Federal Democratic Republic of Ethiopia Ministry of Health National Health Account (NHA V) Household Health Service Utilization and Expenditure Survey EFY 2003 (2010/11) March 2014 Recommended Citation: Ethiopia Ministry of Health. April 2014. Ethiopia’s Fifth National Health Accounts 2010/2011. Addis Ababa, Ethiopia Program Management and support, funding for the NHA activities, and printing of this NHA report was provided by the United States Agency for International Development (USAID) through Health Sector Financing Reform/Health Finance & Governance (HSFR/HFG) Project which is part of the USAID’s global Health Finance & Governance Project (HFG) Implemented by Abt Associates Inc. under cooperative agreementI -AID-OAA-A-12-00080. Table of Contents Pages List of Tables ....................................................................................................................................................... V List of Figures .................................................................................................................................................... VII Acronyms .......................................................................................................................................................... VIII Executive Summary ...........................................................................................................................................IX 1. INTRODUCTION ......................................................................................................................................... 1 1.1 The Ethiopian Economy ......................................................................................................................... 1 1.2 The Ethiopian Health Sector ................................................................................................................. 2 1.2.1 The Health System .......................................................................................................................... 2 1.2.2 Health Services ................................................................................................................................. 4 1.2.3 Health Outcomes ............................................................................................................................ 5 1.2.4 Health Care Financing .................................................................................................................... 6 1.3 Background to the Study ....................................................................................................................... 7 1.4 Objectives of the Study .......................................................................................................................... 8 1.5 Limitations of the Study ......................................................................................................................... 8 1.6 Organization of the Report ................................................................................................................... 9 2. METHODOLOGY OF THE STUDY ...................................................................................................... 10 2.1 Sampling Design .................................................................................................................................... 10 2.1.1 Coverage and Method of Data Collection ............................................................................. 10 2.1.2 Sampling Stages and Sample Selection ..................................................................................... 10 2.1.3 Sampling Weights.......................................................................................................................... 11 2.1.4 Sample Size and Sampling Frames ............................................................................................. 11 2.1.5 Recruitment and Training of Enumerators and Supervisors .............................................. 13 2.1.6 Deployment of Field Survey Teams.......................................................................................... 14 2.1.7 Data Processing and Analysis ..................................................................................................... 14 3. HOUSEHOLD CHARACTERISTICS ...................................................................................................... 15 II 3.1 Demographic and Socioeconomic Characteristics ....................................................................... 15 3.1.1 Age and Sex Composition .......................................................................................................... 15 3.1.2 Marital Status ................................................................................................................................. 15 3.1.3 Educational Status ......................................................................................................................... 16 3.1.4 Employment Status ....................................................................................................................... 17 3.1.5 Housing and Housing Amenities ............................................................................................... 18 3.1.6 Ownership of Physical Assets .................................................................................................... 21 4. GENERAL HEALTH STATUS .................................................................................................................. 23 4.1 Self-Reported Health Status and Incidence of Mortality ............................................................. 23 4.2 Use of Emergency Health Care ......................................................................................................... 24 4.3 Incidence of Mortality .......................................................................................................................... 26 4.4 Self-Reported Illnesses and Health Care Seeking Behavior ........................................................ 29 4.5 Reasons for Not Seeking Health Care ............................................................................................ 33 4.6 Prevalence of Chronic Illnesses ......................................................................................................... 36 5. USE OF OUTPATIENT HEALTH SERVICES ........................................................................................ 38 5.1 Outpatient Health Care Seeking Behavior ..................................................................................... 38 5.2 Choice of Outpatient Service Providers ......................................................................................... 41 5.3 Bypassing the Nearest Outpatient Service Providers .................................................................. 44 5.4 Distance Traveled to Obtain Outpatient Health Services .......................................................... 47 5.5 Patient Satisfaction with Outpatient Services ................................................................................ 48 5.6 Patient Compliance with Outpatient Health Care Treatment Prescriptions ......................... 50 6. USE OF INPATIENT HEALTH SERVICES ............................................................................................. 52 6.1 Inpatient Health Service Seeking Behavior ..................................................................................... 52 6.2 Choice of Inpatient Health Service Providers ................................................................................ 55 6.3 Bypassing the Nearest Inpatient Health Service Providers ......................................................... 57 6.4 Distance Traveled to Obtain Inpatient Health Services .............................................................. 60 6.5 Patient Satisfaction with Inpatient Health Services ....................................................................... 61 7. HEALTH CARE EXPENDITURES ........................................................................................................... 63 III 7.1 Out-of-Pocket Expenditures on Health Care ................................................................................ 63 7.2 Health Spending by Type of Health Services and Health Care Providers ............................... 65 7.3 Health Spending by Type of Service and Components of Health Care ................................... 67 7.4 Source of Funds for Financing OOP Health Spending ................................................................. 71 8. HEALTH INSURANCE COVERAGE ..................................................................................................... 73 8.1 Health Insurance Coverage ................................................................................................................ 73 8.2 Source of Money for Payment of Health Insurance Premiums .................................................. 75 9. CONCLUSIONS AND POLICY IMPLICATIONS .............................................................................. 76 9.1 Conclusions ............................................................................................................................................ 76 9.2 Policy Implications ................................................................................................................................ 79 References ........................................................................................................................................................