In his campaign to be Director-General of the WHO, Tedros Adhanom Ghebreyesus often returns to a familiar touchstone: his efforts as Ethiopia’s Minister of Health to reform the country’s health system. The initiative paid huge dividends: HIV/AIDS, tuberculosis and malaria deaths dropped by more than 50%, as The New York Times recently noted.
Will this and other experiences be enough to persuade countries to vote for him? The answer will be decided at the next World Health Assembly, which opens May 22 in Geneva.
In this 3rd part of the GHN Q&A, Tedros explains how health system reforms were carried out and the lessons he learned from the experience.
Tell us about the reforms you led in Ethiopia’s health system and the results.
The reform effort in Ethiopia had to start with a shift in mindset and attitude toward one with a focus on primary care with health promotion and disease prevention at its core and one which prioritized accountability and a metrics and results-orientation within the Ministry itself. We then had to build all the necessary inputs for the system—investing in thousands of new health centers and health posts, strengthening our pharmaceutical supply chain, developing an information system from the grass roots to headquarters that would accommodate our diverse patient and provider needs, and importantly increasing financing for the system. To strengthen our human resources, we used task shifting—moving tasks from higher to lower-skilled providers with appropriate training—while at the same time investing heavily in new medical schools to train more providers. We also worked to ensure we were training professionals in all the necessary skills to conduct a comprehensive reform, for example, developing new master’s programs in hospital management, monitoring and evaluation and field epidemiology. The field epidemiology program was modeled on the [US] CDC’s epidemic intelligence officers, so Ethiopia had its own capacity to detect, monitor and respond to disease outbreaks. And finally, we looked for community-driven solutions, mobilizing 38,000 women health extension workers from communities across Ethiopia through the Health Extension Program, which put women at the core to promote healthy behaviors and expand access to basic health care services.
These investments paid off, and within 6 years, we had built a primary care system that covered the entire population. Investing in all the building blocks of the health system—service delivery, workforce, information systems, pharmaceutical supply chain, financing and emergency preparedness—also played a key role in achieving nearly all the Millennium Development Goals.
As we work toward the Sustainable Development Goals—and particularly universal health coverage—I believe this experience will be essential for the next Director-General, as we are asking countries make similar leaps. I am the only candidate with that hands-on experience, so I believe I would bring a unique perspective.
What was the most important lesson you learned from that experience?
We learned many lessons in this effort, but 3 I think are particularly relevant as the world looks to achieve universal health coverage. The first is we have to have political commitment at the highest levels of government. That commitment is necessary not only to secure the financing necessary, but also the flexibility to design a system that works for each individual country. Second is that we have to shift mindsets not just at the top of any organization but throughout. There needs to be a shared vision because from that flows the goals, priorities and specific tasks. Third, we need to set ambitious goals and make mobilizing the resources to meet them part of the plan.
When we started our efforts in Ethiopia, for example, we only had around 20% of the necessary resources, but we said, “this is where we need to go, so let’s develop the plan for mobilizing the other 80%.” And importantly, when I say ambitious, I mean ambitious in scale, speed and quality. Achieving goals like universal health coverage are too important not to set our sights on the endpoint we believe is right on all these dimensions and work toward that ambition.
This interview has been edited for clarity and length.
Read other installments of Global Health NOW’s Q&A with Tedros.
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