(1910) Menilik II inaugurated the foundation of the first Ethiopian hospital named after him. Eight blocks, still serving today, were built on the site of the tents.

In the history of the Ethiopian Health Service one cannot ignore the role played by traditional medicine in Ethiopia, which was practised long before the introduction of modern medicine, and even today, it is still being extensively utilized by the majority of the population.

The traditional medicine practitioners can be divided into several categories:-
- Wogesha (Bone setters)
- Kitel betash (herbalists using vegetation as medicine),
- Tebel rechi (Spiritual healers, usually using holy water as medicine)
- Yelimed Awalaj (Traditional birth attendants)

However, it should be realized that a traditional medical practitioner can have several skills, i.e. more than one of the categories mentioned above.

The traditional Ethiopian Pharmacopia comprised items from the animal and vegetable kingdoms and even some minerals. Several surgical procedures are being practised. It should be mentioned that harmful procedures are also being widely practised.

(Source: National Atlas of Ethiopia)

A more recent survey was conducted by the Ethiopian Nutrition Institute 1972 E.C. (1980) on 35,635 school children and 19,128 members of randomly selected households in 42 towns from nearly all the regions of Ethiopia.

The survey results showed that the overall prevalence of goiter ranges from 0.4% to 66.3% with a mean of 25.1%.

The prevalence in high altitude (over 2000m.) appears to be significantly greater than that of lower altitude (less than 2000m.) areas. The mean for the higher altitudes was 33.9% while that of the lower ones was 19.2%.

(Source: National Atlas of Ethiopia)

In some 350 communities examined between 1953-1976 E.C (1961-84), Schistosomiasis mansoni patients were found in 62%; and among the positive communities 40% had a prevalence of higher than 10%.

So far the disease transmission has been proved in 30 localities, all with a prevalence of more than 10%, but localities with active transmission must be more numerous and further verification is needed.

Although the transmission is taking place in various water-bodies, the small highland streams at moderate altitude, roughly 1000-2000m above sea level, are the most important because the vast majority of endemic areas belong to this category.

The transmission is also provided in lakes Tana (Bahir Dar, Gorogora), Ziway, and Abaya; and in irrigation systems, (Wonji, Metehara and Finchaa). One estimate shows that the population living in the risk area, i.e. 1000-2000m altitude, is 18 million; and 14% (2.5 million) of this may be infected.

In the long run, proper human excreta disposal is the most fundamental and long-lasting solution for control or eradication of the disease.

Measures with quicker results include chemotherapy to cure the disease and reduce parasite egg output; snail control by various methods; improvement of water supply and sanitation to reduce the chance of getting infected, and to eliminate excrete contamination of water bodies.

(Source: National Atlas of Ethiopia)

It can be diagnosed, and usually can be cured with no damaging after-effects, but only if it is recognised early and treated properly.

If left untreated it may cause severe physical disabilities. It is often the cause of severe emotional distress to patients and patients’ families, and may also seriously disturb their social life.

Not all patients suffering from leprosy are equally infectious to others. Those from whom the skin smears are negative are not regarded as infectious cases and will not spread the disease. Patients with positive skin smears may infect others if they are not under regular treatment.

There are two types of leprosy: Tuberculoid which is non-infectious and Lepromatoes which is infectious. Only patients who discharge live leprosy bacilli can infect other people.

Most people who come into contact with leprosy bacilli do not develop leprosy. They have high resistance to mycobacterium Leprae. Only very few people who lack high resistance will get leprosy from an infectious patient.

Leprosy conspicuously affects the highland regions rather than the lowland areas. In highland areas of the country the high prevalence rates range from 2.6 to 8.1 per thousand while in lower areas the rate of the disease ranges from 0.05 to 1.7 per thousand.

(Source: National Atlas of Ethiopia)

The settlement of the majority of the population on the highlands and plateaux can be considered a result of the presence of malaria in the fertile lowlands. This has brought about overcrowding in the highlands and the problems of overtilling.

Soil erosion and deforestation can be partially attributable to the effects and dread of malaria which restricted the free use of land.

There are two seasons of malaria transmission in Ethiopia. They follow the “small” rains of April-May and the “big” rains of June-August.

Transmission normally occurs below 2000 metres elevation. However, due to periodical climatological changes, this limit extends above this altitude, resulting in high morbidity and mortality casuality rates.

The periodic epidemics that the country has experienced in the past have claimed a large toll of life mainly around these fringe areas.

There are 42 Anopheles species recorded in Ethiopia whose distribution is shown in map 1. Among them, A.gambiae is the main vector responsible for the greater portion of malaria transmission with A.funestus, A.pharoensis and A.nili as secondary vectors.

Fur Plasmodium species that infect human beings viz. P.falciparum P.vivax, P.malaria and P.oval, are present.

The former two are dominant and are distributed all over the country whereas the latter two are found in localized areas. P.ovale is extremely rare.

The Malaria Control Programme (MCP), which was established in 1951 E.C. (1959), has brought down the prevalence and intensity of transmission significantly with the application of residual insecticide, supplemented with chemotherapy.

The initial task of the programme was to delineate malarious from non-malarious areas through parasitological and entomological surveys.

Once an area has been identified as malarious, the main activities of the programme include the mapping of the affected localities undertaking parasitological and entomological studies to determine the prevalence of the disease and the relative distribution of the Plasmodial and Anopheles vector species.

Such information will be useful to determine the intensity of transmission and general malariogenic potential of each empidemiological area. This is followed by the application of appropriate control measures which include residual spraying, chemoprophylaxis and chemotherapy.

The scope and the number of times of application of spraying is determined by the intensity of transmission, the prevalence rate and the general malariogenic potential of each empidemiological area.

DDT has been used continuously for the last 25 years in the malaria control operations and to date, the Anopheles vector species are still susceptible to the residual insecticide.

Likewise, chloroquine which is the primary drug of choice has also been utilized for an extended period of time.

The Plasmodium malaria species in Ethiopia are still sensitive to chloroquine in spite of the development of chloroquine-resistant Plasmodium falciparum in the neighbouring countries of Kenya and Sudan and other East African countries.

The opening up of the fertile arable lowland valleys for expanded agriculture, the development and rapid growth of many urban centres and the general population increase are a few of the many contributions attributable to the programme’s activities.

The programme is undertaking its malaria control activities having established a network of infrastructure in various parts of the country (map2), and is thus presently protecting about 12 million people from malaria infection. It has also planned to extend its services to areas in the south and southwestern parts of the country during the coming few years.

(Source: National Atlas of Ethiopia)

Accordingly, the Ministry of Health formulated its policy in terms of an emphasis on disease prevention and control, priority to rural health services, promotion of self-reliance and community involvement in health activities.

As a result, a considerable increase in the number of health service units can be observed since the start of the revolution of 1966 E.C. (1974).

Health stations increased from 650 to 1916, health centres from 93 to 140, hospitals from 84 to 86, and hospital beds from 8624 to 11,000. The annual output of trained health personnel of various categories has increased from 766 to 1627.

A significant achievement was also gained in the field of control of communicable diseases. Right after the revolution, small-pox was eradicated through mass involvement.

The Expanded Programmed on Immunization (EPI) against 6 childhood diseases has been launched nationwide, and vertical programmes such as the Malaria Control Service, National Leprosy Control, etc, are being integrated step by step into the existing general health service system.

The Community Health Service, which is a new system of health care delivery through organized community health activities, has been initiated during the past 10 years.

These community health activities are being carried out by trained Community Health Agents (CHAs) and trained Traditional Birth Attendants (TBAs) who are selected, supported and administered by Peasant Associations (Pas), or Urban Dwellers’ Associations (UDAs);. At present there are about 4500 CHAs and 5000 TBAs.

The Ministry of Health is responsible for their training, technical supervision, monitoring and evaluation through health stations and health centres.

In addition to supporting and administering the CHAs and TBAs, communities are also actively involved in the establishment of new health service units, maintainance expansion of the existing units, control of communicable diseases and other activities.

The five Health Service maps show the distribution of various services in 1974 E.C. (1982), and their density in relation to population estimates as of the same year. The graph shows the significant increase in basic infrastructure since 1966 E.C. (1974).
Major constraints encountered in the plan implementation were as follows.

- Low implementation rate of construction of health institutions
- Shortage of trained manpower
- Insufficient health budget
- Inadequate supervision, monitoring and evaluation of health service units

Concerning health, the Ten-Year Plan of 1977-1986 E.C. (1985-1994) has specific objectives, strategies, targets and programmes.

According to the Plan there will be an increase of Community Health Services from 4500 to 36,000; in the number of Health Stations from 1916 to 3600; in the number of Health Centres from 140 to 360, and a substantial increase in hospital beds. Besides, all available health services will be strengthened.
 

(Source: National Atlas of Ethiopia)

- Infant mortality rate per 1000 live births 144
- Child (1-4 years) mortality per 1000 children 92
- Life expectancy at birth in years 46
- Crude birth rate per 1000 population 47
- Crude death rater per 1000 population 18
- % Annual rate of population growth 2.9

The reasons why the health service system, prior to 1966 E.C. (1974), was not able to solve the above mentioned health problems of the country were:-

- Most of the health institutions were found in the few urban areas and were concerned with the curative rather than the preventive aspects.
- The community involvement was almost nil.
- The health budget was very low.
- The shortage of trained manpower was acute.
The numbers of health institutions prior to the 1966 E.C. (1974) revolution were:-
- Health stations 650
- Health centers 93
- Hospitals 84, with 8624 beds

This made possible a health service coverage of only 15% - 20% of the total population. But just a decade later in 1974 E.C. (1982), the potential health service coverage for the whole country has grown to 45% of the total population.

(Source: National Atlas of Ethiopia)