Success in Protection of the Poor in Ethiopia: Lessons From Fee Waiver Scheme Implementation in Amhara Region

Success in Protection of the Poor in Ethiopia:  Lessons from Fee Waiver Scheme Implementation in Amhara Region

Abstract

Background: Amhara is the second most populous region in Ethiopia with a total population of 17.69 million [BoFED, Amhara, 2011]. Health service utilization in Amhara is 0.28 [RHB, annual report, 2011]. Poverty impedes access to basic health services for many Ethiopians.

Methods: Compilation and analysis of checklist-based supportive supervision data was used.  Primary data on number of fee waiver beneficiaries and associated fees charged for use of services and medicines by indigents was collected from 124 health facilities in 2011. Data on budget allocation to indigents was collected from 122 district administrations.  

Results/outcome:  A total of 1,319,114 indigents received free healthcare services. Average number of fee waiver beneficiaries and government budget allocation for waiver reimbursement per district were 7,946 and Birr 20,791, respectively.  A great proportion of the facilities (53.3%) were reimbursed on the basis of fee for service and 43.8% of them on capitation. As the selected fee waiver beneficiaries were too poor to pay for health services prior to reform implementation, access to health services for this segment of the population increased.    

Conclusions:  Over 1.3 million indigents currently are getting basic health services in the region. The implementation of the fee waiver scheme has contributed to reducing barriers for accessing health services by the poor and increased health facilities' internal revenue for quality improvement. Equity in health service delivery has improved. The community and the government have actively participated in identification and selection of, and budget allocation for, indigents. Ownership of the reform together with commitment and perseverance of the regional government and implementing partners is all behind the success in fee waiver scheme implementation. It is also strongly recommended that the experience be shared with other regions and countries.