Health System Performance in Ethiopia: A subnational analysis utilizing HAQ

Abstract

Motivated by a national prioritization exercise to assess the Ethiopian health system, the Health-Access and Quality (HAQ) index was used to examine subnational Ethiopian performance. Building from methods developed in previous HAQ analyses in 2015 and 2016, the index was decomposed to measure how performance differentiated between young, working, and elderly populations. Additional analyses were performed to assess the effects of spending and development on health. To examine health spending efficiency, a stochastic frontier function was created, and to study gaps between observed and expected performance, a linear mixed effects model was built. Results showed that HAQ performance increased over time across all Ethiopian states though at different rates. Differences in performance were seen between the three different age groups, with much of the observed progress since 1990 being accumulated in the youngest age group. When compared to other Sub-Saharan African countries, inefficiencies in spending overlapped with other major economies. And when controlling for development status, some high performing subnational unites showed observed values lower than expected. As Ethiopia’s population continues to grow, and its disease burden shifts, interventions will need to be targeted at the most needy to prevent inequities from continuing to increase.