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Analytical summary - Health system outcomes

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The National Health Policy emphasizes core principles of democratization and decentralization of the Health Care System of Ethiopia. Preventive, promotive and curative components of health services in the country have shown a remarkable improvement, meeting equitable and quality health components of health care for all parts of the population[1] and encouraging private and nongovernmental organization participation in the health sector.

The health sector follows a 5-year rolling plan as part of the national development plan. Since 1997–1998, three consecutive phases have been completed and currently the country is implementing the fourth comprehensive Health Sector Development Programme (HSDP).[2]

In line with the national policy of devolution of power, the Federal Ministry of Health and the regional health bureaus focus mainly on policy, strategy and technical support while woreda health offices manage and coordinate the operation of the woreda health system under their jurisdiction.

The health system has had a huge transformation over the past two decades, with a dramatically improved potential access to care through the accelerated expansion of health facilities. An innovative community-level health service, the Health Extension Programme was introduced by training and deploying female health extension workers and institutionalizing community health care at the health post level. Over the past decade, the Government of Ethiopia has given priority to the expansion of health facilities, especially those of primary health care. In order to expand comprehensive obstetric care services further to the community level, the Government is planning an accelerated expansion of primary hospitals in each woreda.

Recently, the Ministry of Health has introduced a three-tier health care delivery system. Level one is a woreda health system comprised of a primary hospital (for 60 000–100 000 people), health centres (for 15 000–25 000 population) and their satellite health posts (for 3000–5000 population), connected to each other by a referral system. The primary hospital, health centres and health posts form a primary health care unit. Level two is a general hospital for 1–1.5 million people and level three is a specialized hospital for 3.5–5 million people. Over the past two decades, the private sector and private-for-profit sector has rapidly expanded.

The current 5-year health sector strategic plan, the HSDP IV (2011/12–2014/15)[2] is a component of the 5-year national development plan known as the Growth and Transformation Plan. Its priorities are improving maternal and newborn care, improving child health, reversing and maintaining the prevalence of HIV/AIDS, tuberculosis (TB) and malaria.

The major health system response focuses on the primary health care approach:

  • decentralized management of health service delivery with emphasis on district health systems
  • human resource management and health financing
  • medicines and health technologies
  • information for health planning and management
  • strengthening of partnerships for health.[1]

Health care facility expansion has improved physical access to health services with an emphasis on primary health care units, resulting in a potential health service coverage estimated at 92.2%.


In general, service coverage has increased over time, although the performance is not uniform across programmes. Owing to economic, sociocultural and geographical factors, health care utilization is still low, with a 0.36% utilization rate.[1]

Ethiopia is among 57 countries in the world identified by WHO to be facing a critical shortage of health workforce. Overall, there is a global deficit of 2.4 million doctors, nurses and midwives. In Ethiopia, per 10 000 population, there are <0.5 physicians, 2 nursing and midwifery workers, <0.5 dentistry workers, <0.5 pharmaceutical personnel, <0.5 environmental and public health workers, 3 community health workers and 2 hospital beds.[3]

The shortage, uneven distribution, poor skill mix and high attrition of trained health professionals remain the major concerns.[1]

The medicine supply system is unreliable and has long procurement procedures, resulting in low availability of medicines. Availability of essential medicines is 52% in the public sector and 88% in the private sector.

To monitor the performance of its health services, the Government has designed and adapted a new health management information system and implemented it country wide. However, this health management information system is inadequate for data generation and dissemination and for decision-making at different levels of the health system.[1]

Despite the improvements made in expanding access to health services, the disease burden is still high and the service utilization rate remains low, partly due to the burden of high out-of-pocket spending that restricts an already poor society from health care utilization. The Government has initiated and is implementing community-based health insurance and social health insurance schemes to address financial barriers to accessing health services.

To improve the quality of health services, the focus is on the provision of quality health services at standard health facilities at all levels, including speedy delivery and effectiveness of services, patient safety, ethical considerations and professionalism, with adequate numbers of health workers and sufficient finance and pharmaceuticals.

Quality improvement has become an integral part of service delivery in the health system, thus the Federal Ministry of Health has established a quality management committee and designed a reference manual to guide its implementation.[2] The implementation of HSDP I, II and III has achieved notable results, especially in family planning.[2]

The contraceptive prevalence rate reached 29% in 2011, compared with 15% in 2005.[4] However, it is notable that interventions that can be routinely scheduled, such as immunization, had a much higher coverage than services that rely on a functional health system and 24-hour availability of clinical services.

Although the majority of maternal deaths could be prevented through appropriate reproductive health services before, during and after pregnancy, only one fifth of all deliveries are currently attended by a skilled health professional.[2]

Concerning disease burden, notable progress has been achieved in malaria control, with large-scale expansion of prevention programmes and improved access to more effective antimalarial drugs. Encouraging results have been achieved in HIV/AIDS control, sustained prevention efforts and increased antiretroviral therapy coverage leading to stable HIV prevalence.

However, TB control is still far from reaching the international standards for Millennium Development Goal achievement. The TB case detection rate is still below the international target, while the treatment success rate has almost reached targets. Although DOTS, the basic package that underpins the Stop TB Strategy, is believed to be one of the most cost-effective interventions in the health sector, TB control is still inadequate to meet HSDP targets.[2]


  1. 1.0 1.1 1.2 1.3 1.4 WHO Country Cooperation Strategy 2008–2011 Ethiopia (pdf 616.72kb). Brazzaville, WHO Regional Office for Africa
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Health Sector Development Program IV, 2010/2011–2014/15. Final draft (pdf 780.81kb). Addis Ababa, Government of Ethiopia, Federal Ministry of Health, 2010
  3. World health statistics, 2010 (pdf 4.62Mb). Geneva, World Health Organization
  4. Ethiopian Demographic and Health Survey 2011 (pdf 683.08kb). Addis Ababa, Central Statistics Agency; Calverton, Maryland, ICF Macro