In the past, I have blogged about some country-specific case studies that have been launched to evaluate the system wide effects of rapid ART scale up in developing countries. In this month’s PLoS of Medicine, a case study of the Ethiopian experience based on secondary document analysis, was published by Yibeltal Assefa, Degu Jerene, Sileshi Lulseged, Gorik Ooms, and Wim Van Damme.
In their paper, they document the rapid expansion of ART treatment in Ethiopia since about 2003. As of today, over 100,000 patients are receiving ART treatment in Ethiopia up from nearly nothing just half a decade ago. About 25% of those who have started ART in the public sector have been loss to follow-up or presumably have died.
Their work highlights some successes and some potential areas for concern. They find find no major declines in measures of health system performance and actually find that indicators such as infant and child mortality immunization coverage have improved in recent years. However, they also find that there has been a rather dramatic decline in physicians in the public health service and attribute this to internal migration of health professionals towards mainly AIDS NGOs who have “poached” these workers. However, it appears that simultaneously there have been other efforts to rapidly scale up human resource availability in the country, so that the number of other health professionals has increased over this time period offsetting these losses.
This work points to an overall positive picture in Ethiopia, perhaps because it was able to so rapidly scale up human resource availability over this time period. Ethiopia is usually considered an outlier on how it is handling its health workforce needs, so it would be interesting to think about how realistic it would be to assume similar effects in other countries. But, I am happy to see yet another case study that is adding to our knowledge of the impact of global health initiatives on health systems. I’m off to Ethiopia in a few weeks and am looking forward to seeing some of this myself first hand.Share on Facebook