Primary Health Care in Ethiopia: From Haile Sellassie to Meles Zenawi

Abstract

This paper examines developments in primary health care (PHC) in Ethiopia under the authoritarian/feudal regime of emperor Haile Sellassie, the socialist/military rule of Mengistu Haile Mariam and the sprouting democracy and free market economy under Meles Zenawi. The focus is on health policy, progress and problems in implementing programs and on recent decentralization efforts. The primary health services of the Derg have been described1 but continuity and change under these three governments and the relationship with the health services of the rebel forces in Tigray and Eritrea has not been analyzed except for a paper on community participation.2 The grassroots, community based health services of the TPLF and EPLF have been characterized as efficient, equitable and community based, consistent with the PHC approach.3'4 Similar achievements were reported from other liberation movements, including those in Mozambique5 and Vietnam.6 Primary health care essentially is the application of the basic needs approach in the field of health, with a central focus on correcting inequities and improving the health status of the poor and dispossessed. The concept of PHC, developed at the WHO-UNICEF conference in Alma Ata in 1978, has been used during the last two decades in Ethiopia and most other developing countries with variable results. The Alma Ata Declaration of Health for All by the Year 2000