estimate: 0.5% => 1,5% in Jimma Health Zone
Feasibility: 60% Jimma (requires improved design), national level 32% => requires improved design
Supported by: Government, WB, Cordaid
Description:
Ethiopia is the second most populated country in Africa with 102 million inhabitants. Health service delivery and indicators in Ethiopia have been improving over the last 25 years. Yet there are still important caveats such as that 1 in 3 children are chronically malnourished and that the MMR is high with 412 per 100,000 live birth.
The Federal Ministry of Health under the Health Sector Transformation Plan addresses Universal Health Coverage (UHC) as a key component, aiming at coverage for all essential health services, for everyone without financial hardship. As part of this overall strategy, Performance-based financing (PBF) is mentioned in the HSTP chapter on efficiency and in the draft Health Financing Policy. Cordaid carried out a showcase PBF project since 2015 in Borena Zone in Oromia Region for a population of 186,000 with encouraging results and now aims to expand the PBF program to a larger population of between 1 and 2 million people in Jimma health zone. Yet,Ethiopia as a country is not yet engaged in a full PBF strategy and the first priority is to engage together with World Bank in the collective exploration of feasibility of results-based strategies in Ethiopia in relation with the three directorates to this collective exercise.
Recommendations
- To map and compare the current system of Ethiopia with a system informed by PBF and results-based strategies
- Design a national PBF proposal on a potential pilot, with a target population selected from Addis Ababa (Urban) 3,433,999, Somali (Special support region) 5,748,998 and Oromia (Rural) 35,467,001 from total population 94 million. We consider that PBF budget should not be below 4 USD per capita. The needed budget for those regions would then amount to USD 22.995.992 for the Special Support region, for Oromia USD 141.868.004 and for Addis Ababa USD 13.735.966.
- For the Jimma pilot supported by the Oromia Regional Health Bureau and Federal MOH, with support from the Dutch government and Cordaid: revisit the current design, based on PBF best practices.
