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Transform: Primary Health Care Project


  • Ethiopia’s financial planning and budgeting capacity at the primary health care level needs strengthening.
  • Abt is working to improve capacity and health care financing reform implementation.
  • Personnel’s public financial management skills are improving and enrollment in community-based health insurance is growing.
The Challenge

For the Ethiopian Ministry of Health to achieve its ambitious targets to reduce maternal, neonatal and infant mortality by more than half, substantial investments are needed at the woreda (district) level. The Ministry’s challenges include health sector financing needs; financial planning and budgeting capacity gaps; poor quality and low availability of health services; and the low utilization of maternal, newborn and child health services.

The Approach

Abt executes the health care financing work implemented under the Pathfinder-led and USAID-funded Transform: Primary Health Care project. Targeting the primary health care (PHC) level, efforts focus on:

  • Strengthening public financial management (PFM) to improve woreda-based planning, budgeting, budget execution, and reporting.
  • Improving revenue retention and utilization practices at health facilities to help ensure that resources contribute to service delivery quality improvements.
  • Supporting community-based health insurance (CBHI) implementation and its expansion to more woredas to promote increased utilization of health services.
The Results

In collaboration with local counterparts, Abt has:

  • Developed PFM guidelines for use at the PHC level—the first of their kind in Ethiopia—and trained woreda finance and health office personnel and health facility finance staff in their use.
  • Launched mentoring for woreda and health facility PFM teams to help them apply skills acquired through training, and to reinforce PFM best practices. 
  • Upgraded the skills of health facility personnel, enabling them to better prioritize retained revenue during their budgeting process so that it is used to increase the availability of essential commodities and supplies and to finance facility improvements that enhance the quality of PHC services.
  • Increased the number of CBHI-implementing woredas and the CBHI enrollment rate in some woredas.