Ethiopia is one of the poorest countries in the world, with gross national income of US$100 (in 2000), less than half the average for Sub-Saharan Africa. Neonatal deaths of some 135,000 a year account for 29 percent of child deaths. According to a 2000 demographics and health survey, coverage of care is extremely low: only 6 percent of women deliver with a skilled attendant present and only 8 percent receive postnatal care within 48 hours of delivery. The poor and those in rural areas have even lower coverage. Health professionals are in short supply. At the same time, obstetric services may be unused even when accessible because of issues of affordability and acceptability (most health workers are male).
In 2004, the government and major stakeholders held a national partnership conference to develop a national plan for scaling up child survival interventions. The government decided on a health extension package that would deploy two female health extension workers to each kebele (commune of 5,000 inhabitants). Those workers are mainly responsible for MNCH interventions, such as immunization, micronutrient supplementation, and family planning, but they also have other public health and some clinical responsibilities. In addition, one primary school graduate per 50 families will be trained to promote healthy family behaviors.
Estimates based on the marginal budgeting for bottlenecks tool suggest that, during the first eight years, progressive scaling up of the health extension and health promoters packages, together with some upgrading of clinical services, will cost an additional US$4 per person per year. That effort could result in a 30 percent reduction in the NMR, attributable mostly to improved behaviors, such as clean delivery and exclusive breastfeeding, and to increased demand for care. Increased coverage with family planning and tetanus toxoid vaccination through the health extension package accounts for about 10 percent of the NMR reduction. By the end of the 12-year period, an additional 30 percent reduction in NMR is expected from strengthening clinical services. A comprehensive package of family-based, outreach, and clinical services is projected to reduce the NMR by nearly 50 percent, associated with a 25 percent reduction in the maternal mortality ratio—as compared with a less than 5 percent reduction in the maternal mortality ratio with family and outreach care alone. The incremental annual cost of almost US$10 per person is more than three times current public spending on health of US$2.70
Source: Knippenberg and others 2005.