An assessment of the causes of malnutrition in Ethiopia: A ...

access to a basic package of quality primary health care services. This can be accomplished
with a decentralized state system of governance and with service packages that include
preventive, promotive, and basic curative and rehabilitative services. However, the health
facility to population ratio of the country still remains low and the scope of health care
services offered by these facilities are far from adequate.
The geographic coverage (based on the assumption of a health center serving 10,000
people) of conventional health facilities in Ethiopia is 64 percent (73.2 percent when private
facilities are included) (MOH 2005a). This appears to be satisfactory, given the size,
population, and economic potential of the country to increase the number of health facilities.
Currently Ethiopia has 2,899 health posts, 1,797 health stations, 519 health centers, and 126
hospitals. Nevertheless, overall access to health care and the level of funding to the system is
sub-optimal. Consequently, the national health infrastructure is plagued with a shortage of
trained workers, high attrition, and shortages of medicines and medical equipment. The
physician to population and the nurse to population ratio of the country are still far below the
desired norm set by the WHO for developing countries.
Utilization of formal health services has traditionally been low and remains so with
about 36 percent of the population utilizing such services each year. This is due, in part, to the
great geographical distance almost half the populatio n must travel to reach a health facility.
Furthermore, financing health care remains a major problem. The annual total per capita
health expenditure is only about US$5 (ibid).
In response to prevailing and newly emerging health problems in the country, the
high under-five morbidity and mortality rates, and in recognition of the weakness in the
existing health delivery system, the Health Sector Development Program (HSDP) was
launched in Ethiopia in 1998. In order to upgrade the health care services offered to the
general public, HSDP-I focused on three areas of health intervention program. These areas
were:
1) improve the coverage and the quality of health services;
2) ensure that HSDP-I was managed by regional, zonal and woreda health officials; and
3) be financia lly sustainable.
The HSDP-II began in 2002 and aligned itself with the existing and new health
related policies and strategies for a concerted and mutually reinforcing national effort to
improve the health sector (MOH 2003a).
The main policy contexts that are considered during the design and implementation of
HSDP-III (2005/6 – 2009/10) are the commitment towards the achievements of MDGs by
aligning the objectives and targets of the sector development program with that of the
Sustainable Development Poverty Reduction Program (SDPRP). In addition, the policy seeks
to institutionalize village health services through the implementation of the Health Service
Extension Program (HSEP), the Accelerated Expansion of Primary Health Care (PHC)
Facilities, and the Child Survival and Maternal Mortality Reduction initiatives. In this
context, creating adequate links between nutrition security issues and the Health Services
Extension Program is critical for increasing the population’s access to preventative health
services that reduce levels of child malnutrition, as well as morbidity and mortality.
The ultimate goal of HSDP-III is to improve the health status of the Ethiopian
population. The specific goals are to:
1) increase access to promotive, preventive and basic curative and rehabilitative services
to all segments of the population, especially women and children;
2) increase and maintain an acceptable standard of quality health services and ensure
proper utilization by population; and
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