Ethiopia has been implementing Health Sector Development Programme (HSDP) since 1997/8 (1990 Ethiopian Calendar (EC)). The first phase of HSDP was completed in 2002 and the second phase was completed in June 2005. This necessitated the development of the third phase of HSDP, which covers a period of five year i.e. July 2005 to June 2010.
There is a new, four-tier structure to the health service, not only providing the infrastructure for the delivery of health care (which the project will strengthen through the provision of medical equipment), but also for the continuing education of health teams at various levels.
Tier 1: The Primary Health Care Unit. A health centre will cater for 25,000 people and is fed by five health posts, each responsible for 5,000 people. Every health centre is to be staffed by a health officer, a clinical nurse, a community nurse, an environmental sanitarian and a laboratory technician.
Tier 2: The District Hospital. To be fed by ten health centres covering a population of 250,000. Staffed by four GPs and a health officer, together with clinical and community nurses, a pharmacist and a laboratory technician. It will carry out routine curative and referral care and oversee the community health work of the population. There will be only limited cold surgery as the emphasis will be on life saving surgery with appropriate training provided for GPs. Gonder College of Medical Sciences (GCMS) is the only district hospital within the area of the project.
Tier 3: The Regional Hospital. Staffed by six or more specialists and serving a population of one million, it will be responsible for the referral work from district hospitals and will be the focus of training and development. GCMS fulfils this role also.
Tier 4: Specialist Hospitals. These comprise of regional hospitals with specialist units serving 5 million people. Again, GCMS fulfils this role but the specialist units are underdeveloped.
The new health care structure for the country assumes a much stronger role for the health centres, assumes decentralisation of care and services, and seeks to meet the needs of the poorer rural population as well as reducing the burden on the central hospitals. Our project acknowledges the capability of current medical staff but recognises the restrictions placed on their capacity through the lack of necessary medical equipment.