Documenting the Achievements and Addressing the Challenges: Conclusion and the way forward

Ethiopia is making substantial progress towards the achievement of the Millennium Development Goals (MDG). To explain these patterns, it is important to note that the Health Sector Development Program (HSDP) is focused on increasing access to primary health care and strengthening health systems, implementation of harmonization, and reform of the health information system to support evidence-based decision making for performance improvement. While service coverage has improved over time, the performance has not been uniform across programs. Interventions that can be routinely scheduled, such as immunization, had much higher coverage than those that rely on functional health systems and 24 h availability of clinical services, such as skilled care at birth. These mixed results highlight that although interventions needed to control disease and to avert much of the burden of maternal and child disease are known, they require a functioning health system to have an effect at the population scale; although MDGs focus on specific diseases and conditions, targets cannot be achieved without strengthening health systems. Furthermore, progress towards the MDGs requires health to be prioritised within overall development and economic policies. In practice, this means recognizing health as a precondition for development and applying a health “lens” to processes such as civil-service reform, decentralization and growth plans. In the context of the ongoing decentralization in Ethiopia, integrated district health systems are the means by which specific health programmes can best be delivered to meet the overall health care needs. However, Ethiopia is still facing multiple challenges, derived from weak district management capacity, inadequate human resources, poor infrastructure, and insufficient funding. In fact, MDGs cannot be met with the limited resources available and Ethiopia will require further support from partners with improved aid effectiveness: this framework is inherent in the eighth MDG "Develop a global partnership for development”.