Effectiveness and sustainability of a diagonal investment approach to strengthen the primary health-care system in Ethiopia

Yibeltal Assefa, Dessalegn Tesfaye, Wim Van Damme, Peter S. Hill

Research output: Contribution to journalA1: Web of Science-articlepeer-review

Abstract

Weakness of primary health-care (PHC) systems has represented a challenge to the achievement of the targets of disease control programmes (DCPs) despite the availability of substantial development assistance for health, in resource-poor settings. Since 2005, Ethiopia has embraced a diagonal investment approach to strengthen its PHC systems and concurrently scale up DCPs. This approach has led to a substantial improvement in PHC-system capacity that has contributed to increased coverage of DCPs and improved health status, although gaps in equity and quality in health services remain to be addressed. Since 2013, Ethiopia has had a decline in development assistance for health. Nevertheless, the Ethiopian Government has been able to compensate for this decline by increasing domestic resources. We argue that the diagonal investment approach can effectively strengthen PHC systems, achieve DCP targets, and sustain the gains. These goals can be achieved if a visionary and committed leadership coordinates its development partners and mobilises the local community, to ensure financial support to health services and improve population health. The lessons learnt from Ethiopia's efforts to improve its health services indicate that global-health initiatives should have a proactive and balanced investment approach to concurrently strengthen PHC systems, achieve programme targets, and sustain the gains, in resource-poor settings.

Original languageEnglish
JournalLancet
Volume392
Issue number10156
Pages (from-to)1473-1481
Number of pages9
ISSN0140-6736
DOIs
Publication statusPublished - 2018

Keywords

  • ALMA-ATA DECLARATION
  • EXTENSION PROGRAM
  • DEVELOPING-COUNTRIES
  • AVAILABILITY
  • SERVICES
  • LESSONS
  • PEPFAR
  • POLICY
  • MEXICO
  • ZONE

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