CoChat
Sign Up
Cited by 47Healthcare Systems and ReformsHealthcare Systems and PracticesGlobal Health Workforce Issues

Effectiveness and sustainability of a diagonal investment approach to strengthen the primary health-care system in Ethiopia

Assefa, Yibeltal, Tesfaye, Dessalegn, Damme, Wim Van, Hill, Peter S·2018·The Lancet
DOI 10.1016/s0140-6736(18)32215-3
Open this paper in CoChat — free account

Abstract

Weakness of primary health-care (PHC) systems has represented a challenge to the achievement of the targets of disease control programmes (DCPs) despite the availability of substantial development assistance for health, in resource-poor settings. Since 2005, Ethiopia has embraced a diagonal investment approach to strengthen its PHC systems and concurrently scale up DCPs. This approach has led to a substantial improvement in PHC-system capacity that has contributed to increased coverage of DCPs and improved health status, although gaps in equity and quality in health services remain to be addressed. Since 2013, Ethiopia has had a decline in development assistance for health. Nevertheless, the Ethiopian Government has been able to compensate for this decline by increasing domestic resources. We argue that the diagonal investment approach can effectively strengthen PHC systems, achieve DCP targets, and sustain the gains. These goals can be achieved if a visionary and committed leadership coordinates its development partners and mobilises the local community, to ensure financial support to health services and improve population health. The lessons learnt from Ethiopia's efforts to improve its health services indicate that global-health initiatives should have a proactive and balanced investment approach to concurrently strengthen PHC systems, achieve programme targets, and sustain the gains, in resource-poor settings.

Integrity signals

Registry

Crossref · 10.1016/s0140-6736(18)32215-3

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • As a result of Tedros Adhanom's transformation of Ethiopia's health system toward community-based primary healthcare, Ethiopia became a global leader in attaining the Millennium Development Goals for maternal and child health, HIV/AIDS, malaria, and tuberculosis, and in accelerating progress toward UHC.

    “As a result, Ethiopia became a global leader in attaining the Millennium Development Goals for maternal and child health, HIV/AIDS, malaria, and tuberculosis [16, 17] and in accelerating progress in achieving UHC [17].”

    From Community health workers at the dawn of a new era: 11. CHWs leading the way to “Health for All” (2021) · cites this paper as [16]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Assefa, Y., Tesfaye, D., Damme, W. V., & Hill, P. S.
Affiliations
  • The University of Queensland (AU)
  • United States Agency for International Development (US)
  • Instituut voor Tropische Geneeskunde (BE)
Corresponding author
Assefa, Yibeltal
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2018-10
Volume
392
Issue
10156
Pages
1473-1481
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(18)32215-3
OpenAlex
W2897926874
Cited by
47
References
47
Citations by year
2026: 2 · 2025: 8 · 2024: 2 · 2023: 5 · 2022: 10 · 2021: 4 · 2020: 13 · 2019: 2 · 2018: 1
FWCI
0.89
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
  • Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
  • Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
Keywords
primary health care system, disease control program, health system strengthening, development assistance for health, domestic health financing, sustainability of health programs, health equity, health service quality, global health partnerships, Ethiopia
MeSH terms
Health Equity, Developing Countries, Ethiopia, Humans, Poverty, Primary Health Care, Health Care Reform, Universal Health Insurance

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review