Policymakers and institutional structures affecting health inequality in Ethiopia: a Qualitative Study

Abstract Background : Ethiopia generally provides a story of progress in child health, but unevenly distributed. The attitude, knowledge, political drives, interest groups and institutional dynamics in health equity policy setting and execution has not been explored in Ethiopia. Without addressing these issues, the right kind of policy choice and implementation cannot be attained. Methods : This study was conducted between 2015 and 2017 in Ethiopia. The study utilized a qualitative framework, grounded in social determinants for health and health policy. Semi-structured interviews; executed policy analysis; and reviewed the literature. In-depth interviews were conducted among twenty-one policymakers and reviewed 23 policy documents and over 350 literatures, Transcribed data, policy extracts and articles were synthesised and analysed by ATLAS.ti 7.1.4. Results: Ethiopia is in an early state of recognizing and intervening against health inequalities. The quality and level of knowledge is mixed and gets reduced as one goes to the rural areas. Consensus is slowly developing on the major underlying causes of inequality. The contents of health policy documents are neither comprehensive nor strongly supported by evidence. There are multiple interest groups with varying level of knowledge and power. Complex political and institutional relations affect policy making process negatively. Participants demonstrated denialism; blaming of victims; misconceptions; and one size fits all attitudes. Conclusions : Any future work for improving health equity needs to be build more on evidence and embrace more participatory processes to address all types of interest groups.