Listening to Health

Born in Asmara Eritrea in 1965, Tedros Adhanom (Ph.D), got his first degree from Asmara University and his Msc and PhD from the University of London and the University of Nottingham, respectively. He was appointed State Minister of Health in 2004 and then promoted to Minister a year later.
Capital’s Pawlos Belete spoke with Teodros Adhanom a father of five, about the conclusion of the extraordinary 16th ICASA 2011 Conference, Ethiopia’s HIV/AIDS situation and universal health insurance. He believes the country will have a health system similar to “middle class,” countries within the next 15 years.

Capital: What is your assessment of how prepared Ethiopia was for the conference now that it has occurred?
Dr. Tedros Adhanom (Ph.D):
As soon as we started preparing two years ago we took it seriously, which paid off. The competition for hosting the event was intense so we wanted to make it the best. We looked at the examples of previous hosts and tried to build on strengths and address challenges. We also got other Ethiopians who have had experience with big events like this to give us feedback and candidly advise us where our focus should be.  This was the back bone of our success.
So we began identifying individuals and institutions who we felt could bring a lot to the table. Then, we created a partnership to carry out the important task of hosting the conference successfully. We hired a secretariat and several task forces to support them. In the committees we designated very capable people such as Dr. Yigeremu Abebe, [President of ICASA 2011]. He is a pioneer on issues related to HIV/AIDS prevention and control activities in Ethiopia. We made sure that committee chairs and members were also competent in their respective fields. I think this is really behind our comprehensive success. We have assembled a good, responsible team that worked effectively.
Capital: What is your reflection about the turnout and the content of the conference?
Dr. Tedros:
I think it would be good if you ask the participants themselves. But to share my perspective, many people I have met have given very encouraging feedback. Their response was beyond our expectation. This conference has really set a new standard for ICASA conventions to come. We want future events to be even better but this is really setting a new standard. The next meeting will be hosted in Durban South Africa. They were one of our strong competitors to host the 16th ICASA but we still hope they will do it much better because that is what we wish for our continent. The feedback, so far, is really overwhelmingly great. We will document the strength, weakness, opportunities and challenges (SWOT) through an analysis of the conference so that other countries will have the chance to make use of it. We found that there was not an organized documentation process at other conferences. This was one of the weaknesses of previous ICASAs. We hope to document our experiences to avoid such short falls so that we can help people compare and contrast strengths and challenges so ICASA will keep getting better.
Capital: What is the rationale behind working so hard on this conference?
Dr. Tedros:
We wanted to learn from others and share our experiences and we feel we have done both things.  This is also an ideal setting to get Ethiopia’s voice out to the rest of the world. Right now there are some very substantive issues to address with respect to HIV/AIDS; especially the cancellation of round 11 of the Global Fund, people are really worried. This happened because the global economic crisis has ravaged nations that were contributing to the fund. This is very worrisome because in the past 10 years it has been a vital source of finance for a number of poor countries. Their contribution to the health sector, in particular to HIV/AIDS, Malaria, and TB was really huge. The world has shown its solidarity in the past 10 years and the result achieved is incredible. For instance, from less than 500 thousand people living with HIV/AIDS being treated six years ago, it now has increased to over seven million people who are on ART. If you take both prevention care and support in HIV/AIDS, there is a significant improvement. The same is true with malaria and TB. All these achievements are due to the solidarity we have witnessed over the past decade. But the current situation with the economy of donors is really becoming a danger to what we have achieved so far and what we can achieve in the future. Therefore, this conference is serving as a venue to discuss this very important issue which is timely. We are coming to a common position to have the voices of millions really heard and become the voices of millions of people who are out there crying for help. We can represent them and come up with workable solution in such a conference. I think in that respect this conference has managed to send out its messages in a bold manner with in a timeline of needs.
Capital: Who covered the cost of the conference?
Dr. Tedros:
As soon as we learned about the conference, we indentified potential partners. Because after learning from others, we have prepared our proposal for funding. Through that proposal we simply identified potential partners in terms of finance and other contributions. Many partners have contributed.
Once we finished our funding proposal we approached Sheik Mohamed al-Amoudi. He agreed righteously without asking any questions. I think it already cost him more than four million Euros to refurnish the hall with all the necessary conference facilities. His team arranged the hall in a manner it can host 14 parallel sessions at a time. In addition to that, the hall has got one community village, one exhibition center and a media center. All the venues are equipped with state-of the- art air conditioning equipment, well furnished with all the necessary audio visual equipment. He is the biggest contributor for the success of this conference. Thus, the highest contribution came from him both in terms of moral, finance, in kind and you name the rest. Then, there are other partners like the US President Emergency Plan, USAID, CDC, UNAIDS, Global Fund,  Bill and Melinda Gates Foundation, almost all UN Agencies and many other partners. Besides, all the relevant government offices have contributed their part.
Capital: How would you describe the current HIV/AIDS status in Ethiopia?
Dr. Tedros:
It is in a declining trajectory at present. As you have probably seen from UNAIDS report, Ethiopia is one of the 22 countries in Sub-Saharan Africa that were able to reduce new HIV/AIDS infections by more than 25 percent. In both treatment and prevention, Ethiopia is second in rank. It is providing ART service widely accommodating 60 to 79 percent people in the service. This makes Ethiopia one of the top eight countries in the service of ART. This level of achievement is higher than the average for other African countries which is around 42 percent. Not only that, we are now building a very good health system with a focus on primary health care. This system has even greater potential to improve the overall heath situation in the country. We are witnessing very encouraging results. But, I have to underline that the problem is still serious. It needs more attention. The fight against the epidemic is still ahead of us. This should not open any room for complacencies, but be used as a motivator to work even harder to kick it out. The achievement so far is really good but the fight is still on. It still needs more attention.  
Capital: Following the global economic crisis, many donor countries supporting most of Ethiopia’s health programs are either cutting down funds or pulling back. How are you planning to fill the gap?
Dr. Tedros
: Of course, it will have some impact. We normally focus on primary health care. It means prevention and health promotion. I think focusing on that will significantly reduce our cost. In promoting prevention and health promotion we can avert new health related infections that means you will have to pay for expensive medical fees. I think focusing on prevention is the answer. We have to really work hard and avert the problem before it comes by investing in primary health care that can make this happen and which is relatively cheap. And the third issue is coming up with some strategic solutions; For instance, something that can bring sustainability by raising domestic resources. We are trying to increase our internal resources. We have already started that, raising and using domestic resources in a manner that it complements what we are getting from outside. So, we don’t expect that, though there is a financial crisis and there is a reduction in donation to the health sector in general and some of the specific programs like HIV/AIDS, Malaria and TB in particular, I don’t think that it would be drastic. So, we hope it will really keep its balance. And then with a combination of the selected solutions, I have already stated, we will be ok.
Capital:  What are the challenges of educating and providing healthcare to people in Ethiopia?
Dr. Tedros
: The challenge is not in the size. It is mainly in the way  we really address our health problems.  Understanding the problems and also designing the right strategy. And for that, I think we have a very good strategy starting from the policy with a clear vision and how to implement it. This is something we have tried and shared with other countries too. There is a clear vision, objective, and strategies on how to get the intended end result. Therefore, the challenge is really working to make what is envisioned occur. Beyond that I am really lucky to work in a government that is politically committed.
In some villages we have already seen that by transferring skills and knowledge to the grass roots community, we have witnessed a promising result but we have to scale it up. In a bid to achieve the MDGs, the more you educate your people, the more will be its result. However it is not also impossible to do that in an uneducated society. In some villages you can’t even believe the extent of change observed following the transfer of knowledge and skills through health extension workers in a short while. So, the issue is making the health extension program work based on its design, trying to involve the local community in a manner that insures knowledge and skill transfer. Once the local community is convinced, they can implement the program so that they are equipped to safeguard their health in a better manner. Some people link the level of education with health or wealth effectiveness. But if you really understand it the right way even without these conditions you can achieve better health conditions. So, the problem is, I think, from our side. If we are not able to scale up best practices we have witnessed in our community, it would be all the same. Therefore, I believe, if we can really implement the strategies we have at hand, we can make a huge difference in the health condition indicators of the country. It will really change significantly even in the current situation without wealth or education.
Capital: Given the current level of human resource and strategies Ethiopia has at present, where do you picture Ethiopia 10 years from now?   
Dr. Tedros:
In 10 to 15 years Ethiopia will be a middle income country. That is the goal the government put forward. So, we are working toward that which I truly believe can happen also especially if we can continue with this pace of economic growth. In the health sector we will have a health system that can be in line with the health system in middle income countries.
Capital: How is the progress in setting up health Insurance in the country?
Dr. Tedros:
We are installing health insurance system in two ways. The first one is the social health insurance which is already ratified by our parliament and we are in the process of setting up a social health insurance agency. The second one is a community health insurance that serves the non-formal sector and mainly the rural community. We started a pilot project in 13 districts. We consider health to be a public good. It is an end by itself and also a driver of economic growth. We can provide health to the people at very low cost with universal access. That is the goal of the health system. 
Capital: How did an academician turn into a humble politician?
Dr. Tedros:
To be a minister is to be a public servant. That is really what it means. Humility is attached with a ministerial position because I think I should act as a servant of the people. That is what I believe in. It can help you if you try to put yourself as a public servant and listen to what others say rather than dictate. That gives you the room to understand more about issues concerning you. I don’t call it humble but I call it listening. I prefer to listen.  I try to understand myself and others. I can learn personally, it can also help me in what I do if I listen. I like to listen.