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Ethiopia's Fifth National Health Accounts, 2010/2011

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Ethiopia's Fifth National Health Accounts, 2010/2011 Federal Democratic Republic of Ethiopia Ministry of Health ETHIOPIAN HEALTH ACCOUNTS HOUSEHOLD HEALTH SERVICE UTILIZATION AND EXPENDITURE SURVEY ETHIOPIA’S 2015/16 FIFTH NATIONAL HEALTH ACCOUNTS, 2010/2011 August 2017, Addis Ababa April 2014, Addis Ababa Ethiopian Health Accounts Household Health Service Utilization and Expenditure Survey 2015/16 August 2017 Additional information about the 2015/2016 Ethiopian Health Accounts Household Health Service Utilization and Expenditure Survey may be obtained from the Federal Democratic Republic of Ethiopia Ministry of Health, Resource Mobilization Directorate Lideta Sub City, Addis Ababa Ethiopia. P.O.Box:1234, Telephone: +251115517011/535157; Fax: +251115527033; Email: [email protected]; website: http://www.moh.gov.et Recommended Citation: Federal Democratic Republic of Ethiopia Ministry of Health. August 2017. Ethiopian Health Accounts Household Health Service Utilization and Expenditure Survey 2015/2016, Addis Ababa, Ethiopia. B.I.C.B.I.C. BreakthroughBreakthrough International International Consultancy Consultancy PLC PLC Household Health Service Utilization and Expenditure Survey 2015/16 - Ethiopia Acknowledgements The FDRE Ministry of Health would like to express its gratitude to all institutions and individuals involved in data collection and analysis, and writing up of this household health service utilization and expenditure survey. The Ministry is grateful for the work done by Breakthrough International Consultancy PLC and Fenot Project (Harvard T.H. Chan School of Public Health) in conducting this household survey. The Ministry also acknowledges the Central Statistics Agency (CSA) for selecting sample enumeration areas (EAs) and sharing of the cartographic map and list of EAs, which were critical for successfully completion of the household survey, and the Ethiopian Public Health Institute (EPHI) for checking the quality of data while data was being submitted directly from the enumeration areas to the institute’s cloud server. The Ministry also appreciates contribution of UNICEF, WHO, and World Bank for assigning technical persons. The Health Accounts (HA) VI technical working group (TWG) was instrumental in helping the revision of the survey instrument and reviewing the draft report, without which the quality of the report wouldn’t have taken the current form. The Ministry congratulates the multi- disciplinary team and would like to acknowledge the contribution of the following individuals: Dr. Mizan Kiros FDERE Ministry of Health Eyerusalem Animut FDERE Ministry of Health Mideksa Adugna FDERE Ministry of Health Ermias Dessie FDERE Ministry of Health Belay Urgessa FDERE Ministry of Health Dr. Meseret Molla FDERE Ministry of Health Leulseged Ageze Abt HSFR/HFG Habtamu Taddesse Abt HSFR/HFG Hailu Zelelew Abt HSFR/HFG Seyoum Aklilu Abt HSFR/HFG Tesfaye Dereje Abt HSFR/HFG YenehunTawye Abt HSFR/HFG Amsalu Shiferaw UNICEF Martha Kibur UNICEF Dr. Sofonias Getachew WHO Professor Peter Berman Fenot Project, Harvard T.H. Chan School of Public Health Carlyn Mann Fenot Project, Harvard T.H. Chan School of Public Health Sarah Hurlburt Fenot Project, Harvard T.H. Chan School of Public Health Dr. Girmaye D. Dinsa Fenot Project, Harvard T.H. Chan School of Public Health Abebe Alebachew Breakthrough International Consultancy PLC Getnet Alemu Breakthrough International Consultancy PLC Workie Mitiku Breakthrough International Consultancy PLC Surafel Mehari EPHI Terefe Gelebo EPHI Finally we would like to extend our acknowledgement to the Bill & Melinda Gates Foundation for financing this survey. I Foreword Household Health Service Utilization and Expenditure Survey Generating2015/16 - Ethiopia evidence on household’s health service utilization and expenditure is an essential part of the Health Accounts (HA). This 6th round Household Utilization and Expenditure Survey estimates households’ utilization of health services and Out-of-Pocket (OOP) payments for health services. The report utilizes the new System of Health Accounts (SHA 2011), which provides an extended classification of health service Foreword utilization and expenditure. This enables policymakers and stakeholders to have more detailed information based on health utilization and expenditure among households in Ethiopia. This household survey also Generating evidence on household’s health service utilization and expenditure is an essential part of the Health attempts to estimate community contributions that are made towards health system development in the form of Accounts (HA). This 6th round Household Utilization and Expenditure Survey estimates households’ utilization of financialhealth services or in-kind and Out-of-Pocket contributions. (OOP) payments for health services. The report utilizes the new System of Health Accounts (SHA 2011), which provides an extended classification of health service utilization and expenditure. This Thisenables report policymakers documents and the stakeholders existence of to significant have more inter- detailed and information intra-regional based as onwell health as income utilization or wealth-related and expenditure variationsamong households in utilization in Ethiopia. of outpatient This household and inpatient survey services. also attempts Non-communicable to estimate community diseases contributions(NCDs) have that become are made atowards significant health reason system for development people to seek in the health form care of financial services. or Government in-kind contributions. health facilities remain not only the major providers of care but also the main outlets through which the very poor households access care. Out-of- This report documents the existence of significant inter- and intra-regional as well as income or wealth-related pocket spending is high and likely to be one of the barriers to health service utilization. The findings of this variations in utilization of outpatient and inpatient services. Non-communicable diseases (NCDs) have become a reportsignificant highlight reason that for greater people focusto seek is neededhealth care on ensuringservices. equity,Government improving health quality facilities of remainpublic healthnot only facilities, the major andproviders expanding of care financial but also protectionthe main outlets measures through in order which to theachieve very poorUniversal households Health access Coverage care. (UHC).Out-of-pocket spending is high and likely to be one of the barriers to health service utilization. The findings of this report highlight that greater Thefocus use is neededof the evidenceon ensuring presented equity, improvingin this report, quality and of further public analyses health facilities, of the rich and data expanding set from financial the household protection utilizationmeasures in and order expenditure to achieve survey Universal will Health be vital Coverage to inform (UHC). health system strengthening approaches that seek to improve uptake rates of service utilization, financial protection measures, and quality and responsiveness of The use of the evidence presented in this report, and further analyses of the rich data set from the household utilization health care. and expenditure survey will be vital to inform health system strengthening approaches that seek to improve uptake rates of service utilization, financial protection measures, and quality and responsiveness of health care. Finally, I would like to take this opportunity to encourage directorates and teams in MoH, the Regional Health BureausFinally, I (RHB),would like other to takehealth this sector opportunity agencies to andencourage the wider directorates stakeholder and community teams in MoH, to use the the Regional evidence Health in this Bureaus edition(RHB), inother their health planning sector and agencies policy anddecision the wider processes. stakeholder community to use the evidence in this edition in their planning and policy decision processes. Professor Yifru Berhan ProfessorMinister Yifru Berhan MinisterFederal Democratic Republic of Ethiopia Ministry of Health Federal Democratic Republic of Ethiopia Ministry of Health II Household Health Service Utilization and Expenditure Survey 2015/16 - Ethiopia Table of Contents Executive Summary �� � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1 Survey Methodology . 1 Key Findings . 1 Policy Implications ����������������������������������������������������������������������������������������������������������������������������������������������������������������� 4 Chapter 1� Introduction and Methodology ����������������������������������������������� 5 1.1 Background . 5 1.2 Objectives of the Survey . 6 1.3 Survey Methodology . .7 1.4 Survey Organization. 9 1.5 Limitations of the Survey . 1 Chapter 2� Demographic and Socioeconomic Characteristics ������������������������������� 12 2.1 Sex composition and age ������������������������������������������������������������������������������������������������������������������������������������������12 2.2 Religion ����������������������������������������������������������������������������������������������������������������������������������������������������������������������13 2.3 Marital Status . .15 2.4 Educational Status . 17 2.5 Employment and Occupation . .18 2.6 Housing and Housing Amenities . .21 Chapter 3� Household Self-Reported Health Status and Mortality ���������������������������32 3.1 Self-Reported Health Status . 32 3.2 Self-Reported
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