How Ethiopia’s Two Tier System Is Destroying The Country

Tigrayan supporters attending the 40th Anniversary of the Tigrayan People’s Liberation Front (TPLF) in Mekelle, Ethiopia, 18 February 2015

By M. T. Gebre

The Ethiopian government is in a fantasy world when it comes to its economic growth predication. From making an inflated premature milestone celebration when it comes to the social safety nets of its population, in particular the health care sector, to being a country content on being an equity loving government among its diverse population – the government is a mouth piece for a nation that is manipulating the world with the belief that it is becoming a more human society.

One area, the world, in particular Yale University has congratulated Ethiopia on is its health care system. Yet, that system is one that is influenced by corruption, incompetence and political intervention. Heavily controlled and influenced by partisan cadres rather than health care professionals, it is still a system lacking direction. Those that continue to speak up against its shortcomings, are either imprisoned, sent abroad as refuges or become mere observers, as their status and positions are compromised.

My experience in the Somali region of Ethiopia, as a health care professional, has given me a glimpse of where Ethiopia’s health care system is and is headed.

A region, largely undeveloped and with a system that is discriminatory of women, the corruption rate in this region has truly been neglected. Even the government of Ethiopia has often recognized these shortcomings but looked elsewhere, since the development of this area is not in their political interest. Lack of resources and almost no health care professionals has produced a crises and the region still has difficulty keeping those working in the area and attracting prospective health care workers.

As a result, poorly trained professionals, such as a nurse trained for a mere six month serves as a medical director, not based on her or his qualification but because of their political affiliation. They often serve the government’s political interest rather than the publics. Often time, health care is not available to the public unless based on their political status and privilege. Most health care workers are lax with their availability, often choosing to chew “khat” – a stimulating flowering plant native to the Horn of Africa and the Arabian Peninsula – rather than be available to those in need.

This can be dangerous because access to medical attention shouldn’t be hindered by the time the help is needed. Access should be a constant and accessible at all hours, especially when it is urgent and time sensitive. The corrupt system that is in place has caused many preventable citizens lose their lives for lack of basic attention.

As a result of the aforementioned harmful practices, I have witnessed widespread severe complications such as urinary and reproductive tract infections, death by severe bleeding, abscess formation, and increased susceptibility to many blood borne diseases. In addition to effective over-night solutions being hard to come by, the government is not doing enough prevention and information campaigns that may help the population to smoothly transition into healthier cultural practices.

The gross mistreatment of women in the Somali region of Ethiopia can be illustrated by many things such as female genital mutilation, early marriages, and ultimately the environment in which women are forced to give birth. The lives of the women in the Somali region are perhaps some the worst in the world. Harmful and illegal practices are the norm in this region. Unfortunately the government does not even take minimal action to prevent this mistreatment.

The most horrific cultural practice is sewing a woman’s genitals after performing female genital mutilation (FGM) — a fourth degree FGM. This practice is so common that even healthcare professionals have had to accept it and live with it. I haven’t seen any one openly opposing this situation during my work in the region, probably because it is dangerous to do so. Other harmful practices like early marriage and having too many children that the family cannot afford to raise is just as ordinary. It seems that the federal government either does not know what is happening in the region or it does not give attention to the problems.

The age at which women in the Somali region get married is low, perhaps, the lowest in Ethiopia. On average a Somali region woman is married by the age of 15. Further, on average a man can have 2-3 wives and there are usually 8-10 children per mother. Moreover, giving birth without a skilled attendant is widespread and dangerous. To make matters worse, the majority of women give birth both in an unsafe environment and with an unskilled birth attendant. Thus, high maternal morbidity and mortality characterizes the region. The consequences affect not only the mothers but the children as well. As the children also have significantly high morbidity rate and death rate.

One of the causes of morbidity in child health that is encountered most often is malnutrition. Malnutrition has become a major health sector burden in the Somali region. A physically and mentally adequate generation in the future is not plausible should these practices continue. The fact is that these horrible practices target women, and as women will bear and raise the next generation, they deserve proper education.

Ultimately they can pass on this education to their children, both male and female, ensuring the well-being of the next generation. Since this has yet to occur, two generations of women remain helpless. The women are victims of this corrupt system, and the female children they have brought into this world are destined for the same fate.

The government has turned a blind-eye to all of these problems, yet they boast that the inclusive health sector in Ethiopia is booming and that we will achieve the health status of middle income countries by 2020. The government of Ethiopia needs to be true to itself and to the world. That is unrealistic and a claim made for the purpose of sheer propaganda. More effort and attention in changing the bureaucratic system and harmful cultural practices through education on reproductive health and family planning may lower maternal and child mortality and can save the generation. Educating and empowering women by breaking social norms and reducing discrimination against the female gender must have taken place a long time ago. Perhaps, the political cadres of the region are too busy fabricating false data about the booming health sector to tell the world and the Ethiopian populace instead of doing something tangible to actually help improve it.

This is deeply saddening because corruption and mistreatment should not be instilled within a health care system. Rather, they should be meeting the health needs of all people in the country whether they are rich, poor, Somali or Tigray.

I hope, the upcoming Ethiopian New Year gives the people of Ethiopia the wisdom needed to bring systemic change in the country. I hope those who can truly change the country, the government officials, will do their part.

The author of this article, M. T. Gebre is a graduate of Jimma Medical School and served as a Medical Doctor in Deghabour Hospital, in the Somali Region of Ethiopia. The article is based on her reflection of her time at the hospital. She currently resides in Toronto, Canada.