Availability of health care in Ethiopia is remarkably low and only 52% of the population actually have access to medical services of any kind.
In Ethiopia, infant mortality is 90.23 per 1,000 live births and one in every 8 children does not survive to its fifth birthday (source: WHO - World Health Statistics 2008). Ethiopia's main public health problems include HIV/Aids, malaria, respiratory infections and perinatal conditions.
Diseases that we take for granted as curable remain major killers in Ethiopia. Tetanus, diphtheria, measles and diarrhoea often cause death, particularly among children. Polio, whooping cough, malaria and other endemic diseases are features of everyday life. Providing a comprehensive health service, accessible to local communities, is presently beyond the scope of the Ethiopian government.
In recent times the country has experienced severe misfortune and political upheavals which have caused untold suffering to its people. According to the United Nations Children's Fund (UNICEF), per capita income in Ethiopia is US$220 and average life expectancy is 53 years (all figures: 2007).
According to the World Health Organization in its 2006 World Health Report, Ethiopia has a total of only 1936 medical doctors (in 2003), which is equivalent to about 2.6 per 100,000. Globalisation is said to affect the country, with many educated professionals leaving Ethiopia for a better economic opportunity in the West. Despite the Ethiopian government making recent salary increases to professionals nationwide, a general family doctor can get at least 85 times more annual salary working in the United States than working in Ethiopia. As of 2006, there are more Ethiopia-trained doctors living in the city of Chicago than remaining in Ethiopia.
Ethiopia has poor health status relative to other low-income countries, even within Sub-Saharan Africa (see Table 1-1). Largely, this can be attributed to preventable infectious ailments and nutritional deficiencies. Infectious and communicable diseases account for about 60-80 % of the health problems in the country. The Health and Health Related Indicator of Ethiopia's Ministry of Health (MoH) indicates that malaria, helminthiasis (a disease resulting from infestation with parasitic worms) and respiratory tract infections are the major causes of outpatient visits at the country's health institutions.
Widespread poverty along with general low income levels of the population, low education levels (especially among women), inadequate access to clean water and sanitation facilities and poor access to health services have contributed to the high burden of ill-health in the country. Average life expectancy at birth is also relatively low at 51.8 (50.5 for males and 53.1 for females) (1) and is further expected to decline to 49.4 years if present HIV infection rates continue (2).
This situation is further aggravated by the high population growth. Young people constitute one third of the total population in Ethiopia. This implies profound reproductive health needs. The major reproductive health problems faced by the young population in the country are gender inequality, early marriage, female genital mutilation (FGM), unwanted pregnancy, closely-spaced pregnancy, unsafe abortion, and Sexually Transmitted Infections (STIs), including HIV/AIDS (3).
Poor nutritional status, infections and a high fertility rate, together with low levels of access to reproductive health and emergency obstetric services, contribute to one of the highest maternal mortality ratios in the world: 77/1,000 live births (4).
Nutritional disorders rank among the top problems affecting the population in general and children and mothers in particular. The Ethiopia Demographic and Health Survey (EDHS) 2000 found that:
• 52% of children under the age of five years were stunted while 26.3% were severely stunted;
• 11% were wasted and 1% severely wasted;
• 47% were underweight and 16% severely underweight;
• Infant and under five mortality are 97/1,000 and 140/1,000 respectively.
Malaria remains the major causes of morbidity as well as mortality in the country. A study conducted in year 2001 indicated that only 31% of cases of fever seen in health facilities were properly managed; only 7 % of children with malaria received early diagnosis and treatment and the case fatality rate was 5.2% (5).
The HIV epidemic has expanded rapidly over the last two decades and in 2003, prevalence was estimated at 4.4% of the adult population. It is also estimated that 1.5 million people are living with HIV/AIDS - this is a staggering number to cope with for a resource poor country. Although there are encouraging signs regarding the rate of progression of the epidemic in the last few years, there is no room for complacency. Given the size of the population and the magnitude of damage already inflicted, it will take a number of years to see a noticeable decline in the socio-economic impact of the disease. Similarly, despite the advances in management of the epidemic and the increasing resource availability, the situation faced is still far from ideal and one which is unlikely to give respite in the near future.
Worldwide, non-communicable diseases account for some 60% of mortality and 47% morbidity(6). Changing nutritional intake is causing an increase in the incidence of diabetes and hypertension. Increasing urbanisation contributes to an increase in morbidity and mortality from traffic accidents.
It is estimated that by year 2020 over 70% of the global burden of diseases will be caused by non-communicable diseases. In Ethiopia, although a national data is no available, some small-scale studies show that chronic and non-communicable diseases are emerging as public health problems. For instance, a study in Butajira area, Central Ethiopia, showed that 24% of the 'DALYs' is attributable to non-communicable disease (7).
Note: DALYs for a disease are the sum of the years of life lost due to premature mortality (YLL) in the population and the years lost due to disability (YLD) for incident cases of the health condition. The DALY is a health gap measure that extends the concept of potential years of life lost due to premature death (PYLL) to include equivalent years of 'healthy' life lost in states of less than full health, broadly termed disability. One DALY represents the loss of one year of equivalent full health. (Source: WHO).
Another small-scale study in Jimma indicated a prevalence rate of 7.3% for cardio-vascular diseases, hypertension, asthma, epilepsy, cancer and diabetes mellitus (8). Studies have indicated that the prevalence of mental health problems range from 3.5% to 17% in Ethiopia with prevalence being higher among women (9). Alcohol and stimulant abuse (particularly the narcotic ‘chat' or ‘khat' plant) and ‘stress' aggravate these problems (10). In terms of DALYs, mental health problems accounted for 11% of the total loss (11).
Ethiopia is also known to have one of the highest levels of road traffic accident in the world. In one study it was reported that the road traffic injury and fatality rates were 946 and 59.5 per 10,000 registered vehicles, respectively (12).