Measurements of Universal Health in Ethiopia

Measurements of Universal wellness in EthiopiaTASKThe UK Department for International Development (UK-DFID) has recently decided to altogetherocate funds for establishing global health c everywhereage in low income countries. The Director of the Global health Division of the UK-DFID invites you to submit a scoping report with a critical assessment of the causa of index numbers carryed to evaluate and monitoring device universal health coverage in a low income country of your choice. Your report will be judged on the bag of the following criteriaIllust symmetryn and critical assessment of at least 5 relevant direct or indirect indicators (statistics), their sources and boilersuit musical note of selective information. The sources (online) and any other supporting references cited should be numbered either in the footnote or in the Bibliography at the end of the document.Use and reliability of those selected indicators for planning and programme interventionsPotential count ry-specific barriers, where applicable, in implementing the universal health coverageClarity of presentation, independent critical thinking and creativityOne of the master(prenominal) aims of the UK department for international schooling is to promote the development and eradication of poverty by means of the establishment of Universal Global Health coverage in low in come countries. As a turn up this scoping report focuses on Ethiopia a low income region which has a history of soaring birth sets, famine, war and the second highest commonwealth in Africa (91million) 1. The regions health help system as consequence is among i the poorest in Africa, making it an ideal region in assigning the types indictors needed to provide UGH 2. In order to monitor and evaluate UGH it is important to firstly acknowledge that there is no one metric barroomment or indicator of health, as health differs from one soul to another and as a outcome an average or optimum is often defined to moni tor the overall health of the population 3. The innovation Health Report 2013 has provided a widely used framework in order to successfully monitor UGH 4. Figure 1 illustrates the framework which focuses on three main areas of health. Service coverage the vital health care services that are needed, Financial coverage Ability to acquire these services without financial gruellingy and universe of discourse coverage the number people that have access to these services. The indictors used in this report aim to cover these three dimensions while also beingness clean-cut specifically to Ethiopias health requirements.Table 1 Statistics adapted from WHO data repository 8Population using amend drunkenness-water sources (%)YearRuralUrban19904%80%200019%87%201139%97%Adequate access to clean water is a prefatorial human right and the s sluiceth millennium Development Goal 5. Clean water is essential to ample quality of life story and is used in a diverse range of fields from prefa tory hyd balancen, irrigation, sanitation to complex health care institutions such as hospitals making it a vital component of health 6. This indicator is categorised into ether ameliorate or unimproved source with improved sources indicating clean water. This classification makes it a simple indicator resigning identification of areas where safe water sources are abundant and areas that need improved water source access, perhaps through water aid programs. This indicator is particularly useful as it drive out show the range of human impacts on the quality of water through the presence of nitrate as well as compounds and bacteria which can indicate waterborne pathogens the common netherstanding of disease. 7. Data is provided through national household surveys, the demographic health surveys (DHS) and RADW (Rapid assessment of drinking water quality project) which is carried out by both the WHO and UNICEF with the DHS often providing high quality statistics 4. Table 1 illustrate s that the percentage of improved water sources is disproportionate from 97% users in urban area in 2011 compared to just 39% in rural areas in 2011. This suggests that water sanitation programs should be focused in rural areas where there are less people using improved drinking sources. The results also illustrate that although there are far more users of improved sources in urban areas, the number of users in rural area over three decades have seen a greater increase from just 4% in 1990 to over 39% in 2011 which could be attribute to better surveying in these areas in recent times. The indicator however is a proxy to number of people that have access to clean water as it shows the percentage of users of improved sources and not the amount people that have access to safe drinking water, meaning some social-economic groups such as the isolated poor or antique are not accounted for as they are less likely to have access to these improved sources 7. The indictor is limited sole(pre nominal) showing percentages for rural and urban areas an meter reading of sub-urban regions would provide are more in-depth analysis of overall water quality in the region. Recognition of which gender the improved water source is mainly being used by i.e. men, women or children is also unaccounted for which could be crucial indicator as children are highly impacted from waterborne pathogens 2. Furthermore even though water is being used from an improved source, this water still needs to be obtained from larger sources leading to possible contamination during transportation or even storage invalidating the indicator. Guidelines presented by WHO for safe drinking water is also assumed unceasing over time by indictor limit it accuracy 9, overall this indicator can provide an overview of water quality but accuracy of the indicator can be skewed to urban areas.The overall health of the population is often measured by life expectancy, this indicator is widely used and data regarding t his indictor is readily available. Life expectancy is a longer term measure of health and an overall indication of health over the years. Life expectancy in Ethiopia has been improving over the years from around 55 years at birth in 2004 to 62 years in 20118. It is an important indicator in reflecting the overall mortality rate rate of the population this is helpful for the govern psychological as it illustrates the cut down through time of the overall population and improvements in life expectancy can reflect better nutrition, hygiene and effective medical intervention indoors the nation 10. all the same unless a comprehensive cohort/period life table is developed, life expectancy at birth assumes that health conditions remain constant throughout the lifespan of the individual, an in dead on target assumption given the higher mortality rates in the first year of life and lower mortality at around middle age.Table 3Data adapted from WHO, World Bank and DHS. 8, 10,11BCG among 1 years olds (%) 8Under 5 mortality rate per 1000 births 10Children Fully Immunised (%) 11Year19800240N/A200051%14614.3%201180%6824%Vaccination is an essential component of health in some low-income countries with the fourth MDG main aim being the reduction of child morbidity and mortality 5. Immunisation can help reduce mortality and usually is cost effective while also being an excellent indictor of the health among children. BCG is the best indicator of full immunisation coverage as the WHO states children can be classified full immunised once they have received a tuberculosis vaccination (BCG) 9 therefore a BCG indicator is vital in monitoring health of children. Table 3 illustrates the importance of BCG vaccination with the percentage of coverage improving over the years from no vaccination in 1980 to over 80% of 1 year olds having being immunised in 2012 suggesting an improvement in the protection of children against TB, this is further reinforced by the decline in under five m ortality rate. The validity of the indictor can be backed up by it its correlation to under 5 mortality rate Table 3 illustrates a linear relationship in increasing immunisation and declining child mortality, showing the success of the indictor in monitoring UGH among children. However universal health through immunisation in reality is hindered by a delay in diagnosis of tuberculosis in Ethiopia which can exacerbate the disease 12, combined with the majority of children and citizens being concentrated in rural areas where there is no real means of transportation available to attend a hospital for vaccination, 2 making the indicator biased to people who can access vaccination facilities. The BCG indicator is effectively used in TB prevention, treatment and psychological suffering through basic programmes such as stop TB strategy programme 4. Data provides estimations between the accurately reported immunisation figures by national authorities and those where data may present mislea ding figures 8. This means the data may not be fully accurate as it is a estimation of actual and misclassified figures. However this indicator is vital for monitoring and guiding disease and eradication programmes and efforts in Ethiopia. Although BCG percentage shows a high coverage over tuberculosis it does to provide accurate analysis of UGH in terms of other diseases such as malaria. The percentage of full immunised children is a better indictor for UGH as it indicates children which are protected against all diseases. However only 24% of children are fully immunised which suggest that although 80% of children are immunised this is misleading as this 80% are only immunised against TB and not other deadly diseases. Although the WHO suggests children are not fully covered against diseases until they are immunised from TB, the immunisation of other diseases prior to the TB vaccination needs to be considered. anaemia is defined as a condition which is characterised by low levels o f haemoglobin in our blood, in the case of Ethiopia genus Anemia is a major concern with low come groups being among highest at risk 13. This is an important indicator in children as anaemia is associated with impaired mental and physical development and increasing morbidity and mortality. This indicator is particularly helpful because it has allowed a number of preventions programmes to be put into place such as compound outreach Strategy and Targeted supplementary foods intervention programme which aim to improve nutrient in among children. More than 44% of population in 2011 is still anaemic with 21% percent of children having moderate anaemia illustrating the importance of this indicator in monitoring UGH in children and future programme intervention development. However this indicator is constraint to children limiting its capability, it is also misleading as there are also other factors related to anaemia such iron deficiency, and Vitamin A levels which this indictor does no t account for providing incorrect assessment 9.Table 3 Indicators adapted from WHO, DHS and UN 8,11,14Maternal Mortality Ratio MMR per 100,000 live births 8Live Births Delivered at Health Facility (%)11Births attended by sure-handed heath Personnel (%) 15Year1990950N/ANA20057005.3%5.7%20113509.9%10.0%Maternal mortality in Ethiopia is among the highest in the world and it is the biggest killer of women in Sub-Saharan Africa with the fifth MDG aiming for a reduction of 75% from 1990 to 2015 5. Maternal health is often measured by the maternal mortality ratio which is expected to be useful in indicating the deaths among women, the risk associated with pregnancy, monitoring achievement towards MDG 5 and the capacity of health systems within Ethiopia to provide effective health care 14. Table 1 illustrates the maternal mortality ratio, illustrating initially that there is reduction in maternal morality in Ethiopia and an improvement over the years with some considerable progress towar ds MDG 5. However the MMR ratio does not take into consideration several key factors that can impact women during her pregnancy. The indictor is irrespective of the duration of pregnancy and also where the birth took place giving an wrong assumption how amount of mortalities. The relationship between the MMR to percentages of live births that took place in health facility shows a poor correlation because although there has been a strong reduction in mortality from 1990 to 2011 this is misleading as only 9.9% of these births took place in adequate well equipped hospitals suggesting MMR should be higher. Measuring mortality is difficult and inaccurate as it is a ratio based on estimations between the total maternal deaths and total live births which does not account for women which have died during the pregnancy. The ratio also fails to show the factors which lead to high or low level of mortality which could prove vital to reducing mortality as an indication of this would allow a f ocus in future planning to reduce the MMR. Sources of data are varied with different methods being used to derive country estimates, with many rural areas having no data at all making results biased 14. A more accurate indictor of UGH of maternal health is number of live births in health facilities and births attended by skills personal, both indictors show low percentages suggesting and poor health care service as an increase in number births at hospital and with better equipped personnel is likely to reduce maternal deaths. These two indictors also show why maternal death rates are so high as apposed just showing number of deaths. The MMR indictor used is not a reliable indictor of UGH among pregnant women and more focused indictors such one shown in table 3 are recommended for UGH.As stated in the introduction there is no one measure of universal health among a country, individual, or the world. Each indicator has it own weakness and strengths as illustrated above. All the indict ors in this report have been chosen as they are most meet to Ethiopia and it requirements, this report suggests that some indictors i.e. Immunisation and percentage population using improved water sources may be better indictors than other such as life expectancy and maternal health in monitoring UGH. However any indictors used to monitor UGH should be chosen for future policy planning, MDG assessments and intervention schemes.Bibliography1 The World Bank, working for a world free of poverty. http//www.worldbank.org/en/country/ethiopia (Accessed 15 February 2014).2 Murray, J.S., Moonan, M. Recognizing the healthcare needs of Ethiopias children. Journal for Specialists in paediatric Nursing 2012 17(4)339-343. 10.1111/j.1744-6155.2012.00328.x (Accessed 15th February 2014).3 Abraha, M.W., Nigatu, T.H. Modeling trends of health and health related indicators in Ethiopia (1995-2008) a time-series study. 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