Six Building Blocks of the Health System: Progress towards integration in Ethiopia

The Health Sector Development Program (HSDP) is based on the integration of the six building blocks of the health system: (i) service delivery; (ii) health workforce; (iii) information; (iv) medical products, vaccines and technologies; (v) financing; and (vi) leadership and governance. The backbone of “service delivery” is the Health Extension Programme to provide integrated preventive, promotive and basic curative services at community level. Furthermore, at all levels, programmes are integrated at the point of service delivery. Concerning “health workforce”, the focus is on the production of key categories of health workers in short supply (i.e., new cadres, such as integrated emergency surgery officers), integration in skill mix, task shifting, public-private partnership, and cost-effectiveness in staff retention and motivation. Integration has been ensured for “information”, “financing” and “leadership and governance” building blocks according to the principle of harmonization “One-Plan, One-Budget and One-Report”. In particular, different data sources have been integrated for evidence-based decision making, as well as an integrated reporting system has been implemented for performance monitoring and accountability purposes. Monitoring the performance of the health sector is based on a core set of sector-wide indicators that provide a comprehensive picture of sectoral performance, with an explicit statement on planned targets and measurement of actual achievements. Concerning “medical products, vaccines and technologies”, the implementation of the integrated pharmaceutical logistic system is under way, while health insurance has started implementation and the Millennium Development Goals (MDG) Performance Fund has been established as a pooled funding mechanism to finance priorities under HSDP. “Leadership and governance” has ensured strategic policy frameworks combined with effective planning, monitoring, and accountability. Progress have been made towards the integration of building blocks; however, huge challenges have still to be addressed to speed the current pace of change into dramatically faster progress to achieve MDGs by 2015.