Development aid and health equity in Ethiopia

Terefe Degefa,Kristian Hoelscher

doi:10.1080/21665095.2020.1794921

Terefe Degefa, Kristian Hoelscher

Open Access

https://doi.org/10.1080/21665095.2020.1794921

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Abstract

ABSTRACT In recent decades, Ethiopia has been a major recipient of development aid and made considerable progress towards achieving development outcomes, particularly in the health sector. Central to this has been reforms prioritizing community-based health interventions and a commitment to attaining universal health coverage (UHC). Yet while encouraging, access to health services has tended to disproportionately benefit those with greater economic means, higher levels of education, or those residing in urban areas. In light of this, the current article examines the progress towards UHC and donor organizations’ perceptions of how development aid intersects with issues of health equity in Ethiopia. Using primary qualitative interviews with bilateral and multilateral donor organizations and a review of relevant policy documents, we consider how issues of equity in health coverage are understood and reflected in the positions of donors. In doing so, we shed light on the processes underlying and shaping donor actions in supporting progress towards achieving equitable and universal health coverage in Ethiopia and identify challenges that remain.

Highlights

Inequitable access to healthcare is a fundamental development and human rights issue (Braveman and Gruskin 2003b; WHO 2008) and global policy agendas such as the Sustainable Development Goals (SDGs) have converged around the need to address health equity (Marmot and Bell 2018)
Drawing on semi-structured interviews from key informants at bilateral and multilateral donors and supported by document analysis, we examine donor perceptions on Ethiopia’s health sector progress and how issues of health equity are being operationalized by donor organizations
We accessed the majority of the key bilateral and multilateral organizations operating in the sector, and individuals we interviewed were in senior positions with considerable experience and knowledge of both their own policy priorities and the terrain of the Ethiopian health sector more broadly

Summary

Introduction

Inequitable access to healthcare is a fundamental development and human rights issue (Braveman and Gruskin 2003b; WHO 2008) and global policy agendas such as the Sustainable Development Goals (SDGs) have converged around the need to address health equity (Marmot and Bell 2018). Tackling issues of equity and inequalities was seen to have been considerably under-represented and that ‘a new, ninth (MDG) Goal need(ed) to be added – to reduce inequality’ (Fukuda-Parr 2010, 34). The inclusion of SDG Goal 10 focused on reducing inequality within and among countries, reflecting a shift that is beginning to change ‘well-established understandings of development’ and may result in ‘changes to the way “development” is conceptualized’ (Freistein and Mahlert 2016, 2040). The increased attention to equity concerns as constituent aspects of development agendas is central to health-related global development goals. The 2005 Assembly meeting of the World Health Organization introduced the landmark resolution on Sustainable Health Financing, Universal Coverage and Social Health

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