By Elias Meseret
Among the many pressing challenges facing Ethiopia today is the issue of creating an effective national health care system.
Nowadays, the private sector is taking on an increasingly larger share of the provision of medical care. In this regard, the growth of private hospitals is an encouraging sign.
However, there are increasing signs that this sector is getting out of control, as some of the institutions are simply doing business without having regard to the patients they take care of. Discussions over the issue have sparked a lot of controversy recently after what happened to the late legendary singer Tilahun Gesesse in his last hours.
Horror stories ranging from patients being given wrong medicines to the unavailability of health officers during the night time are becoming common these days. The quality check that the Government conducts on these private health institutions is also questionable. As Capital found out after visiting some of them, the majority of the private health sector is neither willing to take the blame nor to prepare themselves for a better service delivery in the future.
Wolde Rufael Dirar, head of health institutions inspection and quality control in the Addis Ababa Health Bureau (AAHB) agrees that there is a problem.
“We really understand that there are private hospitals and clinics that are functioning either beyond their capacity or below their capacity by taking only their business interests into consideration. We are now preparing a task force to tackle it,” he told Capital. “In the coming fiscal year, we are also preparing to take over the control on pharmacies and health experts’ registration and licensing from the Federal Government. This will give us the edge in tackling the current problems that are attracting a lot of debate.”
According to Wolde Rufael, who took over the position three months ago, the case with Tilahun is under investigation by experts from the city’s health bureau and the Ministry of Health (MoH). He told Capital that Betezatha and Senay hospitals are under scrutiny regarding what happened the day the singer passed away. “The investigation has been ordered by the minister of health. The report will be finalised in the coming few days and we shall wait and see what results and actions will be taken.”
In Ethiopia, most health institutions, both private and public, are concentrated in urban centres. The World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and the United States Agency for International Development (AID) provide technical and financial assistance to eliminate the sources of health problems in the country.The people who mainly get service from private health institutions are still the well-to-do citizens who can pay more to get a ‘better’ service.
It is, however, undeniable that the Government has embarked on an effort to spread health care services throughout the county. In addition to establishing hospitals, health centers, and outpatient clinics, it has also initiated programs to train Ethiopian health care personnel so that they can supplement the private institutions that exist in a few major urban centres.
“I totally do not agree with the presupposition that private hospitals are not working properly. We are the ones who supplement the often congested and inefficient public hospitals. Note should be taken that we all should not be blamed for faults by some institutions,” owner of one of the biggest private hospitals in Addis, who wished to remain anonymous, told Capital.
The Government has increased the involvement of the private sector, both for profit and non-profit, in the delivery of health services. Today, practically all drug vendors and drug stores are privately owned, as are more than 70 per cent of pharmacies. The role of private health clinics and medical services is growing in importance, particularly in urban areas. According to the latest figures, there are over 200 NGO health clinics and eight NGO hospitals operating throughout the country, particularly in rural areas.
Government recognition of how the public and private sectors can complement each other is growing, and it will propose improved regulation in a number of areas, including hospital autonomy, pharmaceutical distribution and licensing.
AMERF, one of the NGOs working in the health sector in Ethiopia, says 60 per cent of health workers leave their job within a year, many abandoning the public sector for better paid posts in the private sector. According to a medical doctor, who also declined to be named, due to what he calls ‘heat’ in relation to the death of Tilahun, specialist doctors are now paid not less than 25 to 30 thousand birr a month.
Concerning the exorbitant fess that private hospitals charge, there are confusing answers. While the city’s health bureau says it cannot interfere in such price adjustments, as there is a free market principle in place, private hospitals say their profit margin is not as big as some suggest.
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