TY - JOUR
T1 - Aligning priorities in Ethiopian health finance
T2 - How do the essential health services package and health benefit plans compare?
AU - Koon, Adam D.
AU - Wright, Jenna
AU - Ageze, Leulseged
AU - Charles, Jodi
AU - Holtz, Jeanna
N1 - Funding Information:
This study was made possible by the United States Agency for International Development's financial support of the Health Finance and Governance project. The authors thank the many health financing experts interviewed for this study for sharing their time and wisdom. We recognize their important contributions and the stewardship of the Ministry of Health in expanding access to health care in Ethiopia. We are grateful to the staff at the Health Sector Financing Reform/Health Finance and Governance project office in Addis Ababa for their support and their expertise on the Ethiopian health system. Finally, the authors thank Hailu Zelelew, Jeremy Kanthor, and Chris Lovelace for their helpful comments on an earlier draft of this manuscript. This work was supported by the United States Agency for International Development (AID‐OAA‐A‐12‐00080), under the Health Finance and Governance Project.
Publisher Copyright:
© 2021 John Wiley & Sons Ltd.
PY - 2022/1
Y1 - 2022/1
N2 - Priority setting is a key function of health systems in low- and middle-income countries that seek to achieve universal health coverage. Essential health services packages (EHSPs) and health benefit plans are two types of instruments used in setting health care priorities. Both instruments exist in Ethiopia, but little is known about how they are aligned. To gain insights into the evolution, purpose, policy objectives, and governance of the EHSP, community-based health insurance (CBHI), and social health insurance (SHI) in Ethiopia, we conducted a case study. This included a desk review of relevant documents as well as qualitative analysis of key informant interviews conducted with 15 leading health finance experts in Addis Ababa. Interviewees understood the EHSP to be a key priority-setting instrument in the country by coordinating the activities of health system stakeholders, and guaranteeing the right of citizens to a basic level of care. Community-based health insurance and SHI were described as mechanisms for the government to expand health coverage and provide financial protection. Interviewees acknowledged that Ethiopia had drawn on the experience of other countries when designing health benefit plans, but contrasted Ethiopia's experience with that of other countries. We found that in Ethiopia, the EHSP, CBHI, and SHI are not explicitly aligned. We propose that EHSPs play an important role in early stages of health systems development. However, as governments develop health benefit plans with expansive packages of services, the importance of EHSPs becomes less clear.
AB - Priority setting is a key function of health systems in low- and middle-income countries that seek to achieve universal health coverage. Essential health services packages (EHSPs) and health benefit plans are two types of instruments used in setting health care priorities. Both instruments exist in Ethiopia, but little is known about how they are aligned. To gain insights into the evolution, purpose, policy objectives, and governance of the EHSP, community-based health insurance (CBHI), and social health insurance (SHI) in Ethiopia, we conducted a case study. This included a desk review of relevant documents as well as qualitative analysis of key informant interviews conducted with 15 leading health finance experts in Addis Ababa. Interviewees understood the EHSP to be a key priority-setting instrument in the country by coordinating the activities of health system stakeholders, and guaranteeing the right of citizens to a basic level of care. Community-based health insurance and SHI were described as mechanisms for the government to expand health coverage and provide financial protection. Interviewees acknowledged that Ethiopia had drawn on the experience of other countries when designing health benefit plans, but contrasted Ethiopia's experience with that of other countries. We found that in Ethiopia, the EHSP, CBHI, and SHI are not explicitly aligned. We propose that EHSPs play an important role in early stages of health systems development. However, as governments develop health benefit plans with expansive packages of services, the importance of EHSPs becomes less clear.
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U2 - 10.1002/hpm.3349
DO - 10.1002/hpm.3349
M3 - Article
C2 - 34636078
AN - SCOPUS:85116850536
SN - 0749-6753
VL - 37
SP - 417
EP - 428
JO - International Journal of Health Planning and Management
JF - International Journal of Health Planning and Management
IS - 1
ER -