Exploring Provider Decisions when Resources Are Scarce

June 27, 2018
Transforming Health Care Initiatives in Ethiopia
Transforming Health Care Initiatives in Ethiopia

By Henock Asaye, Junior, Public Policy & Global Health Major 

It’s been 10 years. I traveled to Ethiopia for the first time that I can remember in 2008. 

The amazing experiences included visiting relatives I have never seen before, seeing historical monuments and visiting the site where Lucy—the oldest human remains found to date—was discovered. I traveled throughout the country to places such as Axum, Bahir Dar and Harar. In each of these places, I had different experiences and met individuals from all backgrounds. 

I will hold onto these memories until I grow old—but I also have other, less fond memories of that trip.

In 2008, I witnessed the poverty and famine that has ravaged Ethiopia for the previous decade. The poverty conditions of a country are directly related to the health outcomes of the population. More than 36 percent of Ethiopians are either below the poverty line or vulnerable to falling into poverty. To make matters worse, preventable diseases account for 60 percent of the health problems in Ethiopia. Through further research, my hunch was correct: Ethiopia’s quality of care is among the lowest-rated throughout the world. In order to help reverse these conditions, I decided to make a change to the health outcomes of the country. 

Many organizations—such as the United Nations and Doctors Without Borders—have programs to alleviate the burdens in Ethiopia, but their main focus is in the urban areas. To add to this, the disparity between the urban and rural areas has not been shrinking. A recent quote from the World Health Organization noted, “The main health concerns in Ethiopia include 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, inefficient distribution of medical supplies and disparity between rural and urban areas are the root of the problem.” 

Ethiopia needs intervention programs that help bridge the gap between these areas in order to provide adequate health services for all parts of the country. 

My organization—Oasis Medical Relief—aims to increase human resources in many low-budget hospitals in Ethiopia. Yearly, there is an excess of a billion dollars’ worth of unused medical supplies in the United States. Upon further understanding of the need for resources, I became more interested on the ethical framework that health care providers use to provide treatment when resources are scarce. 

My project this summer with the Kenan Institute of Ethics will examine the disparities in available medical supplies and available medical professionals. By taking this twofold approach, I will be able to see discrepancies in personal doctor-patient treatment and access to supply. 

Will doctors whose ethnic groups (Amharas, Tigrayans, Gurage, Oromo) differ from their patients treat those patients differently? Will the quality of care drop? How do physicians allocate the limited number of medical supplies? How will overly-busy doctors distribute their time between patients? If there are limited health care professionals available to treat patients, how will hospitals provide adequate care for all patients? If they cannot, will race, socioeconomic status or culture impact the decision as to who receives treatment? These are the questions I’ll be exploring in both urban and rural areas—and seeing whether and how the answers differ in each context. 

To find a solution to the problem, we need to focus on why some hospitals lack supplies while others do not. Based on my findings at the hospital, I will work with the Ethiopian Ministry of Health to determine how to best distribute medical supplies between the urban and rural areas and give recommendations for future distribution methods.

As of now, I have set up meeting dates and times to meet with health care professionals at each of the designated hospitals. In addition, I have a list of medical supplies that these hospitals are lacking and will arrange shipments of these supplies to these hospitals based on their responses. 

Till next time.