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Ethiopia is the oldest nation in Africa and probably the world. Ethiopia during ancient times included all land south of Ancient Egypt (Kemet) and included: Meroe, Kush (Nubia), Punt – modern day Sudan, and all of East, West and North Africa.

According to Diodorus Siculus (History, Book III: 2), the Sicilian Greek historian who lived from 90 to 21 BC., the Ethiopians were the first people on earth and created the first system of letters for writing which is called hieroglyphic among the Egyptians, and mistakenly attributed to Egypt.

The world’s oldest and longest enduring royal dynasty was established in Ethiopia dating back to King Solomon and ending with Haile Sellasie, the last emperor of Ethiopia. Coffee was first produced in Ethiopia and is still the major national export.

Modern day Ethiopia still boasts notable historical and world cultural heritage sites including the Great Rift Valley, the birthplace of humanity, the churches at Lalabella, considered a Seventh Wonder of the World, Axum the capital of the old Kingdom, which had its own language (Geez), and is home to the oldest Church in Ethiopia, Our Lady Mary of Zion, built in the fourth century AD by the emperor Ezana at the start of the Christian era. It is also believed to be where the original Ark of the Covenant between God and Israel is housed.

Modern day Ethiopia is still a land of many ethnic groups, probably the most diverse national ethnic make up of any country, with more than 200 languages. The country was also home until recently to a tribe of ancient Hebrew Jews, Falashas, who were airlifted to Israel during the 1980s under the Jewish state of Israel Repatriation Program.

Modern Ethiopia is an African democracy with national elections, benefiting from two decades of peace and stability, and among the fastest growing economies in Africa. Today under the leadership of Prime Minister Menes Zenawi and his government, Ethiopia is recovering from two decades of conflict and misguided leadership under the previous military rulers (Dirge). The country has opened for business and has once again the vision to become a major leader on the African continent, a position it last held during the first half of the1970s.




Ethiopia's Director of Medical Health Services,
Dr Abraham Derso, speaks with Corporate Africa
CA: Dr Abraham, could you tell us about the overall state of health care in Ethiopia, especially in terms of infectious diseases, HIV / AIDS and TB in particular?
Dr AD: I can provide you with an overview of what is taking place in the Ministry, concerning HIV, TB, Malaria and other critical infectious problems, and also maternal and child health, all of which are considered to be our main concern.  Currently, we have accomplished  a considerable amount in terms of preventing the spread of HIV, where the prevalence rate stands at around 2.1 currently, with an HIV incidence of around 0.28.
CA: Is that percentage?
Dr AD: With regard to Malaria during the past year we have not seen any increase and mortality has also significantly decreased.  In terms of Tuberculosis the key detection rate remains at a required level, with the recovery rate standing at around 30 per cent currently. I would like it to be as high as 70 per cent but next year there will be more action to help increase detection rates. Our maternal mortality rates are 5.91 per hundred thousand head of population, and we have achieved an under 5 years old mortality rate of around 1.21. In these terms with regard to maternal mortality, in child care, as well as our measures against infectious diseases, we may achieve the Millennium Development Goals, although considerable work needs to be done in the next few years.
CA: So it seems that all around you have got good management control in term of these infectious diseases. But tell me, Dr Abraham, about the actual national health infrastructure that is being exploited to increase prevention etc.,  including infrastructure such as your hospitals, medical professionals, doctors and nurses?  What are the actual trends in terms of the number of doctors and their immigration for example?
Dr AD: Our health care system is on three levels, including a Medicare Plan, a health plan for buying courses of health treatment and for health centres
CA: Yes
Dr AD: These are the facilities for primary care.  One health course is expected to cater for five thousand people and a health centre is expected to serve 25 thousand people. Currently, we are also planning a new structure for primary hospitals, as part of the primary care sector, just to address the problem of obstetric emergencies. The second level is represented by general hospitals. We also have tertiary care levels represented by tertiary hospitals. Therefore  prevention services are represented in our health system, within the primary care level where we also have basic care services. Otherwise services are within the hospitals, as well as in the tertiary care level of the system.
CA: They supply the care?
Dr AD: In terms of the number of doctors, we have got one of the lowest experienced doctor ratios, especially when it comes to specialists as well as general practitioners; the number of doctors is very low. We also have the problem of external and internal migration; internally from the public sector into private facilities. So we do not have the number of doctors needed in some of our districts, so our ratio of doctors per head of population remains very low.
CA: What is the percentage?
Dr AD: It is like 1 doctor to more than 46,000 people.
CA: And with the increase of Malaria is it likely to be more?
Dr AD: Yes, this is the national situation. The government has been doing a good deal in terms of increasing the number of doctors, and by opening ten medical schools. There is also an attempt to implement a different strategy, which has worked very well specially with HIV. All HIV services should be matched with senior experienced doctors. We also have planned for mid level staff, like nurses and health officers to be involved and be properly trained, incorporating both the public sector and private institutions. We now have a thousand nurses being trained.  We anticipate similar trends during the next six years.
CA: Can I ask about the nature of health care. Is it public or  private?
Dr AD: We have a pluralistic type of healthcare, the majority actually being public, but especially in major urban areas and towns we also have a thriving kind of private healthcare. We also have member organizations – not- for-profit kinds of organizations. Otherwise the majority is public.
CA:  In terms of the national response strategy to infectious diseases, what role does the private sector play? In particular do international investors play any role at all?
Dr AD: In this sector with regard to HIV, TB and Malaria, we have gained a lot of support from bilateral and multilateral organizations for their programs. International development agencies have actually provided considerable technical as well as financial support.
CA: What about the private sector?
Dr AD:  The private sector also contributes a lot, especially with PPP programs with HIV and TB.   We have five facilities here in Ethiopia which will assist in HIV care. In terms of International private investments, currently a number of hospitals and health facilities are starting to buy international private facilities. The degree of support from international private financiers has enabled a program.
CA: In terms of PPP projects, are there any high visibility projects, incorporating the government and private investors out in the community. For example, in Nigeria you have Coca Cola that is supporting a major national TB program, are there any such programs in Ethiopia?
Dr AD: A few months ago, a pharmaceutical company working in collaboration with Coca Cola contacted us.  Coca Cola is sponsoring the supply of pharmaceutical drugs and a US company is involved as well.  We received a shipment of medicinal drugs and are waiting for additional supplies. The Ministry is organized in such a way that I am responsible for medical services and there are different departments or Directorates responsible for other functions.
CA: Some of the actual challenges you mentioned such as the number of doctors and related training,are challenges that are faced by most countries in Africa, and indeed, in the EAC Africa community. Is there any joint initiative or program in the EAC to train doctors and maintain their services? Is there a regional strategy?
Dr AD: I am not aware of such programs. I think that most of the training is just within Ethiopia and the private institutions. I am not aware of any regional collaboration.
CA: But Ethiopia is open to private investors in the health and Medicare sector?
Dr AD: We have got an investment agency with a laboratory to facilitate all kinds of programs which investors could partner. Ethiopia has a population of nearly 80 million but has few health facilities, and does not have nearly as many private heath facilities as the West. To find medical experts is very difficult but we intend to build them internal and with the support of partners from overseas and elsewhere.
CA: Thank you, Dr Abraham DERSO, Director of Medical Health Services, at the Ministry of Health, Ethiopia.