In 2002, the Ethiopian Federal Ministry of Health set out to provide primary health care for the nation's 85 million rural citizens -- many of whom didn't live within accessible distance of a hospital or even a doctor. The plan was shocking to some, said Dr. Kesetebirhan Admasu, Ethiopia's Minister of Health. After all, they had given themselves only five years to implement it, and lacked both the resources and facilities needed to train an anticipated 30,000 community health workers. With only a year of training, these workers would be sent out to villages across the country to address disease prevention and promote general health. Since the program's unlikely implementation, however, Ethiopia has seen decreases in the number of women dying in childbirth, and in children dying before the age of five, among other markers of success.
That Ethiopia's health care development began with simple, community-driven improvements, instead of through "top-down" means like the creation of hospitals, is itself significant. Equally important, however, is that the idea was implemented by the nation's own government.
It's far from the norm for a government to pilot its own program when the money is coming from outside donors -- Ethiopia receives over 70 percent of its aid from the United States and from the Global Fund to Fight AIDS, Tuberculosis, and Malaria. In fact, it's rare for the governments of developing countries to have much say in where aid money goes at all. Kampeta Sayinzoga, representing Rwanda's Ministry of Finance and Economic Planning, explained how when her government asked for seed money for low-income health insurance, they were told by donors not to waste their time. Using tax money, the government funded a three-year pilot anyway, and 90 percent of Rwandans are now insured.