Primary health care in Ethiopia under three political systems: community participation in a war-torn society.

This paper examines primary health care (PHC) development with an emphasis on community participation in Ethiopia under the feudal regime of emperor Haile Sellassie, the socialist/military rule of Mengistu Haile Mariam and the sprouting democracy and free market economy of Meles Zenawi. In spite of the rapid expansion of primary care under Mengistu, community participation was hampered by the protracted war and centralized, urban-based, bureaucratic approaches and attitudes that failed to promote an enabling environment for community participation. The socialist government, although implementing various community programs and expanding the rural health services, did not succeed in revolutionizing the health services. A comparative examination of the democratized rebel health services of the Eritrean People's Liberation Front (EPLF) and the Tigray People's Liberation Front (TPLF) illustrates the inconsistencies between stated policies of the Ethiopian government and actual strategies, and identifies factors promoting and impeding participatory health care development in a war environment. Achievements, opportunities and potential dangers to PHC and community participation in the post-war era characterized by economic progress, democratization, decentralization, lingering ethnic conflict and private initiatives are briefly described.