Improving health service coverage through change in health system structure: The Experience of Ethiopia

The Ethiopia health care system was following a centralized management and a long tier health care delivery system prior to the early 1990’s. With this system health services were mostly accessible to the urban and peri-urban population and the rural majority and the underserved were inaccessible. Following the 1993 health policy of a decentralized health management and a better health care delivery tier system, access to health services has improved a lot for the rural majority and the overall national health service coverage has increased significantly. Specifically with the introduction of a community based health care delivery system using health extension workers has shown a  dramatic change in most maternal and child health indicators. These advances are owed largely to government efforts with substantial support from the development partners. Although impressive progress has been made in access to health services, there is still work to be done in improving the quality of services and sustaining the gains achieved.