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Primary health care in Ethiopia under three political systems: Community participation in a war-torn society

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  • Kloos, Helmut

Abstract

This paper examines primary health care (PHC) development with an emphasis on community participation in Ethiopia under the feudal regime of emperor Haile Sellassie, the socialist/military rule of Mengistu Haile Mariam and the sprouting democracy and free market economy of Meles Zenawi. In spite of the rapid expansion of primary care under Mengistu, community participation was hampered by the protracted war and centralized, urban-based, bureaucratic approaches and attitudes that failed to promote an enabling environment for community participation. The socialist government, although implementing various community programs and expanding the rural health services, did not succeed in revolutionizing the health services. A comparative examination of the democratized rebel health services of the Eritrean People's Liberation Front (EPLF) and the Tigray People's Liberation Front (TPLF) illustrates the inconsistencies between stated policies of the Ethiopian government and actual strategies, and identifies factors promoting and impeding participatory health care development in a war environment. Achievements, opportunities and potential dangers to PHC and community participation in the post-war era characterized by economic progress, democratization, decentralization, lingering ethnic conflict and private initiatives are briefly described.

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  • Kloos, Helmut, 0. "Primary health care in Ethiopia under three political systems: Community participation in a war-torn society," Social Science & Medicine, Elsevier, vol. 46(4-5), pages 505-522, February.
    • Handle: RePEc:eee:socmed:v:46:y::i:4-5:p:505-522
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    Citations

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    Cited by:

    1. Shuey, Dean A. & Qosaj, Fatime Arenliu & Schouten, Erik J. & Zwi, Anthony B., 2003. "Planning for health sector reform in post-conflict situations: Kosovo 1999-2000," Health Policy, Elsevier, vol. 63(3), pages 299-310, March.
    2. Maes, Kenneth C. & Hadley, Craig & Tesfaye, Fikru & Shifferaw, Selamawit, 2010. "Food insecurity and mental health: Surprising trends among community health volunteers in Addis Ababa, Ethiopia during the 2008 food crisis," Social Science & Medicine, Elsevier, vol. 70(9), pages 1450-1457, May.
    3. Tewodaj Mogues, 2011. "The Bang for the Birr: Public Expenditures and Rural Welfare in Ethiopia," Journal of Development Studies, Taylor & Francis Journals, vol. 47(5), pages 735-752.
    4. Mogues, Tewodaj & Ayele, Gezahegn & Paulos, Zelekawork & Fan, Shenggen, 2006. "How Effective is Public Spending? Public Investment Composition and Rural Welfare in Ethiopia," 2006 Annual meeting, July 23-26, Long Beach, CA 21258, American Agricultural Economics Association (New Name 2008: Agricultural and Applied Economics Association).
    5. Maes, Kenneth & Kalofonos, Ippolytos, 2013. "Becoming and remaining community health workers: Perspectives from Ethiopia and Mozambique," Social Science & Medicine, Elsevier, vol. 87(C), pages 52-59.
    6. Hirvonen, Kalle & Bossuyt, Anne & Pigois, Remy, 2017. "Complementarities between social protection and health sector policies: Evidence from the Productive Safety Net Program in Ethiopia," ESSP working papers 112, International Food Policy Research Institute (IFPRI).
    7. Kalle Hirvonen & Anne Bossuyt & Remy Pigois, 2021. "Evidence from the Productive Safety Net Programme in Ethiopia: Complementarities between social protection and health policies," Development Policy Review, Overseas Development Institute, vol. 39(4), pages 532-547, July.
    8. Nahu, Asteraye, 2006. "Determinants of demand for health care services and their implication on Health care financing: the case of Bure town," Ethiopian Journal of Economics, Ethiopian Economics Association, vol. 11(1), pages 122-122, April.

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