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Ethiopia as a model for health care leadership

Despite extensive poverty and limited resources, Ethiopia has made impressive strides in improving its health care system and can serve as a model for other countries seeking to make similar gains, a new paper by Yale researchers suggests.
Ethiopian Health Minister Tedros Adhanom Ghebreyesus.

The east African nation - which is more than double the size of California and has one of the largest populations in Africa - has successfully applied concepts of grand strategy to implement achievable priorities, work with diverse partners and external funders and develop middle-level management to promote new health policies.

Taken together, the country's wide-ranging approach has resulted in tangible changes on the ground and in improved health for more than 80 million Ethiopians. Ethiopia has, for example, constructed numerous new health centers and clinics and trained personnel to staff them, expanded access to clean water and nutritious food and sharply cut the number of deaths from malaria.

"Ethiopia's health reform strategy has been guided by an extraordinary clarity of purpose, reflecting the priorities of the country rather than the priorities of donors," said Leslie Curry, a research scientist and lecturer at the School of Public Health and one of the paper's authors. "The real progress in areas that matter to the Ethiopian people reflects key strategic approaches, including authentic engagement of complementary partners and program implementation that can rapidly respond to front-line realities."

Ethiopia demonstrates that a country, even an economically disadvantaged one, can surmount internal and external obstacles and make measurable improvements in health within a relatively short time span, the authors said. The paper traces Ethiopia's improved health care system to the 2005 appointment of Health Minister Tedros Adhanom Ghebreyesus and the country's ongoing partnership with the William J. Clinton Foundation.

Yale researchers also continue to work closely with health and government officials in Ethiopia to address the country's health challenges. Ethiopia, for instance, sends a delegation of health officials to Yale each spring for the Global Health Leadership Institute (GHLI) seminar. The program trains people in grand strategy-overcoming limited resources in order to accomplish far-reaching goals-and assists them in developing solutions to specific health care challenges.

The paper also notes that Ethiopia has successfully navigated a long-standing divide in the field of global health between vertical solutions (combating single diseases such as malaria and HIV/AIDS) versus a more horizontal approach-such as expanding infrastructure or training additional health workers. The authors detail how that the two approaches have fallen in and out of favor since the modern global health movement began in earnest in the post-World War II era.

"Effective grand strategists in global health will find ways to apply both vertical and horizontal approaches at once in varying ways, viewing these as means to the larger end of improving health and health care globally," said John Gaddis, the Robert A. Lovett Professor of History and a GHLI affiliate.

The paper is published in the current issue of Global Health Governance. Other authors include Elizabeth H. Bradley, professor at the Yale School of Public Health and director of both the GHLI and the Global Health Initiative at Yale, Michael Skonieczny, the GHLI's executive director, and Lauren Taylor, a GHLI research associate.

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