State of the World's Minorities and Indigenous Peoples 2013 - Ethiopia

Ethiopia has made positive gains in health care indicators over the past decades, consistent with the trend in East Africa generally. Both maternal and child mortality have reduced, and the government has been lauded for its commitment to training community health workers, especially women, to assist with basic health needs. However, substantial challenges remain, including maternal mortality, malaria, tuberculosis and HIV/AIDS, compounded by acute malnutrition and lack of access to clean water and sanitation. The limited number of health institutions, disparity between rural and urban areas and severe under-funding of the health sector all make access to health services very difficult. It is estimated that more than half of Ethiopia's population lives more than 10 km from the nearest health facility, often in regions with poor transportation infrastructure. Another major issue in the Ethiopian health sector is brain drain – there currently are more Ethiopian doctors working in Chicago, USA than in Ethiopia according to some experts.[1]

But for many minorities and indigenous peoples in Ethiopia, health concerns are exacerbated. Although health data in Ethiopia is rarely disaggregated by ethnicity, regional data provides some insights, given the residency patterns of minority groups. Reports indicate that many negative health indicators are above the national average in federal regions populated predominantly by minority groups, such as Gambella, Afar, Oromia, Somali region, Benishangul-Gumuz, and the Southern Nations, Nationalities and Peoples (SNNP) region. For instance, while the under-five mortality rate in Addis Ababa is 72 per 1,000, the rates in Benishangul-Gumuz and Gambella are 156 and 157 per 1,000 respectively; the national average is 123 per 1,000.[2] The percentage of teenage girls between 15 and 19 years of age who have been pregnant is 4.3 per cent in Addis Ababa, but is 20 per cent in Afar, 27 per cent in Benishangul-Gumuz and 30 per cent in Gambella – the national average is 17 per cent.[3] Early pregnancy is a major risk factor for other health problems, including obstetric fistula (see case study on p. 68). Distribution of health care infrastructure is also uneven. According to the Ministry of Health, Addis Ababa has 33 hospitals for a population of 3.1 million, whereas Afar region has two hospitals for a population of 1.5 million, Somali region has eight hospitals for a population of 4.5 million, and SNNP region has 20 hospitals for a population of almost 16 million.

A substantial proportion of minority groups and indigenous peoples in Ethiopia are pastoralists. Pastoralism brings unique health challenges, especially for women. As reflected in the statistics above, pastoralists who live in rural, low population density areas often must travel long distances to access health services.

Gender disparity in health indicators also is heightened – for instance, men outlive women in pastoralist areas, the inverse of national data. This disparity may be a result of the intensive household work burdens put on pastoralist women as well as clear boy-child preferences in pastoralist communities. Harmful practices such as female genital mutilation (FGM) and early marriage, as well as chronic malnutrition, also contribute to lower health status among pastoralist women.

On 20 August 2012 the government announced that Prime Minister Meles Zenawi had died after governing for 21 years. Under Meles, Ethiopia became one of Africa's largest recipients of foreign donor aid, including health aid, receiving more than US$3 billion total aid in 2010 for example. Despite this, the health system remained chronically underfunded.

Ethiopia's progressive Constitution is protective of minority rights, with a system of ethnic federalism that protects the right to self-determination. However, under Meles the system was never truly implemented. Instead, Ethiopia remains a nation of centralized decision-making and minimal democratic space. After Meles' death, his deputy, Hailemariam Desalegn was quickly elevated to acting head of government.

Desalegn is not expected to preside over any substantial change in Meles' policies. For example, controversial villagization schemes continued in five regions of Ethiopia in 2012. The villagization programme, resulting in forced resettlement of tens of thousands of people, has had serious negative impacts on minorities and indigenous peoples in Ethiopia. Although the asserted purpose of the villagization process is to provide enhanced public services, including health care, relocated Ethiopians report that the promised services have not materialized. Severe negative health consequences, including starvation and malnutrition, have resulted from the lack of arable land, and those who resist relocation report beatings, arbitrary detention and even killings as a result of their resistance. In Ethiopia's Gambella region, the indigenous Anuak community was so negatively affected by the programme that in 2012 it brought a complaint to the World Bank's Inspection Panel, claiming that the US$1.4 billion that the World Bank had provided to the Ethiopian government in support of the programme was contributing to massive human rights abuses.

Notes

1. Roeder, A., 'Transforming Ethiopia's health care system from the ground up', Harvard School of Public Health News, 29 August 2012, retrieved June 2013: http://www.hsph.harvard.edu/news/features/ethiopia-primary-care-health-conference-html/.

2. Ibid.

3. Macro International, Ethiopia Atlas of Key Demographic and Health Indicators, 2005, Calverton, MD, 2008, retrieved July 2013, http://pdf.usaid.gov/pdf_docs/PNADM636.pdf.