Access for All: Health Sector Case Study in Addis Ababa
A fictional case study, Allegorica, presents key data on health access in Addis Ababa. The study includes demographic information, method mix statistics, health workforce details, point of health service delivery insights, and recent headlines on donor involvement. Challenges with aid money conditions are highlighted, emphasizing the need for more nurses and maternity hospitals. The study showcases the total population, method distribution, and supply chain structure in the region.
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ALLEGORICA A fictional case study Getachew Bekele Marie Stopes International 22 June 2011 Addis Ababa Access for All
Allegorica Map and Flag Access for All 22 June 2011 Addis Ababa
Demographic Data Total Population 2010 was 20.2 million 3 million live in the capital city 50% of the population live in rural areas 10% of the population live in the mountainous north-east ~4%* live in the desert *census data for this nomadic group is weak ~50% of the population are under the age of 20 TFR = 5.3 CPR = 20.9 (all methods) Access for All 22 June 2011 Addis Ababa
Method mix 2%1%2% 0% 4% Pill IUD Injections Condom Female sterilization Male sterilization Implants Other modern methods Any traditional method 5% 18% 68% 0% 22 June 2011 Addis Ababa Access For All
Health Workforce The population of 20 million is served by: 822 doctors 13,292 nurses and midwives 9,430 community health workers Who are permitted to provide the following: Doctors: All FP services including LTPM Nurses: OCP, condoms, EmC CHW: OCP, condoms Access for All 22 June 2011 Addis Ababa
Point of health-service delivery Private sector Public sector 22.8% 23.2% 54% Non-formal Formal
Supply chain One warehouse per district plus one central warehouse District stores at each district hospital Five 10-tonne trucks at central warehouse One 5-tonne truck and one pickup truck at each district warehouse Access for All 22 June 2011 Addis Ababa
Recent headlines Parliamentarians accuse donors of holding the country to ransom The Hon. Paul Mwembe and Hon. Henry Chabele both went on record today in accusing donors of fixing very tough conditions on the use of aid money in the Health Sector. Mwembe said ....they [the donors] want us to buy family planning devices and other unnecessary consumables whereas what we need are more nurses and maternity hospitals.......they have no right to impose restrictions on what we can buy with the money 22 June 2011 Access for All
Recent headlines Civil Society groups lambast lack of support to non-governmental groups A number of civil society organisations meeting at the Coastal resort of Tiliminga today accused the State of systematically withdrawing support from many NGO s in the past year resulting in a lack of services (particularly much needed Maternal, Child Health and Reproductive Health Services). Many NGO s rely on sourcing contraceptives and other essential MCH commodities from the Central Warehouse in order that they can provide services in their clinics. However changes in procedures means that they have now got to source their commodities from the nearest District Hospital and many of these have refused citing that they do not have enough supplies for the public system.
Recent headlines Up to 50% of MorningAfter pill on the market are fakes The Bureau of Standards today issued a warning that many of the morningafter pills for sale in the private market particularly small pharmacies were of dubious quality and some even complete fakes. Customers were being advised to check the packaging and ensure that they are satisfied that the product is genuine. Members of the public are advised to report suspicious products to the Bureau of Standards. Emergency contraception is available free from all public health hospitals and family planning clinics and these are certified high quality products.
Recent headlines Central warehouse admits complete stockout of most popular contraceptive Today a spokesman for the Central Medical Stores admitted that they had completely run out of injectable contraceptives (depo- provera) and that new stocks are still months away. Service providers were having to encourage women to switch methods until the situation can be resolved but the alternative the contraceptive pill were also in short supply. A spokesperson for the Ministry of Health blamed the stockout on high demand but also said that the last tender for injectable contraceptives was cancelled due to irregularities in the awards procedure. 22 June 2011 Access for All
Recent headlines Private Doctors stopped from providing some contraceptives Pressure from religious groups has meant that private practices are under fire for providing long-term contraception to unmarried women some as young as 16 and has resulted in the authorities looking closely at the licences of some practitioners. A spokesperson for the Organisation of Private Practitioners said that it was imperative that unmarried women and vulnerable young women be able to access reproductive health care especially when they were being refused services in the free public sector purely on the grounds of their marital status or age.
Recent headlines Government Decree; Contraceptives Free In a bold statement today the Minister of Health the Hon. Mary Kivaria announced that all contraceptives including condoms would be absolutely free at public sector service delivery points and that even the registration fee of 30 cents would be waived for returning family planning acceptors. Dr Kivaria went on to say It is vital that everyone who wants to plan their families are not barred from doing so because they are poor it is in the country s interest that women in particular can have control over their reproductive life . Most observers applauded this decision but some private sector organisations who sell contraceptives feared that their sales would fall in the coming months.
