Strengthening Primary Health Care Systems Performance in Lower and Middle-income Countries


The Harvard T.H. Chan School of Public Health has been investing in strengthening the Ethiopian primary health care system for over 7 years through the implementation of a number of grants from the Bill & Melinda Gates Foundation.

To view and download reports and technical products from our Ethiopia work, please visit the Publications and Resources page.

Fenot: Achieving Excellence in Primary Care

The Fenot – Achieving Excellence in Primary Health Care project (2015-2021), implemented in collaboration with ABH Partners, is contributing to the development of Ethiopia’s primary healthcare system (PHC), building on the achievements of three previous projects, HEPCAPS I and HEPCAPS II, and Resource Tracking and Management, implemented in Ethiopia from 2012-2015. Fenot focuses on two strategic areas that are aligned with strategies of the Health Sector Transformation Plan (HSTP).

Strategic Objective 1: Efficiency, quality and equity of primary health care services improved by using locally available and relevant evidence for planning, monitoring, decision making, policy analysis, and follow-up action within FMOH and RHBs

General Description

Focusing on maternal and child health issues, Fenot is helping the Ministry of Health and Regional Health Bureaus (RHBs) to better use evidence for decision-making for policy and program strategies, and develop and implement innovative practices and solutions to bridge the divide between those who generate evidence and those who are expected to use it. We are working to build technical capacity in interpreting and using evidence at different levels, promoting the contributions of academic institutions, and helping the FMOH and RHBs use data and evidence generated by different institutions and sectors. Fenot is also supporting efforts to define and develop appropriate institutional structures and to build capacity at the federal and regional levels to perform high quality evidence-based policy analysis in order to refine programs and strategies based on evidence.

Strategic Objective 2: Increased domestic financial resources for improved primary health care systems comprised of: additional financial resources from domestic sources; improvements in efficient use of resources; and better budget utilization in public programs.

General Description

In order to institutionalize health financing analytic work, the FMOH created a case team within the Partnership and Cooperation Directorate (PCD) called the “Health Economic and Financial Analysis (HEFA) Case Team”.  Harvard has been collaborating with PCD and the HEFA case team through the HEPCAPS II and RTM projects in addition to Fenot.  Fenot is also supporting the Regional Health Bureaus and Ethiopian universities on strengthening health financing and economic initiatives.

Below is a summary of some of the health financing objectives Fenot is supporting:

  • Strengthening FMOH and RHBs capacities to advocate and improve domestic resource mobilization and utilization
  • Providing technical support to the HEFA case team to conduct the 6th and 7th round National Health Accounts.
  • Providing technical advice on costing health services at federal and university hospitals and revising user fees
  • Undertaking analytic work using NHA datasets, such as analysis of out-of-pocket payment (e.g. analysis of the level of catastrophic expenditure)
  • Strengthening health financing analytical capacity within the FMOH and RHBs and use of financing-related evidence to develop service delivery improvement strategies
  • Enrolling key staff from FMOH, EHIA, universities and RHBs in a continuous health financing and decision science training, as well as work-based training through a learning-by-doing process
  • Strengthening Pre-service Training on Health Economics and Health Financing in Ethiopia
  • Informing solutions for increasing domestic resource mobilization for health at national and sub-national levels

Previous Fenot Investments in Innovations to Strengthen the Primary Health Care System

Fenot previously supported a number of initiatives to increase access to quality PHC services for socially and economically disadvantaged citizens.

HEPCAPS – Developing the Long-Term Capability of Ethiopia’s Health Extension Program Platform (2012 – 2015)

Prior to the Fenot project, the Harvard Chan School implemented the HEPCAPS project in Ethiopia, in collaboration with John Snow Research & Training (JSI) and the Yale Global Health Leadership Institute (GHLI). The overall objective of HEPCAPS was to assist the Government of Ethiopia to sustain and improve the effectiveness of its primary health care system, both in urban and rural areas, and to accelerate the achievement of priority maternal, newborn and child health outcomes and disease prevention and control efforts. Details of the HEPCAPS project can be found here.