The Federal Democratic Republic of Ethiopia Ministry of Health HSTPHealth Sector Transformation Plan Health Sector Transformation Plan 2 HealthHSTP Sector Transformation Plan 2015/16 - 2019/20 (2008-2012 EFY) October 2015 Contents Acronyms .................................................................................................................................................... 7 Foreword by the Minister of Health ....................................................................................................... 10 Executive summary ................................................................................................................................. 12 Chapter 1: Introduction .............................................................................................................. 16 Chapter 2: Country Context ....................................................................................................... 18 Chapter 3: Performance of the Health Sector Development Programme (HSDP) – Situational Assessment ................................................................................................................................22 3.1. Community Ownership – the center of remarkable achievement .........................................22 3.2. Health Status – Impact and Outcome Analysis ........................................................................23 3.2.1. Overall health outcome: Life Expectancy and Demographic Dividend ...........................23 3.2.2. Reproductive, Maternal, Neonatal, Child, Adolescent and Youth Health (RMNCAYH) ...23 3.2.2.1. Maternal and child health MDG performance ...........................................................23 3.2.2.2. Child health services ....................................................................................................24 3.2.2.3. Maternal health services ............................................................................................25 3.2.2.4. Family Planning: ...........................................................................................................28 3.2.2.5. Adolescent and youth friendly reproductive health .................................................29 3.2.3. Nutrition ................................................................................................................................30 3.2.4. Prevention and control of major disease burdens ...........................................................31 3.2.4.1. HIV/AIDS, Tuberculosis and Malaria - MDG 6 Performance .....................................31 3.2.4.2. HIV/AIDS Prevention and Control Services ................................................................33 3.2.4.3. Tuberculosis and Leprosy Prevention and Control services; ...................................33 3.2.4.4. Malaria Prevention and Control Services ..................................................................35 3.2.4.5. Non-Communicable Diseases (NCD) ..........................................................................36 3.2.4.6. Mental Health...............................................................................................................37 3.2.4.7. Injuries ...........................................................................................................................37 3.2.4.8. Neglected Tropical Diseases - NTDs ..........................................................................37 3.2.4.9. Eye Health .....................................................................................................................39 3.2.5. Hygiene and environmental sanitation .............................................................................39 3.2.6. The unfinished agenda to further improve health status ...............................................40 3.3. Processes and Inputs ..................................................................................................................40 3.3.1. Health Extension Program ..................................................................................................40 3.3.2. Process of improving quality and access to health services ........................................... 41 3.3.3. Public Health Emergency Preparedness and Response ..................................................44 3.3.4. Health Information System ................................................................................................44 3.3.5. Health workforce .................................................................................................................45 3.3.6. Pharmaceuticals Supply Chain and Logistics Management ............................................ 47 3.3.7. Infrastructure and ICT .........................................................................................................49 3.3.8. Health Care Financing..........................................................................................................50 3.3.9. Regulation .............................................................................................................................52 3.3.10. Leadership, Management and Governance .......................................................................54 3.4. Situational Analysis from perspective of Equity......................................................................55 3.5. Lessons Learned from HSDPs ....................................................................................................61 3.6. Key successes and their contributing factors in the health sector .......................................64 Chapter 4: Health Sector Transformation Plan .......................................................................68 4.1. The Structure of HSTP: ................................................................................................................68 4.2. The Policy Framework .................................................................................................................69 4.3. The Health Sector Strategic Assessment ..................................................................................71 4.3.1. Vision of the Health Sector: ................................................................................................71 4.3.2. Mission of the Health Sector ..............................................................................................71 4.3.3. Core Values and Guiding Principles of the Health Sector: ................................................71 4.3.4. Strengths, Weaknesses, Opportunities and Threats - SWOT Analysis ..........................72 4.3.5. Stakeholder Analysis ........................................................................................................... 74 4.4. Strategy of HSTP .......................................................................................................................... 75 4.4.1. Customer Value Proposition ...............................................................................................75 4.4.2. Strategic Themes and Strategic Results ...........................................................................75 4.4.3. Strategic Perspectives .........................................................................................................83 4.4.4. The Health Sector Strategic Management House ............................................................83 4.5. Strategic Objectives (SO) and Strategy Map .............................................................................84 4.5.1. List of Strategic Objectives .................................................................................................84 4.5.2. Objective Commentary ........................................................................................................84 4.5.3. Strategy Map ........................................................................................................................98 4.6. Performance Measures and Strategic Initiatives ....................................................................98 4.6.1. C1: Improve Health Status ...................................................................................................98 4.6.2. C2: Enhance Community Ownership ..................................................................................99 4.6.3. F1: Improve efficiency and effectiveness ........................................................................100 4.6.4. P1: Improve Equitable Access to Quality Health Services ..............................................100 4.6.5. P2: Improve Health Emergency Risk Management ........................................................103 4.6.6. P3: Enhance Good Governance .........................................................................................103 4.6.7. P4: Improve Regulatory System .......................................................................................104 4.6.8. P5: Improve Supply Chain and Logistic Management ....................................................105 4.6.9. P6: Improve Community Participation and Engagement ...............................................106 4.6.10. P7: Improve Resource Mobilization ..................................................................................106 4.6.11. P8: Improve Research and Evidence for Decision-Making.............................................107 4.6.12. CB1: Enhance use of Technology and Innovation ............................................................108 4.6.13. CB2: Improve Development and Management of