Leading at a Time of Crisis

Dr lia Tadesse’s Ministerial Legacy

A recent development has seen Dr Lia Tadesse, who has been the minister of Health for the past four years, replaced by Dr Mekedes Daba. This transition comes at a crucial moment in Ethiopia’s health system history. The past four years have seen the health system suffer from the COVID-19 pandemic and the destruction of many health facilities due to ongoing wars in different regions of the country. In what was a difficult time for the Ministry, Dr Lia’s leadership has been applauded by many. While there have been many positive strides from her tenure, there are still questions that remain unanswered. EBR’s Dr Brook Genene closely investigates the problems within the Ethiopian health system and the role the women in the leadership roles have played in navigating them.

March 2020 was a complex and confusing period for Ethiopians. It marked the first COVID-19 case in the country, creating uncertainty and fear among the public. Dr Lia Tadesse, the new minister of Health, was responsible for providing the information to the media then. The first case was identified as a 48-year-old Japanese citizen at the time. Following the announcement, many people rushed to acquire sanitisers, disposable gloves, and face masks. Pharmacies were visibly crowded with customers seeking these products. Following the detection of the first case, the Ethiopian Ministry of Health regularly updated the number of people who have been infected with the illness and those who have lost their lives. It started a challenging time for Dr Lia and her office.

Despite the many challenges, Ethiopia was lauded for handling the pandemic well. The responsible parties worked together to combat the illness by creating awareness and using public figures to educate on proper hand washing and the need to stay home while debunking myths regarding the COVID-19 vaccination.

Under the leadership of Dr Lia, the country navigated through this challenging time and resumed normal activities. According to Dr Daniel Burssa, a senior advisor to the Ministry of Health, the highlights of Dr Lia’s tenure include the mobilisation of 2.3 Billion Dollars in donations, an extension of health insurance coverage to 54.3 million people, and the change in outpatient service attendance per capita increasing from 1.0 in 2020 to 1.5 in 2023 – which means there was an influx of 160 million OPD visits.

While the stats above underlie the strides made in the past four years, one aspect of the health sector remains overlooked- the health professionals.

A recent Facebook post on Hakim- a page where health professionals write medical information and offer opinions- raised much debate among the public. A Doctor compared the salary of a newly graduated General Practitioner with the price of a shoe. The post noted that a Doctor’s salary before tax is 9500 birr while the shoes mentioned were worth 12,500 birr.

Recently, there has been a massive outcry from health professionals, especially Doctors, about low salaries, lack of health benefits, transportation, housing, and a better working environment. This has resulted in many Doctors who are unsatisfied with their jobs, changing their profession, leaving the country, or remaining unemployed, unsure of what to do next.

According to 2020 data by WHO, Ethiopia has 1.039 Medical Doctors for 10,000 people. This is lower than neighbouring countries like Sudan (2.626), Kenya (2.26), and Egypt ( 7.094). The number is 35.5 in the USA. The WHO recommendation is 1 Doctor to 1000 patients. Despite this limitation, finding a job in the health sector has been daunting in Ethiopia.

“Some Doctors are living in disbelief of their status quo, some are leaving the profession altogether, while the majority are looking to find a job abroad. With this trend, the system will collapse if no novel retention and recruitment strategy is applied. “Dr Ephrem Alemayehu is a medical doctor now working abroad.

Many Doctors feel that the Ministry of Health needs to listen to their issues. “I was hoping the officials would come to hospitals and see what is happening. It would have been good to have these discussions with the health professionals.” States Dr Mubarak Zeynu, an internal medicine resident at St. Paul Hospital Millenium Medical College.

Addressing the questions of health professionals will be one of the main tasks of the new minister of Health, Dr Mekdes Daba. Like Dr Lia, she specialised in Obstetrics and Gynecology. She also did her subspecialty in Family Planning and Reproductive Health. She won the 2021 International Federation of Gynaecology and Obstetrics prize and was president of the Ethiopian Association of Obstetricians and Gynaecologists. She was also a pioneering member of the Ethiopian Medical Women Association. Dr Mekdes’s leadership will bring positive change and innovation to the healthcare sector.

Dr Mekdes has served as Director at the Center for International Reproductive Health Training (CIRHT), focusing on enhancing reproductive health training and services. Her work in this area has been recognised as essential, and her contribution to reproductive health initiatives, particularly in the context of Ethiopia’s healthcare needs, has been described as exemplary. Sub-Saharan Africa alone accounted for approximately 70% of global maternal deaths in 2020. Prioritising the Health of mothers and women, in general, will go a long way in helping Ethiopia thrive as a nation. This is one of the main areas of focus by Dr Mekdes. In addition, lending an ear to the plight of health professionals is paramount.

Many people believe the issues health professionals raise can only be addressed briefly. “I recommend a genuine discussion where all stakeholders are involved”, states Dr Ephrem. This idea was shared by Dr Kirubel Tesfaye, another medical doctor working outside of Ethiopia.” Most of us were optimistic before the 2019 meeting with the Ministry of Health and the FDRE prime minister. We presented the problems and possible solutions for them. Most people were ready to play their part in the change they were hoping to bring; that energy is gone now. “

Under the leadership of Dr Lia, the Ministry of Health has worked with partner organisations to solve the problems of unemployed Doctors and has tried to increase the number of Physicians going into speciality while ensuring employment for junior Doctors in their place. Despite that, the problem persists.

According to Dr Kirbuel, many Doctors are leaving the country for better opportunities. He has been interviewing many Doctors who have left the country for better opportunities and the path they have taken on his YouTube channel, Hakim Podcast. With over 9000 subscribers, it is visible how interested physicians are in learning the different paths out of the country. “It would have been positive if Physician migration were structured around using the talent later on and using it as a tool for knowledge and skill transfer but that is not the case”, he explains.

In a LinkedIn post, Dr Mekdes has previously noted that the more the needs of health professionals are overlooked, the less we will see of them. This shows her awareness of the situation and can be seen in a positive light for those hoping for a change.

Dr Eyob argues that the government can keep the benefits of health professionals on par with those of bankers, federal judges, and others. As for new graduates, empowering them through creating small associations and financing them to open private clinics, workshops to hone entrepreneur skills, and partnering local investors with unemployed clinicians to open healthcare facilities in rural parts of the country are some solutions that he says are necessary.

WHO states that the health system is losing health workers due to unfair pay, poor conditions, lack of respect and overworking. By 2030, the world will have a 10 million health workers shortage. This sends an alarm bell for countries like Ethiopia in need of care.

Dr Mekdes is now the third female minister of Health to follow in the footsteps of Dr Adanech Kidanemariam and Dr Lia. If the country’s problems are to be addressed, the involvement of women in leadership roles is crucial. Both Dr Lia and Dr Mekdes have proven their quality with the roles they have acquired. They have also inspired so many young women with their work. While the tasks they face seem difficult, having solid female leadership indicates a society that is evolving and embracing new ways. EBR

12th Year • March 2024 • No. 127