Financing Ethiopia’s Development: Confronting the Gap between Ambition and Means

Ethiopia set out – and in large measure achieved – a very ambitious program of economic and social development under its Growth and Transformation Plan (GTP-I).The scale of public sector involvement was very large: for the five-year Plan period, it called for budgetary government spending and public enterprise off-budget spending of 41% of GDP, more than half of which was to come from budgetary resources. As Ethiopia prepares for the second version of its GTP (GTP-II), it must confront a fiscal numbers problem: Ethiopia’s tax share of GDP under GTP-I reached only the 12%-13%level, and revenue flows from official international assistance are shrinking. This paper dissects the financing challenge that Ethiopia must meet to achieve its goal of becoming a middle income country. It concludes that only export-led manufacturing in a context of a major expansion of the number of active formal enterprises coupled with best practice performance in all other areas related to revenue generation will square the circle of Ethiopia’s development financing challenge.Keywords: Ethiopia, Development Financing, Resource Mobilization, Tax, Private Sector Developmen

The Impact of Financial Access on Firm Growth: Evidence from Ethiopian Grain Traders and Millers

Although both formal and informal financial institutions exist in developing economies, firms are often constrained by lack of access to financial services. Grain traders and millers in Ethiopia need a lot of finance to pay their suppliers (e.g. farmers) but it is not clear whether or not which sources of credit matter most for their growth and expansion. Using firm survey data collected for the purpose, we assessed access to and the impact of different sources of finance on growth of traders and millers in Ethiopia. Descriptive and econometric methods (e.g. ordered probit) were employed to address the issue. The results indicate that both formal and informal sources of credits are accessed by a small number of firms on a sporadic basis. With credit from commercial banks is mainly channeled to large businesses while microfinance institutions (MFIs) are designed to assist small and micro enterprises as part of a poverty alleviation strategy, medium firms such as most grain traders and millers have limited access to finance. Bank or MFI credit was found to have no impact on growth and expansion in the econometric analysis. Access to informal credit is also limited and largely used to meet short-term emergency cash requirements. Without improved and regular access to finance, grain traders and millers cannot make the necessary investment to provide effective marketing services for the transformation of agriculture.Key words: finance, financial access, Growth, Grain, Grain traders and millers, Ethiopi

Socio-economic Assessment of Legume Production, Farmer Technology Choice,Market Linkages, Institutions and Poverty in Rural Ethiopia: Institutions, Markets, Policy and Impacts Research Report No. 3

Today, about 1.1 billion people continue to live in extreme poverty on less than US$1 a day. Another 1.6 billion live on between US$1–2 per day. Three out of four poor people in developing countries lived in rural areas in 2002 (WDR 2008). Most depend on agriculture for their livelihoods, directly or indirectly. In much of sub-Saharan Africa, agriculture offers a promising opportunity for spurring growth, overcoming poverty, and enhancing food security. Of the total population of sub-Saharan Africa in 2003, 66% lived in rural areas. More than 90% of rural people in these regions depend on agriculture for their livelihoods. Ryan and Spencer (2001) estimated that three-quarters of the 1.3 billion people living below the poverty line in developing countries lived in rural areas. Of these, an estimated 66% relied on marginal lands (TAC 1997). Broad-based agricultural development through improving the productivity, profi tability and sustainability of smallholder farming is the main pathway out of poverty for millions of poor farm households. Agricultural productivity growth is also vital for stimulating growth in other sectors of the economy. But accelerated growth requires a sharp productivity increase in smallholder farming combined with more effective support to the millions coping as subsistence farmers, many of them in marginal areas. Gallup and Sachs (2000) estimated that, in comparison to temperate regions, productivity was 27% lower in the humid tropics and 42% lower in the dry tropics

Incidence and predictors of puerperal sepsis among postpartum women at Debre Markos comprehensive specialized hospital, northwest Ethiopia: A prospective cohort study

Background: Puerperal sepsis is one of the leading causes of maternal mortality, particularly in low and middle-income countries where most maternal deaths occur. Women with puerperal sepsis are prone to long-term disabilities, such as chronic pelvic pain, blocked fallopian tubes, and secondary infertility. Besides this, puerperal sepsis has received less attention. For this reason, this study aimed to determine the incidence of puerperal sepsis and its predictors among postpartum women at Debre Markos Comprehensive Specialized Hospital. Methods: A prospective cohort study was conducted among 330 postpartum women from September 2020 to 2021. A pre-tested interviewer-administered questionnaire with a data extraction checklist was used to collect the data. Data were entered into Epi data 4.2 and analyzed using STATA 14.0. The incidence rate of puerperal sepsis was calculated, and a Kaplan-Meier survival curve was used to estimate the survival probability of developing puerperal sepsis. The cox-proportional hazards regression model was fitted to identify predictors of puerperal sepsis. Results: The study participants were followed for a total of 1685.3 person-week observations. The incidence rate of puerperal sepsis was 14.24 per 1,000 person-weeks. However, the overall incidence of puerperal sepsis was 7.27%. Not attending formal education [AHR: 3.55, 95% CI: (1.09–11.58)], a cesarean delivery [AHR: 4.50; 95% CI: (1.79–11.30)], premature rupture of the membranes [AHR: 3.25; 95% CI: (1.08–9.79)], complicated pregnancy [AHR: 4.80; 95% CI: (1.85–12.43)], being referred [AHR: 2.90; 95% CI: (1.10–7.65)], and not having birth preparedness and complication readiness plan [AHR: 2.95; 95% CI: (1.08–10.50)] were statistically significant predictors of puerperal sepsis. Conclusion: The incidence of puerperal sepsis was 7.27%. Not attending formal education, cesarean delivery, premature rupture of membranes, complicated pregnancy, referral status, and absence of birth preparedness and complication readiness plan were predictors associated with the incidence of puerperal sepsis

Multimorbidity in younger deprived patients: An exploratory study of research and service implications in general practice

<p>Abstract</p> <p>Background</p> <p>Multimorbidity has been defined as the co-existence of two or more chronic conditions. It has a profound impact on both the individuals affected and on their use of healthcare services. The limited research to date has focused on its epidemiology rather than the development of interventions to improve outcomes in multimorbidity patients, particularly for patients aged less than 65 years. Potential barriers to such research relate to methods of disease recording and coding and examination of the process of care. We aimed to assess the feasibility of identifying younger individuals with multimorbidity at general practice level and to explore the effect of multimorbidity on the type and volume of health care delivered. We also describe the barriers encountered in attempting to carry out this exploratory research.</p> <p>Methods</p> <p>Cross sectional survey of GP records in two large urban general practices in Dublin focusing on poorer individuals with at least three chronic conditions and aged between 45 and 64 years.</p> <p>Results</p> <p>92 patients with multimorbidity were identified. The median number of conditions was 4 per patient. Individuals received a mean number of 7.5 medications and attended a mean number of GP visits of 11.3 in the 12 months preceding the survey. Barriers to research into multimorbidity at practice level were identified including difficulties relating to GP clinical software; variation in disease coding; assessment of specialist sector activity through the GP-specialist communications and assessment of the full scale of primary care activity in relation to other disciplines and other types of GP contacts such as home visits and telephone contacts.</p> <p>Conclusion</p> <p>This study highlights the importance of multimorbidity in general practice and indicates that it is feasible to identify younger patients with multimorbidity through their GP records. This is a first step towards planning a clinical intervention to improve outcomes for such patients in primary care.</p

National disability-adjusted life years(DALYs) for 257 diseases and injuries in Ethiopia, 1990–2015: findings from the global burden of disease study 2015

Background: Disability-adjusted life years (DALYs) provide a summary measure of health and can be a critical input to guide health systems, investments, and priority-setting in Ethiopia. We aimed to determine the leading causes of premature mortality and disability using DALYs and describe the relative burden of disease and injuries in Ethiopia. Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for non-fatal disease burden, cause-specific mortality, and all-cause mortality to derive age-standardized DALYs by sex for Ethiopia for each year. We calculated DALYs by summing years of life lost due to premature mortality (YLLs) and years lived with disability (YLDs) for each age group and sex. Causes of death by age, sex, and year were measured mainly using Causes of Death Ensemble modeling. To estimate YLDs, a Bayesian meta-regression method was used. We reported DALY rates per 100,000 for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases, and injuries, with 95% uncertainty intervals (UI) for Ethiopia. Results: Non-communicable diseases caused 23,118.1 (95% UI, 17,124.4–30,579.6), CMNN disorders resulted in 20,200.7 (95% UI, 16,532.2–24,917.9), and injuries caused 3781 (95% UI, 2642.9–5500.6) age-standardized DALYs per 100,000 in Ethiopia in 2015. Lower respiratory infections, diarrheal diseases, and tuberculosis were the top three leading causes of DALYs in 2015, accounting for 2998 (95% UI, 2173.7–4029), 2592.5 (95% UI, 1850.7–3495.1), and 2562.9 (95% UI, 1466.1–4220.7) DALYs per 100,000, respectively. Ischemic heart disease and cerebrovascular disease were the fourth and fifth leading causes of age-standardized DALYs, with rates of 2535.7 (95% UI, 1603.7–3843.2) and 2159.9 (95% UI, 1369.7–3216.3) per 100,000, respectively. The following causes showed a reduction of 60% or more over the last 25 years: lower respiratory infections, diarrheal diseases, tuberculosis, neonatal encephalopathy, preterm birth complications, meningitis, malaria, protein-energy malnutrition, iron-deficiency anemia, measles, war and legal intervention, and maternal hemorrhage

Primary stroke prevention worldwide: translating evidence into action

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course

National mortality burden due to communicable, non-communicable, and other diseases in Ethiopia, 1990–2015: findings from the Global Burden of Disease Study 2015

Background: Ethiopia lacks a complete vital registration system that would assist in measuring disease burden and risk factors. We used the Global Burden of Diseases, Injuries, and Risk factors 2015 (GBD 2015) estimates to describe the mortality burden from communicable, non-communicable, and other diseases in Ethiopia over the last 25 years. Methods: GBD 2015 mainly used cause of death ensemble modeling to measure causes of death by age, sex, and year for 195 countries. We report numbers of deaths and rates of years of life lost (YLL) for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases (NCDs), and injuries with 95% uncertainty intervals (UI) for Ethiopia from 1990 to 2015. Results: CMNN causes of death have declined by 65% in the last two-and-a-half decades. Injury-related causes of death have also decreased by 70%. Deaths due to NCDs declined by 37% during the same period. Ethiopia showed a faster decline in the burden of four out of the five leading causes of age-standardized premature mortality rates when compared to the overall sub-Saharan African region and the Eastern sub-Saharan African region: lower respiratory infections, tuberculosis, HIV/AIDS, and diarrheal diseases; however, the same could not be said for ischemic heart disease and other NCDs. Non-communicable diseases, together, were the leading causes of age-standardized mortality rates, whereas CMNN diseases were leading causes of premature mortality in 2015. Although lower respiratory infections, tuberculosis, and diarrheal disease were the leading causes of age-standardized death rates, they showed major declines from 1990 to 2015. Neonatal encephalopathy, iron-deficiency anemia, protein-energy malnutrition, and preterm birth complications also showed more than a 50% reduction in burden. HIV/AIDS-related deaths have also decreased by 70% since 2005. Ischemic heart disease, hemorrhagic stroke, and ischemic stroke were among the top causes of premature mortality and age-standardized death rates in Ethiopia in 2015. Conclusions: Ethiopia has been successful in reducing deaths related to communicable, maternal, neonatal, and nutritional deficiency diseases and injuries by 65%, despite unacceptably high maternal and neonatal mortality rates. However, the country’s performance regarding non-communicable diseases, including cardiovascular disease, diabetes, cancer, and chronic respiratory disease, was minimal, causing these diseases to join the leading causes of premature mortality and death rates in 2015. While the country is progressing toward universal health coverage, prevention and control strategies in Ethiopia should consider the double burden of common infectious diseases and non-communicable diseases: lower respiratory infections, diarrhea, tuberculosis, HIV/AIDS, cardiovascular disease, cancer, and diabetes. Prevention and control strategies should also pay special attention to the leading causes of premature mortality and death rates caused by non-communicable diseases: cardiovascular disease, cancer, and diabetes. Measuring further progress requires a data revolution in generating, managing, analyzing, and using data for decision-making and the creation of a full vital registration system in the country