Changing Systems to Change Lives in Ethiopia: Aster’s Story

Aster Amanuel Desalegn lives in Debre Markos, 190 miles from the Ethiopian capital of Addis Ababa. She is a 70-year-old mother of four and grandmother of two. Her granddaughters, Emuye, 6, and Blen, 8, live with her.

On a trip back from visiting family in Addis Ababa 20 years ago, Desalegn fell ill and went to the nearest health center for help. Doctors said her blood sugar level was critically high and she needed to start treatment right away. For the past 12 years, Desalegn has been taking insulin.

Desalegn and her family go to Debre Markos Hospital for all their health care needs. She goes once a month for checkups and to refill her prescription. Debre Markos Hospital is a public facility that serves 3.5 million people in and around Debre Markos. Desalegn says she is happy with the services she gets at the hospital, but that was not always the case.

“I felt anxious when I was about to go to the hospital because that meant spending more than half the day, and sometimes all day, there because the waiting time was so long,“ Desalegn said. “And after lining up outside for a long time in the sun or rain, I might not even get my prescription filled because the pharmacy had run out of insulin.”

The availability of essential medicines and quality service in Ethiopian pharmacies has been recognized as a critical problem by the Federal Ministry of Health. In 2011, the USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, implemented by MSH, collaborated with the Federal Ministry of Health and regional health bureaus to develop a way to improve the quality of pharmaceutical services. The Auditable Pharmaceutical Transactions and Services (APTS), a package of interventions, is the result of this collaboration.

APTS was piloted in Debre Markos Hospital and showed unprecedented success. In a short time, the availability of essential medicines increased while expiry and wastage decreased. The pharmacy was remodeled to eliminate a grilled window, where people lined up to receive counseling and medication, and replaced with a walk-in pharmacy with more space, where confidential counseling can be carried out. The remodeling contributed to a significant decrease in wait time.

“We live on a retirement stipend I get from the government,” Desalegn said. ”I can hardly afford to buy medicines from private pharmacies. I don’t have to do that now since in the last five years I haven’t been turned away from the hospital. I always go home with my medicine.”

Her monthly visit to the hospital now takes Desalegn less than two hours, leaving her enough time to go back home to make lunch and rest before her granddaughters come home from school.

“These changes at the hospital mean so much to me. I’m blessed to have lived to see them,” Desalegn said with a broad smile.

After seeing the results of APTS at Debre Markos Hospital, the Federal Ministry of Health and regional health bureaus developed an APTS regulation, with the ultimate goal of implementing it in all Ethiopian health facilities. To date, more than 70 health facilities have implemented APTS, with scale-up progressing quickly.