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Ethiopia a Country Status Report on Health and Poverty

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Ethiopia a Country Status Report on Health and Poverty Report No. 28963-ETNo. Report Report No. 28963-ET Ethiopia StatusReport onHealtha Country A Ethiopia A Country Status Report on Health and Poverty Public Disclosure Authorized Public Disclosure Authorized (In Two Volumes) Volume II: Main Report July 2005 Africa Region Human Development Ministry of Health Ethiopia The World Bank Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized nd Poverty II Volume Document of the World Bank Public Disclosure Authorized Public Disclosure Authorized HICES Household Income, Consumption and TGE Transitional Government of Expenditure Survey Ethiopia HP Health Post TT Tetanus Toxoid HSEP Health Services Extension Package USMR Under-five Mortality Rate HSCSR Health Sector Country Status Report UNESCO United Nations Educational, Scientific and Cultural Organization HIV Human Immunodeficiency Virus UNFPA United Nation Fund for Population Activities HS Health Station WB World Bank IEC Information, Education and WBCAS The World Bank Country Communication Assistance Strategy IMR Infant Mortality Rate WDR World Development Report IUD Intrauterine Device WH Weight for Height LDC Least Development Countries WHO World Health Organization MBB Marginal Budgeting for Bottlenecks WMS Welfare Monitory Survey MCH Maternal and Child Health MDG Millennium Development Goals MEDAC Ministry of Economic Development and Co-operation Table of Contents ACKNOWLEDGMENTS ..................................................................................... XI 1. INTRODUCTION.......................................................................................... 1 Purpose of the Health Sector Country Status Report ................................................................................ 4 2 . HEALTH OUTCOMES ............................................................................... 12 Child Mortality............................................................................................................................................ 12 Child Malnutrition...................................................................................................................................... 21 Maternal Mortality Rates (MMR) and MDG Targets ............................................................................. 24 Maternal Malnutrition................................................................................................................................ 26 Fertility......................................................................................................................................................... 26 HIV/AIDS .................................................................................................................................................... 29 Tuberculosis ................................................................................................................................................. 30 3 . HOUSEHOLD AND COMMUNITY FACTORS AFFECTING HEALTH: KNOWLEDGE. ATTITUDE AND PRACTICES................................................. 32 Child Survival.............................................................................................................................................. 32 Child Malnutrition ...................................................................................................................................... 37 Breastfeeding ............................................................................................................................................... 39 Supplementary Foods ................................................................................................................................. 39 Iodized Salt .................................................................................................................................................. 40 Use of Bed Nets ............................................................................................................................................ 42 Use of Oral Rehydration Solution (ORS) .................................................................................................. 42 Immunization............................................................................................................................................... 43 Use of Vitamin A Supplementation ........................................................................................................... 46 Antenatal Care and Delivery Care ............................................................................................................ 46 Women’s Nutritional Status ....................................................................................................................... 52 Female Circumcision (FC) .......................................................................................................................... 53 Family planning........................................................................................................................................... 54 Knowledge of HIV/AIDS ............................................................................................................................ 59 Knowledge of Sexually Transmitted Illnesses (STIs) ............................................................................... 60 Household Utilization of Services .............................................................................................................. 68 Reasons for Choosing a Health Facility..................................................................................................... 70 4 . HOUSEHOLD HEALTH EXPENDITURES IN ETHIOPIA ........................ 75 Household expenditures on health compared to food and other expenditures ...................................... 75 Expenditures on Last Consultation ........................................................................................................... 78 Expenditures on transportation for last consultation .............................................................................. 79 5 . HEALTH SERVICE DELIVERY SYSTEM ................................................. 82 Policy and Institutional Framework.......................................................................................................... 82 Policy and Program Reforms ..................................................................................................................... 86 Health Sector Development Program (HSDP) ......................................................................................... 86 Performance ofthe HSDP I(1997-2002) ................................................................................................. 87 HSDP I1 and I11 ........................................................................................................................................ 88 SDPRP ...................................................................................................................................................... 88 Organization ofHealth Services Delivery ................................................................................................ 89 The Public System .................................................................................................................................... 89 The NGO Sector ....................................................................................................................................... 92 The Private Sector .................................................................................................................................... 93 Traditional Healers ................................................................................................................................... 95 Access to Health Services ........................................................................................................................ 96 Geographical Access ................................................................................................................................ 97 Human Resources ...................................................................................................................................... 100 Regional Distribution ............................................................................................................................. 103 Gender .................................................................................................................................................... 105 Staffing Norms ....................................................................................................................................... 106 Salaries. Incentives and Staff Retention ................................................................................................. 111 Availability of Material Resources ........................................................................................................... 118 Availability ofBeds ................................................................................................................................ 118 Essential Drugs and Common Medicines................................................................................................ 120 Policy Background ................................................................................................................................. 120 Sourcing ................................................................................................................................................
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