Ethiopian Healthcare - Sure & Steady

As our plane touches down in Addis Ababa, the capital of Ethiopia, we are pleasantly surprised by how cool the air is and how crisp the sun is. The weather was more mid-summer English midlands than sub-Saharan Africa. More pleasant surprises were in store as we went about our journey to better understand this fast changing country in the eastern part of Africa. Ethiopia is on the rise. There is a visible boom in the country’s infrastructure and the city is dotted with construction sites and real estate development that indicates better days ahead. The Chinese are here busily building away, as is a large expats community as part of the multi-lateral agencies that setup offices in Addis.

As we drive through the city, our taxi driver proudly shows us the city center with its new shopping malls, hotels, business centers and the new African Union building. The aspiration is clearly to become the Geneva or Vienna of Africa, the veritable capital of Africa. We were keen to understand how this country transformed from the gloomy days of the 80’s and 90’s when a military Junta ran the country to a more reformist, democratic yet very tightly controlled country now looking aspiringly towards the future.

Ethiopian healthcare, like much of the country, is also undergoing a sea change. A raft of reforms - introducing a professionalized cadre to manage public hospitals, restructuring of the payment and payer architecture, federalization of governance and introduction of quality monitoring in public health have created a better, more well managed system. The pubic health system is not without its shortcomings. Much like India, there is overcrowding and often inefficiencies that riddle the delivery mechanism. Availability of infrastructure – medical and non-medical and the crippling power crisis is a bane to the delivery of quality care. When we visit the Black Lion Hospital, the largest public hospital in Addis and a part of the University of Addis Ababa Medical Centre, long waiting lines await us. The availability of diagnostics and investigative infrastructure is often patchy as are long waiting times. Having said that, the center is free at the point of use and offers primary, secondary and tertiary care. The new Cardiac Centre is state of the art and well equipped, however, the availability of trained manpower remains a critical issue in its optimal use.

The inadequacy of the public system has led to a growth in private healthcare. As I sit down with Prof. Kabede Oli, CEO of the rather aptly named Landmark Hospital, I ask him about how private healthcare has evolved in the country. “There is unprecedented growth in private provisioning, given the gaps in the system and a more demanding patient base”, says Prof. Oli, over a cup of aromatic Ethiopian coffee that is peaty and sweet all at once. Prof. Oli has straddled both sides of the system. Having spent his career in the public system, he points to the merit and demerits of both the public and private system. The drivers for private healthcare remain much like anywhere else in the world. A rising middle-class not averse to spending money for quality. Some good practitioners moving from the public sector to setup independent practices. The pressures on the public health system. A growing penchant for an open economy that will surely further accelerate this growth.

I ask Prof. Oli about a possible divide between the private and public health systems. Between the haves and have-nots. His answer was indicative. He says the divide is growing, especially since there has been an exponential growth in private healthcare. Though he still argues that private healthcare will help the system by reducing the burden of the public sector. There is no doubt that the health infrastructure in the public sector is in need of the type of investment that one sees in the private sector.

What is heartening to note is the aspirations that have swept the country and its people. Dr. Oli asks me about the requirements of Joint Commission International, an international accreditation agency known for its stringent quality standards and demanding assessments. As aspirations and incomes grow people will come to expect quality, and with that one hopes more hospitals aspiring for outcomes and not just outputs.

The growing burden of Non-Communicable Diseases (NCD’s) in Ethiopia is very evident. Most specialists I spoke with noted an increased rate of diabetes, heart disease, cancer and infectious diseases. This has led to new innovative delivery models now being established. Dr. Gavit, a practitioner who has worked in diverse health systems like those of the United States, the United Kingdom and Germany proudly showed me his new medical center. He intends to use the facility primarily for preventive health checks and disease management. He says there is a growing need for such infrastructure given the changing demographics and disease profiles.

I ask Dr. Gavit about what he believes would be the future of Ethiopian healthcare. Like many others he expressed his country’s desire to create a health system that is self reliant, efficient and self-sufficient. Most health practitioners here hold India as a shining example of healthcare that is advanced, yet accessible. Where public and private healthcare need not have an antagonistic existence.

As I was boarding the plane back to India, I noticed a mother carrying her child, clearly in need of advanced neurological attention. She told me that she is going to a hospital in Delhi to seek treatment. I asked her why did she not use the hospitals in Ethiopia. She replied plainly, our system is good for basic care and some advanced care, but for specialized treatment, we have to look for options abroad. As I wished her luck, it helped me contextualize the changing healthcare landscape of this vast and beautiful country, which has an ancient culture, language and history. It lies at the cusp of moving from a externally reliant system to a more self-sufficient one, aspiring to ensure that its system can take care of its citizens. It could well look at India to learn on the opportunities and pitfalls that our system has to offer its citizens as its looks to dominate the African social, political and economic discourse.